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Gaza Was ‘An Emergency Even Before Corona.' What Happens Now?

Dr. Salam Khashan, an OB-GYN in Gaza, on what it's like to brace for COVID-19 in a place already suffering from severe medical shortages.

by Leila Ettachfini
Apr 6 2020, 2:50pm

Image courtesy of Dr. Salam Khashan

Salam Khashan’s shifts at the Nasser Medical Complex in Gaza can exceed 24 hours.

“When I am in the ER, and I call for a bed because I have, for example, a patient with hypoglycemia who needs to be admitted, they usually answer that we don't have a bed,” the doctor said. In that scenario, the patient may have to wait in the emergency room for hours as Khashan, an OB-GYN, calls other departments to search for an empty bed.

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“Sometimes we have patients whose diagnoses and treatment plan we know, but we cannot treat them in Gaza because we don't have the medications,” she said. “We have a [medication] shortage by about 50 percent.”

What Khashan described may sound newly familiar to doctors in places like the U.S., where the medical system is currently overwhelmed by the exponential growth of the novel coronavirus. But Khashan is not describing Gaza under COVID-19. She’s describing an average day at work in a medical system suffering under a 13-year blockade imposed by Israel that severely restricts the movement of people and resources in and out of the Gaza Strip.

Now, doctors and civilians alike are concerned knowing that Gaza’s medical system is unable to meet the needs of Gazans regularly, let alone if Gaza is to experience a coronavirus outbreak that mirrors China’s, Italy’s, or the U.S.’s, even by a small fraction.

“It’s an emergency even before corona,” said Khashan.

On March 22, the first two cases of the virus were detected among Palestinians in Gaza returning from Pakistan. By the time they arrived in Gaza, Hamas, which governs the strip, had already set up quarantine facilities for those traveling into the area. Those cases and the seven to follow were detected inside the quarantine centers.

Since then, Gaza’s doctors have been put on high alert in an attempt to stop the virus before it's too late. Khashan works in the obstetric and gynecology department, but new COVID-19 protocol in both Gaza and the West Bank means she asks every patient she sees if they’re experiencing any symptoms. “If I have a new patient coming from her home to ask about the problem behind her vaginal bleeding, I have to ask her if she is having a fever or chest pain, shortness of breath, or a cough,” she said. “And if any of those symptoms are positive, especially the question of if you are coming from outside Gaza or have you had contact with travelers, then I have to call the infection control committee.”

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Today, at least 12 people in Gaza have tested positive for COVID-19 in Gaza. According to the Palestine Ministry of Health, six have recovered and the rest remain in an isolated corona health facility.

In some ways, Khashan’s concerns are similar to those facing doctors in the U.S.: there aren’t enough ventilators, not enough beds, not enough personal protective equipment (PPE), not enough hands, not enough hospitals. But in more ways, doctors in Gaza face COVID-19 challenges that will be unfamiliar to the majority of the world, even as other countries face their own extreme versions of this pandemic.

While the U.S. has approximately 52 ventilators per 100,000 people—which already falls well below the current need with COVID-19—Gaza has approximately three per 100,000 people. “The Ministry of Health urgently needs to be provided 100 ventilators and 140 ICU beds to achieve the first response to facing the Coronavirus outbreak, as we have only 63 ventilators and 78 ICU beds [in the Gaza Strip],” said the Palestine Ministry of Health in an April 1 statement.

Still, ventilators need electricity, and right now Gazans only have about eight hours of electricity per day, forcing hospitals to run on generators for the remainder of each day. Generators need fuel, and fuel is expensive. Long before coronavirus, electricity shortages have been to blame for several hospital and health center closures in the Gaza Strip.

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“You may have electricity for ventilation, but you don't have electricity to light the surgery room,” Khashan said, recalling one instance where surgeons had to use their cell phones for light during a surgery. Often, she said, doctors must choose to allocate electricity to the resources and patients most in need.

