Getting aid into Gaza with Mr Andrea De Domenico, Head of OCHA in the OPT

Andrea De Domenico:

It’s an honour to be invited here by the Balfour Project.

I follow some of your presentations. I always enjoy them. It’s an important voice in the spectrum of the situations that we have witnessed throughout the years in Palestine and Israel.

 I will focus on Gaza. After the events in October 2023, we face an escalation of violence in the OPT that is unprecedented. But today we’ll focus solely on Gaza, with an overview of how aid and humanitarian assistance are delivered in Gaza.

I’ve been in Gaza 5 times since January. The counting of trucks is not a correct metrics to measure humanitarian assistance in Gaza. Unfortunately, the entire world has been focusing on counting trucks. First and foremost, a truck is not a unique metric. You can have fuel on a truck that is bringing gasoline to a desalination plant. The desalination plant can provide drinking water to 500,000 people.  One truck can also bring mattresses – probably 100 mattresses.

It is important to go beyond counting trucks and instead look at what is needed – what is adequate. That is the right way to look into what humanitarian assistance gets into Gaza.  The obligation of the parties to the conflict is not only to bring aid across the border but to bring aid to people. The obligation doesn’t stop at the border. It starts there. What is important as a humanitarian aid worker is to reach people wherever they are – to reach the people that are in need and try to prioritise those people.

The conditions in Gaza are overwhelmingly dramatic. We have 2.2 million people that are in desperate need of assistance – the entire population of Gaza. Not everybody has the same level of vulnerability. When we deliver assistance, we really need to find people that need it the most. It’s challenging. It has been challenging for seven months and it is still challenging day in, day out.

We need to make sure that aid is arriving consistently.  We’ve gone through a very hard period. Initially there was a complete blockade – impossible to bring anything into Gaza. In the recent weeks we had a progressive opening up. And troubleshooting solutions to issues we have raised for months. Finally, the authorities and the Israeli military have decided to help us to address them, at least in part.

Bottlenecks

But there is a series of bottlenecks. It’s a sequence. If you have multiple bottlenecks, it’s not that when you take one out you then have reached the objective because there are several more bottlenecks that you have to go through. That’s why the predictability of the assistance is so important. This is a combination of pipelines that are consistently and properly managed. It’s important to see how Egypt and Jordan and others have allowed this assistance to come in. The entire international community needs to support.

Looking at the level of funding of the crisis in Gaza, we have generous support from the UN member states.

There are 2.2 million people who need everything – setting to one side the current population in Rafah that have so far been able to remain in their own houses. The rest of Gaza has moved at least once. We have 1.2 million people today in Rafah. Rafah in the past was 270,000 people. Some of those people now in Rafah have moved 7 times, trying to seek a safe place to find shelter and survive. There is no space – nowhere to be safe in Gaza.

I’ve visited Rafah since October. In recent weeks, even near to the guest houses and the offices where we work in Rafah, we hear the sounds of bombs that are getting very close, not more than 500 metres away.  Since October, there is no electricity and no water at all in Gaza.

Access to water was already complicated before 7 October, but there were three lines from Israel that were essential to maintain access to drinkable water. There were a lot of desalination plants across the Gaza Strip built by the international community throughout the 20 years of humanitarian presence. They have been progressively made unable to work. Now 2 lines from Israel have been reopened – good! Recently there was an Israeli commitment to reopen a third line. But the distribution network has been heavily impacted by bombardments. We’re trying to bring back some level of access to drinking water. But this is not enough. The war has taken a gigantic toll.

Nowhere is safe

There is nowhere to be safe in Gaza. Today we count more than 34,000 people killed. We do not know the numbers buried in the rubble. In the Northern part of Gaza, Gaza City, Jabalia, Beit Hanoun, Beit Lahia, there are entire areas that have disappeared. The Gaza that I remember was no longer there. Whole areas have been completely destroyed and disappeared. There are dirt roads everywhere.  You have clearly seen tanks going through and so there is no more paved road. All around you have almost a lunar scenery at times where even destroyed buildings have then been completely cleaned away.

Areas that in the past were high rise – all of a sudden there is nothing.  We have counted 78 thousand injured. Being injured today in Gaza is simply dramatic. You have followed the systematic attacks on hospitals. We at the UN have called regularly on all the parties to say if there are armed groups that have hidden weapons. We’ve never been able to prove it. That was the Israeli allegation. But we called on Hamas not to do it in a preventive manner. The sanctuary that hospitals should be for everybody should be respected. We call on the Israeli authorities to respect those hospitals, which have been attacked by Israel systematically. It’s really concerning: violating a fundamental element of international military law and exacting an unbelievable price from the people. The suffering that generates is immense, not only because of those injured who cannot be treated properly.

