I have spent the past 38 years examining the impact of Israeli policy on Gaza’s economy and society. During that period, the economy was effectively hollowed out and the majority of Gazans were unable to secure their basic needs. Yet, as bad as conditions were prior to the Oct. 7 Hamas attack on Israel, total systemic collapse was never an imminent threat. Now it is.
There is a desperate need for basic resources in Gaza, including food. Despite this, the first aid convoys weren’t allowed into Gaza until Oct. 21. According to the United Nations Office for the Coordination of Humanitarian Affairs, by Nov. 7, a total of 650 trucks had entered Gaza, or 36 trucks per day — 7 percent of the 500 trucks that entered Gaza daily prior to Oct. 7. As of Nov. 3, the World Food Program estimated that “current stocks of essential food commodities will be sufficient for about five more days.”
Even bread is becoming increasingly scarce. Eleven bakeries have been destroyed in the south and the one mill able to grind wheat is inoperative due to the lack of electricity and fuel. No bakeries are operational in the north. The average Gazan is living on two pieces of Arabic bread made from stockpiled flour, according to the UN. Essential items such as rice, legumes, and vegetable oil have almost disappeared in the market. Wheat flour, eggs, and dairy products are no longer available in shops across Gaza. Local and international NGOs are providing limited food assistance as best they can.
Chris Gunness, the former spokesperson for the United Nations Relief and Works Agency for Palestine Refugees in the Near East, argues that the only way to address the looming food catastrophe is for Israel to open the still-shuttered Kerem Shalom border crossing, which can handle the quantities of aid needed; the Egyptian-controlled Rafah crossing point, where roads were bombed early in the war, cannot handle the volume. The question still remains, over a month later. Why haven’t leaders of the United States and European countries demanded a mutual cease-fire, which would stop the death and destruction, and facilitate the release of hostages and the safe entry of needed levels of aid?
In addition to food, Gazans need fuel, electricity, and water. Israel has banned the entry of fuel, arguing that it may fall into Hamas’s hands. There are also reports that Hamas is hoarding vast quantities of fuel; unconscionable, if true. Since Oct. 11, there has also been a total electricity blackout. People are relying on backup generators, but their use is limited by dwindling fuel supplies. Fuel is also essential for the operation of sewage treatment plants. The majority of Gaza’s 65 sewage pumping stations are reportedly inoperative, including at least 25 in Gaza City and the north, with “the imminent risk of sewage flooding in large areas of the city.”
The lack of fuel and electricity, as well as damage from air attacks, has been devastating for the health care sector. The Turkish-Palestinian Friendship Hospital, Gaza’s only cancer hospital, shut down last week after it ran out of fuel. According to the UN, 14 out of 35 hospitals with inpatient services are no longer functioning due too the loss of power or damage (with the remainder functionally impaired). In addition, 46 of Gaza’s 72 primary care facilities are no longer operational. Referring to the only two units still receiving power in the Kamal Adwan Hospital in Beit Lahia — the neonatal intensive care unit and the pediatric emergency room — one doctor said when the fuel runs out, “the hospital will turn into a mass grave.” Furthermore, without fuel, ambulances cannot run. According to Dr. Clementine Ford of Medecins Sans Frontieres, the entire hospital health care system has already collapsed.
The depletion of fuel is particularly dangerous for the water supply, which is growing desperately low. Thomas White, director of UNRWA Affairs in Gaza, said, “people are beyond looking for bread. [They are] looking for water.” Without fuel, water cannot be pumped and desalination plants cannot operate. The one desalination plant in the north and one in the middle and southern parts of Gaza are no longer working (however, two water pipelines from Israel to the middle area and to western Khan Younis have been reactivated, but the one in the north has not).
Adding to the growing scarcity of water was Israel’s recent bombing of the Tal al-Zaatar water reservoir in the northern Gaza Strip, which supplied water to 70,000 people. In addition, Israel destroyed a major supply tank that provided 60 percent of Jabaliya’s water supply, further contributing to levels of forced displacement. Although aid trucks brought in 100,000 liters of water on Nov. 2, this was only enough to “cover the drinking water needs for some 20,000 people for one day,” according to the UN. By Nov. 7 the amount of drinking water entering Gaza could only serve 4 percent of the population.
Not surprisingly there have been a growing number of reports indicating that people are drinking seawater and contaminated water from agricultural wells, among other unsafe sources. According to the US State Department, 52,000 pregnant women and more than 30,000 infants under 6 months of age are consuming contaminated or brackish water, putting them at risk of infection and disease. If this continues, it is only a matter of time before communicable diseases such as cholera and other water-borne diseases appear.
Other numbers emerging out of Gaza are equally horrifying (as of Nov. 7): 10,328 Palestinians killed, according to OCHA, including 4,237 children; people interned in mass graves; more than 2,450 people missing and presumed buried under the rubble, 1,350 of them, children; the wiping out of entire multigenerational extended families; 45 percent of all housing units destroyed or partially damaged; and nearly 1.5 million people, or close to 65 percent of Gaza’s total population, internally displaced (over 15 percent with disabilities) — 725,000 are taking shelter in 149 UNRWA facilities; 122,000 in hospitals, churches, and public buildings; 131,134 in schools; and the remainder with host families. The health care risks resulting from extreme overcrowding are obvious.
According to the UN, “thousands of cases of acute respiratory infections, diarrhea and chicken pox have already been reported among people taking refuge at UNRWA shelters.” Hospitals are running out of medicines and other needed supplies. Care International reported that pregnant women are being forced to endure emergency Cesarean sections without anesthetics, as are other patients requiring immediate surgery, including children needing amputations. Alarmingly, the World Health Organization also reports that the displaced have access to only three liters (or 13 cups) of water per person per day, far below the minimum of 15 liters (or 63 cups) recommended by the WHO. Prior to current hostilities, Gazans were consuming an average of 84 liters of water per capita daily, which already was below the average of 100 liters needed for cooking, washing, drinking, and bathing (and far below the Israeli average of 240-300 liters per capita).
Gaza is approaching a state of total collapse and this collapse is undeniably one of choice. The G7 group of leading industrial democracies have called for “humanitarian pauses” in order to enable the delivery of aid to Gaza. Advocating a “pause” in the perpetuation of mass atrocities rather than advocating an end to those atrocities (in the form of a cease-fire) effectively means that Palestinian lives do not matter. Cynically, the West is saying to Palestinians, we will feed you but you may be killed the following day. Furthermore, a colleague with extensive experience in the delivery of humanitarian aid in conflict areas told me that even if a pause is achieved, the likelihood that aid will actually reach those in greatest need is very low given the large-scale destruction of Gaza’s infrastructure, especially the roads.
Ford of Medecins Sans Frontieres said there is a new acronym used by doctors in the Gaza Strip: WCNSF or “Wounded Child No Surviving Family,” which also speaks to the fact that an average of 160 children are killed each day in Gaza and to the West’s inability to stop it. Whatever the outcome of this horrific war — in which 1,400 innocent Israelis were also savagely killed and more than 240 people held hostage— world leaders, particularly those in the United States and Europe, cannot claim to have made any ethical intervention. What they can claim is that they allowed the slaughter of innocents to continue unimpeded and without mercy.
Sara Roy is an associate at the Center for Middle Eastern Studies at Harvard University.