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Source: Office for the Coordination of Humanitarian Affairs (OCHA)
15 May 2009

Office for the Coordination of Humanitarian Affairs
occupied Palestinian territory

MAY 2009

Movement in and out of Gaza remained largely banned
The movement of Palestinians in and out of the Gaza Strip through the Erez and Rafah Crossings has remained largely banned. The number of exceptional medical and other humanitarian cases allowed through Erez in May (1,132), however, was more than two-fold the parallel figure during April (515). One of the main reasons behind this increase was the resumption of the referral of patients to medical treatment in West Bank, Israeli and Jordanian hospitals since the end of April (see section on the Referral Abroad Department). Due to this reason a total of 586 patients and their accompaniers crossed Erez in May, compared to 173 in April. The majority of the remaining Palestinians who crossed Erez were holding permits to visit families outside of Gaza.

The number of exceptional cases allowed entry into Egypt through the Rafah Crossing in May (1,564) decreased by 36 percent compared to April (2,427), while the number of those back to Gaza increased by 21 percent (1,327 compared to 1,095). The daily average of people who crossed into Egypt (50) and those who entered Gaza (43) through the Rafah Crossing during May 2009 represents only 17 and 15 percent respectively of the parallel figures for May 2007, one month before the Hamas take-over.

Gaza’s “buffer zone” further expanded
This month, the Israeli Air Force dropped thousands of leaflets across the North Gaza and Gaza governorates warning that people who enter an area within 300 metres from the Gaza-Israel border will be risking their lives. This is the first time that residents of Gaza are officially informed that the “buffer zone”, instituted following the Israeli “disengagement” from Gaza in August 2005 on a 150 metre-wide strip of land along the border, has been expanded by 150 metres. An exception to this definition is an area along the northern border of Gaza – the past location of three Israeli settlements - where the no-go area is significantly larger (see Map).

The access prohibition to the “buffer zone” is enforced by the Israeli military by means of opening warning fire in the direction of the people present in the relevant areas. Consistent reports by Gazan farmers since 2005 indicate that such enforcement has never been uniform across different areas and periods of times, including numerous reports about farmers targeted with warning shots while staying as far as 1,000 metres from the border.

In addition, Israeli forces continued to prevent fishermen from accessing sea areas located beyond three nautical miles from the shore. Several incidents of warning shots fired from IDF vessels towards fishermen’s boats, forcing the latter to return to the coast, were reported every week during May. The restrictions on access to the sea undermine the current sardine catch, the bulk of which is located in deeper waters.

MAP Gaza Strip: Areas Restricted for Palestinian Access
June 2009

Wastewater continues to pose a serious environmental and health threat

In the first week of the month, a total of 54 truckloads carrying water and sanitation supplies, including plastic pipes, hoses, plumbing spare parts, cement and power generators, were allowed entry into Gaza through the Kerem Shalom crossing. This was the largest shipment of water and sanitation supplies since the tightening of the blockade in June 2007. The imported materials enabled the implementation of various urgent water and sanitation projects by the Gaza Coastal Municipalities Water Utility (CMWU), the ICRC, The World Bank, Oxfam GB and UNICEF. Notably, the entry of these supplies allowed the completion of a critical ICRC project providing a sea outfall from the Khan Younis emergency wastewater treatment lagoons.

Yet, despite the significance of May’s shipment, the large majority of projects aimed at maintaining, rehabilitating and upgrading the sewage and sanitation infrastructure of the Gaza Strip have been disastrously affected since the tightening of the blockade following the Hamas takeover of Gaza, due to restrictions on the import of supplies, construction materials and fuel. The impossibility of implementing projects has resulted in a gradual dilapidation of water and wastewater systems and created a significant health and environmental hazard.

According to the Gaza CMWU, every day approximately 80 million litres of untreated and partially treated wastewater are being discharged into the environment. In the Middle Area, for example, about 10 million litres of raw, undiluted, sewage flows every day into Wadi Gaza and from there into the sea, while in Khan Younis area, mixed storm water and sewage soaks directly into the aquifer. Moreover, even though the damage incurred to the wastewater infrastructure during the “Cast Lead” offensive was limited, the destruction and damage caused to thousands of structures that were connected to the wastewater network, resulted in additional quantities of untreated wastewater flowing into the environment.

