COVID-19 in Palestine: A Tale of Two Territories
The COVID-19 pandemic has caused wide-scale disruptions on the global movement and the flow of goods. Most countries have closed their borders and limited trade to an extent unseen in modern times. For Palestinians in the occupied West Bank and besieged Gaza Strip, conditions were not all that different from what they were accustomed to. Gaza has been sealed off from the world since 2007 when Hamas came to power. Freedom of movement in and out of Gaza was already minimal, and a policy of letting in only what was deemed enough to stave off a full out humanitarian crisis had been outlined by Israel shortly after the blockade was established.
Home to important tourist destinations like Bethlehem, Jericho, and Hebron, international visitors can access the West Bank through Ben Gurion airport in Tel Aviv, or by flying into Amman and crossing the border between Jordan and the West Bank. Tourism is an integral backbone of the West Bank’s economy, and the summer months of May to September are a time of relative economic prosperity as tourists from all over the world and thousands of Palestinians living in the diaspora return. In 2016, tourism brought in an estimated 305 million dollars, despite Israel collecting 90% of pilgrim related tourism revenue. Despite the occupation’s relative laxity when compared to the siege on Gaza, the West Bank is still littered with over 700 checkpoints and obstacles restricting Palestinian movement in the West Bank. In my own experience, traveling from Ramallah to Bethlehem means passing through four Israeli Defense Forces (IDF) checkpoints, while the trip from Ramallah to Nablus takes commuters through five checkpoints (see Figure 1).
Figure 1: Map of West Bank Obstacles
The pre-COVID-19 restrictions are an important preface for understanding how this new and deadly virus uniquely affects Palestinians. With freedom of movement and access to vital resources beyond their control, Palestinians were woefully unprepared to combat a COVID-19 outbreak.
Palestine is divided between the West Bank and the Gaza Strip. The territories are physically, economically, and politically distinct, which means that discussing COVID-19 in Palestine necessitates two microscopes. The Palestinian Authority, which ostensibly governs the West Bank, has responded to COVID-19 in a differnet manner than the way the Hamas governed Gaza Strip has responded to the pandemic owing to the particular constraints each has faced.
The West Bank
The West Bank, as previously mentioned, is a dream destination for people all over the world. It is home to the birthplace and baptism sites of Jesus, as well as many other holy sites valued by Christians, Muslims, and Jews alike. Revenue from tourism makes up an estimated 2.8% of the West Bank’s GDP. In fact, the first cases registered in the West Bank were linked to a group of Greek tourists visiting Bethlehem. Since those initial cases in late February, the West Bank has seen a slow increase in cases until a shark uptrend started in late June.
Timeline: West Bank Spread and Government Response
March 5th: First cases amongst Palestinians confirmed in Bethlehem after Greek tourists visited. State of emergency declared, with foreign tourists banned and public buildings were closed for one month. The shutdown included schools, all tourist and religious areas, national parks, and hotel reservations for foreign tourists. Traveling within and between cities was to be done only out of necessity. All gatherings were banned, and each governor would be in charge of ensuring compliance.
March 7th: Israeli military placed Bethlehem in lockdown with 16 confirmed cases.
March 9th: The first case was reported outside of Bethlehem, in Tulkarm.
March 16th: With 39 total cases between Bethlehem and Tulkarm, Palestinian PM Mohammad Shtayyeh announces a 5.5 million dollar donation from Kuwait to support the Palestinian response to COVID-19.
March 18th: One case reported in each of Ramallah and Nablus. Naftali Bennett, former Israeli Defense Minister and current Knesset member, announces West Bank Palestinians commuting to Israel for work will be given accommodation to stay in Israel. Israel and Palestine cooperate to close transit between Palestinian cities.
March 22nd: Shtayyeh extends the non-essential movement ban between and within cities for two more weeks.
March 25th: A women in her 60s from Biddu, just outside of Jerusalem, became the first Palestinian fatality from COVID-19.
March 26th: Israeli military confiscates tents meant for a field hospital in Khirbet Ibziq.
April 4th: 216 total cases confirmed. Many of the new cases have been traced back to Palestinians returning from work stays in Israel and Israeli settlements.
April 15: Israeli authorities shut down a testing clinic in Silwan, East Jerusalem after discovering the Palestinian Authority was supplying the clinic with testing kits.
May 5th: President Abbas declared a state of emergency for 30 days.
May 14: Only one new case has been confirmed since May 8th.
May 17: After more than two months under lockdown, seven governorates had zero active cases.
