Executive Summary

For nearly 16 years, Israel has imposed a stifling blockade on the Gaza Strip, affecting all its vital (social, economic, and humanitarian) sectors. Despite the humanitarian situation of Gaza reaching an unprecedented deterioration and the succession of seven Israeli governments since the beginning of the blockade, Israel has maintained its collective punishment policy against more than 2.3 million Gazans in a way that clearly exposes Israel’s intention to inflict great material and moral damages on them.

Israel imposed its blockade on Gaza after Hamas won the legislative elections in January 2006. Greater restrictions and sanctions were imposed in mid-2007 after Hamas took full control of the Strip.

Israel also carried out repeated military attacks—including four major attacks, the last of which was in May 2021—against Gaza, causing the almost complete disruption of the economy and production, the destruction of large parts of the infrastructure and economic facilities, and the death and injury of thousands of unarmed civilians.

The blockade caused the multiplication of the humanitarian crisis indicators in Gaza. For instance, the unemployment rate has risen from 23.6% before the imposition of the blockade in 2005 to 50.2% at the end of 2021—one of the highest rates in the world.

Likewise, poverty has risen sharply due to Israeli restrictions from 40% in 2005 to 69% in 2021.

Gaza’s economic indicators plummeted due to the blockade. The long closure procedures, the ban on exports and imports, and the destruction of factories and economic facilities during the military attacks left heavy losses in all economic and productive sectors. The most recent military attack in May 2021 alone destroyed hundreds of economic facilities, with a total loss of about $400 million.

Moreover, since Israel prevents or restricts the entry of medicines and medical supplies into Gaza, the health sector is one of the most affected by the blockade, causing health care services to decline by 66%.

In this annually updated report, Euro-Med Monitor sheds light on the impact of the Israeli blockade on Gaza. It examines the most prominent humanitarian crises suffered by the population in Gaza, particularly in terms of the health, economic, and social aspects.

Insolated enclave

Israel has a long history of isolating the Gaza Strip and imposing numerous closures over the past two decades. However, the blockade imposed following the victory of the Hamas movement in the 2006 Palestinian Legislative Council elections was an unprecedented form of collective punishment. Israel declared the Gaza Strip a closed area and imposed penalties on the Hamas-led government, including restrictions on imports of fuel, other goods, and the movement of people in and out of Gaza.

The blockade was further tightened in 2007, when all kinds of fuel, including gasoline and diesel, were restricted, along with goods such as meat and biscuits. In addition, the fishing zone was limited, and all border crossings were closed.

Over the years, Israel worked to broaden and deepen the isolation of the Gaza Strip. One of the most draconian restrictions in its impact was Israel’s separation of Gaza from the West Bank. This separation policy restricted entry into and exit out of Gaza, preventing university students and professionals from continuing their education outside the Gaza Strip. The policy also had a profound impact on patients receiving healthcare, businessmen trading, and families staying united.

Israeli military attacks

During the past 14 years, Israeli forces launched four major attacks on the Gaza Strip: in 2008-2009, 2012, 2014, and 2021. In addition, other air and ground attacks occurred during the entire period of the blockade.

Operation Cast Lead (2008-2009)

The first of the major attacks started on 27 December 2008 and lasted for 21 days—ending 18 January 2009.

On the first day of the attack, around 80 Israeli warplanes launched a series of raids on Hamas government buildings and security facilities. The airstrikes continued for eight days, after which Israel launched a massive ground operation, using a large number of its tanks, infantry soldiers, and special military units.

Over the course of the three-week operation, Israeli forces dropped an estimate of 1 million kilograms of explosives, causing the destruction of nearly 4,100 houses and damaging 17,500 others. 1,436 Palestinians were killed, and approximately 5,400 others were injured, including many women and children.

Operation Pillar of Defense (2012)

This attack started on 14 November 2012 and lasted for eight days, ending 21 November 2012. Israeli warplanes killed 162 Palestinians, wounded nearly 1,300, and destroyed 200 houses. Another 1,500 homes were damaged.

Operation Protective Edge (2014)

A deadly Israeli attack on Gaza started on 8 July 2014 and lasted 51 days—ending on 26 August 2014.

Euro-Med Monitors field team documented 60,664 Israeli land, sea, and air raids, which killed 2,147 Palestinians (in many cases multiple deaths in the same family) and wounded 10,870 others. 17,123 homes were damaged, of which 2,465 were destroyed.

Operation Guardian of the Walls (2021)

The operation started on 10 May 2021 and lasted for 11 days, ending on 21 May 2021.

The attack resulted in the killing of 254 Palestinians, including 66 children, 39 women, and 17 elderly people, in addition to the injury of about 1,948 others, according to the Palestinian Ministry of Health. (According to the field statistics of Euro-Med Monitor, the number of wounded reached 2,212).

