Power outages in Gaza increased from 14 hours a day in January 2017 to 18 hours in May to an all-time high of 21 hours a day in July. The strip’s energy crisis stems from a dispute over fuel taxes between Hamas and the Palestinian Authority in April.

In addition to the impact on the daily lives of civilians, long blackouts inevitably disrupt the normal functioning of civilian infrastructure. Power cuts hinder the operation of water and wastewater treatment facilities, heightening the risks of water-borne and diarrheal disease outbreaks. Power cuts also interfere with the treatment of thousands of patients at Gaza’s health facilities and clinics.

Effect of Power Shortage on Health Facilities

In light of the power shortages, hospital administrations adopted a number of practices and coping mechanisms to conserve electricity. In a statement published in May 2017, the Kuwait Charity Specialized Hospital in Gaza announced that surgical operations, dentistry and x-rays will only take place when the hospital generators are turned on. Due to the shortage of electricity, the hospital’s generators are switched off for 14 hours every day and completely switched off every Friday. Al-Shifa Hospital, Gaza’s largest medical facility, reduced surgeries by approximately one-third due to the power cuts. Hospitals have reportedly postponed elective surgeries and have reduced 80% of cleaning, catering and sterilization services.

Without fuel, 11 obstetric theatres, 40 surgical operation theatres, five hemodialysis centers and emergency departments will be forced to close critical services. In April 2017, the Palestinian Ministry of Health announced the closure of four hospitals in the strip. Abu Yousef Al Najjar Hospital in Rafah, Beit Hanoun Hospital, Al Dorra Pediatric Hospital, and the Mental Health Hospital in Gaza have closed due to power shortages.

Although hospitals are equipped with generators, fuel shortage makes it difficult for them to operate continuously. Additionally, the generators are oftentimes overloaded and prone to malfunction.

Effects of Power Shortage on Patients

The power and fuel shortages have forced hospitals to suspend several key services and delay surgeries for many patients. For example, Fayaz Ahmed’s surgery was postponed for weeks because his doctors were not able to ensure continuous supply of electricity for his six-hour surgery.

Dr. Mohamed Abu Selmia, director of Al Rantisi Pediatric Hospital, the only specialized hospital for children in Gaza, says that CT scans, X-rays and other machinery at the facility do not work optimally because of the blackouts. Dialysis patients are especially at risk. When power supply is interrupted, blood cycle rotation stops. Without prompt action, a patient’s blood could get coagulated, leading to adverse health consequences. “Depending on the patient’s condition, the interruption of dialysis might lead to death,” says Dr. Mohamed Shatat, who oversees the Dialysis Department of al-Shifa hospital.

Medical Referrals

In light of the limited health capabilities of Gaza hospitals, treatment in Israel or the West Bank has become an increasingly preferred option for Gaza residents. However, patients who are unable to receive adequate treatment in Gaza stand a very low chance of receiving treatment outside the strip.

The Palestinian Authority has reduced its financial support for civilians seeking medical care outside Gaza. In May 2017, the Palestinian Authority’s Ministry of Health issued 1,484 referral decisions, the lowest number of referrals for Gaza patients since January 2015. In June, the Ministry of Health issued permits for 477 people to travel outside Gaza for treatment – the lowest number since the World Health Organization (WHO) started to monitor referrals in 2009. Of 1,920 patient applications in June 2017 for a permit to exit Gaza and seek health care in Israel or the West Bank, 20 were denied and 949 were delayed with no response by the date of the patients’ hospital appointment. Among those delayed were 222 children under the age of 18 years old.

According to Ashraf al-Qidra, a spokesman for Gaza’s Health Ministry, “The ban not only worsens health conditions of those patients but some had actually died waiting.” Between April and June 2017, 11 patients, including three newborn babies, died after their permits for medical treatment were either rejected or delayed. Abeer Abu-Jaiab a 45 -year-old woman, died in Al-Aqsa Hospital in Gaza on 8 June 2017 while awaiting a permit to access health care at Augusta Victoria Hospital in Jerusalem.

Conclusion

No agreement has yet been reached to end the electricity crisis in Gaza, despite UN demands that parties to the conflict address the problem at hand before it develops into a humanitarian crisis. The Palestinian Authority’s decision to stop funding Gaza’s electricity is leading to a serious deterioration in the humanitarian conditions in the strip, the consequences of which are a direct violation of the non-interference principle of medical impartiality. Without fuel, hospitals in Gaza have been unable to provide adequate health care to the civilian population. The Palestinian Authority must reverse its decision. The health care of civilians in Gaza should not be adversely affected due to disputes between the Palestinian Authority and Hamas. Further, Israel’s strict regulations on health permits coupled with its blockade of the strip, which deprives Gaza’s health sector of vital resources, only worsens the already dire situation. By controlling access to the strip, Israel has an obligation to ensure access into and out of the Gaza strip for humanitarian assistance and aid.