insiderblmGAZA CITY — As much of the world waits for a vaccine, many patients in Gaza are just waiting for a hospital bed.
That was the case for Mai, a 27-year-old mother of two, when she began to experience symptoms last month. Initially, Mai, who asked that only her first name be used, was diagnosed with bronchitis and sent home to recover. But her symptoms grew worse, until she was struggling to breathe.
“I had a severe headache, pain and dryness in my throat, and even trying to speak left me feeling exhausted,” she recalled recently.
Mai was eventually given a COVID-19 test, and it came back positive.
“It was terrifying,” she said. “The first thing that came to mind was my children. How can I protect them, when I can’t protect myself? What do I do?”
Mai was admitted to hospital for emergency treatment but could stay only one night. The hospital was filled with other COVID-19 patients, some of whom died the night she was there.
“I was given oxygen, but then the next day I was asked to leave because they needed my bed for more critical cases,” she said. “I was so afraid. It was like my soul was trying to leave my body.”
Mai was sent home, but in Gaza, where almost every house contains an extended family, it’s almost impossible to self-isolate. “My children are 3 and 5,” she said. “They didn’t understand why I couldn’t hug and kiss them. It took me 21 days to recover, and every second felt like a century of pain.”
Mai recovered, but others have been less fortunate.
More than 2 million people live in Gaza, a narrow strip of land whose inhabitants have lived under a blockade controlled by Israel and Egypt for more than a decade, making it nearly impossible for most residents to travel beyond its borders. Today the territory is described as “one of the most isolated spots on earth.”
Over the summer it appeared that that isolation, along with strict rule under Hamas, had protected its residents from COVID-19; there were no cases of community transmission until late August, though the economy suffered under the additional restrictions. Now, with COVID-19 spreading through Gaza’s densely packed homes, the isolation is working against it, with hospitals left scrambling for basic medical supplies like respirator masks and ventilators.
“Gaza is one of the most densely populated places on earth, and its people are vulnerable to contagion,” says Reham Owda, a Gaza-based political analyst. “The health service has been weakened by the Israeli blockade, by the internal division between Hamas and Fatah, and by the three wars on Gaza, in 2008, 2012 and 2014. The political and security situation has limited the capacity of the health ministry to access medicines, medical supplies and equipment.”
Before the pandemic, Gaza had only 70 intensive care beds. The ministry of health has increased that to 200 beds, but they still lack vital equipment, particularly ventilators. Kuwait recently donated 15 new ventilators to Gaza, but hospitals are suffering an acute shortage of oxygen, and Gaza is still waiting for three oxygen generator plants, funded by international donors.
It may be weeks before the oxygen generator plants arrive, which will be too late for many patients, said Dr. Bassem Naim, a former minister of health. “The situation is very critical today,” he said, noting the testing positivity rate of 37 percent.
At Gaza’s hospitals, the doctors are rapidly becoming overwhelmed.
Dr. Maha Abu Jahal has been working 12-hour shifts with no breaks as one of a small number of frontline health workers battling the coronavirus. She is part of a rapid response team at the epidemiological department at the Al Remal Clinic, one of the few hospitals in the Gaza Strip.
“My colleagues and I spend more time at work than at home. We’re all worried about transferring the infection to our family. Sometimes the fear and anxiety is overwhelming. But we have to keep going,” she says. “It is our duty.”
Gaza has recorded just over 29,000 COVID-19 cases since the pandemic began, but it is now averaging about 1,000 new cases a day, driving that total figure up rapidly. More than 200 people have died, and hospitals have been reporting steady increases in the number of critical cases with COVID-19 patients, who now make up 30 to 40 percent of daily admissions, according to Naim, the former minister.
In the past three months, testing identified 28,000 cases, but those numbers likely understate the scope of the spread, given the lack of adequate testing kits. At the beginning of December, testing for COVID-19 was halted because Gaza ran out of kits. The World Health Organization stepped in with additional testing kits, but a spike in cases has again depleted supplies.
While many countries have been hit hard by COVID-19, Gaza’s problems are made worse by blockade, which has devastated the economy. Electricity is available in most areas for only a few hours a day, medical supplies are low, and about 70 percent of the population lives below the poverty line.
“Our health system is fragile after years of war and siege,” Abu Jahal says. “It is painful when a patient passes away because of COVID-19. All we can do is keep helping other patients to survive.”
Doctors don’t have enough of the drugs they need to treat COVID-19 patients. There are few antibiotics, anticoagulants and other vital supplies. And the shortages extend to protective equipment for medical staff. “The lives of doctors and nurses are put at risk because they don’t have face shields or masks while treating patients,” says Naim.
Because of this, doctors are terrified of infecting their families. “I change clothes constantly,” says Abu Jahal. “I shower all the time, and I have to keep my distance from my children. But it is with the support of my family that I am able to carry on.”
COVID-19 is also affecting Gaza’s chronic health issues in other ways. Because the health ministry is trying to conserve resources by directing hospitals to concentrate on COVID-19 patients and emergencies, many other medical procedures are being delayed to save on medications, disposable equipment and manpower.
“That decision has had a devastating impact on public health, but we are trying our best to help people as much as we can with this unique situation we are in,” says Naim. Cancer patients, who even before the pandemic struggled to get medication, are particularly vulnerable.
In the meantime, as vaccination campaigns have begun in the United States, it’s unclear when Gaza, which has been promised access to doses, will receive them, and medical professionals fear the situation will grow worse.
“Sometimes I feel I cannot continue,” Abu Jahal says, “but remembering that we give hope to these patients to continue in their struggle to survive and remembering the light in my children’s eyes, and how much they are proud of me, makes me continue with the spirit of a warrior.”
