Journal Essay

Negative Impact of Policy on Humanitarian Assistance in Gaza

Martha Myers

Summer 2009, Volume XVI, Number 2

Ms. Myers is the country director for CARE in the West Bank and Gaza.

There are really no good reasons for the people of the Gaza Strip to be sliding towards the kind of poverty that characterizes the poorest places on earth. Palestinians are generally healthy, well-educated, and have a good work ethic. Gaza faces the Mediterranean with what could be a viable port if it were ever successfully developed, and it borders a state with a dynamic economy, Israel.

However, Gazans are poor, and the entire Gaza Strip is being sustained by international humanitarian assistance. With Gaza’s border hermetically sealed by Israel since October 2007, the already fragile private sector has collapsed from want of production materials, export markets, electricity, fuel and cash. Almost the only jobs in Gaza at this point are as employees of the huge assistance effort — those who work for the United Nations, the nongovernmental organizations, or in the service sector that supports and supplies that assistance effort. Even Gaza’s farmers now require assistance in order to continue producing food. CARE International, with the support of the European Commission’s Humanitarian Aid Office (ECHO), operates a scheme that purchases produce from local farmers and redistributes the needed fresh food to Gaza’s hungry. Without this kind of assistance, farmers have no place to sell their produce in Gaza’s impoverished and cash-strapped market and therefore would be unable to capitalize planting in a new season, deepening Gaza’s food insecurity. The Fatah Palestinian Authority (PA) in Ramallah continues to pay salaries to its employees in Gaza, many of whom have not actually reported to work since the June 2007 outbreak of internecine violence in which Hamas expelled effective Fatah control from Gaza. The PA funds for these salaries are provided largely by the donors.

So why are Gazans poor? An estimated 70 percent live in deep poverty on less than $1.25 a day (46 percent when foreign assistance remittances are calculated as household income).1 The numbers of Gazans dependent on international food assistance has risen from 80 percent before the December-January Israeli assault on the Strip to 88 percent now. Of course, to say there is no good reason for the poverty would be, at this point, to ignore a lot of water under the bridge — the widespread and debilitating trauma and stress afflicting 1.4 million people under terrible pressure and subjected to daily violence. It would be to ignore the degraded, overcrowded education and health systems, the crumbling water, sanitation, electricity androad networks, and the evisceration of the private sector over the past two years.

There is a lot of work to be done, expensive work, to stand the Gaza Strip up again. This work would all be in the realm of the possible and sustainable except for the web of policies that have bound the people of Gaza in virtual chains. Who are the authors and implementers of these policies, and what are the policies that have so devastated Gaza?

Three actors play primary roles in Gaza’s suffering today: Israel, Fatah and Hamas. Policies they have formulated and are implementing hinder and retard the delivery of much-needed humanitarian assistance to a population almost wholly dependent on it for basic needs. In some cases, the harm done to the innocent seems to be inadvertent, a by-product of policies whose intent is focused elsewhere. In many cases, the intent seems painfully clear — that the people of the Gaza Strip will pay for supporting Hamas.

The members of the Quartet (the United States, Russia, the European Union and the United Nations), who have so steadily supported Israel’s occupation, have turned a blind eye to what John Holmes, UN undersecretary-general for humanitarian affairs, has characterized as the “collective punishment” of Gaza’s civilian population.2 Quartet policies have fueled the disastrous division in the current Palestinian political scene, and they cannot pretend to be uninvolved. Of course, the policies that hinder humanitarian assistance today are closely related to (and in some cases are one and the same as) the policies that have steadily dispossessed and impoverished the Palestinian people for more than half a century. In particular, it is important to remember that the Gaza Strip only exists because Israel exists. Its borders were arbitrarily drawn in 1948, and over 70 percent of its population comprises refugees from towns and villages that are in Israel today.