Closure of border crossings

After Israel imposed the blockade on the Gaza Strip, it closed all border crossings except the Erez Crossing (for the movement of people) and the Kerem Shalom Crossing (for goods). Both were closed security and political tensions between the Palestinian and Israeli sides.

Another crossing is Egypt’s Rafah Crossing in the south of the Gaza Strip, which Gazans usually rely on to travel to and from Gaza as an alternative to the Erez Crossing, on which Israel imposes severe restrictions for crossing.

Before Israel imposed its blockade on Gaza, individuals and goods moved in and out through six crossings: Erez, Karni, Nahal Oz, Kerem Shalom, Sufa (via Israel), and Rafah (via Egypt).

The average number of trucks allowed to enter Gaza before 2006 was about 70 per day, in addition to 583 trucks loaded with humanitarian supplies. The majority of those goods entered through the Karni Crossing in the northeast. Nahal Oz Crossing, east of Gaza City, was the main entrance for the fuel needed to power Gaza’s sole power station.

The Karni and Sufa crossings were closed in 2007 and 2008, respectively. Now, most goods enter the Gaza Strip through the partially operational Kerem Shalom Crossing.

During the two years following the imposition of the blockade, the average number of trucks entering Gaza per day dropped to 112 total per day—a fifth of what entered before the blockade.

After that, Gaza was denied exporting goods except in small amounts.

As for Erez crossing, which is designed to handle large numbers of daily travellers, it only allows a small number of foreigners working in international relief institutions or journalists to move. In addition, a small number of Palestinians are allowed to leave the country on humanitarian grounds.

First: freedom of movement

Gazans have only two travel ports: the Rafah Crossing bordering Egypt and under Egyptian control, and the Erez Crossing bordering Israel and under Israeli control.

Freedom of movement – Erez Crossing

Palestinians face numerous complex restrictions if they decide to travel to or from Gaza through the Israeli-controlled Erez Crossing. Gazans usually go through long procedures, from bureaucratic follow-ups in order to register their names for travel and security checks to a waiting period that may extend to several weeks or months to obtain an Israeli permit. However, obtaining this permit is conditional upon the fulfillment of certain stringent criteria set by the Israeli authorities, which change from time to time.

Even those fortunate few who obtain a permit may be denied travelling when they arrive at the crossing for no clear reasons. The Israeli authorities sometimes send notifications to merchants, including old and well-known businessmen who have travelled through the Erez Crossing for many years, informing them that their permits have been withdrawn without explanation for what is known as a “security ban”.”

The Israeli authorities open the Erez Crossing for some exceptional cases, which are grouped as follows:

1. Holders of commercial permits.
2. Patients and their companions.
3. Exceptional humanitarian cases (marriage, death, or illness).

Although the Israeli authorities allow these groups to cross, it takes a long time to process their requests. In addition, processing a request for visiting a sick relative may take more than 50 working days, and the permit is not granted in most cases. A request for a patient who needs treatment or an urgent surgery may take more than 23 working days.

Before the blockade was imposed on Gaza, the monthly average of Palestinian travelers from the Erez crossing was about 30,000. In 2019, the number dropped to about 14,960, while in 2020, the number was 4,600—a decrease of about 69.3%. In 2021, the monthly rate of exits reached 8,954, which is a 70% drop compared to before the blockade in 2006.^[1]

Months after the Israeli military attack on the Gaza Strip, the Israeli authorities announced a number of facilities related to the right to freedom of movement for the residents of the Strip. In September 2021, the Coordinator of Israeli Government Activities announced an increase in the quota of merchants and workers allowed to enter Israel by 5,000, bringing the total number to 7,000.

A table showing exits from Erez Crossing from January 2010 – November 2020 

Freedom of movement – The Rafah Crossing

The Rafah Crossing is the main lifeline for Gazans who need or wish to travel to Egypt and other countries since Israel’s Erez Crossing is so tightly controlled.

In 2005, before the blockade was imposed, the Rafah Crossing operated normally. Records show that an average of 40,000 people per month entered or left Gaza via the crossing. However, this has changed since July 2013 due to the political situation in Egypt, which greatly affected the work of the crossing and caused it to be closed for long periods, exacerbating the humanitarian situation.

Since May 2018, the Rafah Crossing began to operate on an almost regular basis. Despite this, travel conditions through the crossing caused great suffering for travelers. For example, a person wishing to travel from the Gaza Strip via the Rafah Crossing is put on a waiting list with tens of thousands of other people. These periods sometimes extend to six months or more, which may cause losses to the travelers or affect their medical, educational, or professional opportunities. Added to this are the complications of travel through the Sinai, which is often very dangerous.