Médecins Sans Frontières have reported on the psychological impact on health workers that have spent the last seven months basically amputating limbs of the wounded. Many women and children are so traumatised, with all the symptoms of post traumatic disorder. All this has been happening with the continuous degradation of the health service, the entire system with less and less access to basic drugs and equipment. The UN WHO has struggled to keep afloat.

 Al Shifaa hospital was attacked at the very beginning of the war. It was completely dysfunctional. And then the community went back trying to resume some minimal services, at least the emergency and some maternity. Al Shifaa was attacked and completely destroyed and damaged in a way that is beyond repair at the moment. It is shocking to see the impact on the health facilities. The systematicity of it is also of greatest concern. Big efforts have been made by the humanitarian community to maintain some of these services. On rare occasions we managed to do it.

Today there are 300,000 people still in the north of Gaza. The Strip is divided in half by a corridor military road that has been newly created in the middle between Gaza and Ein Derbala, just north of the Wadi Gaza. The north was the centre of Gaza, the highest density of population was there. 1.2 million people resided there out of the 2.250 million that were in Gaza before the war. Now we have only 300,000 remaining in this area.

The total population of Gaza is 2.25 million. 900,000 people moved south seeking safety; they have yet to find safety.  The most impacted have been women and children. 70% of the 34,000 people killed are women and children. The systematic attacks not only hit hospitals but also hit all civil infrastructure. 73% of the schools have been destroyed and all the universities have been completely destroyed. We have witnessed the Israeli army blowing up these universities.

The destruction of civilian infrastructure is legitimate only when there are imperative military objectives. It will be necessary in the future to look into what was the rationale for this behaviour. The result that we’re dealing with, and this will not be done by someone else, nobody else.

Basically, the entire population of students of Gaza today do not go to school because the remaining schools became shelters for internally displaced people – crowded, crammed with several 100 people sharing one bathroom. And you can imagine with limited access to water what it means for living conditions.

Famine across Gaza

The integrated phase classification methodology is an internationally accepted standard used in all crises from Somalia to Yemen. The expectation is that if by the end of the month of May things do not improve dramatically, we will have a potential famine in Gaza I the integrated phase classification has five degrees of seriousness.  At the moment there are 1.1 million people so half of the population of Gaza on the highest level of this, which is the emergency phase.

In Yemen when the worst the declaration of famine there were 160,000 people in phase five. Here we’re talking about 1.1 million. This is a man made and totally preventable situation.

Our advocacy has reached some of the Israeli authorities: in the last two or three weeks they have facilitated a little bit what we what we’re trying to do. But expecting that this will solve the issue in a matter of days is unrealistic.

The reality is that to avert famine it is a combination of food for sure but also nutrition.

It is therapeutic feeding that will help children and those impacted to get out of malnutrition and then be treated. It is about access to health, to water and sanitation. Those five components are fundamental to avoid famine. We are struggling to avert famine, but we are not there yet. Particularly concerning is the situation of the most vulnerable people – the persons with disability, elderly women, children, unaccompanied and separated children.

 UNICEF estimates that there are 17,000 unaccompanied and separated children. Under bombardment people flee, people die, families are split, and communication is very limited. It becomes very difficult for families to find their children. It is simply beyond imagination, the suffering. We have increasing accounts of gender-based violence in this moment of desperation. The most vulnerable are children and women.

We have seen unfortunately scenes of people being shot in situations where aid was being distributed. Some cases have been reported by international media, but it’s something that we see with a certain regularity in Gaza. There is an obligation on everybody to protect civilians. We have repeatedly called on the parties to make more effort to protect civilians because what we have seen is not protection of civilians.

We estimate that there are around 630,000 children that are completely out of school and the worst is that there is very, very limited possibility that they will go back to school any time soon. Consider the level of destruction that we’re witnessing.

Our ability to operate has been extremely challenged. The bulk of the assistance that has entered into Gaza so far has entered through Rafah at the beginning and then at some point Israel accepted to open Kerem Shalom. There is a scanning of the humanitarian nature of the consignment either in Nisana in the South, or in Kerem Shalom and then the humanitarian assistance centre here. And then it is distributed through Salahuddin Road, or we go through town and then we go to the Coastal Rd. The South is relatively easier to serve.