The UN and several other organizations have developed a response plan to help doctors and civilians combat COVID-19 in Palestine, including both the West Bank and Gaza. The plan requires $34 million in aid divided among health care, education, food security, shelter, and access to washing services. So far, the plan is only 25 percent funded.

"You may have electricity for ventilation, but you don't have electricity to light the surgery room."

Despite the UN’s efforts toward aid, its position remains that it is Israel’s responsibility under international law to ensure Palestinians receive essential health services.

“The legal duty, anchored in Article 56 of the Fourth Geneva Convention, requires that Israel, the occupying power, must ensure that all the necessary preventive means available to it are utilized to ‘combat the spread of contagious diseases and epidemics,’” said Michael Lynk, the United Nations Special Rapporteur on human rights in occupied Palestine.

As the virus devastates crowded, well-off cities like New York, a main concern is Gaza’s density. Restricted movement in Gaza under the Israeli blockade has created one of the world’s most densely populated areas where nearly 2 million people live within 140 square miles. Both that density and the area’s poverty (Gaza’s unemployment rate is 47 percent) are barriers to social distancing and quarantine.

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Khashan points out that asking people to self-quarantine and social distance isn’t particularly helpful when, for many, neither is an option. “Many of the people here work day by day,” she explained. “If a worker goes out to work in the morning, they get some money and then buy drinks and food for that day. They don't have savings, and they don't have another way to supply themselves with drinks and food.”

Khashan herself is having trouble self-isolating, despite working in a hospital where she knows her chances of exposure to COVID-19 are higher than the rest of the public. She lives with seven family members and shares a room with her two sisters.

“I'm afraid without using PPE I will be a carrier and bring [the virus] from the hospital to the house,” she said. “I don't have a choice except that I have just to face what is in front of me—to deal with that and to do my best.”

This article originally appeared on VICE US.

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Health

Israel's Military Supports Cancer Patients. Just Not the Ones in Gaza

An IDF tweet in support of cancer patients ignored the reality of what it's like to need healthcare in Gaza.

by Leila Ettachfini
Nov 13 2019, 1:01am


Anadolu Agency via Getty images

On Friday, the Israel Defense Forces’ Twitter account posted a photo of two young women, dressed in green army jumpsuits and holding the long braids they had just chopped off of their own hair. Their new blunt cuts framed bright smiles. A rifle rested on one woman’s lower back. The photo had a caption.

“Noam and Inbal donated their hair to make wigs for cancer patients. What a beautiful act of kindness,” it said.

On its face, the tweet was not unusual for the IDF, which was recently dubbed “the worst influencer in the world” by The Outline. The IDF’s tweets have included memes about veganism and videos about DIY Halloween costumes hosted by soldiers. In posting on such upbeat topics, the account has become somewhat of a twisted joke among those aware of the army’s human rights record. The UN, for example, has accused Israel of enacting “collective punishment” due to the conditions in Gaza. (The IDF did not respond to VICE’s request for comment.)

As a result, the IDF regularly faces criticism for the discrepancy between their charming tweets and the havoc its soldiers wreak on the lives of Palestinians. But the image of Noam and Inbal garnered even more criticism than most of the IDF’s posts, and for a very specific reason: the suffering of cancer patients in Gaza due to the IDF-imposed blockade.

The executive director of Human Rights Watch’s Middle East and North Africa division, Sarah Leah Whitson, chimed in. “Hi Noam and Inbal - great that you want to help!” she tweeted. “Can you please ask your bosses at the @IDF to open the #Gaza border so that cancer patients there can get urgently needed medical treatment? They and so many other Palestinians urgently need medical care but are blocked by #Israel.”

Conditions in Gaza have been on the decline since 2007, when Israel imposed a land, sea, and air blockade on the area. The decision effectively stopped most goods from going in and out of the territory and restricted the movement of Gaza’s population. These restrictions have had devastating consequences on nearly every aspect of life for Gazans, limiting employment opportunities, food security, and access to healthcare. The blockade has caused Gaza’s unemployment rate to spike to 38 percent and led human rights organizations to dub it “the world’s largest open air prison.”