In 2020, when the crossing’s work was mainly affected by the outbreak of the Coronavirus pandemic, the monthly average of Palestinians entering and exiting through the Rafah Crossing amounted to about 4,245. The crossing was closed for extended days, and hundreds of thousands remained—including patients, students, and business owners—waiting to exit and enter through the crossing. As for 2021, the crossing work improved significantly, and it was opened most days of the year to tens of thousands of residents. The monthly rate of entry and exit of individuals through it during 2021 was about 15,000[2].

A table showing the statistics of entry and exit through the Rafah crossing from January 2010 until December 2021

Second: Transportation of goods

The Israeli-controlled Kerem Shalom Crossing operates five days a week (from Sunday to Thursday) for the entry and exit of goods to and from the Gaza Strip. Its work is significantly affected or completely closed during political and security tensions, Israeli military attacks on the Strip, or Israeli holidays.

Since the Israeli authorities started the blockade, they have only allowed an unannounced list of goods to enter the Strip. All goods not on the list are banned.

Gazans usually rely heavily on the Kerem Shalom Crossing to bring necessary materials that cannot be produced or manufactured in Gaza, including raw materials needed for construction and industries, fuel, medical equipment, canned foods, fruits, and others.

In 2021, the Israeli authorities closed the crossing for several days and on separate occasions, the most prominent of which was for two weeks in May during the military attack. The Israeli authorities allowed many materials to enter Gaza except construction materials, which were banned for about 111 days (from the beginning of the military attack on 10 May until 30 August).

Israel severely restricted the entry of construction materials and banned all “dual-use” goods that Israel claims may be used for military purposes. Israel put these goods on a long list that includes medical equipment, essential items for the agricultural and fishing sectors, communications equipment, and other goods. Although Israel considers these goods to be dual-use, many of them are essential to daily life and Gaza’s economic growth.

Movement of goods through the Kerem Shalom Crossing

In 2005, about 10,400 trucks entered Gaza through the Karni Crossing. After the blockade was imposed, Israel closed the Karni Crossing in June 2007, the Sufa Crossing (designated for building materials) in 2008, and Nahal Oz (designated for fuel) in 2010.

Since then, specifically from 2007-2010, the number dropped to about 2,400 trucks per month (23% of the rate before the blockade). The Kerem Shalom Crossing became the only crossing designated for transporting goods to and from the Gaza Strip.

In the first half of 2021, the monthly average of trucks entering the Gaza Strip was about 6,087 trucks[3], which is only 50% of Gaza’s needs, considering the population increase since 2005.

According to the Agreement on Movement and Access of 2005, Israel agreed to allow Gaza to export 400 trucks daily to Israel, the West Bank, and other countries, based on estimates of Gaza's exporting capabilities.

In 2005, nearly 10,000 trucks exited Gaza—about 833 trucks per month. However, from June 2007 to October 2014, the number of trucks exiting Gaza per month declined to 1.5%, about 14.7 trucks. In the first half of 2020, the number declined again by 38% to 316 trucks per month.

In 2021, the number of trucks exported from Gaza through the crossing significantly decreased during and after the Israeli military attack. The monthly average of trucks leaving between January and April reached about 443, compared to only 139 monthly between May-August.

The monthly average of trucks exported from Gaza through the Kerem Shalom Crossing during the first ten months of 2021 amounted to about 290[4], which is only 2.4% of the monthly average of 2005, one year before the blockade.

The movement of goods through the Salah El-Din Gate with Egypt

The movement of goods entering from Egypt through the Salah al-Din Gate adjacent to the Rafah crossing remains vital for Gazans. They include fuel and building materials, which are not allowed to enter through the Israeli Kerem Shalom Crossing. However, the gate operates on a limited scale and does not meet the needs of the population of Gaza, with over 2 million people. Private companies under the control and supervision of the Egyptian army and the Hamas authorities in Gaza operate the gate.

This gate operates three days a week (Sunday, Tuesday, and Thursday) unilaterally, where goods enter Gaza. Goods cannot be exported through it to Egypt and abroad. But in August 2021, the Egyptian authorities, for the first time since tightening the blockade on the Gaza Strip in 2007, allowed five trucks loaded with iron scrap to enter Egypt.

In June 2021, the Israeli authorities asked Egypt to prevent the entry of cement and other construction materials through the Salah al-Din Gate into the Gaza Strip to prevent their access to Palestinian armed factions.

The Salah al-Din Gate witnessed several closures during 2021. As a result, hundreds of merchants incurred losses estimated at at least 36,000 Israeli shekels ($11,600) per week, according to the head of the Private Transport Association in the Gaza Strip, where each truck in the event of the crossing’s suspension incurs approximately 600 Israeli shekels (about $200) per day.

