After Hamas’ 7 October attack on the Re’im music festival and kibbutzim in southern Israel, the military response by the Israeli government has been catastrophic to human life in Gaza. The Israeli Defense Force’s (IDF) military campaign in Gaza for the past nine months has destroyed an already struggling society. Before the war, Gaza suffered from high unemployment rates, limited aid due to an Israeli-Egyptian blockade, a medical system under pressure and malnutrition, especially among young children. The war has compounded these factors, leading to imminent starvation among the population and a medical system that can no longer function because of inadequate supplies and unsafe work conditions for staff.

In the decade before the current war, Gaza had been an enclave blockaded by sea, land and air by both Israel and Egypt at its southern border. Since 2009, the UN Office for the Coordination of Humanitarian Affairs (OCHA) and others have reported dire humanitarian crises from previous Israeli offensives (such as the January 2009 Israeli military campaign in Gaza).

In addition, the continued IDF military campaigns in Gaza over the years have eaten away at the enclave’s fragile health infrastructure. The desperate humanitarian state of Palestinians in Gaza predates the current war, however. Since their displacement and dispossession in 1948 – in what is known as the Nakba (Arabic word for catastrophe) – “humanitarianism” has been one of the most consistent aspects of Palestinian life (Feldman, 2009). Thus, this piece will analyze how humanitarianism became part of Palestinian life as well as the wider, global implications of the current war.

Infrastructural Damage and Economic Impact

Since 7 October, the war in Gaza has resulted in approximately $18.5 billion in infrastructural damage (WB; EU & UN, 2024). The humanitarian crisis, however, has led to a Palestinian death toll higher than 37,000. Over the course of the war, these numbers have been reported by the Health Ministry in Hamas-run Gaza, but independent reporting by organizations such as the United Nations and Save the Children have reported similar numbers, if not higher, because of the destruction of infrastructure, increased levels of starvation and a devastated public health system. In June, a correspondence in the English medical journal, The Lancet, estimated a death toll of up to 186,000. The Lancet alsoreleased a July correspondence stating that although the much contested death toll has been refuted by Israeli authorities, it has been accepted as accurate by Israeli intelligence services, the WHO and the UN. This correspondence suggests that the death toll is even higher than current estimates because of the intensity of the conflict.

According to the Interim Damage Assessment report released by the World Bank in collaboration with the European Union and the United Nations in March 2024, “physical destruction is severe in every sector of the economy,” and most of the damage has been sustained in “the housing sector and population centers.” (WB; EU & UN, 2024) Such levels of destruction are unprecedented, with approximately 62 percent of all homes in Gaza – over 290,000 units – being destroyed. Moreover, Gaza is a cultural heritage center and UNESCO has reported that 50 sites have been damaged in the enclave since the start of the war. This damage has been inflicted on religious and archaeological sites, monuments and historic buildings.

The economic impact on Gaza has also been dramatic. Before the war, unemployment rates in the strip were around 45 percent (one of the highest in the world). They spiked to about 79.3 percent in 2023 (Chart 1), the highest they have been in over two decades. The increase in unemployment rates means a reduction in total GDP for the year. For example, Gaza’s GDP between 2006 and 2022 shrank by 27 percent, and before the war, poverty levels were at 26.7 percent. Gaza’s population may never recover from this economic malaise, especially with the destruction of homes, businesses and places of worship. The UN agency for trade and development (UNCTAD) stated the following in their January 2024 report on the social and economic deterioration in Gaza:

“UNCTAD underscores that the resolution of Gaza’s crises requires ending the current military operation and lifting the blockade as a pivotal step toward realizing a two-state solution along the 1967 borders, in line with international law and relevant United Nations resolutions.

The report urges donors and the international community to recognize that the constraints on the Palestinian economy, particularly in Gaza, extend beyond the recent confrontation.”

Importantly, UNCTAD emphasizes the need for an end to the current conflict and a realization of a two-state solution. However, it is early days to be calling for a two-state solution, given the state of the ongoing war in Gaza. The destruction of infrastructure, the economy and human life in Gaza have led to numerous calls for a ceasefire from human rights organizations and governments around the world. Aside from the goals the Israeli war cabinet has outlined for their military campaign in Gaza (the return of the hostages taken on 7 October and the destruction of Hamas’s capabilities), the global community and Israel’s allies have pressured Israel to consider a ceasefire that will halt the growing death toll. The war’s impact on human life, the economy, and by extension, regional actors, has been immense.