Above all others, Israel’s policy of siege has harmed the civilian population of Gaza. Responding to repeated rocket fire from the Strip, Israel designated Gaza as a “hostile entity” in September 2007 and set up a blockade around it. The siege impedes the delivery of humanitarian assistance because it impedes access to and from Gaza. The policy has not been meaningfully challenged by the international community, which continues to fund the huge transactional costs the Israeli siege imposes on assistance delivery. The donors set up mechanisms to meet the Israelis on their own terms, tacitly legitimizing a policy that contravenes international conventions and law. The Fatah PA has not paid much more than lip service to rolling back the siege, at times even taking advantage of it to prosecute its own squabble with Hamas. This is indicated in the matter of transit through Rafah, where protocols for the passage of people have vested them with considerable authority, and the transfer of patients out of Gaza for medical treatment. The de facto authority in Gaza, Hamas, has remained obdurate in matters such as the release of Israeli soldier Gilad Shalit, now hostage for almost three years. It insists on maintaining its political dominance regardless of the cost to the people of Gaza.

The siege has shut down the import and export of goods and the movement of people into and out of Gaza. It has tightened steadily with a climax in November and December 2008, when, for example, the number of trucks carrying goods into Gaza in November 2008 declined to an average of one truck a day, 4 percent of the number that entered Gaza in December 2005.3 This is tantamount to trying to provision the city of Philadelphia with 23 truckloads a month — an obvious absurdity.

As part of the siege policy, no building materials — cement, steel, wood or glass — are allowed into Gaza. Nor are pipes or spare parts for the water, sanitation or electrical grids. Fuel and cooking gas have also been restricted, leading to power outages and contributing to the further debilitation of the private sector. Leading up to the December 2008 Israeli attack and during much of “Operation Cast Lead,” most bakeries in Gaza had to close for lack of both flour and cooking gas. The World Food Programme stepped in to supply flour to commercial bakeries that still had access to cooking gas, to avert catastrophic bread shortages. The policy of prohibiting all pipes — just because some pipes are used to manufacture the crude Qassam rockets fired at Israel by Hamas and other groups in Gaza — has been particularly disastrous to the water system. Many humanitarian-assistance organizations have suspended or canceled important water and sanitation projects due to the unavailability of pipes. Donors have largely acquiesced to the Israeli-created reality, supplying the water system by means of tankers.

The Israelis assert that they have a list of about a dozen “humanitarian” items that they will allow into Gaza under tightly controlled circumstances. However, they will not divulge the list, and it changes frequently. For example, the Israelis recently rejected shipments of macaroni, not previously forbidden, at the Kerem Shalom crossing into Gaza. After outrage was expressed by two American congressmen and a U.S. senator (the fi rst American political figures to visit Gaza in years), the macaroni was admitted, but jam was forbidden the next week. CARE, trying to import a dryer purchased with U.S. government funds for use in sterilizing linens at a hospital, was told by the Israelis that they did not see it as necessary or humanitarian. On the fourth try, and after accruing storage and shipping costs that doubled its value, the dryer did enter Gaza. Thus, the organizations that deliver humanitarian assistance are in a constant and very expensive guessing game about what they will be able to get into Gaza. In the meantime, the needs mount, particularly in light of the wholly unmet need for reconstruction after “Operation Cast Lead.”

The siege also prevents the movement of people, making the responsible delivery of humanitarian assistance very challenging indeed. International nongovernmental organizations (INGOs) operating within a web of restrictions and limitations on their interactions with Hamas need access to Gaza for their personnel in order to exercise adequate oversight and management. A recent, informal poll among these organizations indicates that about a third of INGO requests for access to Gaza were granted by the Israeli authorities. There was no predictability in terms of who would be given permission or in what time frame. Many organizations reported that they didn’t even bother to apply to enter; they assumed access would not be granted. Furthermore, even for those with access, passage between Israel and Gaza at the Erez crossing is extremely unpredictable; it can take less than an hour or a whole day, for reasons that are never clear. Even with permission and coordination, entry can be refused after several hours of waiting. Furthermore, Erez’ hours of operation change, and it not infrequently closes without warning, forcing unplanned overnights in Gaza, contributing to increased transactional costs. Only a handful of Gazans are permitted to leave, degrading the planning, strategizing and training of international humanitarian-assistance organizations.

