Israeli obstructions to aid and attacks on humanitarian workers

Doctors of the World’s year in the Occupied Palestinian Territory

At Doctors of the World, we deeply acknowledge and respect the immense dedication of our teams in Palestine. They have chosen to work for the health of communities, driven by a commitment to solidarity and social justice.

Despite the countless challenges, including attacks on their lives and their work, our teams remain on the ground, facing intolerable injustice with resilience. Their unwavering presence in such difficult conditions deserves the highest recognition.

Through their work and testimonies, they shine a light on realities that profoundly challenge our shared moral responsibility. We amplify their voices to raise awareness within our global community and to continue advocating for the respect of human dignity. Our entire organisation stands firm with our teams and their families. We extend our strongest possible support in recognition of their invaluable contribution and steadfast commitment to our shared mission. Their courage and dedication inspire us all.

This year has seen an alarming deterioration of the situation in the Occupied Palestinian Territory. While the International Court of Justice has warned of a risk of genocide, the war is dangerously spreading to the occupied West Bank and Lebanon.  In this report, Doctors of the World reflects on its experience in delivering medical assistance amid aid obstructions, the targeting of civilians and its personnel and shrinking humanitarian space.

The report includes a detailed account of events amounting to the obstruction of Doctors of the World’s humanitarian response in the Occupied Palestinian Territory, covering the period between 7 October 2023 and 24 September 2024.

• For almost a year, heavy bombing and ground fighting by the Israeli military have threatened the lives of Doctors of the World staff in the Gaza Strip. Minimum conditions of safety cannot be guaranteed even within the areas which Israel has unilaterally designated as “humanitarian zones”, which have been repeatedly hit by Israeli strikes. One of our colleagues has been killed and three have been severely injured. Every single one of our staff has experienced one or more family members being killed, in violation of the obligation of parties in conflict to respect and protect both civilians and humanitarian workers¹. Doctors of the World’s premises have been raided and damaged by Israeli forces, despite Doctors of the World clearly following “deconfliction” procedures.
• Both Doctors of the World’s staff and our operations have suffered repeated waves of forced displacement as a result of Israeli military displacement orders. As of September 2024, 92% of Doctors of the World staff are currently forcibly displaced. Doctors of the World operations have been displaced up to three times, first moving from Gaza City to Rafah, and then to Deir Al Balah. In August, part of the operations were again displaced from Deir Al Balah to Khan Younis.
• Doctors of the World staff members continue to act as frontliners and aid providers while they are themselves unprotected, displaced, and deprived of proper food and clothing, surviving in overcrowded conditions vulnerable to bombing, diseases, and the weather.
• Only four trucks containing Doctors of the World aid were able to enter the Gaza Strip over the year. Shipments were blocked for up to two months before they were allowed to enter the enclave.
• In the occupied West Bank, all Doctors of the World teams have reported that restrictions on humanitarian access and movement increased drastically after October 2023. This was due to an increase in settler attacks, the escalation in Israeli military raids against Palestinian communities, and the tightening of Israel’s military infrastructure of movement restrictions.

Israel, as the occupying power, must ensure the adequate provision of food, medical supplies, shelter, and other essential supplies necessary for the survival of the civilian population in the occupied territory². Not only are the Israeli authorities failing in this obligation, they are impeding the lifesaving work of humanitarian actors striving to ensure the survival and meet the basic needs of the civilian Palestinian population.

Gaza Strip

Forced displacement of staff and operations, attacks on premises, and barriers to the provision of medical aid and services

Timeline of obstructions and attacks against Doctors of the World staff and operations

Dire conditions of survival for Doctors of the World’s staff

92% of Doctors of the World’s staff are currently living in forced displacement, with most having been forced to flee at least four times. Doctors of the World’s staff members are living in overcrowded shelters, non-rehabilitated structures, and makeshift tents, all of which fail to meet basic safety and dignity requirements.

“At least 70% of our colleagues have completely lost their homes.” – General Coordinator for Doctors of the World in Palestine

The health of staff members is direly affected by the continuous forced displacement, overcrowded conditions, medical shortages, and lack of clean water, healthy food, clothes, and hygiene materials. Many colleagues have contracted impetigo, chest infections, skin diseases, hepatitis A, and food poisoning. Some members of the Doctors of the World’s teams are suffering from chronic diseases and are unable to find the medication they were taking before October 2023. Three colleagues had babies during the war, in extremely precarious conditions, facing immense challenges in ensuring their survival due to shortages in newborn care items, difficulties with breastfeeding and limited access to baby formula.