On average, about 2000-2,400 trucks enter the Salah al-Din Gate on a monthly basis, according to the Private Transport Association. Despite the importance of the gate for importing materials and goods that are not allowed through the Kerem Shalom Crossing with Israel, it meets only about 20% of the needs of Gaza.

Collapsing economy

The Gaza Strip’s economy has wallowed in a general recession ever since the Israeli blockade was imposed, resulting in the near-total closure of commercial crossings and paralysis of the economic movement, especially during the Israeli military attacks.

Over the past three decades, the contribution of the Gaza Strip to the Palestinian GDP has been reduced by half, reaching only 18% in 2021.[5]

The Israeli 11-day-long military attack on Gaza in May 2021 exacerbated the economic collapse. During the attack, Euro-Med Monitor noticed focused attacks on economic facilities, including factories and production and service units, which were directly targeted by either Israeli warplane raids or guided artillery shells. Plastic, nylon, and food product factories were targeted, in addition to renewable energy facilities.

During the attack, the Israeli army directly targeted the Gaza Industrial Estate, one of the largest industrial and production clusters in the Strip, as it includes dozens of factories and companies that employ hundreds of workers. A large part of the production operations of the Strip's factories takes place within it.

The direct Israeli attacks caused extensive destruction to the economic facilities in the Strip, including the destruction and damage of about 1,500 economic facilities, including nearly 100 factories, and the destruction of residential buildings and towers that include shops providing various services. The Israeli army also targeted industrial workshops, educational institutions, training centers, agricultural lands of large areas (some of which contain livestock and poultry farms).

In addition, the fishing sector was greatly damaged due to the closure of the sea and the prohibition of fishing throughout the attack and its aftermath. The repeated reduction of the fishing area from time to time as a form of collective punishment also damaged the fishing industry.

The total material losses and damages were between 290 and 380 million dollars, and the social sectors were the most affected, constituting more than half of the total damage (140-180 million dollars). Losses in the housing sector accounted for about 93% of the total social sector damage. While the productive and economic sectors were the second most affected, the agriculture, services, trade, and industry sectors incurred the largest losses, according to the Gaza Rapid Damage and Needs Assessment (RDNA) conducted by the World Bank from 25 May to 25 June. The conflict generated economic losses (interrupted economic flows, production, and services) that ranged between 105 and 190 million dollars.[6]

As a result of the direct targeting of the economic sectors—especially the agricultural sector, on which much of the population of Gaza depends—the marketing capacity of many agricultural plant and animal products has weakened due to restricted movement and difficulty in accessing agricultural land and animal and fish facilities. Additionally, markets were disrupted, and many agricultural products and fish lost their exportation opportunity. This led to a sharp drop in prices in many commodities and huge losses to producers.

In general, the repeated military attacks on the Strip, along with the enforced blockade and long-term occupation, inflicted heavy economic losses on the population. According to a UNCTAD report issued in November 2020, the economic cost of the Israeli occupation of Gaza during the past decade was estimated at $16.7 billion, which means that the per capita economic loss due to the blockade amounted to about $9,000.

The unemployment rate in the Gaza Strip remained among the highest in the world. After reaching about 23.6% in 2005, it reached about 50.2% in 2021.[7]

These economic crises were accompanied by a shrinkage in per capita GDP by 27%, and poverty rates jumped from 40% in 2005 to 69% in 2021.

Following the Israeli attack on Gaza in May 2021, about 62% of the population of over two million people were food insecure.[8]

“After the nearby Abu Iskandar factory was bombed and a fire broke in it, the flames moved to the [my] company’s factory, and the raw materials started burning. The fire was so huge that all the equipment consisting of solar panels, electric cables, spare parts, and machinery was melted and turned into ashes. The factory was completely destroyed.”

“The factory employed 20 workers before the bombing, but now we had to be satisfied with only 9 workers,” he added.

Agricultural sector

The agricultural sector is one of the most important economic sectors in Gaza. About 40,000 people work in this field, supporting an estimated 200,000 people in Gaza.

However, this sector faces major challenges in light of the restrictions imposed by the Israeli authorities and the direct targeting of agricultural land periodically during the year.

The Israeli authorities’ control extends to agricultural lands in the Gaza Strip. It imposes a 300-meter-wide buffer zone along the separation fence. Although the Israeli authorities claim they allow farmers to reach 100 meters from the fence on the condition of prior coordination, its practices on the ground prove the opposite. Farmers are exposed to grave dangers when approaching that area and are therefore unable to conduct their business normally.

Application of this policy remained in effect until September 2005, when the Israeli authorities declared that Palestinians should stay at least 150 meters away from the fence. In November 2008, this distance was expanded to 300 meters.