CHART 1 Gaza Unemployment, 1995-2023

Cost to Human Life and a Collapsing Medical System

Before the current war broke out, about half of Gaza’s population was under the age of 18. Throughout this war, roughly 40 percent of the casualties have been children. As of late June, an estimated 21,000 children were reported missing according to Save the Children. This number includes almost 4,000 children buried under the rubble and 17,000 unaccompanied minors and separated children. In early May, Save the Children also estimated that 10,000 of the bodies buried under the rubble were children. Also, as of the publication of the March 2024 interim assessment, over 31,000 people had been killed, with approximately 70 percent of them being women and children.^[1] Moreover, the Internal Displacement Monitoring Centre estimates that 1.7 million people in Gaza were displaced by the end of 2023.^[2] The head of the UN World Food Programme, Cindy McCain, said in early May that northern Gaza has entered a famine and it was now moving south.^[3] Yet, a recent report by the Integrated Food Security Phase Classification (IPC) said that the available evidence does not indicate that a famine is underway in northern Gaza. However, the IPC report did state that famine is imminent as 1.1 million people in Gaza face “catastrophic food insecurity.” In early July, UN experts declared that malnutrition and hunger have spread throughout the Gaza Strip.

CHART 2 Gaza Population, 1995-2023

On 21 May, the UN halted food distribution in Rafah because of inadequate supplies and security concerns caused by Israel’s military operations. The UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) confirmed on X that it had suspended food distribution because of limited supplies and the danger posed to its aid workers. Also, on 17 May, OCHA reported that only five bakeries in Gaza remain operational.

Also, as this war continues, Gaza’s medical system is collapsing. Nearly 84 percent of health facilities in Gaza have been damaged, with the total cost of destruction reaching USD 554 million. In total, 649 health facilities have been impacted since the start of the war and over three quarters of the hospitals have suffered more than USD 222 million in damage. Additionally, hospitals and facilities that remain functioning are overcrowded and have limited access to essential medicines and supplies. They are also vulnerable to power outages. For instance, a February 2024 Emergency Situation Update on the Occupied Palestinian Territories by the WHO stated that 659 people working in healthcare were killed, 843 were injured and 98 ambulances were damaged.^[4]

Under international humanitarian law (IHL), health establishments such as hospitals should be protected in times of armed conflict. Additionally, under IHL, the sick and wounded – regardless of the party to which they belong in armed conflict – have the right of respect, protection and medical care. Hospitals and other health establishments can lose the protection they are granted under IHL if they directly or indirectly interfere in military operations – such as by launching attacks or storing weapons. However, since the start of the war in Gaza, the IDF has stated that its attacks on health infrastructure and medical staff are in accordance with IHL provisions. Although the IDF has emphasized their efforts to protect civilians and keep hospitals functioning, organizations such as Doctors Without Borders have disproved such claims, especially after the raid on Nasser Hospital in February of this year.^[5] When the WHO entered Nasser Hospital after the Israeli special forces raid, they said it had ceased to function and patients had died because of the interrupted supply of oxygen and electricity. Although Israeli forces have repeated their compliance with IHL, the destruction to civilian life and medical establishments in Gaza paints a different picture of their conduct.

The lives of Palestinian civilians in Gaza have been
plagued by the failures of humanitarianism.
Their lives are dictated by the availability and
accessibility of essential goods […] Palestinians
in Gaza live with the understanding that their
lives depend on humanitarian assistance

The lives of Palestinian civilians in Gaza have been plagued by the failures of humanitarianism. Their lives are dictated by the availability and accessibility of essential goods. Surgical operations are often a luxury because of electricity outages and unavailable medical supplies. Certain foods are a rarity, and the right to mobility to visit family in the West Bank – or, to leave Gaza – is a miracle. Palestinians in Gaza – before the war and even more so now – live with the understanding that their lives depend on humanitarian assistance. Without it, they would have no access to food, water, education or a functioning healthcare system. Unfortunately, in moving forward, dependence on humanitarianism should be deconstructed to give Palestinian civilians in Gaza the agency needed to lead normal, healthy lives.