Israeli policy related to the siege has been to limit the use of the small number of crossings into Gaza. Erez is the only crossing for people. Nahal Oz is opened intermittently to admit industrial diesel fuel. (Although Nahal Oz can also efficiently transfer diesel and gasoline, Israel has not allowed more than token quantities of either for several months, and much of the supply to Gaza comes through the tunnels. In the month of December, Nahal Oz opened for a total of eight days for industrial-fuel transfer to the Gaza power plant.4) The Karni Crossing, the main crossing for commercial goods and the only one equipped for the fast, cost-effective transfer of goods — the grain belt for wheat — was completely closed for many months and is now only partially and intermittently open. Kerem Shalom, in the far southeast corner of the Strip, is now the major conduit for goods.

The Israelis, with some justification, claim they cannot open Nahal Oz or Karni fully for security reasons; they have been attacked at these crossings a number of times. However, it is clear that depriving the Gaza Strip of goods and fuel is about more than day-to-day security at a crossing point. It is about pressuring and punishing the de facto Hamas authority and all those who happen to live in its proximity. Hamas has done little to address Israeli security concerns, perhaps wanting to be able to attack the Israelis anywhere they can access them. Nor have they created a protected zone for the crossing. The result is that the people of Gaza have to bear shortages and increased costs for goods.

For the international community, trucking the goods that meet basic needs — food, medicine, shelter supplies and basic hygiene provisions, including chlorine for the water system — via the much longer trek to Kerem Shalom increases time and distance. This means more expensive aid or aid packages; less of each dollar goes to the fi nal beneficiary and more to the middle man. Furthermore, Kerem Shalom operates on a back-to-back system: Israeli trucks enter the east side, where the goods are screened and trucks are off-loaded. “Sterilized trucks” then move the goods (on pallets) to the west side of the crossing and off-load them again; then, Palestinian trucks are permitted in from the Gaza side of the crossing to reload the pallets. Needless to say, a process that involves three different trucks and security screening in a fairly small crossing is not efficient, and Kerem Shalom can only process a limited number of trucks in a day. At present, trucks from the Gaza side of the border may pick up pallets only between 2:00 p.m. and 4:30 p.m. The international community, particularly those working in the occupied Palestinian Territory (OPT), have objected to the focus on Kerem Shalom and the underuse of the other crossings. No real muscle, however, has been put into insisting that Israel adhere to the principles and protocols of the 2005 Agreement on Access and Movement.

There are some very narrow categories of exceptions to Israel’s policies. A notable one has been the transfer of medical patients for treatment through Erez to Israel, East Jerusalem, the West Bank, the Arab world and beyond. While the need to transfer patients has grown with the weakening of the Gaza health system due to the Israeli siege and the Fatah/Hamas struggle for control, the transfer numbers have dropped steadily, zeroing out in the early days of Operation Cast Lead and then again on March 22, 2009. By way of comparison, the World Health Organization reports that an average of 900 patients were referred out of Gaza every month in the first half of 2008, a number that is probably far below the level of demand but indicative nonetheless.5

The matter of medical referrals has become fraught, with the ill and injured paying the price as Israel, Fatah and Hamas attempt to exert hegemony. While Israel has narrowed the corridor to medical treatment outside Gaza, Fatah and Hamas have made a bad situation worse. The procedures for referring patients out of Gaza involve the Israelis and the Fatah Ministry of Health in Ramallah. Hamas has been largely sidelined in the decision-making process. Of course, if patient treatment is to be paid for by the Fatah Ministry of Health, the need for its involvement in decision making is obvious and rational. However, even those who could and would pay for their own treatment are caught up in the narrow system, which considers transfers only for pediatric, oncological, cardiovascular and ophthalmological cases.