However, the Israeli military attack on the Strip in December 2008 led to imposing a new buffer zone of 1,000 - 1,500 meters wide along the separation fence. This area constituted about 17% of Gaza and 35% of its agricultural land.

Moreover, during the years of the siege and military attacks, the Israeli forces destroyed large areas of agricultural lands, which led to heavy losses incurred by farmers and landowners.

After the 2012 military attack, Israel allowed the residents 100 meters near the fence, but in 2013, the number rose to 300 meters.

Israel determines these permissible distances that Palestinian farmers are obligated to abide by, fearing that the authorities will target them if these rules are breached. Yet, the Israeli forces often target farmers in the permitted areas, even if the rules are not violated, without any justification. In addition, Israeli forces carry out periodic incursions of agricultural lands where farmers work in safe areas.

In addition, the Israeli forces spray pesticides along the security fence that extends along 40 kilometers in the eastern Gaza Strip, apparently to prevent trees from growing to expose the area for security considerations. The spraying operations usually cost farmers hundreds of thousands of dollars over the course of the year.

The spraying operations continued during 2021, as Israeli drones sprayed large areas of land adjacent to the separation fence in the eastern Gaza Strip several times during the year.

In addition, during the year 2021, farmers incurred great losses as a result of Israel opening rainwater floodgates to the east and north of the Strip, which caused large areas estimated at 700 dunums of agricultural land planted with crops to be flooded and completely destroyed. Losses were estimated at half a million dollars, according to the Palestinian General Federation of Trade Unions in Gaza.

During the military attack of May 2021, Israeli forces targeted large agricultural areas, including trees, plants, greenhouses, and water wells, in addition to poultry and livestock farms of all kinds. The Israeli forces used their firepower to control the border agricultural lands, preventing farmers from accessing their lands and practicing their agricultural activities. This resulted in the damage of hundreds of acres of agricultural vegetables (open and greenhouses) and trees, either as a result of direct targeting or as a result of the interruption of irrigation water on crops during the days of the attack.

In addition, livestock breeders suffered heavy losses, represented by the death of large numbers of birds and animals as a result of the interruption of supplies of animal feed due to the closure of border crossings. On the other hand, agricultural facilities, feed factories, wells, main and secondary pipelines, agricultural ponds, fish farming stations, feed stores, agricultural equipment stores, pesticides, and bee farms were severely damaged.

Following the attack, Euro-Med Monitor’s field team visited the sites of six farms in various regions of Gaza and conducted interviews with owners of damaged farms, during which they reported the size of the losses they incurred as a result of the Israeli attack.

Euro-Med Monitor interviewed farmer Yasser Mohammed Hneideq, who owns a peach farm east of Khan Yunis in the southern Gaza Strip. He said: “I have a peach farm on an area of ​​100 dunams, less than one kilometer from the eastern border. The ripening of the peach fruits coincided with the start of the attack. We were supposed to pick the fruits and sell them in those days. But we could not reach the area as it is borderline and is subjected to heavy air and artillery shelling around the clock. On May 13, 30 workers and I took a risk to pick the fruits and avoid some losses, and we were able to pick 700 kilograms of peaches, but during our work, an Israeli drone targeted the ground with at least one missile that exploded in our vicinity, so we had to flee immediately. As a result of our inability to reach the farm after that, all the fruits fell on the ground and became unmarketable, causing losses estimated at $60,000, while 50 seasonal workers and 10 permanent workers lost their jobs.”

Fishing crisis

The Oslo Accords, signed by the Palestine Liberation Organization (PLO) and Israel in 1994, stipulate that Palestinians are allowed to sail up to 20 nautical miles (37 kilometers) off the shores of the Gaza Strip. However, Palestinians have always been prevented from reaching that distance and only allowed less than 12 nautical miles.

Due to restrictions, periodic attacks, and bans on the entry of supplies necessary for fishermen to continue their work, the number of people working in the fishing field decreased from about 10,000 in 2000 to about 4,000 fishermen, and about 500 others working in fishing-related professions, such as fishmongers, mechanics, electricians, boat builders, and fishing equipment dealers during 2021. These people support an estimated 50,000 people, which means threatening the livelihood of these fishermen would threaten the lives of tens of thousands of citizens in Gaza.

Fishermen in Gaza suffer their inability to practice their work freely in the area they are allowed to sail and work as a result of repeated Israeli attacks, limiting the fishing area, which ranges from 6 to 15 nautical miles at best, in addition to banning the supply of equipment and supplies for fishermen.

