Cities under siege (I)

Posted on February 6, 2018 by Derek Gregory

This is the first of a two-part post, in which I return (at last!) to a promissory note I issued last year about siege warfare in Syria. My return is prompted by a series of reports about the catastrophic situation in Eastern Ghouta (a suburb of Damascus) and Idlib.

First, Eastern Ghouta, which has been under siege by the Syrian Arab Army and its allies since April 2013. Most of Eastern Ghoutta was designated as one of four ‘de-escalation zones’ (see map above) under an agreement reached in May 2017, in which aerial violence and all other hostilities would be suspended for six months and humanitarian aid would be allowed across the siege lines.

But the agreement turned out to be primarily a way of killing time. Aron Lund writes:

In September, just as the Eastern Ghouta’s de-escalation zone was finalized, the situation abruptly worsened. After ordering a halt to the already heavily restricted commercial traffic through the Wafideen crossing [see map below: more here and here], the Syrian government refused to permit any more UN aid missions.

It was a transparent attempt to stoke the humanitarian emergency in Eastern Ghouta, but this time the effect was more severe than during previous rounds of food cuts. With the rebel trading tunnels out of commission for half a year, smuggling could no longer compensate for the shortfall or bring in medicine or basic necessities like fuel, which has not entered the Ghouta since February.

Food stockpiles dwindled quickly and triggered a scramble for whatever remained available on the market, the panicky mood inflamed by suspicions that rebel-connected businessmen were hoarding goods for speculation purposes. From August to October, the already high prices inside Eastern Ghouta increased fivefold, far beyond any other region of Syria.

Air strikes (above) and artillery bombardment resumed in November and have continued, and urgent medical evacuations were denied. Here is UN Senior Adviser Jan Egelan in December 2017:

Six months ago a very detailed evacuation plan was delivered to the government for needy cases of evacuation, on medical grounds from eastern Ghouta. Since then, names have been added regularly and it is now, we now have a revised list of 494 names. There are among them 282 cases that need] specialized surgery, specialized treatment, specialized investigations that [they] cannot get inside. There are 73 severe cancer cases, 25 kidney failure cases and 97 heart disease cases [that are] very concerning, five acutely malnourished children that need to be evacuated, six acute mental health cases etc.

The list had to be revised because 12 patients had died while waiting for ‘a half an hour drive to hospitals in Damascus and elsewhere that stand ready to help and save lives.’ Egelan explained that ‘231 of the cases are female, 137 are children, 61 are over 65 years old. So these are civilians, in the midst of this horrific war.’

He added: ‘Civilians, children, no one can be a bargaining chip in some kind of tug of war, where many things are negotiated at the same time. These have a right to be evacuated and we have an obligation to evacuate them.’

Siege warfare involves not only closure of movement across the lines for those inside; it also involves opening the zone to violence from the outside. The assault on Eastern Ghouta has provided ample evidence, but the second case is even more instructive.

And so, second, what was supposed to be the ‘de-escalation’ zone of Idlib has been converted into a ‘kill box’ (for a discussion of the term in relation to remote warfare, see here and here). Here is Martin Chulov and Kareem Shaheen writing in the Guardian:

Russian and Syrian jets bombed towns and villages across north-west Syria on Monday, devastating civilian areas and forcing fresh waves of refugees to flee to open ground in the biggest aerial blitz on opposition-held areas since the fall of Aleppo more than a year ago. Monitoring groups said as many as 150 airstrikes were recorded in Idlib province by Monday, with dozens more pounding up to 18 towns across the region by nightfall. Residential areas bore the brunt of the strikes, which severely damaged at least two major hospitals, and levelled dozens of buildings in which panicked locals had taken shelter.

Refugees and locals say they fear that Idlib has been transformed into a kill box, with the international community paying scant regard to their fate, as regional powers, Russia, Turkey and Iran all vie for influence in a vital corner of the country.

These strikes were in retaliation for the downing of a Russian aircraft – in this spectacularly asymmetric war, only air-to-ground attacks are acceptable – but aerial violence against civilian infrastructure in Idlib precedes that incident. Owdai (al Hisan) hospital in Saraqab City was hit by air strikes on 21 and 29 January, for example, and has now closed indefinitely MSF reports that the loss of the hospital is all the more devastating because ‘medical needs in the area are expected to increase due to the massive displacement of Syrians fleeing fresh violence in Idlib’s eastern countryside and northeast Hama.’

Since then, the strikes intensified:

“The Russians are on a frenzy. They’re going mad. The shelling is ongoing throughout the day and night. The warplanes are hitting residential areas,” Hadi Abdullah, a local journalist, told Al Jazeera by phone from the town of Kafr Nabl in the northwestern Syrian province bordering Turkey…

The main hospital in Maaret al-Numan [above: this was the largest hospital in Idlib], east of Kafr Nabl, has stopped working after it was hit by air strikes, according to the civil defence – also known as the White Helmets. “About 10 air raids hit the hospital. It was a disaster,” said Hadi, who had rushed to the scene.”The most difficult and heartbreaking scene was when the volunteers were quickly pulling the babies out of the hospital. I can’t get the image out of my head,” he recalled with a trembling voice.

