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In Rafah, three sewage pumps and 10 water pumps stopped working yesterday, resulting in sewage flowing through the streets, according to the director of UNRWA, while 22 of the 35 hospitals in the territory are no longer functioning. Gaza’s two main telecommunications companies, Paltel and Jawwal, have said that all telecom services are down due to a lack of fuel, which risks leading to a complete communications blackout in the territory – a terrifying prospect for the 2.3 million people trapped there.

On Wednesday, fuel was delivered to Gaza for the first time since October 7. However, the delivery consisted of just over 23,000 litres of fuel – nowhere near the 160,000 litres UNRWA says it needs each and every day just to keep basic humanitarian operations running. What’s more, the use of this fuel is strictly restricted to transporting the little aid coming in through the Rafah crossing only: it cannot be used for other humanitarian work such as medical or water facilities.

The remaining functioning hospitals are desperately trying to keep treating patients in spite of the lack of fuel. Ahmed Muhanna, manager of Al-Awda Hospital, run by ActionAid’s partner Al-Awda, said: “We haven't fuel at all for one week. We [have] shut down the generators, the huge generators, and we are working now on LED [lights] and battery charging, but the services [are] still running in Al-Awda Hospital, with difficulties and challenges."

These impossible conditions are made even harder by the constant shelling that surrounds the hospital and has injured medical staff and equipment. Dr. Ahmed said: “The situation is critical, extremely, extremely critical, because all the time they are bombing around the hospital and close to the hospital. A lot of shrapnel went into the hospital. Many days ago, our staff [were] injured. Eight of [our] staff [were] injured from mild to moderate. And they [were] admitted to the hospital and [they] received management. They are okay now. Today, we find shrapnel inside the hospitals, and the ambulance and cars [were] damaged.”

Dr Adnan is a consultant and the head of the Obstetrics and Gynecology Department at Al-Awda Hospital. He said: 

"In the last [few] days, we have become the only hospital in the entire Gaza Strip and the north who receive obstetrics, cesarean sections and gynecology services. Because all hospitals in Gaza and the north, after the siege, lost any services for women and obstetrics.’

“Yesterday, we performed 16 cesarean sections under exceptional circumstances. There were cases of very severe bleeding and placental abruption as a result of difficulty in access, strikes, etc. We worked under exceptional and very harsh conditions. We did not have blood transfusion services... Blood transfusion is very limited, the blood bank has been closed and is difficult to access.’ 

“We ask God Almighty to end this issue and stop [the] shooting and make room for humanitarian services to be provided to the people because people are suffering, and our women are suffering. There are many children [who] have lost their lives. There are premature babies born at 30 or 31 weeks and we do not have anything to deal with [their cases]. There are no artificial respirators, there are none at all. We look at a child after birth, [their] weight is 1200g, 1300g, 1400g or one and a half kilograms. We do not have anything to deal with them. We look at babies losing their lives because we have nothing. 

“In addition, there are women who suffer from postpartum bleeding and bleeding after operations and there are no blood transfusions at all. Yesterday I had a placental abruption case, and it was opened two or three times. We were trying to find two units of blood to compensate for what was lost. With difficulty, her life was saved.” 

The impact the ongoing lack of fuel will have on people’s health is difficult to overstate. Not only are hospitals unable to run life-saving machines, but without fuel, there is no clean drinking water and no safe sewage disposal. Around 70% of people in Gaza now have no access to clean water. The World Health Organisation has already reported more than 33,551 cases of diarrhea in Gaza, half of which are among children under five, as well as many thousands of instances of scabies, lice, and skin rashes. With no access to potable water and people unable to wash themselves properly, these figures will only rise. 

The difficulties in communication with Gaza already mean the world is left with a worrying information gap about what is happening on the ground. If communications collapse completely, people will be unable to contact their loved ones to check if they are still alive, call ambulance services to collect the injured, or tell the world what is happening to them. 

Alarmingly, in some neighbourhoods in the south of Gaza, people have been given evacuation orders to leave immediately. Many of these people have already made the perilous journey south after being told to leave their homes in the north. Now they will be wondering, where can they go? Where is safe? 

Riham Jafari, Coordinator of Advocacy and Communication for ActionAid Palestine, said: 

“The lack of fuel is pushing services in Gaza to beyond breaking point. In some areas sewage is flowing down the streets, not a drop of clean water is available, and hospitals have closed their doors. The situation is disastrous, yet it is also completely preventable. Tragically, things are likely to get even worse if, as expected, communications collapse completely. Thousands of people are already being denied their fundamental right to clean water, food, and healthcare. Soon, even the small comfort of being able to hear the voices or read the words of their loved ones, will be robbed from them."

“Fuel must be allowed to enter Gaza, and in sufficient quantities, immediately, to prevent suffering on a scale even more unimaginable than what we have already witnessed. Yesterday a UN Security Council resolution called for urgent extended humanitarian pauses for a sufficient number of days A pause lasting only days will not be enough to allow anywhere near enough life-saving fuel and other aid to enter Gaza: only an immediate ceasefire can achieve this. 

“If an extended humanitarian pause is put in place, we call on world leaders to ensure that this is respected. It is clear that the four-hour pauses agreed last week have done little, if anything, to relieve the suffering of the people of Gaza.”


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