The blockade dictates the day-to-day reality for people in Gaza, where Israel controls the borders, airspace, and waters. Gaza's isolation has devastated its economy, impoverished much of the Strip's two million people, and left them without adequate electricity, water and health services.
Poverty contributes to poor health, and poor health leads to poverty - it's a vicious cycle. In Gaza, poverty is rife. At 41.1 percent, the unemployment rate is the highest in the world (youth unemployment is just shy of 64 percent), over a fifth of the population lives in "deep poverty", and 80 percent of the population depends on international aid, primarily for food assistance.
The executive director, Dr Adnan al-Wahaidi, Ard el Insan (AEI), a local NGO, says cases of acute malnutrition with signs of severe wasting among young children in Gaza are increasing.But the real public health concern is chronic malnutrition, characterised by stunting and rickets, says Wahaidi, who has seen rates increase by about 50 percent over the past decade among children aged five years and younger, rising from nine percent to 13.4 percent of the population. Chronic malnutrition during formative years can lead to irreversible consequences and side effects that will affect the body's physiological systems, including the immune system, as well as cognitive achievements and physical development.
Gaza is witnessing other worrying trends - rising rates in younger age groups of non-communicable diseases such as cardiovascular disease, type 1 diabetes, and cancers. He says obesity among children is rising sharply as more families rely on cheap, high-caloric foods because they cannot afford basic, nutrient-rich foods.
The blockade and three Israeli military assaults have had a profound toll on mental health in Gaza, too.
Substance abuse, suicide, domestic violence, depression, anxiety and post-traumatic stress disorder (PSTD) have increased among adults, as have bed-wetting, low academic achievement, nightmares, fear and anxiety among children, according to Dr Sami Oweida, a psychiatric consultant at the Gaza Community Mental Health Programme (GCMHP). He also notes a rise in somatoform disorders - a form of mental illness in which a patient complains of physical ailments, including pain and fatigue that have no apparent physical cause. According to a recent study published in PLOS ONE, a multidisciplinary research journal, Palestinians suffer the highest rates of mental disorders among all Eastern Mediterranean countries. The study attributes this to 50 years of occupation and exposure to related political violence. Dr Oweida says that work the GCMHP undertakes at their centre, coupled with outreach and capacity-building work with local partners, cannot keep pace with the demand. "Any effective therapy is pointless because of the blockade - that is the root cause. The high levels of unemployment, especially among men, the traditional head of the family who can't protect the family and secure its basic needs - that creates anger and frustration ... and is often expressed through violence in the home," he told Al Jazeera. "People see no reason for optimism - they are trapped in a large prison. There is no horizon, no political solutions. The people anticipate a new military assault, it is always on their minds. There are constant reminders of provocation, through drones, sirens, destroyed buildings ... It creates high levels of anxiety in everyone. Nothing will help, except ending the blockade and giving dignity back to the people."
Life for the people of Gaza has become characterised by soaring unemployment, acute fuel shortages, electricity supply for a couple of hours a day, a crippled water and sanitation system, prison-like movement restrictions, and the ever-looming threat of full-scale Israeli aggression on the horizon. Given the current local and international political landscape, conditions seem likely to deteriorate further, compounding adverse conditions for health and pushing a basic and fragile health system ever closer to collapse.
Following the shutdown of the Strip's only power plant after it ran out of fuel, Gaza's 14 public hospitals and 16 health facilities now "face partial or complete closure of essential services", according to the World Health Organization (WHO). Gaza's hospitals, operating on a limited reserve of emergency fuel, donated most recently by the United Nations, have partially closed a number of services to cope with the fuel shortage. With Israel and the West Bank-based Palestinian Authority (PA) unwilling to supply more electricity or fuel, Gaza's hospitals and health clinics will be forced to stop critical services - this will be immediately life-threatening for newborns in critical care, patients in intensive care units (ICU), and hundreds of haemodialysis patients. It could also compromise refrigerated blood and vaccine stocks.
United Nations Humanitarian Coordinator for the occupied Palestinian territories Robert Piper expressed urgent concern about steps by the PA and Israeli authorities to further reduce energy supplies to Gaza, warning that if implemented, the situation would become catastrophic. "A further increase in the length of blackouts is likely to lead to a total collapse of basic services, including critical functions in the health, water and sanitation sectors," he said.
According to a 2016 WHO report, "nearly 50 percent of Gaza Strip's medical equipment is outdated and the average wait for spare parts is approximately six months"
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