‘De-escalation’ has become a prelude to its inverse. “There is a misperception that the de-escalation areas have resulted in peace and stability,’ UN assistant secretary-general Panos Moumtsiz said today. “If anything, these have been serious escalation areas.”

With all these horrors in mind, in my second post I’ll turn to the back-story. You can find other dimensions to the critique of siege warfare in Susan Power, ‘Siege warfare in Syria: prosecuting the starvation of civilians’, Amsterdam Law Forum 8: 2 (2016) 1-22 here or Will Todman, ‘Isolating dissent, punishing the masses: siege warfare as counterinsurgency’, Syria Studies 9 (1) (2017) 1-32.

There’s also a series of important quarterly reports from Siege Watch; these started in February 2016, and the most recent covers August-September 2017 and includes a detailed analysis of both Eastern Ghouta and Idlib.

I plan to approach the issue through one of my favourite books, Steve Graham‘s Cities under siege. Steve’s object was what he called ‘the new military urbanism’ but the situation in Syria – and elsewhere: think Mosul in Iraq (see, for example, here: scroll down) or Israel’s endless sieges of Gaza (see, for example, here) – demonstrate the extraordinary capacity of later modern war to combine cutting-edge technology (never has that adjective been more dismally appropriate) with medieval cruelty. There is another difference; for all Steve’s analytical passion – and empathy – the voices of those inside the cities under siege are largely silent, yet in Syria (again: and elsewhere) digital media allow us to listen to them and to witness their suffering. More soon.

MAP and the meat-grinder

Posted on August 19, 2014 by Derek Gregory

I’ve updated my previous posts on the medical geographies of Gaza several times (see here, here and here), and I’ve drawn on the testimony of Dr Mads Gilbert in extenso, but this testimony from another brave volunteer doctor deserves its own notice.

I met Ghassan Abu Sitta at a wonderful workshop in Paris in December 2012 on War and Medicine, and I learned so much from that one meeting (from everyone there: see my note about War and therapeutic geographies) that I was inspired to develop my own research project on the medical evacuation of casualties from war zones, 1914-2014.

Ghassan is a reconstructive surgeon who used to work at Great Ormond Street in London but is now based in Beirut. He’s recently returned from Gaza where he worked as a Medical Aid for Palestinians (MAP) volunteer at al Shifa hospital carrying out five, six and sometimes seven surgeries a day.

You can read some of the background in this excellent report by Robert Tait for Britain’s Telegraph, published ten days ago and from which I’ve borrowed the photograph above, but Ghassan has just been interviewed in depth by Yazan al-Saadi for Al Akhbar; you can read the full version here.

Ghassan says the attack on Gaza was like ‘a meat-grinder’, which he attributes to:

The amount of ordinance that the Israelis fired, the indiscriminate use of these bombs that are capable of bringing down whole buildings, the use of artillery shelling which is indiscriminate because the shell will hit the first thing it reaches, the fact that they were attacking from the air, from the sea, and by land with artillery at the same time. And there was a night they were doing this and then they lit all of Gaza’s sky with these flares just so people will know that this is what’s happening.

He also provides compelling testimony of his experience at al-Shifa, the main trauma centre for Gaza, that adds important detail to the accounts I’ve noted previously:

‘It looked like a refugee camp. The campus of the hospital has a lot of the families that escaped the bombing or lost their houses and they were living inside the walls of the hospital. Everywhere you go you see makeshift dwellings made out of laundry lines and bed sheeting turned into tents. And the hospital was completely full. Single rooms had four beds in them. In some wards we had two patients per bed.

‘The difference between this conflict and the one before is that nobody was allowing the patients out. So you had 7,000 injured – at the time I was there it was 6,000 and by the time the conflict ended the injured were 10,000. An overwhelming majority have still not been able to get out of Gaza. There have been some numbers, but not significant numbers to break the back of this problem….

‘The contingency plans were that all diesel was kept for the al-Shifa Hospital, so people did not have electricity at home, they would donate the diesel to the hospital. The wells that supply Shifa, like the rest of the water in Gaza, had become so contaminated with sea water, it’s salty. People do the best with what they have….

‘… the majority of the killing was happening because they were dropping ammunition designed to penetrate mountain caves. [The Israelis] were dropping them on civilian dwellings made out of breeze block. And so these four or five storey buildings were being pulverized by these one-ton bombs. That was what was wiping out whole families. And in Gaza, because land is so much in shortage, people come along and build their house, they build enough foundations that when their kids grow up, they can build a floor on top. So when you take out a four storey building, you take out four generations of a family. That was what happened to, I think, 60 families that have been completely wiped out…

The graphic below shows 26 members of just one extended family, the Abu Jame family, killed at home in Bani Suheila on 20 July; it comes from a sequence that is shockingly far too large to reproduce here, compiled by B’Tselem and available here. The infographic lists ‘members of families killed in their homes in 59 incidents of bombing or shelling’ in which 458 people were killed, including 108 women under the age of 60, 214 minors, and 18 people over the age of 60. If you follow the link, you can hover over each image for the names and ages of those killed.

