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The 360 square kms of the 'Strip' represent 1.5% of 'mandate' Palestine. Another 3 million Palestinians live in the ineptly named 'West Bank', and in East Jerusalem. This represents about 11% of mandate Palestine.

Two thirds of the 1.4 million population in the Gaza Strip are refugees and their offspring. The former had fled southwards from their homes and land in 1948 before and during the Arab-Israeli war. The massacre of Deir Yassin on April 4th was a central cause of the panic that drove that mass migration, as well as overwhelming force of arms. The refugees were given materials for building concrete shelters in 'camps' throughout the Strip. They were cheek by jowl, and cold in winter. In spite of UN resolution 242 and others, they have remained trapped in an utterly oppressive environment. Since the start of the second intifada – 'shaking loose', in September 2000, the standard of living has dropped steadily. Unemployment has been over 50% and is rising quickly now. 78% of the population are living under the poverty line of less than US $ 2.1 per person per day, and 10% of children under the age of five suffer from chronic malnutrition. (1) A study in late 2002 found that 17.5% of children aged 6–59 months suffered from chronic malnutrition 53% of women of reproductive age and 44% of children were found to be anaemic (2 )
The Israeli Occupation Force withdrew itself and 8000 colonists last September from the 30% of the Strip they occupied. But the occupation went on. Tight control of the border crossing points has continued, including the one with Egypt - Rafah. Overflights by 'drones', Apache helicopter gunships and F16s persist. The latter were used to cause sonic booms at low levels last autumn. The mental injury to adult and child triggered a petition to the Israeli Supreme Court. (3) The distance from shore within which Palestinians are allowed to fish is set by the occupier, and sometimes banned completely. Thus an important source of high quality protein is limited. A commercial port was being built, but that was bombed along with the airport.

Then in January this year, Hamas received 43% of the votes in scrupulously held elections.(4) Out of this they gained 74 of the 132 seats in the legislature. Hamas, which first came to life in 1987, has been proscribed as a 'terrorist' structure because of its charter and because of its use of suicide bombing from 1993. However, it has maintained a hudna – a truce, with the occupier for 18 months. It has energetically led social, educational projects etc and in Gaza especially. It has widespread support within the populace which wishes to be sumud – steadfast. Ground has been lost in reality and metaphorically; 'not one grain of sand more!'

An already dire state of affairs, was quickly exacerbated. Taxes amounting to $50 million per month that are due to the Palestinian government have been withheld by the State of Israel and financial support by the EU ceased. The latter amounted to 0.5 billion euros in direct and indirect aid per year.

The US has driven this policy of isolation with the clear intention of destabilising the elected government so that it is overturned. There is no money to pay the 150,000 public servants within the 'West Bank' and Gaza strip. This includes doctors, nurses and other health workers. Most have not been paid for two months. There is very little money in circulation. High quality fruit that has been grown for export through Israel has been allowed in only small amounts through Karnai, the commercial checkpoint. No other exports are passing through, and little is coming in. That includes drugs, spare parts for dialysis machines etc. There are no drugs and anaesthetic agents left in the hospitals. Shafa hospital, the main public hospital, was threatened with closure last week. What was to be done for the case of peritonitis? Dr. Moawiya Hassanein at the Ministry of Health (MOH) reported 7-05-06 that Israeli Occupation Forces (IOF) prevented 274 patients last month from passing through the Erez checkpoint to receive vital medical treatment in the hospitals of the West Bank and Israel. He added that they suffer from critical diseases such as cancer, leukemia, cardiac diseases etc. They are in need of urgent and advanced medical treatment as well as surgical operations.

To this economic siege has been added the firing of tens of thousands of shells (5) into 'open ground' for over two months by artillery, tanks and ships. These fall into one of the most densely populated areas in the world. The ostensible purpose is to quell the firing of the primitive and unguided Qassam rockets, which have killed thirteen Israeli subjects in the last two years according to B'tselem ( 6). This Israel based organisation states the indiscriminate nature of these weapons makes their firing a war crime, especially when it is close to Palestinian residential areas. It points out the shelling is a disproportionate response and an inappropriate one, given that these rockets are fired from varying positions. There has been considerable loss of life and limb. In the first fortnight of April, 16 were killed. On 16 April 2006, B'Tselem, along with other Israeli and Palestinian human rights organizations, petitioned the High Court of Justice to cancel the IDF order reducing the safety zone for shells fired into the Gaza Strip to only 100 meters from civilian objects. The petitioners argued that the weaponry is not precise and reduction of the safety zone endangers civilian lives. On 10 April, after the range had been reduced, seven-year-old Hadil Ghiban was killed by a shell that struck her house. The blast also injured twelve members of her family. Gaza Community Mental Health Programme (GCMHP) has documented mental injury to children caused by the noise and shock of shell explosions. In addition to these war crimes, extra-judicial assassination of Palestinian resistance leaders occurs without abatement. Often bystanders are involved. This is usually done by rocket from Apache helicopters or unmanned aircraft.

It is unconscionable and unprecedented that nations who are signatories to the Fourth Geneva Convention and of the UN Charter should be instruments in a siege which is causing suffering and loss now, and which will lead to a humanitarian disaster, probably epidemic disease.

Under international humanitarian law, Israel as occupier, must protect the wounded, sick, children, and pregnant women, enable the free passage of medicines and essential foodstuffs, enable medical teams to provide assistance, and not impose collective punishment. Under international human rights law, Israel must respect the right of every person to freedom of movement, to work, to an adequate standard of living, to education, to adequate health care, and to family life. (6)

The Fourth Geneva Convention of 1949 relative to the Protection of Civilian Persons in the Time of War, states in its first article - "The High Contracting Parties undertake to respect and to ensure respect for the present Convention in all circumstances." In addition, Article 146 of the convention outlines specific obligations of contracting parties, including undertaking legislative procedures, to pursue those suspected of committing serious violations, and to bring them to trial or hand them to a third party interested in bringing them to trial. (7)

The 25 countries of the EU have an additional obligation in that the second article of the EU-Israel Association Agreement states " Relations between the Parties, as well as all the provisions of the Agreement itself, shall be based on respect for human rights and democratic principles, which guides their internal and international policy and constitutes an essential element of this Agreement. (7)

The EU Commissioner, Ms Ferrero-Waldner, is currently negotiating ways to get money into the hospitals and schools without it 'touching' the Hamas dominated Palestinian Authority. AIDA and other NGO groups have spoken strongly against this as being inefficient and destabilising. There are large amounts of money from Arab nations and individuals which are sitting in Cairo and elsewhere because Arab banks fear draconian sanctions by the US if they break the siege.


These words from the total of one hundred and twenty-six in the Balfour Declaration on the 2nd of November 1917 would seem to have been hollow:

' being clearly understood that nothing shall be done which may prejudice the civil and religious rights of existing non-Jewish communities in Palestine,..'

International law is clear as to the state obtaining in Gaza today. There is no requirement to negotiate 'solutions', but for these unlawful actions to cease forthwith.

David Halpin FRCS Orthopaedic and Trauma Surgeon.


1. Jan Coffey – Save the Children UK Programme Manager at press conference with 31 other international aid agencies meeting (AIDA) in Jerusalem on 4-05-06.

2. John Hopkins and Al-Quds Universities for Care International.

3. Gaza Community Mental Health Programme (GCMHP) and Physicians for Human Rights -Israel (PHR): Joint Press Release 14-11-05

4. Jimmy Carter: 'Punishing the innocent is a crime' 05/07/06 International Herald Tribune

5. Conal Urquhart:Observer 7-05-06

6. B'tselem:

7. Palestinian Committee for Human Rights: