No end in sight to overwhelming human cost of conflict

19-08-2014 Operational Update No 02/14

Two ceasefires have brought some respite to civilians in Gaza and southern Israel, amid hope that a durable cessation of hostilities might occur. In Gaza, these breaks in the fighting have barely given people enough time to seek medical care, replenish food and water supplies, or search through the rubble for lost possessions.

ICRC President Peter Maurer visited Gaza, Israel and the West Bank from 5 to 7 August. During his visit to the neighbourhood of Shujaia, in Gaza City,, he saw for himself the massive devastation caused by the fighting. "This conflict has taken an unacceptable toll on the civilian population. The parties to the conflict have obligations under the laws of war. We have witnessed serious discrepancies between those obligations and the reality on the ground and we are determined to engage with the parties in an effort to stop this from happening again," he said. "The parties to the conflict and the international community bear the collective responsibility for creating an environment conducive to sustainable humanitarian efforts where they are needed most. The ICRC is committed to helping decimated communities recover, but that recovery requires tangible changes – including greater respect for the laws of war, for humanitarian work and workers under all circumstances."

In Gaza, close to 1,900 people have been killed and some 10,000 wounded in 37 days of intense hostilities. Most estimates indicate that more than half of the victims are civilians, and as many as 25 per cent are children. The most vulnerable – children, the elderly, the sick and the wounded – have paid the highest price.In Israel, 67 people, including three civilians, have been killed and 77 injured. While life in Israel's southern communities has been disrupted by daily rocket fire, as many as 400,000 people have been displaced inside war-stricken Gaza, where literally no place remained safe during the hostilities in the densely populated coastal enclave. More than 16,000 homes have been rendered uninhabitable – many reduced to rubble. More than half of the victims are estimated to be civilians, and as many as 25 per cent are children. The most vulnerable – children, the elderly, the sick and the wounded – have paid the highest price.

Infrastructure already degraded prior to the hostilities has been heavily damaged, with power grids, water and sewage systems extensively hit. As more than 80 per cent of homes are without power, most Gazans now rely on irregular, trucked water supplies from dwindling water sources. Hospitals are filled to capacity with wounded patients who, even should they recover, have nowhere else to go. Medical staff are exhausted, generators run down, and stocks of medicines and medical consumables dangerously low.

It's all too easy to forget that every single person who becomes a casualty statistic is a human being, with loved ones who are distressed, worried or embittered by what has happened. Thousands of damaged or destroyed homes represent the loss of a lifetime of hard work and effort for as many families. People continue to live in constant fear of a violent death.

In Israel, thousands of rockets have caused three deaths, 77 injuries, damage to civilian property in the south of the country and constant stress for the people living there. Several areas adjacent to Gaza have been evacuated.

ICRC staff on the ground have been hard at work throughout the conflict. The organization has pursued its bilateral dialogue with the parties to the conflict, reminding them of their obligation under the laws of war to protect civilians and civilian objects, and to take care of the wounded. In the West Bank, it has continued to monitor the use of force by the occupying power and insisted on the need to respect international standards for maintaining law and order and public safety. The ICRC has also pressed ahead with the activities it carries out for people arrested in connection with the conflict, including its efforts to restore contact between them and their families.

Priorities for humanitarian action

While the ICRC does its best to bring protection and assistance to the civilian population, its efforts are constrained by an environment in which the rules and principles of humanitarian law are not effectively upheld and in which there is a lack of respect for humanitarian action.

1) Health

Helping to take the sick and the wounded to hospital and supporting the work of those facilities are vital activities carried out by the ICRC around the clock. Throughout the conflict, the ICRC has been working hard to ensure that people obtain the medical care they require. Its efforts have included:

providing financial aid and supplies for the Palestine Red Crescent’s emergency medical services;
coordinating the safe movement of ambulances through conflict-affected zones, and the evacuation of patients, with the authorities on dozens of occasions;
donating 16 war-surgery kits (each containing enough supplies to treat 50 seriously wounded patients or 1,500 patients with minor injuries), medicines, surgical equipment, 850 body bags, 20 stretchers, 68 hospital beds, 129 wheelchairs, 1,325 crutches, 455 walkers, linen (sheets, sterile drapes, scrubs) for eight hospitals, surgical dressing supplies and 200 first-aid kits;
providing fuel for ambulances and hospital generators, and helping deliver fuel donated by the United Nations Relief and Works Agency (UNRWA);
donating wound-dressing materials and intravenous fluids to various ambulance services;
aiding Al Aqsa hospital following a shelling incident, so that it could at least give patients emergency treatment before their transfer by the Red Crescent to other hospitals;
assigning to Al Shifa hospital an ICRC doctor specializing in emergency medicine and a cardiovascular surgeon;
sending in a surgical team composed of an operating theatre nurse, an anaesthetist, a ward nurse and a general surgeon to help cope with the influx of casualties;
playing a protective role on behalf of Red Crescent and civil defence organizations taking the sick and the wounded to hospital;
working to facilitate the entry into Gaza of medical supplies from the Palestinian Ministry of Health and the Red Crescent in Ramallah or from other organizations;
arranging for the delivery of seven truckloads of medical supplies, including 3,000 blood units, from the Ministry of Health in Ramallah to the central medical storage facility in Gaza;
helping Al Shifa and Al Nasser hospitals to improve their post-operative care;
working to facilitate the entry into Gaza of medical supplies from Médecins Sans Frontières;
facilitating the evacuation by the Ministry of Health of 69 patients from Gaza for further care in the West Bank or East Jerusalem; and
donating a generator for the Ministry of Health office in charge of patient referrals outside the Gaza Strip.