Ghassan continues:

‘… they started inventing these humanitarian ceasefires, where people would go out and they would start killing them. We had this on the day of Eid, they said there was a humanitarian ceasefire and the kids went out to a local fair ground and they bombed them. The other time was in al-Shujayeh market, there was a humanitarian ceasefire, they got them into the market, they killed them, then they waited for the ambulances to get there, and then they shelled the ambulances again.

‘So the issue isn’t the type of weapons, but the intent to kill. The amount of ordinance they used and the tonnage of the bombs they used were intended to wipe out whole neighborhoods. That’s what they have done. They have completely wiped out Shejayeh, they wiped out Khuza’a, they wiped out a big part of Rafah, a big part of Khan Younes, and parts of Beit Hanoun….

‘ All the areas around the hospital were being bombed all the time. You would hear it. We heard something we knew it was close, but didn’t know how close it was. We then got a call to the emergency room and we were told that the administration and the out patients building had been hit – a lot of families had taken refuge in that area – so we had to go and help.’

Asked directly whether Hamas or other factions were firing rockets from the vicinity of the hospital, Ghassan is unequivocal:

‘Around Shifa? No, no, no. But in other places you would see them in the sky or hear them. You would learn to distinguish the whoosh of the rocket. Gaza is so small and so flat, I mean you are not going to hide them in the mountains or the jungle because there are no mountains or jungle. People are literally on top of each other. It’s going to happen. But around the hospital there were none.’

Destructive Edge

Posted on August 8, 2014 by Derek Gregory

In a previous post on ‘The Death Zone‘, I suggested readers compare Israel’s extended ‘buffer zone’ in Gaza by following the line of the main highway, Saladin Street. Hugh Naylor has followed that route on the ground – what he calls ‘Desolation Road’ – and his report is accompanied by an interactive map showing some of the vast panorama of destruction:

I’ll have more to say about the caption – about the Israeli military’s targeting in Gaza – shortly. The Guardian has just published a graphic by Nadja Popovich showing the UNRWA-run schools sheltering refugees (many of them from the expanded ‘buffer zone’) that were struck by the Israeli military:

Amnesty International reports growing evidence that health facilities and workers were deliberately targeted by the Israeli military:

Testimonies from doctors, nurses, and ambulance workers who have spoken to Amnesty International paint a disturbing picture of hospitals and health professionals coming under attack by the Israeli army in the Gaza Strip, where at least six medics have been killed. There is growing evidence that health facilities or professionals have been targeted in some cases.

Since Israel launched Operation “Protective Edge” on 8 July, the Gaza Strip has been under intensive bombardment from the air, land and sea, severely affecting the civilian population there. As of 5 August, according to the UN Office for the Coordination of Humanitarian Affairs, 1,814 Palestinians had been killed in the Gaza Strip, 86 per cent of them civilians. More than 9,400 people have been injured, many of them seriously. An estimated 485,000 people across the Gaza Strip have been displaced, and many of them are taking refuge in hospitals and schools.

Amnesty International has received reports that the Israeli army has repeatedly fired at clearly marked ambulances with flashing emergency lights and paramedics wearing recognizable fluorescent vests while carrying out their duties. According to the Palestinian Ministry of Health, at least six ambulance workers, and at least 13 other aid workers, have been killed as they attempted to rescue the wounded and collect the dead. At least 49 doctors, nurses and paramedics have been injured by such attacks; at least 33 other aid workers were also injured. At least five hospitals and 34 clinics have been forced to shut down due to damage from Israeli fire or continuing hostilities in the immediate area.

Hospitals across the Gaza Strip suffer from fuel and power shortages (worsened by the Israeli attack on Gaza’s only power plant on 29 July), inadequate water supply, and shortages of essential drugs and medical equipment. The situation was acute before the current hostilities, due to Israel’s seven-year blockade of Gaza, but have been seriously exacerbated since…

Amnesty International is aware of reports that Palestinian armed groups have fired indiscriminate rockets from near hospitals or health facilities, or otherwise used these facilities or areas for military purposes. Amnesty International has not been able to confirm any of these reports. While the use of medical facilities for military purposes is a severe violation of international humanitarian law, hospitals, ambulances and medical facilities are protected and their civilian status must be presumed. Israeli attacks near such facilities – like all other attacks during the hostilities – must comply with all relevant rules of international humanitarian law, including the obligation to distinguish between civilians and civilian objects and military targets, the obligation that attacks must be proportional and the obligation to give effective warning. Hospitals and medical facilities must never be forced to evacuate patients under fire.

The report includes detailed testimony from Palestinian paramedics and ambulance crews who describe the extraordinary difficulty and danger they faced in attending to casualties from Israeli shelling (see also my post on ‘Gaza 101‘, the emergency number for Gaza, and the update here). Not surprisingly, Israel has rejected Amnesty’s claims and denied targeting hospitals, but when Netanyahu’s spokesperson, Mark Regev, explained that ‘What we’ve had to do on a number of occasions is to hit terrorist targets in the immediate vicinity of hospitals and things like that, where they’ve abused them,’ he failed to address the violations of international law summarised in the last paragraph above.