May 25: With case numbers at 122 across the West Bank, Prime Minister Mohammad Shtayyeh announced a gradual end to the lockdown. Guidelines concerning masks and gathering sizes were emphasized, without concrete limitations. Shtayyeh said cases would be monitored closely, and a return to lockdown could follow a spike in cases.
May 28: After the first confirmed case in Azzun Atma, near Qalqilya and the Green Line. The village was placed on lockdown immediately.
June 20: Prime Minister Shtayyeh locked down Hebron for five days. Only cargo trucks would be allowed into the governorate. Pharmacies, bakeries, and factories would stay open with strict safety guidelines in place. Shtayyeh also announced a two day shut down of Nablus to allow for contact tracing. All public gatherings across the West Bank were banned and those who did not comply would face charges.
June 27: The Bethlehem governorate declared a two-day lockdown. Shtayyeh reaffirmed a ban on all public gatherings.
July 1st: The Governor of Hebron announced a five-day lockdown over the governorate. The only exceptions were pharmacies and bakeries.
July 2: The PA announces a five-day lockdown starting the next day. The lockdown would exclude pharmacies, bakeries, and grocery stores.
July 9th: Lockdown extends into a second week to control the spread of COVID-19.
July 12th: Israeli military orders Palestinians in Hebron to stop construction of a COVID-19 testing clinic.
July 20th: Israeli soldiers demolished a newly constructed clinic in Hebron for not having building permits.
September 13: With 811 cases, Ghassan Nemer, spokesman for the Ministry of Interior, blamed non-compliance with COVID guidelines and said a renewed lockdown is being considered.
Source: Palestinian Ministry of Health
Pandemic Meets Military Occupation
As is the case with most developments in Palestine, it is important to consider how Israeli policy shapes Palestinian response to COVID-19. The Israeli military maintains an active presence in the West Bank and severely limits infrastructure development in much of the territory, including access to critical water infrastructure. For Palestinians, following a stay-at-home order entails so much more than securing the goods needed to withstand extended lockdowns. Staying at home proves incredibly difficult with persistent Israeli home demolitions in the occupied West Bank. 314 Palestinian structures have already been destroyed in 2020, with further demolition orders coming out as recently as last week. Most demolitions orders are given for structures without proper building permits. However, Israeli officials reject over 98% of permit requests from Palestinians, so applying for a permit is mostly pointless. In April, the Israeli government announced a freeze on residential demolitions, without extending the freeze to include WASH facilities. Despite the “freeze,” 63 Palestinian homes and structures were demolished in June, and another 72 were demolished in July. After a relatively successful bout with the first wave, the second wave is growing rapidly, and such persistent restrictions/demolitions in the West Bank have cultivated a perfect setting for COVID-19 to spread unabated.
WASH
Despite significant groundwater resources, the occupation severely limits water access to Palestinians and diverts significant amounts of water to illegal settlements. For these reasons, water availability is not indicative of water access, and Palestinians find themselves in a perpetual water shortage. Before COVID-19, the average Palestinian in the West Bank had access to 70 liters of water per day. This falls below the World Health Organization’s minimum standard of 100 liters per day per person. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) has reported on the water situation in the West Bank on a weekly or biweekly basis since the start of the pandemic. From September 9th to the 22nd, PPE and other safety supplies were delivered to 55 health facilities, and 450 households in severe need were given hygiene kits. Despite these international efforts, water insecurity increased by four percentage points (12% to 16%) from this time last year to now.
Image obtained from Visualizing Palestine
Gaza
As COVID-19 spread across the world, Gazan authorities set up quarantine zones for Palestinians returning to the enclave, and positive cases were kept from reaching the public until late August. The first cases in the general population were found in Maghazi refugee camp on August 24th, after a woman in the camp returned from the West Bank. The camp was immediately locked down, and a 48-hour stay-at-home order was broadcast across Gaza. The next day, two more cases were reported in al-Shifa, Gaza’s central hospital, which has a history of facing more patients than it can care for. Both cases were determined to have no relation to the four cases from Maghazi camp. As of September 4th, 603 cases had been confirmed, with 4 deaths.