As a result of these intolerable conditions of survival, Doctors of the World’s staff members are experiencing protracted physical and emotional fatigue. Every time our teams regain a little stability, new displacement orders force them to start all over again.

“Since 13 October 2023, I have had to flee my house in Jabalia and take shelter in my aunt’s house in Khan Younis. It’s hard to overcome the losses that I have had to endure during the past year. The Israeli army set fire to my house months ago and denied me access to it. I live in a chaotic community without any rule of law and order, without any safety or security. My disabled younger brother lost access to medical care and my family and I lost all connections with most of our friends and relatives. It is impossible for us to obtain any sense of stability, since we cannot stay in one place and have had to evacuate five times because of the Israeli forced displacement orders.” – Doctors of the World Project Officer in Gaza

“It is not easy to see our people living in tents. To hear that every day you have lost one of your relatives, your friends, your belongings. To go to sleep every night not knowing whether you will wake up or not. To return from work without being sure that you will find the place where you are staying intact. It is as if you are alive, but you are not really living. I miss my home, but it has been destroyed, so even if I do go back there, I won’t find my home. We cannot accept that this is our new life.” – Doctors of the World Coordinator in Gaza

The provision of Doctors of the World’s medical services to the population of Gaza is fully dependent on the incredible work of our colleagues on the ground, who have demonstrated their unfailing determination and courage in continuing to deliver healthcare in unacceptable conditions.

Israeli restrictions on the entry of humanitarian aid causing dire shortages for humanitarian operations

The Gaza Strip has been subjected to a 17-year blockade imposed by the Israeli government. On 9 October 2023, Israeli minister Yoav Gallant ordered a “complete siege of the Gaza Strip”. While Israeli military operations are plunging Gaza into the most severe humanitarian crisis its population has ever experienced, Israeli authorities continue to obstruct the entry of aid⁵.

At the onset of the crisis, Doctors of the World purchased drugs and emergency preparedness materials in the occupied West Bank to send to Gaza, as it had done during previous Israeli bombing campaigns against the enclave.

“After October 2023, Israeli authorities did not allow the use of a humanitarian corridor from the West Bank, a territory less than 50 kilometres away, where most of the supplies needed for the Doctors of the World’s emergency response in Gaza were available. We had to wait 11 months for the Israeli authorities to allow our first shipment from the West Bank to Gaza.” – General Coordinator for Doctors of the World in Palestine

Only four trucks containing Doctors of the World’s aid were able to enter the Gaza Strip over the year. All shipments were blocked for up to two months before they were allowed to enter the enclave.

“If the truck is delayed at one of the Israeli crossings, we have to coordinate everything again for the next day. It is a nightmare. The bureaucratic and coordination process is so cumbersome that it in itself constitutes a restriction on humanitarian access.” – General Coordinator for Doctors of the World in Palestine

In late April 2024, a Doctors of the World’s convoy of Primary Health Care (PHC) and Sexual and Reproductive Health (SRH) supplies was prepared to be sent to the Gaza strip but was blocked by the Israeli closure of the Rafah crossing mid-May. Five months later, the supplies could still not reach Gaza due to security and access restrictions at the Kerem Shalom / Karam Abu Salem crossing resulting from the Israeli ground invasion of Rafah.

Israel is classifying certain aid items as “dual-use”, including essential goods such as batteries, vehicles, and water pipes. Without the Israeli blockade and arbitrary measures, Doctors of the Wolrd could be able to send fully equipped mobile medical trucks and construction materials to rebuild health centres in Gaza. In a normal operating environment, Doctors of the World would import trucks, generators, solar panels, diagnostic equipment, fuel, protective materials, communication equipment, and construction materials, all of which are needed to properly address the catastrophic scale of the humanitarian crisis in Gaza.