There’s more. B’Tselem, now back on line, is also providing detailed testimony from Gaza, including (so far) two ambulance drivers, Rami ‘Abd al-Haj ‘Ali and Ahmad Sabah. Here is an extract from the first statement (all testimonies are linked to B’Tselem’s interactive map):

On Friday afternoon, 25 July 2014, I was working at the medical emergency call center in Beit Hanoun. At around 4:30 P.M., we received a call reporting injured people in al-Masriyin Street in Beit Hanoun. We asked the International Red Cross to coordinate our going there. About 15 minutes after we received the call, we got authorization and an ambulance headed over there with paramedics ‘Aaed al-Bura’i, 25, Hatem Shahin, 38, and driver Jawad Bdeir, 52. The team didn’t make it to the wounded people. Soon after they reached the street, they reported back that a tank had fired at them and they were injured. They asked for another team to come and rescue them.

The call center coordinated the arrival of another team with the International Red Cross and got authorization to go rescue the injured team. I drove the second ambulance, and there were two medics with me – Muhammad Harb, 31, and Yusri al-Masri, 54. The street is only about 200-300 meters from the call center, so we were there within minutes. When we reached the entrance to the street, we were surprised to see three tanks and a military bulldozer in the street, about 100 meters away.

Suddenly, with no warning, they opened heavy machine-gun fire at us. The bullets penetrated the ambulance. I tried to turn the ambulance around to get out of there, but the steering wheel must have been hit. Suddenly, I felt sharp pain in my leg and realized I’d been hit by a bullet or shrapnel. Then the windshield shattered. Because I couldn’t turn the ambulance around, I decided to try reversing. They kept firing as I backed up, until we got far enough away. When they stopped, I managed to turn us around and head back to the center.

On the way there we met Hatem Shahin, one of the paramedics from the first ambulance. He’d been hit by shrapnel in his shoulder and leg. He told us that a shell fired from a tank had hit the front part of the ambulance. He said he’d managed to get away but the other paramedic, ‘Aaed, had been hit. He told us that after he ran away from there, he saw the tank fire another shell at the ambulance, completely destroying it. He thought ‘Aaed must have been killed, but we didn’t know for sure.

The next day, on Saturday, a ceasefire was declared from 8:00 A.M. to 8:00 P.M. An ambulance team went to the spot and found ‘Aaed’s body in the burnt ambulance.

To put all of this in context, the BBC has mapped the deaths of 1,890 Palestinians – ‘mostly civilians’, as its accompanying chart shows – killed during the Israeli offensive to 6 August. As you can see, Palestinians were killed ‘right across Gaza’ – not only in the expanded buffer zone shown on the map, though the carnage in Beit Hanoun and Shejaiya is clearly visible – with high concentrations also produced in the killing grounds of Gaza City and Khan Younis:

Finally, in case you’re puzzled by the title for this post: Israel’s attack on Gaza is codenamed Tzuk Eitan in Hebrew, meaning ‘Firm Cliff’ or ‘Resolute Cliff’. According to Yagiv Levy, ‘The operation’s name signals the power, commitment and resilience of the Israeli people.’ But the official English-language version, ‘Protective Edge’, was changed ‘to give it a more defensive connotation’ (really). As Steven Poole explains, ‘the bombing was supposedly “protective”, though not of those bombed’. All of this is of course in line with the designation of the Israeli military as the ‘Israeli Defence Forces’.

I decided I’d prefer to use a version that provides a more accurate rendering of what has happened – in Hebrew, English or Arabic.

All white on the Western Front?

Posted on July 25, 2014 by Derek Gregory

There is a telling anecdote in Lyn Macdonald‘s account of The Somme:

Climbing on to the firestep, the Staff Captain cautiously raised his head above the parapet and looked across. ‘Good God!’ he exclaimed. ‘I didn’t know we were using Colonial troops!’ Pretor-Pinney made no reply. Hoyles and Monckton exchanged grim looks. ‘Dear God,’ muttered Monckton, when the Colonel and the visitor had moved away to a safe distance, ‘has the bastard never seen a dead man before?’ It was a rhetorical question. Lying out in the burning sun, soaked by the frequent showers of a week’s changeable weather, the bodies of the dead soldiers had been turned black by the elements. The Battalion spent the rest of the day burying them.

In fact, it’s doubly revealing. On one side, it confirms the (I think simplistic) stereotype of the General Staff and their distance from death; but on the other side it also speaks to what Santanu Das, writing in the Guardian, calls ‘the colour of memory’:

In 1914, Britain and France had the two largest empires, spread across Asia and Africa, and an imperial war necessarily became a world war.

More than 4 million non-white men were recruited into the armies of Europe and the US. In a grotesque reversal of Joseph Conrad’s vision, thousands of Asians, Africans and Pacific Islanders were voyaging to the heart of whiteness and far beyond – to Mesopotamia, East Africa, Gallipoli, Persia and Palestine. Two million Africans served as soldiers or labourers; a further 1.3 million came from the British “white” dominions. The first shot in the war was fired in Togoland, and even after 11 November 1918 the war continued in East Africa.