Levels of resulting pollution are extremely high, raising serious health concerns. The 50 million litres of partially treated sewage discharged every day into the sea from Gaza city, for example, contain twice the amount of biological pollution and suspended solids than if the Gaza Treatment Plant could function normally.16 Microbiologically contaminated seawater has been found along the Gaza Strip coast and there is evidence of sanitation­ related infections (see “Concerns over health trends” below). Seawater samples taken by WHO and the Ministry of Health in Gaza in 2008 indicated particularly high pollution levels at a number of specific locations along the Gaza Strip coastline. The pollution of the sea represents a serious health hazard to people using beaches for recreation, to fisherman and to the Gaza Strip population, through potentially contaminated sea food.

Of no less concern are the potential health impact of the sewage infiltration into the aquifer and the resulting contamination of underground waters. In Khan Younis governorate, for example, one of the worst affected areas, the average levels of nitrates detected in 2008 in water wells was more than twice the recommended WHO level (70 mg/L), with even higher levels in wells within or close to the city. The aquifer is the single source of water available in the Gaza Strip for all domestic, agricultural and industrial uses. In the course of the past decades, the aquifer has undergone a process of gradual salinization as a result of over pumping.

update on health situation

concerns over health trends in the Gaza Strip
Newly available data indicate a number of worrying trends in the health situation for Gaza residents, including a significant increase in watery diarrheal disease, a rise in stunting levels and high levels of anemia among children 9 to 12 months, and substantial levels of psychological distress among adult patients. At the same time, data indicate a decrease in bloody diarrheal disease and fewer underweight children between 9 and 12 months.

Data collected from the UNRWA Communicable Disease Surveillance System during the period of January to April 2009 shows that the level of watery diarrheal disease among children is double its level during the same period of 2008. The major increase occurred in the Khan Younis and North Gaza districts, where the level of disease was higher by 88 and 77 percent, respectively. At the same time, the level of bloody diarrheal disease during the January to April 2009 period was 14 percent lower than its level during the same period in 2008.

Recently published data from February 2009, on the nutritional status among children 9-12 months,17 show an increase in the level of stunting (disproportionately low height for age), a key indicator of malnutrition;18 an improvement in underweight (weight for age) levels;19 the level of anemia among children 9-12 months remains a severe public health problem in the Gaza Strip.20

WHO recently carried out a survey to measure the prevalence of psychological distress among 500 adult patients visiting five Primary Health Care (PHC) centers in the Gaza Strip, to identify associated demographic risk factors and the ability of general practitioners to identify patients with psychiatric problems using the General Health Questionnaire (GHQ-12). The results of the study reveal that 37 percent of adult patients that sought PHC services showed psychological distress as measured by the GHQ-12. No difference has been detected between males and females. Older patients showed higher rates of prevalence (70 percent).

Number of drugs and disposals at zero level on the rise

In May, 82 drug items were at zero level, up from 65 in April. At the same time, 95 disposable items had reached zero level, up slightly from 90 in the previous month. Financial constraints; unavailability of some drugs items and supplies in the local market; procedures of procurement and logistics of the local authorities; and the non­adherence of donors to the donations guidelines are the main factors associated with this shortage. In addition to these factors, the entry of medical equipment and spare parts is additionally difficult due to the blockade and restrictions in importing these items.

Donation stocks received during “Cast Lead” have had only a moderate impact on these supply shortages, due to a widespread problem of short expiry dates, the preponderance of non­essential items, and a lack of variety in the items sent. In the latter case, a narrow list of emergency and primary care items were donated in large quantities at the expense of items for specialized care. Although supplies have been arriving from the West Bank, the quantities and variety of items sent have been insufficient to significantly address current shortages. Moreover, despite receiving a large amount of medical equipment, much of it does not conform to MoH standards, are second-hand or in poor condition, and lack the required technical documentation. The Central Drug and Disposables store (CDS) continues its work on a final donation inventory report.

During May, WHO coordinated the entry of one shipment of medical drugs/disposables, while another four shipments of materials remained on hold by the Israeli authorities. The latter shipments contain x­ray materials, as well as medical and IT equipment. Since the end of ”Cast Lead”, shipments of medical equipment in particular, have faced increasingly long delays at the border – over a month in some cases.