To ward off further harm to civilians, the ICRC has:

helped to protect health-care and medical storage facilities by working with all sides to take measures to avoid damaging them;
made representations to the belligerents concerning hospitals such as Al Wafa and Al Aqsa, which have suffered the effects of the hostilities, and ambulances working in the field;
monitored and collected information on the conduct of hostilities, by any side, that prompts concern; and
coordinated its activities with other organizations such as the World Health Organization and Médecins Sans Frontières.

2) Water and sanitation

The ICRC has:

taken action to ensure that some 370,000 people have had renewed access to water and sanitation since the beginning of the conflict;
helped assess and repair damaged water infrastructure (and upon request has also accompanied non-ICRC technicians to ensure their safety);
focused on restoring supplies of potable water by providing fuel for Gaza City water pumping operations and Gaza desalination plants;
developed plans to repair or replace emergency generator systems for hospitals with inadequate power generation capacity;
assessed and assisted in the repair of electrical infrastructure to restore power supplies to (so far) 60 per cent of pre-war levels;
worked closely with the local water board to monitor the condition of water supply and distribution facilities and of sewage systems;
set up water points providing clean drinking water in places where displaced communities have returned to their damaged homes;
carried out emergency repairs in Beit Hanoun and Rafah to restore electrical power; and
delivered drinking water to Kamal Edwan hospital for collection by Beit Hanoun hospital.

3) Relief

Since the beginning of the conflict, the ICRC has worked closely with the Palestine Red Crescent to meet the vital needs of the homeless. The unprecedented intensity of the conflict displaced more than 400,000 people, many of whom were seeking safety. The scale of the displacement shifted the focus of joint ICRC-Palestine Red Crescent assistance efforts towards providing people driven from their homes with basic emergency relief – essential household items and (where not provided by other organizations) food. The ICRC has:

supported the Red Crescent assessment of needs of displaced people living in provisional shelters (government or private schools, churches, mosques, etc.) that have not received emergency aid from other organizations; and
so far provided mattresses, blankets, jerrycans, buckets, hygiene items and diapers for over 17,500 displaced people in 16 different provisional shelters and for a further 6,550 people living in informal shelters or with host families.

The current ceasefire period has enabled the ICRC and the Palestine Red Crescent to resume assessments of the needs of people whose homes were either completely destroyed or severely damaged by bombing or shelling. A joint ICRC-Palestine Red Crescent action plan to assist several thousand families, once hostilities cease, is being drawn up.

4) Working with the Palestine Red Crescent Society and the Magen David Adom

The Palestine Red Crescent has taken a total of 2,625 wounded people to hospital and 461 bodies to morgues since the conflict began. In more than 35 cases, the ICRC took action to ensure that the Red Crescent would have access to particularly unsafe areas and protection as it performed its humanitarian tasks.
The ICRC has made available increased funds and other resources to the Palestine Red Crescent, which has publicly appealed for major donations. The Palestine Red Crescent has so far received 2.73 million Swiss francs in aid from the ICRC.
The Palestine Red Crescent uses 42 ambulances based at five stations across the Gaza Strip to take people who are wounded or sick to hospital. In addition, it runs hospitals in Gaza City and Khan Younis, a rehabilitation centre in Khan Younis, and six smaller health-care centres. The ICRC supports this work.
The ICRC and the Red Crescent (over 400 volunteers) have been carrying out a joint operation focused on emergency relief and shelter for Gazans who are displaced.
The ICRC and the Magen David Adom have made many joint trips to the field in order to monitor needs in Israel. The ICRC has continued to collect information on incidents involving the civilian population and civilian property.

It is crucial to have available a stable stock of life-saving medical supplies and equipment. Since the hostilities began, the ICRC has itself brought in or arranged for the following items to be brought in to Gaza:

117 pallets of medical supplies (enough to treat hundreds of people) for distribution by the Red Crescent;
12 truckloads of medical supplies and blood units for use by the Ministry of Health.

5) Activities for civilians and detainees

The ICRC continues to remind the parties to the conflict of their obligation to obey international humanitarian law, in particular by taking constant care to spare the civilian population, civilian objects and infrastructure indispensable to the survival of the civilian population, and by allowing and facilitating rapid and unimpeded passage of humanitarian aid. The ICRC's core activities, such as visiting detainees and providing tracing services, are carried out for persons entitled to protection under international humanitarian law.
During the conflict, the ICRC has monitored and collected information on incidents where there have been concerns that international humanitarian law may not have been complied with. In each case, the ICRC submits a comprehensive report to the authorities concerned and then follows the matter closely.
The ICRC monitors the transfer of patients from Gaza to Israel and elsewhere. It also endeavours to establish the whereabouts of people who have gone missing.
ICRC staff have recently delivered more than 200 family messages to detainees from Gaza (the vast majority of whom were detained prior to the latest military operation). Visits to people held in Ramon, Nafha and Eshel prisons in Israel took place last week. The ICRC has asked to be notified of and granted access to those captured during the current military operation.

The ICRC is very concerned about the unexploded or abandoned ordnance strewn throughout areas where fighting has taken place. These explosive hazards have resulted in several people losing their lives since the cessation of active hostilities. The ICRC intends to further assess the situation and, if needed, support the authorities in their efforts to remedy this problem.

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