A South African labourer said he went to war to “see different races”. If one visited wartime Ypres, one would have seen Indian sepoys, tirailleur Senegalese, Maori Pioneer battalions, Vietnamese troops and Chinese workers.

Today, one of the main stumbling blocks to a truly global and non-Eurocentric archive of the war is that many of these 1 million Indians, or 140,000 Chinese, or 166,000 West Africans, did not leave behind diaries and memoirs. In India, Senegal or Vietnam there is nothing like the Imperial War Museum; when a returned soldier or village headman died, a whole library vanished.

Moreover, as the former colonies became nation states, nationalist narratives replaced imperial war memories. Stories that did not fit were airbrushed. In Europe, communities turned to their own dead and damaged.

In ‘Gabriel’s Map’ I began in East Africa in 1914 with an Indian Army contingent – whose staff officers included, in William Boyd‘s An Ice-Cream War, the young Gabriel Cobb – sent to seize German East Africa defended by the local Schutztruppen under German command. But as I travelled back to the Western Front the colonial troops who also served there slipped from the record. Yet by the end of September 1914 two Indian divisions and a cavalry brigade had already arrived in France (see above), and in October the first sepoys were sent into battle at Ypres. If British, French and German troops were shocked at the devastation of a European countryside that was, in its essentials, once familiar to them, what could the freezing cold, the endless mud and the splintered trees have meant to these men (who usually arrived unprepared and ill-equipped for the winter)?

I suspect a satisfying answer has to wait for Santanu’s next book, India, Empire and the First World War: words, images and objects (Cambridge University Press, 2015). But in the meantime the whitening of the Western Front (and other theatres of the War) can be resisted through other sources. Some of them are listed in his brief essay on ‘The Indian sepoy in the First World War’ for the the British Library (and you can find ‘Experiences of colonial troops’, adapted from his Introduction to Race, empire and First World War writing [Cambridge University Press, 2011] here).

In addition Christian Koller‘s ‘The recruitment of colonial troops in Africa and Asia and their deployment in Europe during the First World War’, Imigrants & Minorities 26 (1/2) (2008) 111-133 [open access pdf here] provides a helpful context and more references (including French and German sources), and Gajendra Singh‘s The testimonies of Indian soldiers and the two world wars: between self and sepoy (Bloomsbury, 2014) is a wider, though inevitably selective account of the fabrication of Indian military identities under the Ra (the chapter on ‘Throwing snowballs in France’ is also available in Modern Asian Studies 48 (4) (2014): it’s an artful discussion of the (mis)fortunes of a chain letter – this is the ‘snowball’ in question – that ran foul of the military censor). The Round Table 103 (2) (2014) is a special issue devoted to ‘The First World War and the Empire-Commonwealth’.

Finally, I’m working my way through Andrew Tait Jarboe‘s excellent PhD thesis, Soldiers of empire: Indian sepoys in and beyond the metropole during the First World War, 1914-1919 (Northeastern, 2013): during my current research on military-medical machines 1914-2014 I’ve found a number of references to the treatment of wounded Indian troops on the Western Front – their evacuation on hospital trains and their treatment in segregated hospitals – and Andrew’s third chapter (‘Hospital’) provides an illuminating reading of what was happening:

‘Between 1914-18, the British established segregated hospitals for wounded Indian soldiers in France and England… [T]hese hospitals were not benign institutions of healing. Like hospitals that repaired the bodies of English soldiers, Indian hospitals played a crucial role in sustaining the war-making capacity of the British Empire. Indian hospitals in Marseilles or Brighton also served an imperial purpose. As sites of propaganda, they reaffirmed the ideologies of imperial rule for audiences at home, abroad, and within the hospital wards. Yet even while the British Empire succeeded to a considerable extent in exploiting the manpower of India, … wounded sepoys were rarely ever mere pawns on the imperial chessboard. Hospital authorities were committed to two policies: returning sepoys to the front, and protecting white prestige. Wounded sepoys found ways of resisting both. In this way, Indian hospitals readily became what British authorities hoped they would not: spaces where imperial subalterns contested the policies and ideologies of imperial rule.’

For imagery of non-European troops on the Western front and elsewhere, try this page at the Black Presence in Britain. More wide-ranging is the exhibition organised by the Alliance française de Dhaka, War and the colonies 1914-1918, that you can visit online here (I’ve taken the image above from that collection).

All of this, clearly, adds another dimension to Patrick Porter‘s lively discussion of Military Orientalism: Eastern war through Western eyes (2009). But it’s not only an opportunity to reverse (and re-work) that subtitle. The Times of India reports a campaign to change ‘the colour of memory’ by instituting 15 August as a Remembrance Day in India:

“This will be our Remembrance Day. We have attended such memorial functions in France where heads of different states converge and the civilian turnout is quite big. But we don’t see a single Indian face there—quite an irony, given the fact that 1, 40,000 Indians defended French soil from German aggression in the Great War, and many never returned home. That’s why we, NRIs from France, came up with this project,” says a representative of Global Organization for People of Indian Origin (GOPIO), France.