Referral Abroad Department continues work
Following resolution of the internal dispute between the Hamas authorities in Gaza and the Ministry of Health in Ramallah in late April, the Referral Abroad Department (RAD) continued normal operations throughout the month of May, with almost all RAD employees reporting to duty.

During the month, the RAD issued 1,080 referral documents: 41 percent for Egyptian hospitals; 33 percent for West Bank, including East Jerusalem, Jordanian and Israeli hospitals; and 26 percent for NGO hospitals in the Gaza Strip. Of the 489 applications for permits submitted to the Israeli District Coordination Office (DCO) during May, 55 percent were approved, 3 percent denied, and 42 percent were under review by the end of the month. About 4 percent of the applicants, all of whom are included in the last category (“under review”), were requested to meet with representatives of Israel’s Security Agency (formerly the GSS) in order to have their applications processed. According to the Palestinian Liaison Officer at Erez, the total number of patients who actually crossed Erez was 303, 20 of whom crossed via back­to­back ambulance. In addition, 450 patients crossed to Egypt through the Rafah border crossing during its three-day opening in May. WHO confirmed that two patients died during May before accessing the medical facility to which they had been referred.

A Human Rights council mission began investigating “cast Lead”

The “International Independent Fact Finding Mission” appointed by the UN Human Rights Council to investigate events related to the Gaza “Cast Lead” offensive, started its work on 4 May.21 The official mandate of the Mission is to “investigate all violations of International Human Rights Law and International Humanitarian Law that might have been committed at any time in the context of the military operations that were conducted in Gaza during the period from 27 December 2008 and 18 January 2009, whether before, during or after”.22 In accordance with this mandate, the Mission will focus on relevant violations by all parties in the oPt and Israel.

The Mission is headed by Justice Richard Goldstone, former member of the South African Constitutional Court and former Chief Prosecutor of the International Criminal Tribunals for the former Yugoslavia and Rwanda. The three other mission members are Professor Christine Chinkin, who was a member of the 2008 “High Level Fact Finding Mission to Beit Hanoun”; Ms. Hina Jilani, who was a member of the 2004 “International Commission of Inquiry on Darfur”; and Colonel Desmond Travers, a former officer in the Irish Armed Forces and member of the Board of Directors of the Institute for International Criminal Investigations.

The investigation will be based on an independent and impartial analysis of compliance of the parties with their legal obligations. To that end, the Mission intends, among other steps, to consult with a wide range of interlocutors who will include victims and witnesses, Palestinian, Israeli and international NGOs, UN and other international organizations, community organizations, human rights defenders, medical and other professionals, legal and military experts, and other sources of reliable information relevant to its mandate, within and outside Israel and the oPt. The Mission, which will conduct its first visit to Gaza between 1 and 5 June 2009, will also seek consultations with relevant authorities.


As part of the Mid Year Review (MYR) of the Consolidated Appeal (CAP) for 2009, in the course of May, the humanitarian needs in all sectors were reassessed. The strategic objectives identified at the end of 2009 remain unchanged: providing humanitarian assistance; promoting and improving the protection of civilians; enhancing monitoring and reporting; and strengthening coordination structures. While the already substantial needs of the population in the oPt grew dramatically in the wake of the ongoing blockade and military action in the Gaza Strip, the inability to implement some of the projects due to the blockade has led to an overall downwards revision of the total request.

Overall, the requested funding for six sectors has been reduced in the MYR, while the requests for another three sectors (Cash for Work and Cash Assistance, Coordination and Support Services, and Food Security and Nutrition) was revised upwards. The overall CAP request is now almost $805 million, reflecting a reduction of approximately $50 million. The actual funding of the CAP 2009 (including the Gaza Flash Appeal) as of the end of May stood at $372 million; this represents about 44 percent of the original request, and is roughly the same percentage funded as at the MYR of the 2008 CAP.

Funding across sectors has varied. While food, coordination and health sectors have seen consistent support, other sectors are comparatively poorly­ funded including shelter (11%), water/sanitation (16%), health (23%) and agriculture (25%).

The Humanitarian Response Fund (HRF) supported two projects for Gaza during May.


1 Article 49 of the Fourth Geneva Convention prohibits the occupying power from transferring parts of its civilian population to the occupied territory.