For those who’ve been diagnosed with cancer, the effects of the blockade have been magnified, severely affecting their access to treatment—and their chances of survival.

One of the biggest barriers to treatment for cancer patients within the Gaza Strip is the fact that they must leave to get it.

“Hospitals and medical clinics in the Gaza Strip have access to limited power supply, sometimes six to eight hours of power access, followed by six to eight hours of blackout, and sometimes less than that,” Jehad Abusalim, a scholar and analyst from Gaza, told VICE.

Regular blackouts mean that machines like cardiac monitors, X-rays, and more are unreliable, Abusalim said. Even with the use of generators, maintaining the necessities of a hospital under occupation and blockade is difficult. In addition to power shortages, hospitals in Gaza face regular medicine and supply shortages.

Even though conditions in Gaza make it exceedingly difficult for many people to seek cancer treatment at home, Israel still makes it incredibly hard for cancer patients to leave. After receiving a cancer diagnosis, Gazans must apply for a medical transfer through the poorly funded Palestinian Authority (PA). If and when they obtain a transfer from the PA, cancer patients in Gaza must apply for an Israeli permit to enter Israel. After submitting a permit request, some cancer patients are interviewed at checkpoints to assess whether or not their request will be fulfilled. (Gazans can try to receive treatment in Egypt instead. However, getting across that border is also difficult and takes longer: the trip from Gaza to Cairo is 12 hours. It takes two hours to get from Gaza to Jerusalem.)

Obtaining an Israeli travel permit for medical reasons also involves sending medical forms to a committee of Israeli doctors. “In many cases, this committee recommends not issuing permits, citing that the treatment is available in Gaza, which technically or on paper can be said to exist there, but happens to be not available later on because the medicine is no longer there or the devices need maintenance or spare parts that cannot be obtained,” Abusalim said.

Permit applications can take months to process—months that a lot of cancer patients in Gaza don’t have; most cancer diagnoses in the region occur in the late stages of the disease, due to a healthcare system that has been gutted by the blockade.

Even after months of waiting, access to treatment is not guaranteed. In 2018, 39 percent of requests to leave Gaza in order to receive healthcare were denied, according to the World Health Organization.

Delayed or denied treatment has had deadly effects in Gaza, where only about 50 percent of women survive five years after a breast cancer diagnosis. In the U.S. and Israel, by comparison, the five-year survival rate is closer to 85 percent.

The blockade that has led to poor outcomes for the region’s cancer patients is enforced by members of the IDF, much like the women in the photo posted Friday—a fact which, for many Gazans, made the soldiers’ efforts feel nothing like “a beautiful act of kindness.”

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This article originally appeared on VICE US.

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What Protests Look Like in a Time of Social Distancing

Organizers are getting creative as it becomes dangerous and even illegal in some places to gather in large groups.

by Leila Ettachfini
Mar 26 2020, 11:43am

Protesters from a group called 'Pause the System' wear hazmat suits as they demonstrate outside Downing Street in London. Photo by Dominic Lipinski/PA Images via Getty Images.

On Sunday, after organizing efforts led by Never Again Action—one of a few American Jewish activist groups dedicated to freeing immigrants from ICE detention camps—nearly a hundred cars gathered outside of the Hudson County Detention Center in New Jersey to demand the release of detained immigrants during the coronavirus pandemic. The cars drove around the building honking and displaying signs advocating for the detained people inside. Mindful of COVID-19 prevention guidelines, the group advised protesters to come in cars only with people they were already living with and to stay inside their vehicles.

In the two months since the novel coronavirus appeared in the U.S., hospitals have experienced extreme shortages in necessary equipment and supplies, record numbers of people have lost their jobs, and the government has yet to pass a relief bill. The result is a country frustrated and suffering from systems that have proven unreliable in a time of crisis.