Gaza 101

Posted on July 21, 2014 by Derek Gregory

101 is the emergency number for Gaza and the rest of occupied Palestine. And perhaps I should begin with that sentence: I say ‘the rest of occupied Palestine’ because, despite Israel’s ‘disengagement’ from Gaza in 2005, Israel continues to exercise effective control over the territory which means that Gaza has continued to remain under occupation. It’s a contentious issue – like Israel’s duplicitous claim that the West Bank is not ‘occupied’ either (even by its illegal settlers) merely ‘disputed’ – and if you want the official Israeli argument you can find it in this short contribution by a former head of the IDF’s International Law Department here and here. The value of that essay – apart from illustrating exactly what is meant by chutzpah – is its crisp explanation of why the issue matters:

‘This does not necessarily mean that Israel has no legal obligations towards the population of the Gaza Strip, but that to the extent that there are any such legal obligations, they are limited in nature and do not include the duty to actively ensure normal life for the civilian population, as would be required by the law of belligerent occupation…’

Certainly, one of the objectives of Israel’s ‘disengagement’ was to produce what its political and military apparatus saw as ‘an optimal balance between maximum control over the territory and minimum responsibility for its non-Jewish population’. That concise formulation is Darryl Li‘s, which you can find in his excellent explication of Israel’s (de)construction of Gaza as a ‘laboratory’ for its brutal bio-political and necro-political experimentations [Journal of Palestine Studies 35 (2) (2006)]. (Another objective was to freeze the so-called ‘peace process’, as Mouin Rabbani explains in the latest London Review of Books here; his essay also provides an excellent background to the immediate precipitates of the present invasion). Still, none of this entitles Israel to evade the obligations of international law. Here it’s necessary to recall Daniel Reisner‘s proud claim that ‘If you do something for long enough, the world will accept it… International law progresses through violations’: Reisner also once served as head of the IDF’s International Law Department, and the mantra remains an article of faith that guides IDF operations. But as B’Tselem, the Israeli Information Center for Human Rights in the Occupied Territories, insisted in an important opinion published at the start of this year:

Even after the disengagement, Israel continues to bear legal responsibility for the consequences of its actions and omissions concerning residents of the Gaza Strip. This responsibility is unrelated to the question of whether Israel continues to be the occupier of the Gaza Strip.

But there’s more. International humanitarian law – no deus ex machina, to be sure, and far from above the fray – not only applies during Israel’s military offensives and operations, including the present catastrophic assault on Gaza, but provides an enduring set of obligations. For as Lisa Hajjar shows in a detailed discussion re-published by Jadaliyya last week, Israel’s attempts to make Gaza into a space of exception – ‘neither sovereign nor occupied’ but sui generis – run foul of the inconvenient fact that Gaza remains under occupation. Israel continues to control Gaza’s airspace and airwaves, its maritime border and its land borders, and determines what (and who) is allowed in or out [see my previous post and map here]. As Richard Falk argues, ‘the entrapment of the Gaza population within closed borders is part of a deliberate Israeli pattern of prolonged collective punishment’ – ‘a grave breach of Article 33 of the Fourth Geneva Convention’ – and one in which the military regime ruling Egypt is now an active and willing accomplice.

So: Gaza 101. Medical equipment and supplies are exempt from the blockade and are allowed through the Karam Abu Salem crossing (after protracted and expensive security checks) but the siege economy of Gaza has been so cruelly and deliberately weakened by Israel that it has been extremely difficult for authorities to pay for them. Their precarious financial position is made worse by direct Israeli intervention in the supply of pharmaceuticals. Corporate Watch reports that

When health services in Gaza purchase drugs from the international market they come into Israel through the port of Ashdod but are not permitted to travel the 35km to Karam Abu Salem directly. Instead they are transported to the Bitunia checkpoint into the West Bank and stored in Ramallah, where a permit is applied for to transport them to Gaza, significantly increasing the length and expense of the journey.

There’s more – much more: you can download the briefing here – but all this explains why Gaza depends so much on humanitarian aid (and, in the past, on medical supplies smuggled in through the tunnels). Earlier this summer Gaza’s medical facilities were facing major shortfalls; 28 per cent of essential drugs and 54 per cent of medical disposables were at zero stock.

Medical care involves more than bringing in vital supplies and maintaining infrastructure (the map of medical facilities above is taken from the UN’s humanitarian atlas and shows the situation in December 2011; the WHO’s summary of the situation in 2012 is here). Medical care also involves unrestricted access to electricity and clean water; both are compromised in Gaza, and on 1 January 2014 B’Tselem reported a grave deterioration in health care as a result:

‘The siege that Israel has imposed on the Gaza Strip since Hamas took over control of the security apparatus there in June 2007 has greatly harmed Gaza’s health system, which had not functioned well beforehand…. The reduction, and sometimes total stoppage, of the supply of fuel to Gaza for days at a time has led to a decrease in the quality of medical services, reduced use of ambulances, and serious harm to elements needed for proper health, such as clean drinking water and regular removal of solid waste. Currently, some 30 percent of the Gaza Strip’s residents do not receive water on a regular basis.’