Health and Sanitation

In late January 2024, UNCTAD stated that current conditions in Gaza have made the strip almost uninhabitable because of inadequate “sources of income and access to water, sanitation, health or education.” The health sector in Gaza was already weak before the war broke out. Now, there are few functioning hospitals, little to no essential medical supplies (i.e. anesthetics for necessary surgeries), and outbreaks of diseases, especially among children. Importantly, inadequate medical supplies and food are a result of Israel’s stringent border policies, which, as described by humanitarian officials, are opaque and can prevent essential supplies from reaching Palestinian civilians in need.

In early 2024, the World Health Organization (WHO) warned of outbreaks of communicable diseases in Gaza. Between mid-October and early 2024, the following was reported:

“179,000 cases of acute respiratory infection, 136,400 cases of [diarrhea] among under fives, 55,400 cases of scabies and lice and 4,600 cases of jaundice.”

Recent numbers from the WHO report that there are now over 96,000 cases of scabies and lice, more than 9,000 cases of chickenpox and 60,130 skin rashes. Because Israel’s military operations have devastated Gaza’s fresh water and sanitation facilities, parents have been forced to bathe their children in the sewage- and pollution-filled Mediterranean. Thus, combined with inadequate supplies of medication to treat ailments, skin diseases will continue to spread. Also, due to crowded living conditions, there is an estimated one toilet for every 220 people and one shower for every 4,500 people. This, in combination with mass hunger and a collapsed healthcare system, is a breeding ground for infectious diseases.

A high prevalence of health conditions like diarrhea existed before the current war broke out. For example, in a 2017 study, over 46 percent of children under the age of five in Gaza reported experiencing periodic diarrhea and 18 percent of them experienced it in a single day. Data recently collected since the start of the current war shows a twenty-five-fold increase in the reported cases of diarrhea among children under the age of five. In retrospect, diarrhea is a common problem across the globe in young children. However, recurring cases of diarrhea –  as is being reported in Gaza – can be fatal and lead to more serious issues such as malnutrition.

The State of Humanitarian Aid

Humanitarian partners and other UN agencies estimate that 2.1 million Palestinians across the West Bank and Gaza require humanitarian assistance, with 58 percent being in Gaza (OCHA, 2023). As was discussed, escalations in Gaza prior to 7 October and restrictions on movement by sea, land and air have contributed to the dire humanitarian crisis. Additionally, a 2023 report by OCHA clarified the following about movement restrictions:

“This land, sea and air blockade on Gaza intensified previous restrictions, imposing strict limits on the number and specified categories of people and goods allowed through the Israeli-controlled crossings. Restrictions imposed by Egypt on the movement and access of people and goods at Rafah, the Gaza-Egypt crossing, further exacerbates the situation.” (OCHA, 2023)

The blockade – imposed primarily by Israel and supported by Egypt at Gaza’s southern border – has exacerbated the decline of living conditions in the enclave. Before 7 October, the entry of aid was already limited at the borders and crossings were strictly regulated. Compounded with the current war, the international community has pressured Israel to open more crossings for aid entry. Josep Borell of the European Union and the UN Secretary-General, Antonio Guterres, have called what is happening in Gaza a “man-made” humanitarian disaster. Although Israel has cited some instances in which Hamas has intercepted aid packages, that number is still low. Israel claims this is because of the precautions they take by blocking aid. However, some claim that Israel has used humanitarian aid as a “weapon against Palestinians,” while individuals such as Jeremy Konyndyk of Refugees International state that Israel is “trying to provide a plausible cover story for collective punishment.”

Since the start of the war, aid organizations have described their inability to carry out their duties across the Gaza Strip. For example, shipments of food kits prepared by the Mercy Corps in March sat idly in a line of trucks at the Rafah border. Aid trucks are lined up at border crossings into Gaza with no assurance of whether they can enter. Even if the trucks enter Gaza after stringent searches at security checkpoints managed by the Israeli military, the damaged infrastructure, inconsistent communication because of electricity blackouts and the inability of workers to distribute aid safely and effectively all hamper humanitarian aid operations in Gaza. In mid-July, thirteen leading nongovernmental organizations, including the Mercy Corps, accused Israel’s military of blocking vital aid from reaching Gaza. The joint statement released by those organizations also criticized the bombing of UN schools which were used as shelters by Palestinians displaced by the war. Other aid organizations that signed this document include Doctors Without Borders, Save the Children, the Norwegian Refugee Council and Oxfam.