On September 13th, 2020, Gaza reported 1,631 COVID-19 infections and 11 deaths, an increase of 1,500 where only 109 cases and 1 death between March and August were confirmed. Unfortunately, for Palestinians in Gaza, lockdown is nothing new: they have lived under a strict and comprehensive Israeli blockade since 2007. The lack of movement in and out of Gaza explains much of why COVID-19 did not reach the general population until late August. However, given Gaza’s minimal access to medical equipment, water, and fuel, a prolonged outbreak in the Gaza strip would prove devastating. Gaza is facing a severe testing kit shortage and depends on donated testing kits from the international community. Access to clean water was, and continues to be, one of the greatest challenges facing Palestinians in Gaza, with over 96% of water inadequate for drinking.
Israeli Restrictions
Israeli policy has exacerbated Gaza’s fuel and medical crisis amid the COVID-19 lockdown, limiting fuel shipments to Gaza’s only power plant, and reducing daily electricity allocations from about 6 hours per day to 2-4 hours per day. The August 13th Israeli fuel ban could potentially disrupt the distribution of necessary 24-hour power to hospitals and stifle sewage treatment and water distribution. Just before the first general population cases were reported, an August 23rd Israeli policy limited entry of goods in Gaza to medicine and food only. On September 1st, Israel reversed its ban on fuel entry into Gaza, enabling the primary power plant to distribute cycles of 8 hours of electricity to its residents. Israel has increased bombardment of the Gaza Strip in retaliation to heightened border tension between Palestinians in Gaza and Israel, citing militants’ launching of incendiary balloons into Israeli territory as the main cause of the airstrikes.
Palestinians sanitize a market in Gaza: Image obtained from The Star
Timeline: Gaza Spread and Government Response
March 21st: The first two cases were reported in Gaza. Both cases were returning from Pakistan and recovered in quarantine before entering the general population.
March 30th: Over 1760 Gazans were in quarantine. Anyone crossing the border at Rafah or Erez is subjected to a 21-day quarantine. There are 9 total cases, all of which have not been exposed to the general public.
April 1st: The Israeli government announced that potential aid to Gaza would be conditional on the return of the remains of two Israeli soldiers from the 2014 war.
May 10th: The Rafah crossing into Gaza opened for the first time since mid-March to allow Palestinians in Egypt to return home. Returning Palestinians had to quarantine before rejoining their families.
August 25th: Gaza reports the first four cases in the general population
Healthcare in Gaza
Prior to Covid-19, with extreme difficulty, Gazans facing serious health conditions might be permitted to travel to Egypt, Israel, or the West Bank for treatment. Such accommodations are seemingly off the table during the COVID-19 pandemic. To contextualize the healthcare infrastructure in Gaza, Matthias Schmale, director of United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) in Gaza, said in late March that “For every 100 patients who would get ill, you would need at least 5 intensive care unit beds. Now there are 60 maximum in the whole of the Gaza strip.” Simple math tells us that Gaza is already rapidly approaching the limits of their infrastructure, which will only intensify considering Gaza is arguably the most population-dense place in the world. Most homes might have 1-2 bedrooms with 8-12 residents. Over 600,000 Palestinians in Gaza are packed into 8 refugee camps. To make matters worse, there are only 120 ventilators across Gaza and some are already being used by patients with other conditions. These camps have grown to house as many people as possible into small quarters with narrow roads and no space to practice proper social distancing. Given high population density, minimal resources, and abysmal infrastructure, Gaza is one of the most vulnerable places in the world, and pre pandemic conditions already placed it on the brink of uninhabitable.
Population density in Palestine (2020): Image obtained from Geo-Ref
WASH
Before the pandemic, WASH in Gaza was already of severe concern with most of Gaza’s water deemed undrinkable, overpopulation, and the siege restricting the inflow of supplies. The same OCHA report mentioned earlier reported that international donors were able to deliver 88,000 water bottles to people in quarantine. However, WASH-related efforts in the Gaza strip are limited by increased restrictions placed on electricity and other supplies shortages.
Overall, COVID-19 has ravaged the entire world, forcing drastic changes to work, education and the most basic human interactions. Palestinian civil society was able to delay widespread infection, but recent weeks have proven the virus is one even the world’s most well-versed in resistance could only stave off for so long. Given the extreme population density, lacking resources and all-encompassing occupation and siege on the territories, the coming months look dire for the Palestinians. While it should not take a pandemic to justify ending the strangling siege on Gaza and occupation of the West Bank, the current conditions make it clear the the israeli government needs to loosen restrictions and send more fuel and aid into Gaza. It should cease all demolitions in the West Bank and establish a more equitable distribution of water and medical supplies. At the same time, the international community ought to support organizations like UNRWA and the Palestinian Medical Relief Society who are at the front lines of the fight against COVID-19 in Palestine.