In-bound transfers are tightly constrained, but so too are out-bound movements. Seriously ill patients requiring advanced treatment had their access to specialists and hospitals outside Gaza restricted:

‘Israel has cut back on issuing permits to enter the country for the hundreds of patients each month who need immediate life-saving treatment and urgent, advanced treatment unavailable in Gaza. The only crossing open to patients is Erez Crossing, through which Israel allows some of these patients to cross to go to hospitals inside Israel [principally in East Jerusalem], and to treatment facilities in the West Bank, Egypt, and Jordan. Some patients not allowed to cross have referrals to Israeli hospitals or other hospitals. Since Hamas took over control of the Gaza Strip, the number of patients forbidden to leave Gaza “for security reasons” has steadily increased.’

As in the West Bank, Israel has established a labyrinthine system to regulate and limit the mobility of Palestinians even for medical treatment. Last month the World Health Organization explained the system and its consequences (you can find a detailed report with case studies here):

‘In Gaza, patients must submit a permit application at least 10 days in advance of their hospital appointment to allow for Israeli processing. Documents are reviewed first by the health coordinator but final decisions are made by security officials. Permits can be denied for reasons of security, without explanation; decisions are often delayed. In 2013, 40 patients were denied and 1,616 were delayed travel through Erez crossing to access hospitals in East Jerusalem, Israel, the West Bank and Jordan past the time of their scheduled appointment. If a patient loses an appointment they must begin the application process again. Delays interrupt the continuity of medical care and can result in deterioration of patient health. Companions (mandatory for children) must also apply for permits. A parent accompanying a child is sometimes denied a permit, and often both parents, and the family must arrange for a substitute, a process which delays the child’s treatment.’

On 17 June Al-Shifa Hospital, the main medical facility in Gaza City (see map below), had already been forced to cancel all elective surgeries and concentrate on emergency treatment. On 3 July it had to restrict treatment to life-saving emergency surgery to conserve its dwindling supplies. All of this, remember, was before the latest Israeli offensive. People have not stopped getting sick or needing urgent treatment for chronic conditions, so the situation has deteriorated dramatically. The care of these patients has been further compromised by the new, desperately urgent imperative to prioritise the treatment of those suffering life-threatening injuries from Israel’s military violence.

Trauma surgeons emphasise the importance of the ‘golden hour’: the need to provide advanced medical care within 60 minutes of being injured. Before the IDF launched its ground invasion, there were three main sources of injury: blast wounds from missiles, penetrating wounds from artillery grenades and compression injuries from buildings collapsing. But this is only a typology; many patients have multiple injuries. ‘We are not just getting patients with one injury that needs attending,’ said the head of surgery at Al-Shifa, ‘we are getting a patient with his brain coming out of his skull, his chest crushed, and his limbs missing.’ All of these injuries are time-critical and require rapid intervention. And yet the Ministry of Health reckons that Gaza’s ambulance service is running at 50 per cent capacity as a result of fuel shortages. That figure must have been reduced still further by the number of ambulances that have been hit by Israeli fire (for more on paramedics in Gaza, and the extraordinary risks they run making 20-30 trips or more every day, see here and this report from the Telegraph‘s David Blair here). When CNN reporters visited the dispatch centre at Jerusalem Hospital in Gaza City last Tuesday, they watched a a screen with illuminated numbers recording 193 killed and 1,481 injured and the director of emergency services dispatching available ambulances to the site of the latest air strike (by then, there had already been over 1,000 of them). But the system only works effectively when there is electricity…

Power supplies were spasmodic at the best of times (whenever those were); they have been even more seriously disrupted by the air campaign, and since the start of the ground assault Gaza has lost around 90 per cent of its power generating capacity. Nasouh Nazzal reports that many hospitals have been forced to switch to out-dated generators to light buildings and power equipment:

“The power generators in Gaza hospitals are not trusted at all and they can go down any moment. If power goes out, medical services will be basically terminated,” [Dr Nasser Al Qaedrah] said. He stressed that the old-fashioned types of power generators available in Gaza consume huge quantities of diesel, a rare product in the coastal enclave.

On occasion, Norwegian ER surgeon Mads Gilbert told reporters, if the lights go out in the middle of an operation ‘[surgeons] pick up their phones, and they use the light from the screen to illuminate the operation field.’ (He had brought head-lamps with him from Bergen but found they were on Israel’s banned list of ‘dual-use’ goods). As the number of casualties rises, the vast majority of them civilians, so hospitals have been stretched to the limit and beyond. According to Jessica Purkiss, the situation was already desperate a week ago:

“The number of injuries is huge compared to the hospitals’ capacity,” said Fikr Shalltoot, the Gaza program director for Medical Aid for Palestinians, an organization desperately trying to raise funds to procure more supplies. “There are 1,000 hospital beds in the whole of Gaza. An average of 200 injuries are coming to them every day.”

