Gaza 2009 ErikFosse LOWRES

Gaza 2009 ErikFosse LOWRES

Gaza 2009

Professor Erik Fosse MD

Rikshospitalet, University of Oslo

Gaza facts

• Governed by Egypt


• Occupied by Israel


• Israel still controls borders,

airspace, harbours

• Size: 360 square km

41 km long 6-12km wide

• Population 1.5 mill

• Mean age 17 years

• 80% under WHO poverty

definition after blockade

Recent history

• Election January 25 2006

• Hamas got 42.9% of votes and 74 of 132 seats in parliament

• In April USA, European countries including European Union and

Norway cut off direct aid to the Palestinian authority beacuse Hamas

would not renounce the use of violence.

• Autumn 2006 Coalition government was formed between Hamas and


• Norway acknowledged the coalition government, but no other country

• All Hamas members of government arrested by Israel

• January 2007 fighting in Gaza between Hamas and Fatah

• 14. June 2007 Hamas gained full control of Gaza strip

• Fatah created an all Fatah government on the west bank which was

announced the legitimate government by Arab states, US and Europe

• Israel immediately closed all borders

• 23 January 2008 Hamas broke the barrier to Egypt, closed after 12


• Tunnels became the only way of smuggling goods and weapons

Effects of the blockade

• All goods production stopped 2006

– Small industry

– Vegetable, fruit and flower export

• Stop in building material import 2007

• Stop in medical equipment

• Stop i grain import, all mills closed

• Stop in electrical power supply

• Stop in fuel

• Poverty increased

• Health care shortage

– Health care controls

– Maternity control

– Chronic illness

– Psychosocial support

• Deficiency disease increased

• During autumn 2008 no western

journalists or humanitarian aid residents

were allowed into Gaza

• No protection of the people

Breadline, Gaza January 2009:

5-6 hours waiting to maybe get some bread

"It's an atrocity what is being perpetrated as punishment on the people in Gaza.

It's a crime... I think it is an abomination that this continues to go on,".

Former president Jimmy Carter to Haaretz 19th april 2008

The attack started 27th December 2008

The Shifa hospital

• Main university hospital

• 546 beds

• 406 MDs

• 278 nurses

• 1011 employees

Total tear of the brachial artery-Interposition of vein graft

Wednesday 31/12 Burial of a doctor

killed while working in an ambulance

Reception area

Reception area-employees and


Rtg avd 1 CT 4 Rtg lab

Innleggelse av thoraxdren

Triage møte 3. januar


T1: Immediate treatment

T2: Delayed treatment

T3: Minimal treatment

T4: Expectant treatment

Areale for T3

60% av pasientene

Invasion started Saturday 3/1

Bombing of the Ibrahim al Maqadma mosque in Beit Lahiya

Ambulances and civillian cars lining up with patients

Patients are coming

Saturday 3/1 Bombing of the

Ibrahim al Maqadma mosque in

Beit Lahiya, chest injury

Sunday 04/01 Bombing of the vegetable

market- surgery in the OR corridor

Two patients in each OR

Tuesdag 6/1 Bombing of al Fakhora –

UN school in Jabalya camp

The heroes

DIME weapon injury?

Kompresjon av karskade


Phosphorous bombs at school in Beit Lahiya

Foto: Omar Barghouti

MoH daily statistics

Statistical office phoned all hopitals at 4 pm.

All injured or dead that could be

identified by name, age and gender were


Killed pr. 180109

Total number of killed: 1300

410 children

Injured pr 180109

Total number of injured: 5300

1855 children< 18 years, 795 women, 2650 men

Consequences of the war

February 8th

• More than 5300 people injured, mostly civillians

• More than 1430 people killed, 431 (32%) children

210 female

• 12 ambulances destroyed

• 11 ambulance personell killed

• Public buildings destroyed (ministries, all police

stations, schools, 42 mosques)

• Al Quds hospital bombed and burned down 9/1

• UN main storage bombed

• More than 4000 buildings totally destroyed

• More than 20 000 buildings severely damaged

Shifa hospital

The war on Gaza 2009:

Situation for the civilians

Special situation in Gaza

Densely populated

Demography (Very young population)

Nowhere to run

No “Civil defense”

Weakened infrastructure

Weakened health

Several accumulated trauma

The war

Targets: The Civilian population?

Ambulances were targets

Overload to the hospitals

Limited supplies to hospitals


Difficult evacuation out of Gaza

Security for international organizations

No western journalists

Mo western witnesses

Psychosocial factors: Terror

Witness and medical professional

Lancet editorial Vol 373 January 17, 2009

We find it hard to believe that an otherwise internationally

respected, democratic nation can sanction

such large and indiscriminate human atrocities in a

territory already under land and sea blockade. The heavy

loss of civilian life and destruction of Gaza’s health

system is unjustified and disproportional, despite rocket

attacks by Hamas. The collective punishment of Gazans

is placing horrific and immediate burdens of injury and

trauma on innocent civilians. These actions contravene

the fourth Geneva Convention.

We are disappointed by the silence of national medical

associations and professional bodies worldwide in

response to this destruction and dislocation of health

services. Their leaders, through their inaction, are

complicit in a preventable tragedy that may have longlasting

public-health consequences not only for Gaza,

but also for the entire region. ■ The Lancet

Consequence of the war concept

• War is terror

• War creates terror

• Causes severe destruction of the civillian


• Invites extremism

The attack on Gaza

• Was a humanitarian

cathastrophe for the


• Was moral cathastrophe for


• A political solution can only

be achieved through

negotiations with all parties

IDF December 28th 2008:

”We hit 90 % of the intended targets”

32% of injured and killed were children

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