Usually, when a growing number of people in the U.S. gravely oppose their government’s actions—or inaction—they take to the streets to voice their concerns and demand change. But with public gatherings now considered dangerous and even illegal in some places, activists and organizers are facing unprecedented challenges—and have been forced to get creative.

Nadine Bloch, the training director of activist network Beautiful Trouble who’s been an organizer since the 1980s, summed it up like this: “The coronavirus has pulled back the veil on the apocalyptic moment we live in and the incredible failure of our system, the inability of our capitalist system to take care of people,” she said. “And so in this moment, more people are being made aware that the system doesn't work for many, many people in the world.”

With the health and safety of their volunteers to worry about, in addition to those in ICE custody, activist groups like Never Again Action must rely on no-contact methods of organizing for the foreseeable future.

On the same day as the car protest in New Jersey, Never Again Action organized a projection on the side of the JFK Federal Building in Boston demanding Governor Charlie Baker use his emergency powers to release ICE detainees in order to save them from the coronavirus. “Anne Frank died of an infectious disease in a crowded detention center,” read the projection. “Governor Baker, release everyone in ICE detention before it’s too late.”

“Banner action or large scale projections only require a few people who can take appropriate health precautions,” said Never Again Action Campaign Director Stephen Lurie, “but they are powerful reminders that action is still possible outside of our homes.”

1585158069904-_IMG_0575
Image by Amanda Zimmerman. Courtesy of Never Again Action.

Never Again Action is known for organizing crowded sit-ins at ICE facilities—and businesses, like Amazon, that work with ICE. Elizabeth Weinbloom, a volunteer with the group, explained that putting their advocacy on hold wasn’t an option in large part because the coronavirus pandemic actually increases the urgency of freeing those detained by ICE. “Conditions [inside ICE detention centers] are incredibly crowded, unsanitary, and unsafe with very little medical access,” she told VICE. “We saw that the risk right now is that when this virus gets into detention centers—and that is a when not an if—it's going to run like wildfire.”

Survived and Punished New York, a prison abolition group that focuses on freeing survivors of sexual and domestic violence, has also seen the urgency of their work increase due to COVID-19. In many prisons, incarcerated people are forced to pay for soap, meaning many of them are forced to go without, despite CDC guidelines that encourage more handwashing to prevent the spread of the virus.

“The coronavirus has launched Survived and Punished NY's organizing into rapid response as we seek to get money, hygiene products, and other necessities to our comrades inside before prisons and package rooms lock down,” said Eliza Petty, a member of the mutual aid working group with Survived and Punished New York. Two weeks ago, the group launched a fundraiser with the goal of shipping 10 bars of soap to as many incarcerated people as possible. After partnering with other groups, Survived and Punished was able to raise over $30,000.

While freeing criminalized survivors of domestic and sexual violence still remains a demand of the organization, Petty said that it was crucial for the group to shift its focus to the immediate needs of incarcerated people during the pandemic in a way that is safe for organizers, volunteers, and supporters.

As advocacy groups learn to adapt to new safe methods and tactics that still make an impact, Lurie says that it is the work of long-time organizers like Bloch that groups like Never Again Action have relied on and built on to get through this pandemic. Last week, Bloch and social change strategist Rae Abileah wrote a guide to activism during a pandemic that encouraged people to get creative with their organizing. They suggest holding rallies via livestream, placing signs in your windows, and even hologram protests. Many other resources, like this packet from David Solnit, have been shared widely for free as advocates work across organizations and neighborhoods during the pandemic.

"The coronavirus has pulled back the veil on the apocalyptic moment we live in and the incredible failure of our system, the inability of our capitalist system to take care of people."

Despite the fear and hopelessness that the coronavirus has caused, Bloch said a crisis like this is exactly the time to get more involved in advocacy, even if it does require a little imagination.

“We want people to understand that in this moment, all is not lost,” she said. “In fact, you know, that old saying, In every crisis, there's an opportunity? The opportunity here is that we build or we rejigger our systems to actually serve people.”