As in so many other contemporary conflicts – Iraq, Libya, Syria – hospitals themselves had already become targets for military violence. For eleven days Al-Wafa Hospital in Shuja’iyeh in eastern Gaza City (see the map above), the only rehabilitation centre serving the occupied territories, was receiving phone calls from the IDF warning them that the building was about to be bombed. [In case you’re impressed by the consideration, think about Paul Woodward‘s observation: ‘I grew up in Britain during the era when the Provisional IRA was conducting a bombing campaign in Northern Ireland and on the mainland. I don’t remember the Provos ever being praised for the fact that they would typically phone the police to issue a warning before their bombs detonated. No one ever dubbed them the most humane terrorist organization in the world.’] The staff refused to evacuate the hospital because their patients were paralysed or unconscious. The Executive Director, Dr Basman Alashi, explained:

‘We’ve been in this place since 1996. We are known to the Israeli government. We are known to the Israeli Health Center and Health Ministry. They have transferred several patients to our hospital for rehabilitations. And we have many success stories of people come for rehabilitation. They come crawling or in a wheelchair; they go out of the hospital walking, and they go back to Israel saying that al-Wafa has done miracle to them. So we are known to them, who we are, what we are. And we are not too far from their border. Our building is not too small. It’s big. It’s about 2,000 square meters. If I stand on the window, I can see the Israelis, and they can see me. So we are not hiding anything in the building. They can see me, and I can see them. And we’ve been here for the last 12 or 15 years, neighbors, next to each other. We have not done any harm to anybody, but we try to save life, to give life, to better life to either an Arab Palestinian or an Israeli Jew.’

But just after 9 p.m. on 17 July shells started falling:

‘… the fourth floor, third floor, second floor. Smoke, fire, dust all over. We lost electricity… luckily, nobody got hurt. Only burning building, smoke inside, dust, ceiling falling, wall broke, electricity cutoff, water is leaking everywhere. So, the hospital became [uninhabitable].’

Seventeen patients were evacuated and transferred to the Sahaba Medical Complex in Gaza City. Sharif Abdel Kouddos takes up the story:

‘The electricity went out, all the windows shattered, the hospital was full of dust, we couldn’t see anything,’ says Aya Abdan, a 16-year-old patient at the hospital who is paraplegic and has cancer in her spinal cord. She is one of the few who can speak.

It is, of course, literally unspeakable. But this was not an isolated incident – still less ‘a mistake’ – and other hospitals have been bombed or shelled. According to the Ministry of Health, 25 health facilities in Gaza have been partially or totally destroyed. Just this morning it was reported that Israeli tanks shelled the al-Aqsa Hospital in Deir al-Balah in central Gaza, killing five and injuring 70 staff and patients. The Guardian reports that ambulances which tried to evacuate patients were forced to turn back by continued shelling. According to Peter Beaumont:

‘”People can’t believe this is happening – that a medical hospital was shelled without the briefest warning. It was already full with patients,” said Fikr Shalltoot, director of programmes at Medical Aid for Palestinians in Gaza city.’

The hospitals that remain in operation are overwhelmed, with doctors making heart-wrenching decisions about who to treat and who to send away, refusing ‘moderately injured patients they normally would have admitted in order to make room for the more seriously wounded.’ Mads Gilbert (centre in the image above) again:

Oh NO! not one more load of tens of maimed and bleeding, we still have lakes of blood on the floor in the ER, piles of dripping, blood-soaked bandages to clear out – oh – the cleaners, everywhere, swiftly shovelling the blood and discarded tissues, hair, clothes,cannulas – the leftovers from death – all taken away…to be prepared again, to be repeated all over. More then 100 cases came to Shifa last 24 hrs. enough for a large well trained hospital with everything, but here – almost nothing: electricity, water, disposables, drugs, OR-tables, instruments, monitors – all rusted and as if taken from museums of yesterdays hospitals.

Al-Shifa, where he is working round the clock, has only 11 beds in its ER and just six Operating Rooms. On Saturday night, when the Israeli army devastated the suburb of Shuja’ieyh, its ‘tank shells falling like hot raindrops‘, al-Shifa had to deal with more than 400 injured patients. Al-Shifa is Gaza’s main trauma centre but in other sense Gaza’s trauma is not ‘centred’ at all but is everywhere within its iron walls. Commentators repeatedly describe Gaza as the world’s largest open-air prison – though, given the cruelly calculated deprivation of the means of normal life, concentration camp would be more accurate – but it is also one where the guards routinely kill, wound and hurt the prisoners. The medical geography I’ve sketched here is another way of reading Israel’s bloody ‘map of pain‘. I am sickened by the endless calls for ‘balance’, for ‘both sides’ to do x and y and z, as though this is something other than a desperately unequal struggle: as though every day, month and year the Palestinians have not been losing their land, their lives and their liberties to a brutal, calculating and manipulative occupier. I started this post with an image of a Palestinian ambulance; the photograph below was taken in Shuja’ieyh at the weekend. It too is an image of a Palestinian ambulance.

For updates see here; I fear there will be more to come. In addition to the links in the post above, this short post is also relevant (I’ve received an e-mail asking me if I realised what the initial letters spelled…. Duh.)