Gaza’s hospitals do not arrive every day after decades of bombing, but the health system remains broken and collapsed while new health problems arise due to lack of care or “horrible” living conditions, warns Aitor Zabalgogeazkoa (Bilbao, 1964), emergency coordinator of Médicos Sin Fronteras (MSF), who left Franja in mid-November.
“People only think about their daily survival because they can’t think about anything else. There is no more mental space,” he assures in an interview with this Madrid newspaper. Searching for water and water, repairing the garden shed, finding a means of transport, buying shoes for the children or medicine: this survival takes up a large part of the day and, according to Zabalgogeazkoa, everything is complicated because Israel blocks a large part of the essential humanitarian aid, from the devices to carry out ultrasound to the elements to install a generator.
“It’s really difficult to know the number of trucks awaiting authorization,” he assures, explaining that MSF currently has more than 200 trucks blocked by Israel “because there are certain items that do not meet the conditions.”
Question. What do these two months of heavy fire in Gaza mean?
Answer. We needed it at all costs because we couldn’t do more, but the loud gunfire also served to knock Gaza out of the agenda and off the front pages. It is very clear that this was the objective of some.
P. What does this represent from a medical point of view?
A. I haven’t been to hospitals in decades, but everything else is paralyzed. There are many things that Israel does not want to get into, arguing that they can be used twice and militarily, but they are essential. For example, external devices for traumatology, devices for performing ultrasound, generator parts and parts for coaches or for fitting out the elevator of the Al Nasser hospital, which has 7 floors. There are things around service delivery that are completely blocked.
P. Does MSF currently have any equipment that it cannot bring into Gaza?
A. We have 221 palés that Israel left behind because there is one item that does not meet the conditions. For example, we were able to bring in water sanitation equipment which had been paralyzed for several months. I think there’s a lot of chaos and it’s all a bit random, you can’t twist it in such a sophisticated way. At the same time, unnecessary products like Nutella are entering Gaza.
P. COGAT, the Israeli organization responsible for coordinating humanitarian aid for Gaza, denies the UN information and ensures that all the necessary food arrives in the Franja.
A. It’s bloody to see the number of trucks waiting for authorization. Israel says “we want to bring in as many tonnes”, but there are loads that remain stuck on the other side for hours or days, waiting for Palestinian distribution trucks to be authorized to arrive. It is also said that they distribute water, but they are limited to bringing it to the other side of the ditch, where the pump does not work in the pipes. The same goes for electricity. These are half-truths.
They say they distribute water, but they limit themselves to bringing it to the other side of the ditch, where the pump does not work in the pipes. The same goes for electricity. Son, half truths
P. Your position is emergency coordinator, how can you coordinate an emergency like the one in Gaza?
A. As a team, we took risks that we hadn’t taken elsewhere. In fact, Gaza is worse than other places, but the idea that it is a very small and confined place, where people cannot get out, changes the economy. It’s just as scary in Sudan or in the Central African Republic, but in Gaza, we have to plan a lot of operations, with what we do, and above all, it takes a lot of time to obtain resources, to obtain aid. The positive point of these years has been the understanding that has existed between all the organizations.
P. What is the priority now?
A. The refuge. Try to bring as much gear as possible each winter. And also water. The absence of these two elements can cause many other health problems. When I left Gaza in November, 85,000 field stores were blocked because Israel had blocked them behind with a few simple pieces of metal. In total, Gaza is missing 300,000 stores. I believe this week’s rain and storm images show how people live. And winter still falls a lot because of her. There are people who sleep on a carpet, protected only by curtains and plastic.
P. In the midst of this uncertainty, how can we anticipate humanitarian aid in the months to come?
A. We go month by month because we can’t look any further. We also only think about daily survival because we can’t think about anything else, there is no mental space. In these Campaña stores there are lawyers, teachers, traders… people who have never cooked online and who do not know how to properly secure the Campaña store because they have not had the opportunity to experience this before, like the majority of us. Survival takes several hours a day: going to the market, looking for food, finding a vehicle… The living conditions are appalling.
P. Another urgent issue, according to the WHO, concerns the evacuation of the sick. The UN estimates that more than 16,000 patients need to leave Gaza, but between October 13 and December 1, 235 people and their companions left.
A. We receive a lot of people who we cannot treat and who must be evacuated. Some spent months waiting. Israel says it can come out, but it’s not like that. There are a lot of limitations, with vehicles, with documents… And we lose a lot of people along the way. We are talking about very complicated cases of oncology or trauma and also chronic patients who have not been treated for years, for example diabetes. Many of them are larger people, who are not included in casualty reports or evacuation lists.
Even having hospitals overflowing with legacy from the bombings, leaving aside other things, like maternal and child health or malnutrition and all that is now emerging
P. How would you define the healthcare system in Gaza at the moment?
A. It’s a completely disassembled system. Even having hospitals overwhelmed with legacy because of the bombings, leaving aside other things, like maternal and child health or malnutrition, and all of that is emerging now. For example, MSF has health centers on the southern outskirts, in country stores. We serve between 800 and 900 people per day. The feeling is that there are not enough staff, that there is not room for everyone…
P. A woman gives birth today in Gaza. Is it worth going to the hospital? Is the van available?
A. If you can make it, I’m sure you’ll be there, but there will probably be a woman who hasn’t had a pre-check and at the time of delivery there could be problems that could end up in a waiting room. The first signs of severe malnutrition in Gaza have not been seen in children, even in mothers who cannot be properly fed during pregnancy and can lead to complications. Hambruna’s statement in August was largely due to these women.
P. Have you been particularly negligent about the health of the gazatias?
A. If Gaza has gone back 30 years since 2023, the women of Gaza have gone back 40 years. The situation of suffering, lack of help and total absence of hygiene and privacy continues to be very complicated and very delicate for many women, in many ways.
If Gaza has gone back 30 years since 2023, the women of Gaza have gone back 40 years
P. Is mental health also part of the list of neglected topics that are currently emerging?
A. It’s a big unknown. At MSF, we currently have several psychologists. How many files can you manage? 20, 30… And there are very worrying clinical scenarios, compared to those that can rarely happen, because the trigger for this trauma is always there, present. I am also very worried about the nursing staff.
P. You want to decide who is the caregiver
A. Exactly. We have companions who have not been able to spend a free day alone over the years, who are not able to relax in their camping store knowing everything there is to do.
P. Listen, the image of Gaza is like a boat plowing water everywhere.
A. For all, there are still aspects that have remained buried, even today.
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