According to Lurie, people are heeding Bloch’s call. “This crisis has grown our movement,” he said. “Dozens of new folks are plugging in onto every call. People from all corners of New York, from seasoned organizers to people with no experience, are rising to the challenge as the pandemic makes the truth clear: our government sees detained immigrants as expendable.”

This article originally appeared on VICE US.

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Anti-Abortion Groups Are Still Holding Protests During the Coronavirus Outbreak

“The abortion industry is still doing abortions...we are not going away unless we’re banned."

by Leila Ettachfini
Mar 20 2020, 12:14pm

Richard Mahoney holds a crucifix during a protest vigil sponsored by The Christian Defense Coalition and Priests for Life outside of the Planned Parenthood of Metropolitan Washington, D.C. on January 17, 2019. (Photo by Zach Gibson/Getty Images)

Across the U.S. and in many other parts of the world, cities and towns that only two weeks ago were bustling with people have since emptied as people try to “flatten the curve” or slow the spread of the novel coronavirus. For millions of people, life as they know it has come to a halt. But there is one group that is relentless in continuing business as usual: anti-abortion protestors.

Those belonging to one group in particular, 40 Days for Life, are committed to disrupting people who wish to enter reproductive health clinics through April 5, despite the possibility of contracting the potentially deadly virus or passing it along to someone else. The organization operates in hundreds of cities across the U.S. where it rallies people to show up in protest outside of clinics and dissuade pregnant people from continuing with their abortions.

“The abortion industry is still doing abortions...we are not going away unless we’re banned,” said CEO & President of 40 Days for Life Shawn Carney in a video titled “Coronavirus and Abortion” posted to the organization’s website on March 18.

Holding a bottle of hand sanitizer in the video, Carney encourages people to show up to vigils (how the organization refers to displays that it places outside of abortion clinics) and comply with the CDC at the same time so that “participating in 40 Days for Life is a safe and healthy thing to do.” But days before 40 Days for Life posted the video, the CDC had already warned the public that social distancing and self-isolation were necessary to slow the spread of the virus. On Sunday, the CDC also recommended that people avoid gatherings of 50 or more people for the next eight weeks.

40 Days for Life did not respond to VICE’s request for comment.

On Thursday, Reproaction, an organization that fights for reproductive justice, called on 40 Days for Life to cancel protests immediately in light of the health dangers posed by the gatherings.

“It is a public health hazard,” co-founder of Reproaction Erin Matson told VICE. “It is the opposite of a ‘pro-life’ effort to encourage large groups of people to gather in direct contradiction of the orders of governors around the country.”

“By their very nature, it is unlikely that the protests outside of health centers that provide abortion care are able to abide by these national rules and therefore are posing a risk of infection spread to the community,” said Jen Villavicencio, an ob/gyn in Michigan and a fellow with the Physicians for Reproductive Health.

Matson also worries about the health risks that protesters pose to others, as clinics that provide abortions are often located inside buildings with other businesses. By blocking sidewalks and or attempting to speak with people entering these buildings, protesters could potentially transfer the virus to passersby, people entering the clinic, and one another.

Villavicencio is also concerned about how protesters will increase panic among providers and patients during an already stressful time. “In the time of a pandemic, anxiety and fear are at an all-time high for both health care providers and patients, and protestors are only adding to that, all while putting themselves at risk of contracting a potentially dangerous infection,” she said.

In the 40 Days for Life video, Carney—who says that he just prayed at the vigil outside of a Planned Parenthood in Houston with his wife and eight children during the coronavirus pandemic—seemed sure that supporters could continue the protests despite the CDCs warnings and avoid coronavirus by taking precautions.

“Be sure to be safe, be healthy, keep a distance, use your hand sanitizer, and pray for an end to abortion,” he said.

40 Days for Life has yet to respond to Reproaction’s call. On Thursday, the organization tweeted a photo of protesters outside a clinic standing shoulder to shoulder, some with their arms around one another.

This article originally appeared on VICE US.