Israel routinely reduces the fishing zone in Gaza. In 2006, Israel reduced the fishing zone to ten nautical miles, then to six nautical miles, and then to three nautical miles in 2009 following Operation Cast Lead. At the beginning of 2019, Israel announced the expansion of the fishing area to 12 nautical miles and then allowed fishing at 15 nautical miles. However, in 2019, the fishing zone was reduced nine times as collective punishment measures, including four times when they closed the sea completely.

In 2021, Israel maintained this policy and reduced the fishing area several times during the year, especially during the Israeli attack in May, when the complete closure of the sea caused the disruption of fishing and indirect damages estimated at $2 million, in addition to losses estimated at $170,000 as a result of the direct bombing that targeted several ports in the governorates of the Gaza Strip.

In the wake of the ceasefire, Israel reopened the sea to fishermen, but only for an area of ​​6 nautical miles, after it was 15 miles in the part extending from the center to the south of the Gaza Strip. On 12 July 2021, Israel announced “the expansion of the fishing area in specific areas of the Gaza Strip sea to 12 nautical miles,” then returned on 25 July to reduce the fishing area to 6 nautical miles on the pretext of the instability of the security situation. Israel expanded it again in September to 15 nautical miles within the facilities announced by the Israeli authorities for the Strip.

In addition, during 2021, dozens of fishermen were exposed to shootings at sea or harassment while sailing within the permitted space, which led to the death and injury of a number of them.

For example, in March 2021, three Palestinian fishermen were killed while working at sea when an explosive device attached to an Israeli hovercraft got stuck in their nets and exploded while they were extracting their nets.

In addition to restricting fishing zones, shootings, and arrests of fishermen and their equipment, the Israeli authorities restrict importing equipment needed to rehabilitate boats damaged by the Israeli naval fire.

Following the Israeli military attack on the Gaza Strip in May 2021, Euro-Med Monitor met Suhail Mahmoud Al-Haj, one of the investors in a fish farm located southwest of Gaza City. He said: “The area surrounding the farm was subjected to repeated and violent Israeli bombardments, which led to severe damage to the farm, as the solar panels that feed the equipment with electricity failed, in addition to the damage to some Dennis fish ponds. After the attack ended, the Israeli side continued to close the crossing and prevented the export movement, which increased our losses significantly. The value of the direct losses as a result of the bombing and the indirect losses as a result of stopping the export are estimated at $110,000, and 15 workers out of 35 lost their jobs as a result of the downsizing production due to damages.”

Deteriorating health condition

Due to the long Israeli blockade, Gazans suffer difficult conditions at various levels, especially in terms of health care. The blockade has caused permanent shortages of medicines, supplies, and basic medical equipment. The health sector is one of the most affected sectors by Israeli prevention policies. It is almost completely collapsed, especially with the outbreak of the Coronavirus pandemic in late August 2020.

During the past 16 years, the health sector has witnessed many setbacks and challenges that have had a severe impact on the health services provided to the citizens of the Gaza Strip. During the Israeli military attacks, the Israeli forces, directly and indirectly, targeted hospitals, health centers, and medical personnel. In addition, the restrictions imposed on the entry of medicines, medical supplies, and maintenance parts for medical devices have a tremendous impact on the health sector.

The health sector in the Gaza Strip is dependent on three supporters. First, external transfers for treating diseases that Gaza hospitals cannot handle. Patients are transferred to hospitals in the West Bank, Israel, or other countries abroad. The second is related to foreign medical delegations, which often specialize in specific health fields such as bones or nerves. These delegations contribute to some extent in treating many medical conditions, especially for those who cannot travel due to the Israeli ban, who constitute 50 % of the total number of patients who obtained permits for treatment abroad. The third is the medical aid provided by the World Health Organization, UNRWA, and the Palestinian Authority.

The population of the Gaza Strip is served by only 36 hospitals containing 3,338 beds, about 78% of which are run by the Ministry of Health in Gaza. According to the Ministry of Health, figures show that there is a severe shortage of basic medicines and medical supplies, in addition to health services for sectors such as cancer patients and maternal and childcare. The deficit in drug balances reached about 45%, while it reached about 33% in medical consumables and about 60% in laboratory and blood bank supplies.

After years of the Israeli blockade, health care services in the Gaza Strip declined by 66%, emergency and operations services by 23%, kidney and dialysis services by 42%, cardiac catheterization and open-heart services by 66%, and orthopedic services by 13%.

While the Gaza Strip records about 1,800 cancer cases annually, the specialized health services provided to cancer patients, who number about 8,600 patients in the Strip, remain in their worst condition, while more than 50% of cancer patients need to travel abroad to receive radiotherapy, chemotherapy, and the atomic survey, which is not available in Gaza.

