One year after violence tore through the Gaza Strip in the summer war of 2014, Palestinian human rights groups have released a report detailing the damage to Gaza's health sector, saying that its effect will last well beyond the ceasefire.

In the report "No More Impunity: Gaza's Health Sector Under Attack", researchers investigated attacks by the Israeli military on ambulances, hospitals, and healthcare workers in Gaza.

According to the report, these attacks crippled the health sector's ability to dispense care to civilians during the 50-day war. 

Drawing on testimonies and on-site evidence, the report estimates that 511 of the 2,217 Palestinians killed in the war were blocked from seeking care and ambulance access. 


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During the war, Dr Ghassan Abu Sitta was volunteering at al-Shifa hospital in Gaza City, where each day was another challenge against the physical limitations of resources and space.

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One of the most devastating things was to deal with children who will be left with a certain amount of disability, knowing there won't be anyone to look after them.

Dr Ghassan Abu Sitta, volunteer surgeon in Gaza

the course of only a few hours - Abu Sitta noticed a shift in his patients' behaviour that made his job all the more difficult: Patients were no longer accepting ambulance rides.

"They started refusing to get in [to ambulances]," said Abu Sitta. "And they started insisting on being brought by car by their families."

During the Israeli assault on Gaza, 45 ambulances were targeted by the Israeli military, causing injuries and fatalities among paramedic crews rushing to the scenes of destruction.

According to Abu Sitta, injured civilians soon became reluctant to accept rides because they believed that in ambulances, "their chances of making it safely to the hospital were diminished greatly".

Attacks on ambulances are among the several cases outlined in the recently released report, which states that 15 hospitals and 43 clinics in Gaza were also attacked. Some suffered minor damage, while others were gutted.

These attacks, levelled against the very sector working to mitigate the war's impact on civilians, eroded health workers' ability to offer care, and patients' opportunities to receive it, said Abu Sitta, who is now the chief of plastic and reconstructive surgery at American University of Beirut. 

The destruction of one hospital, al-Wafa, has left Gaza with no rehabilitation centre and 1,000 disabled children without care.

"There was increasing scope and ferocity of attacks against the health sector," said Abu Sitta. "This aimed to degrade the capacity of the health sector during the attacks."

Al-Wafa hospital was completely destroyed during the war [Medical Aid for Palestinians]

Though coordinates of the ambulances' movements were shared with the Israeli military to prevent attacks and allow mobility, health workers in Gaza note that these attacks not only continued, but also reported similar actions carried out by Israel during the conflicts of 2008-09 and 2012

"During the attacks of 2014, we saw several facilities that were damaged in previous attacks, just get [completely] destroyed," said Bob Jones, the campaigns and research officer at Medical Aid for Palestinians, a group that aided in compiling the report. "We saw continuing attacks on ambulances and medical personnel," Jones told Al Jazeera.

Abu Sitta echoed the sentiment, claiming that a lack of accountability for these actions only increases their likelihood of happening again.

"In 2008, in al-Aqsa hospital, a missile hit the car park. In 2014, a missile went through the operating room and killed some of the staff and the patients," he said.

"I think impunity allows both institutions and individuals to feel they are above international law," he added.

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The report highlighted the case of a seven-year-old boy named Bader, who was wounded by shrapnel in a bombardment of the neighbourhood of Khuzaa.

Efforts to get Bader to healthcare professionals were frustrated by successive obstructions; first, ambulances were not permitted to reach the site of the attack until almost four hours after Bader was injured. On the way to the hospital, Bader and the paramedic crew were then held for 20 minutes at a checkpoint for no given reason.

Less than five hours after he was wounded, Bader died in the ambulance carrying him to al-Shifa hospital.

Al-Aqsa hospital was also attacked by Israeli missiles  [Medical Aid for Palestinians]

Since targeting healthcare workers and facilities during wartime are against international law, both sides took preventive measures to reduce the possibility; ambulance coordinates were shared, and warning systems established so that Gaza hospitals could be notified before strikes.

However, Jones notes that these measures often fell short and have since been called out by humanitarian and human rights groups as being insufficient. He added that sometimes hospitals were only given 15 minutes to evacuate - an impossible feat when taking into account debilitating injuries, overworked staff and the technical entanglements of monitors and ventilators.

He also noted that hospital directors would receive frequent warnings, only to be followed by no attacks.

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"If there is a sense that a warning can be given and then you have to evacuate a whole hospital, which is a massive undertaking, and then there isn't an attack anyway, there is a high risk that hospitals would stop evacuating," he added.

According to both Jones and Abu Sitta, these types of attacks have had a disproportionate effect on children in Gaza.

The health sector's deterioration, as well as the blockade currently stemming the arrival of resources and personnel into the Strip, make it difficult to care for long-term patients recovering from injuries. The impact will extend across generations.

"You had children who had massive burns and were in a unit, who were the sole survivors of their families," said Abu Sitta. "One of the most devastating things was to deal with children who will be left with a certain amount of disability, knowing there won't be anyone to look after them."

Jones and Abu Sitta were recently in Geneva, Switzerland, to present the report's findings to the UN Human Rights Council and call for the international community to hold Israel to account.

On Friday, European states gave unanimous support in a vote to further the investigations launched by the Commission of Inquiry. According to Jones, the Office of the High Commissioner for Human Rights is expected to report on the implementation of recommendations in the commission's report, and in the 2009 UN Fact-Finding Mission, at the March 2016 session of the Human Rights Council. 

"Our main message here is to ask for accountability. A thorough investigation is needed to prevent another round of attacks which would decimate Gaza's health sector further," Jones said. 

Source: Al Jazeera