Social distancing is not possible in Gaza’s refugee camps

Earlier epidemics have proven deadly in Gaza's densely populated refugee camps
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When I first organized my thoughts for this article, it was in late March. Ordinarily the month culminates in coverage about Land Day, a day of protests on the Palestinian calendar marked annually on March 30 to commemorate the deaths of six who were killed demonstrating to prevent a land confiscation in Israel in 1976. Over the years the day has expanded its meaning to emphasize broader Palestinian loss of land. In Gaza, it has taken on another meaning. The Great March of Return, or weekly border protests, started on this day in 2018.

This year, what would have been likely the largest day of protests across the Gaza Strip was a muffled anniversary marked on social media. Because of the pandemic, all gatherings were suspended.

As the coronavirus began to spread–and land confiscations were on my mind–I was reminded of a story about my late paternal grandfather, Ahmed Abu Al-Tarabeesh. Introducing him might be a good start in a reflection on how the residents of refugee camps in Gaza could be overtaken by the coronavirus, in the absence of even the lowest standards of preventive measures and medicines.

My grandfather Ahmed, who used to work in olive oil trade, and my grandmother Mariam, escaped from Israeli forces who were occupying Palestinian cities in the 1948 war. They fled their home in the al-Majdal village, today’s Ashkelon in southern Israel, after one year of marriage.

My aunt Hania told me that my grandfather, like the other residents, closed his house leaving everything behind including my grandmother’s gold jewelry and their identification papers. The story goes, they believed that they would be able to return to their house the following day or two.

“In one hand, he held my pregnant mother’s hand and with the other hand he held onto a water bottle,” my aunt told me.

Palestinian children play in the outskirts of the Khan Yunis refugee camp in the southern Gaza Strip on April 8, 2020. (Photo: Mahmoud Ajjour/APA Images)

My grandfather and grandmother continued south until they reached Deir al-Balah, a city in central Gaza. After a week passed, my grandfather realized that they were not returning. He had constructed a tent from palm leaves and it became the foundation for their new home.

They lived there until the United Nations started its relief program for Palestinian refugees in 1950. When rudimentary refugee camps were constructed, my grandparents moved into Jabalia refugee camp in northern Gaza and it is still a family residence until today.

The family expanded. My grandmother gave birth to eight children, six sons and two daughters. The youngest of them is my father who was four years old then. By the time my grandfather turned 37, they had lived in the camp for 15 years. That year he contracted Tuberculosis. There was a contagion inside the camps.

Tuberculosis is an airborne disease caused by a bacteria called Mycobacterium that can infect the lungs. Tuberculosis is cured by antibiotics and is also preventable by a vaccine. The first effective treatment was developed in 1949, almost 20 years before my grandfather died. However, tuberculosis remains one of the most common causes of death from a single agent, like a virus or a disease, according to the World Health Organization. Its mortality rate today is 16 percent, although that varies vastly from country to country. Ninety-five percent of deaths occur in developing countries. By comparison, the coronavirus has around a 3.4 percent mortality rate and that’s without a vaccine. Anecdotal reporting shows us that both disproportionately impact communities living in cramped spaces.

In 1965 a month after my grandfather became noticeably ill, he died.

A psychiatrist friend of mine, Mohammed Abu Elsebah, told me once that major depression weakens the immune system. Thus, I believe that my grandfather’s psychological trauma and subsequent depression stemming from losing everything in 1948 contributed to his death.

“My mother always told us how our father turned from an active social young man to a depressed isolated man after the Nakba,” my aunt said, using the Arabic word for catastrophe to describe the family’s exile in 1948.

The living conditions in camps both then and now are of compacted units without fresh air or ventilation, poor sewage, and a lack of access to clean water. The camps are fertile ground for the spread of any virus or bacteria. What’s more, overcrowding in individual homes ensures rapid spread amongst family members.

I apologize for this long detour, but the fear of the coronavirus spread in Gaza, especially inside camps, has imparted to me a lingering question: would my grandfather have had a full life had he not lived in a refugee camp where social distancing was impossible?

My father lives in that same house. Today there are 113,990 residents in an area of a half a square mile. Gaza’s refugee camps are one of the most densely populated places in the world. Overall Gaza has a population density of around 13,000 per square mile, but the camps are closer to 50,000 per square mile. That’s close to twice the density of New York City.

These factors forewarn for the possibility of a rapid and dangerous outbreak in the event of the arrival of the coronavirus in the community in Gaza. As of now, there are only 20 confirmed cases of COVID-19, all detected inside isolation centers that included travelers returning from other countries. Gaza instituted a more rigorous form of quarantine for returning travelers, placing both people who demonstrated symptoms and people who did not in government-run quarantine centers for 14 days.

Yet many are starting to wonder if, or will, the virus reach the general public undetected? Gaza has a paucity of tests and the little stock that healthcare workers do have keeps running out. If the pandemic does reach the camps in Gaza, our medical system will not be able to handle an influx of critically ill patients. There are 63 ventilators in Gaza and around 120 ICU beds for a population of nearly 2 million. Gaza also is running a 52 percent medication deficit and will not be able to meet the needs of anticoagulants and antibiotics that are being used to treat COVID-19 positive patients.

On a smaller scale, we’ve already seen Gaza’s hospitals struggle to meet the needs of the 30,000 protesters who were injured in the course of a year at demonstrations.

Physicians for Human Rights Israel and Gisha, two leading rights groups in Israel, sent a letter to the Israeli taskforce on the coronavirus in late April urging distribution of additional medical supplies and testing kits.

“In the Gaza Strip, the healthcare system teetered on the brink of collapse well before the coronavirus pandemic, partially as a result of ongoing movement and access restrictions enforced by Israel,” the groups said in a statement.

The Israeli human rights organization B’Tselem summarized the challenges the Gaza Strip is facing in its statement in March 2020 reporting that “the spread of COVID-19 in the Gaza Strip will be a massive disaster, resulting entirely from the unique conditions created by more than a decade of Israeli blockade.”

Those unique challenges include pre-pandemic unemployment over 50 percent and youth unemployment around 70 percent. Already three quarters of the population received some form of food assistance.

Aside from numbers, I personally witnessed two separate contagions rip through the camps this year alone. For the last 15 years Gaza has had a sporadic resurgence of scabies. In January I became aware that it was once again spreading between children and their families. Intensive medication regimes were instituted for two weeks and around 15 houses were sterilized by the Ministry of Health.

Similarly, last year there were 124 confirmed cases of the measles in Gaza. Even though we have a high vaccination rate, an outbreak still occurred. My wife is a journalist, Sarah Algherbawi, and she found that 30 who were infected came from the same family living in one building in Deir al-Balah camp.

I have no idea what the future holds for the refugee camps in Gaza, but I do know when it comes to infectious diseases and viruses, the past has been alarming.