In general, the Ministry of Health in Gaza remains unable to provide the necessary medical services for patients with blood and tumors in the Strip. The hospitals in Gaza remain threatened with stopping surgical operations completely due to the lack of necessary medical materials, which are prevented from entry by the Israeli authorities, such as nitrous gas used for anesthesia and for patients who are dying in operating rooms.

Throughout 2021, the Israeli authorities refused to allow nitrous gas to enter into Gaza.

During the year 2021, the increase in the number of patients and injured in emergency situations had the greatest impact on the inability of hospitals and medical centers to receive them on a regular basis, despite the opening of new health departments or centers from time to time. However, what these departments need in terms of medicines, materials, medical supplies, and medical staff remains largely missing. Therefore, hospitals in Gaza usually resort to referring serious cases for treatment outside the Strip, either in hospitals in the West Bank, Israel, or Jordan through the Erez crossing or in Egypt through the Rafah crossing.

In this case, the vast majority of patients who receive a medical referral covered by the Palestinian Ministry of Health in Ramallah remain at the hands of Israel to allow them to travel abroad for treatment. In addition, Gaza’s share in the total Palestinian Authority spending on medical referrals in the Palestinian territories remains low, taking into account the collapse of medical services provided to the population in Gaza, where the sector's share is only about 33%.

Furthermore, the health sector is greatly affected by other factors such as continuous electricity cuts and running out of fuel, which sometimes affects the work of these hospitals for several hours or days and causes a real threat to the lives of hundreds of patients who need electricity on a regular basis, such as those in intensive care departments, pediatric nurseries, and kidney patients.

On the other hand, the decrease in financial support directed to the health sector affected the sector’s ability to absorb new employees, which greatly reduced the medical staff and prompted a number of doctors to migrate abroad due to successive financial crises and limited employment opportunities that, if available, would be with low salaries.

Power crisis

The power crisis in the Gaza Strip goes back to 28 June 2006, when the Israeli army bombed the sole power station in the Gaza Strip during one of its military operations. This resulted in the destruction of six main transformers in the station. Since then, Gaza has suffered a large energy deficit. The crisis reached various peaks, during which electricity was cut off for periods of up to 20 hours per day.

The station remained in a near-complete suspension due to Israeli bombardment until it was repaired and returned to work partially in 2009. After the station was repaired, the European Union financed the costs of the fuel needed to operate the plant. This situation continued until the European Union decided to transfer what it used to pay to the Palestinian Ministry of Finance in Ramallah, provided that the ministry would assume the task of paying for the fuel itself. However, the quantity decreased from that moment to 4,500 cubic meters per month, sufficient to produce only 30 megawatts, which can only power one generator at the plant. This caused further cuts in power supply hours during 2010.

In 2011, the power plant in Gaza began using Egyptian fuel and became powered by three generators, producing about 80 megawatts of power. However, at the beginning of 2012, the Egyptian fuel shortage crisis began to emerge after reducing the quantities supplied to Gaza. The plant started to draw on its reserves until they completely depleted, and the station stopped working on 14 February 2012.

Since then, the Gaza Strip has been witnessing a worsening electricity crisis, one of the causes of which were the attacks launched by the Israeli army on the Gaza Strip in 2008, 2011, and 2014, resulting in significant material damage to its facilities and seriously affecting the process of generating and distributing electricity.

In 2017, the electricity crisis reached its climax after the Palestinian Authority’s decision on April 27 to stop paying for the electricity that Israel supplies to Gaza through ten electricity lines carrying 125 megawatts (about 30% of Gaza’s electricity). As a result of this decision, Gazans had no power for more than six hours a day, which significantly affected the daily life of the residents.

In 2018, there was a noticeable improvement in the quantities of electricity delivered to the homes of residents in the Gaza Strip as a result of donations and funds provided by the Qatari government to solve the crisis. At the time, the power plant operated with three generators, and residents had electricity about half of the day. However, this rate is not enough to meet the residents' daily needs of electricity.

The power crisis surfaced again in June 2019 and continued during 2020 as the Israeli authorities prevented fuel from entering Gaza. Citizens only received between four and six hours of electricity per day. Such a low rate affected several major important sectors such as the health sector. The repeated power cuts threatened the lives of hundreds of patients on ventilators, as well as infant incubators and operating rooms.

The impact of power cuts has been reflected in the work of municipalities. Due to power cuts, sewage stations stop working for long hours, forcing municipalities to drain wastewater into the sea, which threatens the lives of citizens and pollutes the seawater. The crisis also had the greatest impact on the commercial and industrial sectors. More than 80% of the sector’s factories stopped working due to a lack of energy, which exacerbated the living crisis and increased the unemployment rate^[9].

