31. By April 2009, the closure had not been lifted, and the flow of goods and cash into the Gaza Strip continue to be severely restricted. An alternative tunnel economy, largely regulated by Hamas, has developed in Rafah along the Egypt-Gaza border, with estimates of the number of active tunnels ranging from 200 to 600. These were targeted by Israeli air strikes starting in December 2008 because of suspicions that arms were being smuggled through the tunnels. Following the ceasefire, operations are reported to have resumed in many of the tunnels, supplying the market with a range of goods, including fuel.
32. During Operation Cast Lead, the limited supply of fuel allowed into the Gaza Strip from Israel, combined with damage incurred to main power lines and transformers, the limited access for technical teams to damaged areas and the closure of the power plant, rendered more than 60 per cent of the population of the Gaza Strip without electricity during the three-week period of military operations.
33. The power outages, coupled with the severe shortage of fuel and spare parts for backup generators, have disabled parts of the water and sanitation system. On
27 December, about 80 per cent of the Gaza Strip’s water wells were partially functioning and the rest were non-functional. The lack of fuel and spare parts forced the Gaza water utility to discharge millions of litres of raw sewage into the sea every day, resulting in significant environmental damage, including to marine life.
34. At the height of Operation Cast Lead, approximately 500,000 Palestinians in the Gaza Strip did not have access to running water, as the Coastal Municipalities Water Utility was unable to repair damage to water and wastewater networks. A further 500,000 people received water for only a few hours a week, and the remaining population received water for between 4 and 6 hours every 2 or 3 days.
35. Damage to sewerage networks and pumping stations affected thousands of people, with raw sewage flooding some streets. On 10 January 2009, the Gaza City wastewater treatment plant was hit during military operations. As a result, one pond treatment embankment was severely damaged, causing the leakage of 200,000 m3 of wastewater into the nearby agricultural fields. Moreover, one of the plant’s sewage pipelines was also hit and damaged on the same day. The damage resulted in the leakage of an estimated 20,000 m3 per day until 23 January.
36. Preliminary findings of the Palestinian Hydrology Group initial rapid needs assessment of households showed that some 5,700 rooftop tanks were completely destroyed and 2,900 damaged. in a couple of areas, 50 per cent of the water networks were destroyed, while other areas sustained damage to 30 to 35 per cent of their water networks.
37. The Gaza Strip health-care system faced serious challenges during Operation Cast Lead. Medical facilities were repeatedly struck during bombardments, and medical staff were themselves victims of some attacks. In the course of the three-week military operation, 16 medical personnel were killed and 26 were injured while on duty. The Israeli bombardment damaged or destroyed 29 ambulances and hit medical facilities. Of the 122 health facilities in the Gaza Strip, 48 per cent were either damaged or destroyed by direct or indirect shelling. On 20 March 2009, all Gaza Strip patient referrals for treatment outside of the Gaza Strip were halted owing to the refusal of the Palestinian Ministry of Health to approve applications issued by the Hamas-controlled Ministry of Health Referral Department in the Gaza Strip.13
38. The three weeks of continuous bombardment by air, land and sea has also had a serious detrimental psychosocial impact on residents of the Gaza Strip, particularly on children.
39. Of particular concern is the impact of the conflict on chronically ill patients. It is estimated that the treatment of 40 per cent of such patients was interrupted as a result of the fact that life-threatening injuries were accorded higher priority in the overwhelmed system. The referral of chronically ill patients to Israeli and West Bank hospitals came to an almost complete halt during the course of the military operations.
40. The United Nations issued a flash appeal on 5 February 2009 amounting to $613 million. The appeal incorporates 106 non-governmental organizations and 82 United Nations projects to respond to the emergency humanitarian and early recovery needs of 1.4 million people in Gaza over a period of nine months in the areas of education, agriculture, health and food security, among others. Despite the assurances by the Government of Israel that humanitarian goods would be allowed into the Gaza Strip, by April 2009 the United Nations was still unable to implement large parts of the flash appeal owing to the refusal to permit the entry of necessary goods and personnel.