There are a lot of issues for the humanitarian community to access the middle area and the central area – and keep in mind that in the South we’re at 1.99 million people. Most people are concentrated in the South but still there are 300,000 people that until November did not receive any assistance and since then have received really drop fed assistance. Today when we go to the north, we have to cross military checkpoints that have been extremely problematic and complicated. The roads are terrible. Discipline at the checkpoints has been complicated at times.

The amount of trucks available to do this operation is limited. We do not have access to fuel. Nor access to all the commodities in a systematic manner due to the limitation of entry.

So the chain of effects that would in normal circumstances allow any humanitarian operation to run smoothly are here challenged all together in a very little piece of land. Airdrops have been initiated and a maritime corridor has been announced. An opening in the north has been announced. That’s a great step forward that has been finally accepted by the Israeli authorities. And in the meantime, they have opened an entry point called Gate 96. But that does not give access directly to the north because it still goes through the checkpoints where we have the challenges I mentioned earlier.

Yesterday a team of my staff waited 9 hours going through this checkpoint either on the way up or on the way out because they were fighting in the area. When the fighting calmed down there were very tight controls. This morning, we were trying again, going around. We received the green light at 9:00 to move there and then we have been at the holding point for three hours waiting to go through the checkpoint. There was some military activity in the beginning and there for the next two hours. We’ve been waiting without any clear explanation.

Every day there is yet another challenge,  yet another problem to solve.This is constraining the ability of the entire humanitarian community, including NGOs that are phenomenal and brave people that decided to go into Gaza despite this challenging situation and the kinetic activities that are quite intense and scary at risk of their life –  as we have seen sadly a month ago with the colleagues of the World Central Kitchen.

The challenges are constant. You have a war zone where the military operations have destroyed everything. There is also a lot of unexploded ordnance. Today we do not have the capacity to deal with it. What we can do is just to make sure that we find it and make sure that we stay far away.

But with the movement of population and particularly if a Rafah operation kick starts, there will be an immense risk for the population that moves around because we were not yet able to clear zones even across the street.  Constantly since the very beginning we continue to coordinate with the Israeli authorities and to some extent with Hamas and the other groups. It’s important. It has allowed us to improve and move the dial on some areas. It has not solved all the issues but is the only way we can engage and continue the dialogue and push and advocate because that’s what we are meant to do to reach people.

The level of challenges particularly on the crossing to the north requires coordination with the Israeli authorities because in general terms we notify through what we call the humanitarian notification system. We tell the parties to the conflict we’re going to move from A to B. The parties have an obligation to facilitate humanitarian assistance. As we deliver, we help the parties to deliver their obligations. It is not only the humanitarian imperative that drives us, but also it is a legal obligation for the parties.

When we have to cross checkpoints in central Gaza, we need to have coordination – meaning that we have to talk to the military, make sure that there is an agreement on their side for us to go through. And that is still a bottleneck on the entire process.

Supply of goods has improved but with ups and downs. The Coastal Rd. at the moment is becoming problematic because the maritime operation will block this road, at least temporarily. We are trying to find ways to have another access that will allow us to have circulation from the South to the north of trucks that is a bit smoother and quicker – that will allow us then to scale up the operations.

Ceasefire now

Last point: we are all hearing about the resumption of negotiations. I really hope that they will find an agreement for a ceasefire. Only a ceasefire will help us to bring the humanitarian operation to the point where it will improve the well-being of people.

We recently launched a flash appeal asking for $ 2.8 billion, considering the limitations that we have and the ability that we have to deliver from now till the end of the year.  Only with the ceasefire will we be able to deliver fully this amount.

If that negotiation fails, we risk to go again into another military operation in Rafah, where we have 1.2 million people that have sought refuge on top of including the residents, 270,000 residents plus the remaining population that moves out that will have to again pack everything up and move to the north.

That will be an immense problem, an immense suffering for people, people that have been living without water, without access to toilet, and then figure out after you know, seven months, six months of living there, a way to cope with this or that it will be again moved and brought to where? There is not much left, there are no services, there is no water available in other areas.

And so, the humanitarian community will have to reinvent again an operation to serve this million people that might have to move. Given the catastrophic impact on the population we really hope that we will not be confronting this reality. But we are fearful that this is what we’ll have to confront. It is important to make sure that we pursue this and for the Israeli government to deliver on the commitments that they have announced recently, which are positive, good.

I must stress that this is an important trajectory that has been announced recently, but these changes need to be materialising on the ground that will allow us really to scale up our operation and be able to serve the people wherever they are. We constantly go for protection of people: civilians must be protected. That is an obligation on the parties to make sure that whatever military objective they want to pursue, they have to respect the life of civilians. It’s fundamental.