The on-again, off-again nature of the referral process and the many actors involved — including the World Health Organization, International Committee of the Red Cross, Israel, the Ministry of Health in Ramallah and Hamas — is beyond the scope of this paper. Suffi ce it to say that, due to Israeli restrictions on Palestinians’ ability to leave the Gaza Strip and the internecine battles between Fatah and Hamas, many who need care have been unable to access it, and the chronically ill have suffered repeated, substantial interruptions to their treatment. On March 22, 2009, the de facto Hamas authorities took over the Referral Abroad Department in the Ministry of Health in Gaza, a section of the ministry they had left intact and in the control of Fatah as a matter of humanitarian expediency. They are reported to have objected to what they say is factional favoritism and use of the referral system to get people out of Gaza who were not really ill, a charge that informed observers do not dismiss as baseless.6 However, their decision to take control has brought all referrals to a halt, serving nobody and harming many. Referrals through Rafah have also ceased, with the Hamas de facto authority reportedly saying that, if the Egyptians don’t permit more access into and out of Gaza through Rafah, nobody will get out. Clearly this policy, which plays politics at the expense of people’s access to health care, is unacceptable. Essentially, Israel, Hamas and Fatah are all impeding those who need treatment unavailable in Gaza from leaving.

As already noted, the 1.4 million people trapped in the Gaza Strip are wholly dependent on international humanitarian assistance to meet their basic needs. In such an environment, and where there are ongoing disputes, it is necessary that all parties adopt policies that protect a neutral and impartial humanitarian space in which assistance can be delivered. Efforts to turn that assistance to one political end or the other can cause tremendous harm to the people who need it most. In the context of Gaza, international assistance organizations are squeezed between the competing agendas of Israel, Fatah and Hamas. Israel effectively controls all assistance going into Gaza, limiting the kind and quantity, thereby limiting the effort severely. Hamas and Fatah, ever jealous of the other’s powers and prerogatives, seek to exert their authority by controlling the flow of assistance and the movements of humanitarian aid workers. As an example, the de facto Hamas authority has recently asked all INGOs to register at the Hamas controlled Ministry of Interior. Most of these organizations are bound by anti-terrorism legislation in their home countries, making this kind of legal recognition diffi-cult. Furthermore, it is likely that the Palestinian Authority in Ramallah would take a very dim view of organizations already registered with it opting to also register with a different “Palestinian Authority.” If Hamas insists on enforcing this policy and politicizing the presence of the INGOs in Gaza, it could lead to their withdrawal.

In response to the constraints experienced by humanitarian agencies, theHumanitarian Country Team, chaired by the Humanitarian Coordinator for the OPT, has prepared a joint framework of principles to guide the provision of humanitarian assistance to Gaza (“Framework for the Provision of Humanitarian Assistance in Gaza”). The framework lays out the four underlying principles of humanity, neutrality, impartiality and independence and then draws a series of straight lines between them and issues facing the delivery of humanitarian assistance — most notably, insufficient of access and excessive interference. The framework has been presented to all parties, including Israel, the Palestinian Authority in Ramallah, the de facto Hamas authority in Gaza and the donors, who represent many of the member states of the United Nations. Using this lens, it would seem to be a simple, yet profound act for all parties to step back and examine the impact of their policies of the vulnerable people of the Gaza Strip.

Until the direct parties to the conflict — Israel, Fatah and Hamas — modify the policies that intentionally or inadvetently impinge on the neutral, impartial and independent humanitarian space, and until the international community holds itself as well as the parties accountable to their obligations to the innocent citizens of Gaza, the wholly unnecessary suffering will continue.


1 The World Bank Group, West Bank and Gaza, “Country Brief,” September 2009,,,contentMDK:2014975 1~menuPK:294370~pagePK:1497618~piPK:217854~theSitePK:294365,00.html#_ftnref5.


2 Louis Charbonneau, “Collective Punishment for Gaza Is Wrong,” Reuters, January 19, 2008,

3 OCHA, “Humanitarian Monitor, Occupied Palestinian Territory,” Number 31, November 2008, p. 4.

4 OCHA, “Humanitarian Monitor: Occupied Palestinian Territory,” No. 32, December 2008, p.5,

5 United Nations Office for the Coordinator of Humanitarian Affairs and the World Health Organization. Joint Statement: Concern over the Halting of Gaza Medical Patient Referrals, March 30, 2009,

6 Author’s notes from Humanitarian Country Team Meeting, Jerusalem, April 6, 2009.