The rapidly deteriorating population in Gaza has also placed aid workers in harm’s way. As of April 2024, UNRWA has lost 180 of its workers, and seven World Central Kitchen (WCK) workers were killed in April in an Israeli airstrike. Miscommunication within the IDF that may have led to the airstrike which killed the WCK workers is still “no excuse” for the incident, according to Jose Andres, the celebrity chef who founded the organization. Thus, some UN agencies like UNRWA and other aid organizations are hesitant to send their workers to unsafe conditions in which the IDF has made mistakes, which have led to the death of innocent people at the forefront of humanitarian assistance in Gaza.

Conclusion

Since the beginning of the war, Palestinians in Gaza have moved south, most notably to Rafah, a city near the Egyptian border. Almost two months after the IDF entered Rafah, the humanitarian crisis reached new heights. Following 7 October, Rafah’s population increased from 275,000 to estimates as high as 1.4 million people. Following the ground invasion, makeshift tents appeared across Rafah and humanitarian aid flows were destabilized. Fewer than 100,000 people remain in this densely populated area of land in southern Gaza.

However, the brutality of the Israeli military has extended past the ground invasion of Rafah. In mid-May, an Israeli airstrike on a refugee camp in Deir Al-Balah in central Gaza killed 27 people, mostly women and children. On 6 June, news broke of an Israeli airstrike on a United Nations school filled with displaced Palestinians in the Nuseirat refugee camp in central Gaza, which killed 35 people. While many news agencies such as the BBC are working to verify what took place, the IDF said that it was a precision attack on a Hamas compound. Much like this school in the Nuseirat camp, displaced Palestinians across Gaza have sheltered in schools and a variety of UN facilities which were deemed safe. As many Palestinians in Gaza have noted, there is no safe place in Gaza. While the IDF states that they tried to minimize civilian casualties when undertaking the operation on the school, Phillip Lazzarini, the Commissioner General of UNRWA, said the school was bombed without prior warning to his agency.

The state of humanitarian aid and aid
workers in Gaza is precarious. Aid workers
are unable to access many parts of the
enclave at risk of their own safety

Additionally, the state of humanitarian aid and aid workers in Gaza is precarious. Aid workers are unable to access many parts of the enclave at risk of their own safety. In April, the UN reported that at least 224 personnel had been killed because of the hostilities – three times as many in any conflict in a given year.  Also, because of ongoing hostilities, aid is not reaching the innocent civilians it should be because there is not enough coming into the strip, and the risks posed to aid workers are too high. Some have described the famine in Gaza as man-made and believe that the IDF’s actions have crossed numerous lines. For nearly ten months, aid into Gaza has been provided via expensive – and sometimes ineffective – air drops by countries like Jordan. Recently, the US-constructed pier off the coast of Gaza delivered 1.1 million pounds of aid. This came after repairs caused by inclement weather on 25 May. Importantly, aid routes have been obstructed because convoy trucks used by aid agencies to deliver supplies were overrun by desperate civilians in need of necessities like food and water. As of July 2024, the pier was dismantled and closed after costing nearly USD 230 million.

According to a recent poll by the Pew Research Center, the share of Americans with little or no confidence in Israeli Prime Minister Benjamin Netanyahu to do the right thing has grown from 42 percent to 53 percent in the last year. This poll also cited less support among the American public for the Israeli government. Additionally, Israel has lost global support because of its military conduct in Gaza. For example, the US State Department told the Israeli Foreign Ministry that Israel will lose its international credibility because of its operations in Gaza. The United States is a staunch ally of Israel, and pressure by Joe Biden’s administration on Netanyahu to be more careful about the safety of civilians has been undermined by its inability to explicitly lay out what it does and does not support in Gaza. In recent months, President Biden has discussed red lines as they pertain to Israeli military operations in Gaza. However, the exact nature of those red lines is vague, and statements from National Security Advisor Jake Sullivan and others from the Biden administration have done little to define them. Pressure on Biden to put a stop to Israel’s operations has grown, and given that it is an election year, Biden risks losing votes from the voters that supported him in 2020, such as Arab Americans. Furthermore, internal strife in the Israeli war cabinet over the handling of Gaza led to Benny Gantz’s resignation on 9 June. Discontent in Israel is also a result of the growing disagreement of the Israeli public and political moderates with Netanyahu and his far-right allies. Thus, what comes next with respect to Netanyahu’s plan in Gaza remains unclear. The future is bleak for many innocent civilians in Gaza, with Israel announcing in late May that it may continue the war through to the end of the year.