The wishful thinking of course is, is the resumption of electricity, water, public sector and free movement across the Gaza Strip. The most important of all is finding a long-term solution for this horrific war that we are witnessing here in Gaza.

Diana:

First question: I’m finding increased pleas from people who have lost everything to fund them. They’re going around on Facebook, on WhatsApp, and so forth. Please indicate if giving aid to people, fundraising to pay companies to move to Egypt is valid, are demands for $5000 plus justified? Is there no other way of exiting the war zone?

Andrea:

This is a sad chapter of the story in Gaza. Gaza is the only place on the planet where, when a war starts, there is nowhere to go. You cannot get out. You cannot get out to Israel, obviously, but you cannot get out to Egypt either. And the sea of course is also sealed. And so, when you think of other wars, you know people will move and find safety somewhere else, you know think Ukraine and the size of Ukraine and people move to the West of Ukraine and find safety.

In Gaza this is simply not possible. And what has happened since the very beginning unfortunately is that an inhuman mechanism has been established whereby paying you can pay your way out. We have heard that the price is between $5,000 to $10,000. It actually depends…  and somehow magically what is not possible for everybody becomes possible for the few that have the means to do it. I stop here. You draw your own conclusions, and it is the sad reality of war.

Diana:

Has anyone asked Israel what their plans are for rebuilding after the war? Do you think that the Israelis are targeting homes? I don’t just think they’re targeting homes. I can tell you that they targeted homes It’s a daily reality.

Now it is true that given the type of warfare that has been initiated and the type of military presence that has been consolidated in Gaza whereby Hamas has built tunnels that are you know across the street. In several instances they are under civilian buildings. But where do you draw the line to justify that to hit the tunnel you can destroy a ten-storey building, killing fifty or a hundred people? What is the right proportion?

In International Humanitarian Law there is a concept of proportionality where you draw the line of proportionality and now and no legal expert will tell you what proportionality is. It is one of those principles that is impossible to prove legally, and it has not been ever proved I think but from the humanity perspective can we not agree that there is a limit to what war should be allowed? And the reality, as I hope I made clear during the presentation on the health facilities, is I do believe that the basic laws of war have not been respected. This is not a problem only for Palestinians in Gaza but it’s a problem for the entire humanity because we are allowing something that we should have never allowed to happen. It’s a step back for humanity and it’s causing immense pain when you have an entire family wiped out in a second, children, women, elderly men – just because there might be a tunnel or there might be a Hamas operative. Is that a right measure? I don’t know. As a human being I’m very troubled by that and I think that we should be mindful of that.

Who’s going to pay the bill? I have no idea.

Historically we have seen that after the recurrent events in Gaza the bill was always presented to the international community. This time around the devastation is beyond the imaginable because believe me I’ve seen areas which do not exist anymore. There is no more the neighbourhood.

In January the World Bank made an initial assessment calculating $18 billion of damages and that was before Khan Younis, which has been in some areas completely flattened – doesn’t exist anymore. I was driving 2 weeks ago in Khan Younis, and you go in a car, and you are two metres under the level of the street, and you have all the rubble from the buildings that are standing next to you. And then you look up and all the buildings are damaged and hit by shells. The bill will be gigantic. Rebuilding will take decades. We have to make sure that we stop the killing and the pain for people that are living there and then we will discuss reconstruction.

Diana:

Two questions about aid coming into Gaza by sea. Is aid by sea a possibility? What are the restrictions there?

Andrea:

One of the most important steps that the government of Israel has taken recently is that they allowed the use of the Port of Ashdod for delivery of humanitarian assistance. That is a major step forward because there’s a big harbour equipped and able to accept a considerable amount of commodities. There is of course always the devil in the detail. There is a limitation the ability that they have to scan what is in the aid consignment and we respect the concerns about security given what has happened historically in Gaza.

If by a maritime corridor you mean the announced operation by the President of the United States. I think we will see, we expect that operation to start. My understanding is at the moment it will start with 50 trucks per day which is not enormous.

The bottom line for us has always been as United Nations, we have said whatever comes additional is good, but let’s not lose focus. The access via land is the key and it has to be maintained and sustained and simplified and streamlined in a way that is adequate to the needs of people. And it’s not only quantity, it’s also quality because you know, solar lamps are not allowed into Gaza simply because they can be considered dual use.

Latrines have been complicated to bring in. Chemicals for the desalination plants have been complicated to bring in; generators, with the lack of electricity. Everything works on generators and as of today we have a gigantic problem with cash availability inside Gaza because there are two ATMs functioning – just two – and of course the ATM needs energy so a generator – that means fuel and fuel is controlled and limited. So again, the obstacles are many. That’s why it is important to maintain land access, because it’s the only way to solve that and expanded the diversity of products that we can bring in.