It is worth noting that the Gaza Strip needs nearly 640 megawatts a month, but the amount that has reached the sector since the beginning of the crisis (during the years of the blockade) has not met even half its needs of electricity. The Israeli lines provide 120-125 megawatts, the power plant provides (by Qatari fuel) from 60 to 70 megawatts only, and the Egyptian lines, which used to provide power with a capacity of 23 megawatts, have been suspended since March 2018^[10].

Legal relief

The residents of the Gaza Strip have suffered from a suffocating blockade imposed by Israel for 16 years. Most exits are closed, and Israel has imposed absolute control over the others. Israel also prevents farmers from working on agricultural land adjacent to the border due to alleged “security” concerns and prevents fishermen from safely practicing their trade where the fish are most abundantly found.

Furthermore, the vast majority of the population is prevented from leaving Gaza for medical treatment, education, or work, and there is a severe lack of sufficient food, building materials, and medicines.

Many of the relevant international agreements show that the Israeli authorities are responsible for its practices that violate international law in the Gaza Strip, most prominently: The Universal Declaration of Human Rights, the International Covenant on Civil and Political Rights, the International Covenant on Economic and Social Rights, the Hague Convention and the Geneva Conventions. All these conventions affirmed a number of basic rights that Israel must adhere to, such as the right to life, physical integrity, movement, health, the right to an adequate standard of living, and more.

Israeli authorities attempted to abandon their obligations as an occupying power by withdrawing their settlers and military forces in 2005. However, Israel continues to exert control over nearly every vital aspect of Palestinian life. Israel’s attempts to avoid responsibility contravenes the provisions of international law, specifically the Hague Agreement of 1907, in which Article 42 of the section titled “Military authority over the territory of the hostile state” states: “Territory is considered occupied when it is actually placed under the authority of the hostile army. The occupation extends only to the territory where such authority has been established and can be exercised.” This means land is to be considered occupied when effective control is achieved, which Israel has exerted over Gaza’s land, sea, and air after its ‘disengagement’ from Gaza in 2005.

According to international human rights law, Israeli authorities are obligated to respect the rights of the Palestinian population in the Gaza Strip, including their right to movement, education, and work, without arbitrary restrictions or conditions, as these rights were guaranteed in the related international conventions.

Israeli authorities have prohibited the entry of many goods, including food and medical supplies, to the Gaza Strip, which is considered an absolute violation of the provisions of international humanitarian law, prohibiting the starvation of civilians. The Fourth Geneva Convention states in Article 55, “To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring the food and medical supplies of the population; it should, in particular, bring in the necessary foodstuffs, medical stores and other articles if the resources of the occupied territory are inadequate.”

Article 56 of the same agreement states, “To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring and maintaining, with the cooperation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory, with particular reference to the adoption and application of the prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics. Medical personnel of all categories shall be allowed to carry out their duties.”

During military attacks on the Gaza Strip, Israeli authorities were found by independent international inquiry to order their forces to target civilian objects, agricultural areas, and other vital installations, which are essential for the survival of the population. That is an explicit violation of the Additional Protocol I to the Geneva Conventions. As Article 54 states: “1. Starvation of civilians as a method of warfare is prohibited. 2. It is prohibited to attack, destroy, transfer or disable objects and materials indispensable to the survival of the civilian population, such as foodstuffs, agricultural areas it produces, crops, livestock, drinking water facilities, networks, and irrigation works, if it is intended to prevent them from the civilian population or discounting their vital value, whatever the motive was whether it was with the intent to starve civilians, to force them to flee, or for any other motive.”

Recommendations

Based on the contents of this report, the Euro-Mediterranean Human Rights Monitor recommends the following:

1. Israel must end its blockade against the Gaza Strip immediately and unconditionally and allow the Palestinians to exercise all their rights, foremost among which is the freedom of movement, and stop its policy of collective punishment against civilians.
2. The international community must assume its responsibilities to protect Palestinian civilians in the Gaza Strip by working to end the long-term Israeli occupation of the Palestinian lands and stopping all forms of the suffocating blockade on more than two million Palestinian citizens living in a deteriorating economic, living, and humanitarian situation.
3. The international community must oblige Israel to guarantee all the rights of the residents of the Gaza Strip as an occupying power and protect the economic, health, food, infrastructure, and other sectors, in accordance with the relevant international norms.
4. The high contracting parties to the Geneva Conventions must fulfill the obligations set out in Article 1 to ensure Israel’s compliance. In addition, the contracting parties must fulfill their legal obligations under Article 146 of the Fourth Agreement, which allows the countries to prosecute those accused of committing grave violations.
5. The International Criminal Court should open investigations against Israeli commanders and soldiers involved in the policy of collective punishment and military attacks against the Gaza Strip and hold them accountable in accordance with international justice standards.

Full report in English
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