However, in discussing the various factors that have led to an unimaginably difficult humanitarian crisis, there is a degree of reductionism with respect to human life. Here, reductionism refers to the reduction of human dignity that is confined to the definition of a “humanitarian problem.” For example, Palestinians in Gaza have faced years of limited electricity, unclean drinking water and insufficient medical supplies because of the blockade. The work of humanitarian agencies is nonetheless vital, but a growing dependence on their presence in Gaza is a myopic stopgap, not the wider political solution that is sorely needed (Feldman, 2009). Additionally, discussions on Gaza have been siphoned off into “a humanitarian challenge or a terroristic security threat.” (Baconi, 2021) This strips Palestinians in Gaza of their agency and their ability to determine their futures following the end of this war – whenever that may be. Furthermore, the current war has shown that any discussion on the humanitarian crisis should be joined with a discussion on the statelessness and destitute state of the Palestinians. Addressing the humanitarian crisis does not stop with the increased entry of aid; rather, it means addressing the root cause of the crisis by examining the agency that is stripped from a stateless civilian population.

Bibliography

Baconi, Tareq. “The Gaza Strip: Humanitarian Crisis and Lost Statehood.” In: Farsakh, Leila H. (ed.), Rethinking Statehood in Palestine: Self-Determination and Decolonization Beyond Partition. Berkeley: University of California Press, 2021. www.jstor.org/stable/j.ctv2rb768k.8.

Feldman, Ilana. “Gaza’s Humanitarianism Problem.” Journal of Palestine Studies 38, no. 3: 22–37, 2009. https://doi.org/10.1525/jps.2009.xxxviii.3.22.

The World Bank, the European Union, and the United Nations, “Gaza Strip-Interim Damage Assessment.” 2024. https://thedocs.worldbank.org/en/doc/14e309cd34e04e40b90eb19afa7b5d15-0280012024/original/Gaza-Interim-Damage-Assessment-032924-Final.pdf.

OCHA, “Humanitarian Response Plan, OPT.” 2023. Humanitarian Programme Cycle. United Nations Office for the Coordination of Humanitarian Affairs (OCHA). www.ochaopt.org/content/humanitarianresponse-plan-2023.

Taha, Amira Mohamed; Mahmoud, Hussam; Nada, Sarah A. and Abuzerr, Samer.. “Controlling the Alarming Rise in Infectious Diseases among Children Younger than 5 Years in Gaza during the War.” The Lancet Infectious Diseases 24 (4): e211, January 2024. https://doi.org/10.1016/S1473-3099(24)00067-7.

“UNCTAD Rapid Assessment: Preliminary Assessment of the Economic Impact of the Destruction in Gaza and Prospects for Economic Recovery.” 2024. United Nations Trade and Development (UNCTAD). https://unctad.org/publication/preliminary-assessment-economic-impact-destruction-gaza-and-prospects-economic-recovery.

^[1] These are numbers received from the Gaza Ministry of Healthy (MoH) that the United Nations was unable to verify at the time of the interim damage assessment’s publication; “Gaza Strip Interim Damage Assessment,” 1

^[2] The World Bank received these figures from UNRWA.

^[3] A formal declaration of famine is complicated by figuring out how many people have died in areas that are inaccessible because of safety reasons https://apnews.com/article/gaza-famine-world-food-program-israel-hamas-war-476941bf2dc259f85a706408b2a665ff.

^[4] WHO, oPt Emergency Situation Update, February 20 2024, https://reliefweb.int/report/occupied-palestinian-territory/opt-emergency-situation-update-23-20-february-2024-1600.

^[5] An update by Doctors Without Borders in April 2024 raises this point.  www.doctorswithoutborders.org/latest/how-israeli-army-besieged-nasser-hospital.

Header photo:

Header photo: Palestinians receive food rations from the United Nations Relief and Works Agency (UNRWA) warehouse the Khan Yunis refugee camp in the southern Gaza Strip, on June 14, 2022. Anas Mohamed. Shutterstock.