Diana:

I had read that animal feed was now on the restricted list as well, which is particularly devastating because I also read that apparently a lot of humans are surviving off the animal feed.

Andrea:

It’s interesting Diana that you mentioned that. Our colleagues from the Food and Agriculture Organisation have been mentioning this since the very beginning of the war. It was a good way to maintain self-reliance when you have you know chicken or the donkeys and then you realize that is animal feed is important for sure for animals like poultry. But donkeys have been the success story in order to bring around water to people because there are areas like in Rafah there are no wells.  So, water has to be fetched in and then being brought to Rafah.

So to do that when you are running out of fuel and cars cannot move anymore, there are some that can still do that because we managed to provide them some fuel, but the vast majority is donkey cart bringing water for people. But the donkey has to survive… And so animal feed is super important. I’ve heard that recently it was approved for entry, but for six months it has not been approved.

Diana:

Could you address the issue of those badly injured children who need to be evacuated abroad for medical treatment? How many, in your estimate, who decides who is eligible and then takes the decision to let them out? Who then looks after them and where do they go? Are they able to take companions like parents with them?

Andrea:

This is another chapter of tremendous suffering and sadness, which is even complicated because not only we have the newly injured with, you know, thousands of people that have been amputated that have no access to any type of rehabilitation and support, but those patients whose pathologies cannot be treated inside Gaza. We had at least 9000 cases that were supposed to be evacuated and only half of those have been allowed, a bit more than half, to evacuate.

One of the issues is that there is a very tight restriction on ages. Males over 18 cannot exit. The percentage of males above 18 that have been allowed to exit is really minimal. Children below 18 then need to have a companion, but they have to be women and they have to be older than 55, which means that young mothers cannot bring their children out.I  remember when I was at the crossing when there was a couple: the mother had cancer and the child had a heart disease. The father wanted to bring them out and the only possibility for the mother was to either send him back (then there was not that restriction on gender that I just mentioned) was either to send him out along with the baby or for her to take the  baby but then she cannot take care of the baby if the mother is also under treatment for cancer. The authority would allow only one of the two parents to get out.

Stories like this are endless, unfortunately. Nobody is telling these stories because, remember, there are no international press allowed in – and this is the 7th month of war.  As much as we try to tell the stories, what we focus on is more assisting people – we’re probably not good enough at telling all these stories. The number of stories like this is terrible. How they are then treated when they go outside?  I know that those who were with the companion of course are followed by their family member. Some UN Member States have opened a certain amount of slots for patients to be referred at some point. There was also a French boat and a British boat, medical boats that were treating injured people.  But the reality is that the number of people evacuated, medically evacuated from Gaza is far from what it should be. We have no data on the excess of fatalities linked to treatable diseases that have not been treated in the last seven months.

I was in the European Gaza Hospital a month ago. They have a department where they do catheterization for the heart, and they said this is the last machine available in Gaza. If we lose this hospital, we will lose the last possibility to do this life saving surgery that should be of a routine kind that can save lives. There is only one X-ray machine, such specialised devices. It’s really the entire system has been put on its knees, that’s the reality. It’s horrendous.

Diana:

What do you think that we can do in order to help the situation at all? Is it a case of donations? Do we just carry on writing to our MPs?

Andrea:

We have seen a progressive shift in the trajectory of the behaviour of Israel vis a vis this situation. I think it is only international pressure that will bring this to a reasonable outcome.

We have unequivocally condemned as the United Nations what happened in October. We keep on asking for the release of the hostages. It’s something that we cannot, and we should have never linked the release of hostages with the lever of humanitarian systems or with the respect of international humanitarian law. Those things should remain separated.

I think hearing the voices of constituents for your politicians is important. They have the ability to change the direction of things. They have to do it with all the means of influence that they can exert. That’s where we should go, because that’s the only hope to give some glimpse of hope for the children in Gaza.

If we think that we will not pay collectively the price of such a failure, it’s a fundamental mistake because this is a crossroads for the credibility of the humanitarian principles, the humanitarian aid, the United Nations and the international community’s credibility vis a vis what we have preached and defended, which is the values of the UN Charter, international humanitarian law and human rights. So I think we have to keep on putting pressure on those who have influence.

The other day, the humanitarian coordinator said something that I think is the real answer. We are the nurses. Politicians are the doctors. We will deal with the symptoms, but the root causes of the disease can be dealt with only by doctors. You are the ones who decide who the doctors are, how they behave. And that’s how we have to move the dial.