2 Stop work orders precede demolition orders. A stop work order is issued after the Israeli Civil Administration (ICA) has identified unauthorized construction, underway or completed, located outside the “Special Outline Plan” of a particular locale. The order invites the owner of the affected construction to submit a request for a building permit and appear at a hearing before the ICA’s Sub Committee of Inspection at Beit El. If the owner does not apply for a permit, the Sub Committee automatically issues a final demolition order. If an application is received, the Sub Committee considers the request. In practice, however, according to information submitted by the Ministry of Defense to the Israeli Knesset, less than six percent of applications are approved. For additional details, see OCHA Special Focus, “Lack of Permit” Demolitions and Resultant Displacement in Area C, May 2008, available at

3 HCJ 2389/04, Abdallah Hussein Bisha rat and others vs. The Military Commander of Judea and Samaria and others.

4 For further details on the rerouting see The Humanitarian Monitor, March 2009.

5 In addition to the self­demolition of the structure in Khirbet Samra, during the month, a Palestinian from the East Jerusalem neighborhood of Jabal al Mukabbir demolished his own home under order of the Jerusalem Municipality, displacing eight people. In addition, the municipal authorities demolished three walls that surrounded residential structures in Al ‘Isawiya neighbourhood. Also during the month, the Israeli authorities demolished a wall surrounding a public park located near the Ibrahimi Mosque in the Israeli-controlled area of Hebron city (H2).

6 In November 2008, a family living in the same area was forcibly evicted from its home after residing there since the 1950s. This eviction followed a Jerusalem court ruling in favor of a group of Israeli settlers claiming ownership of the land on which the house was built. The two buildings fined in May are affected by the same court decision, which is currently being contested. An estimated 500 persons currently reside in houses located on land in the contested area.

7 For information on incentives and financial benefits afforded to West Bank settlers, see B’Tselem, Land Grab: Israel’s Settlement Policy in the West Bank, May 2002, pgs. 73 – 84.

8 At-risk communities, many of whom have experienced previous displacement include: Khirbet Tana (Nablus), Al Aqaba (Tubas), Tell al Khashaba (Nablus), Mughayyar al Deir (Ramallah), Mu’arrajat (Ramallah), Al Malih (Tubas), Massafer Yatta (Hebron), among others.

9 Available at: ocha_opt_movement_and_access_2009_05_25_ english.pdf

10 Concluding Observations of the Committee against Torture, ISRAEL, CAT/C/ISR/CO/4, available at: CAT.C.ISR.CO.4.pdf

11 The Fourth Geneva Convention (article 76) requires that “Protected persons accused of offences shall be detained in the occupied country, and if convicted they shall serve their sentences therein.”

12 Palestine Trade Centre (Paltrade). Gaza Crossings monthly report. May 2009.

13 Ibid.

14 Palestinian Bureau of Statistics (PCBS). The Palestinian Housing and Establishment Census - 2007. February 2008.

15 Palestinian Federation of Industries (PFI). The need for a post­war development strategy in the Gaza Strip. March 2009.

16 Gaza wastewater treatment works was designed to treat 32,000 m3 per day, with effluent quality of 30 mg/L BOD (Biological Oxygen Demand-Measure of effluent strength) and 30 mg/L Suspended solids. It now treats 45,000 to 50,000 m3 per day, and consequently effluent quality is up to 100 mg/L BOD and 100 mg/L suspended solids. A new project is planned to upgrade the capacity of the works to 70,000 m3 per day (CMWU data).

17 WHO Nutritional Surveillance System launched at the MoH (Ministry of Health) Primary Health Care (PHC) facilities.

18 A 7 percent in February 2009 compared to an average level of 4.4 percent in 2006 and 4.2 percent in 2007.

19 A 1.2 percent compared to the average level of 2.3 percent in 2006 and 2.2 percent in 2007.

20 The level of anemia in February 2009 was 65.5 percent, which is slightly lower than its average level in the year 2006 (68.2 percent) and lower than its average level in 2007 (72.1 percent).

21 The appointment of the mission followed the adoption on 12 January 2009 of resolution S-9/1 by the United Nations Human Rights Council at the end of its 9th Special Session.

22 See Press Release from 8 May 2009, available at: http:// 60F307A16D1BC12575B000315895?opendocument

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