Due to the obstruction of the entry of aid into Gaza, Doctors of the World’s teams are facing severe shortages of essential drugs, medical, and lab equipment, including antibiotics, treatments for chronic diseases, hygiene materials, clean water, and healthy food. Medical teams on the ground reported a significant increase in cases of malnutrition throughout September 2024, coupled with the ongoing spread of acute respiratory infections, skin infections, and other communicable diseases due to the lack of hygiene materials and the continuous deterioration of survival conditions. Not only do these shortages undermine public health in Gaza, but they also impede the medical response by creating a vicious cycle severely impacting patients’ recovery. Simple infections that would normally heal in a week are deteriorating and taking months, extra medical resources, and supervision to heal.

Movements to provide humanitarian aid and services inside the Gaza Strip are extremely dangerous due to ongoing airstrikes, even in the Israeli-designated “humanitarian” zone. Doctors of the World has to notify Israeli authorities of all its movements inside Gaza, and must coordinate all movements out of the Israeli-designated humanitarian zone, requests which are often delayed or refused⁶. Israeli strikes have targeted aid convoys from organisations including the World Central Kitchen, the World Food Programme, and Anera, demonstrating that coordination with the Israeli authorities does not guarantee safety for humanitarian workers.

WEST BANK

Access to communities restricted by Israeli military obstacles and security threats posed by the Israeli army and settlers

Since October 2023, the Israeli authorities have significantly reinforced the army’s infrastructure of movement restrictions throughout the West Bank. Its 790 military obstacles (checkpoints, military gates, earth mounds, etc.) effectively disrupt public health services, educational institutions, livelihoods, social relations, and humanitarian access⁷. Between 29 April and 23 May 2024, Doctors of the World collected data on restrictions on the movement of the Doctors of the World’s team operating in the northern West Bank. Doctors of the World found that in the span of three weeks, the field team spent at least 21 hours waiting at Israeli military checkpoints, for an average number of six movements with ten staff per day. This amounts to roughly one full working day per week collectively lost for the entire team due to checkpoint delays. In addition, Doctors of the World’s staff often have to take alternative routes, doubling their travel time, to avoid the main roads due to the threatening presence of Israeli settlers or because the communities where Doctors of the World intervenes have been disconnected from the main axes by Israeli military obstacles.

Crossing Israeli military obstacles poses significant security risks. Doctors of the World’s colleagues regularly report experiencing humiliation, harassment, and aggression from Israeli soldiers at checkpoints. In November 2023, at the military checkpoint at the eastern exit of Jericho, Doctors of the World faced a serious threat when, despite prior coordination with the Israeli authorities and obvious display of Doctors of the World’s logos on their vehicle, a soldier reacted to their approach by opening fire. Fearing for their lives, the Doctors of the World’s staff retreated into Jericho and waited several hours before leaving.

Doctors of the World’s movements are regularly restricted due to security threats posed by state-backed settler violence and Israeli military incursions into Palestinian cities and villages. Doctors of the World operates in rural Palestinian communities which are attacked by Israeli settlers every week. Our teams have been stopped by extremist armed settlers, who control documents and demand to know the purpose of our presence while pointing their weapons at Doctors of the World humanitarian workers. INGO access to communities at high risk of forced transfer has deteriorated substantially. Doctors of the World was unable to access any of the Palestinian communities which were forcibly displaced by state-backed settler violence between October and December 2023. Displaced families were only able to receive Doctors of the World’s support after they reached areas that were less attacked, usually in Area A and B communities.

Doctors of the World also provides medical services to Palestinian refugee camps. The danger of intervening in these communities is extreme, as the Israeli army is increasingly escalating military raids on refugee camps and employing more deadly warfare tactics, including airstrikes. Such attacks could be deemed as violating international law enforcement standards, given that these areas are densely populated with civilians.

These raids exacerbate humanitarian needs (forced displacement, destruction of civilian infrastructure, denial of access to medical emergency teams) while preventing the access of aid actors. On 28 August 2024, the Israeli military launched a ten-day raid on Jenin, blocking Doctors of the World’s access. After six days, Doctors of the World was only permitted to intervene in nearby villages with Palestinians displaced by the raid. Doctors of the World was only able to access Jenin city and the refugee camp after the raid ended on 7 September.

Most of the events reported here could amount to violations of human rights and international humanitarian law. Doctors of the World is gravely concerned for the safety and security of the Palestinian population of both Gaza and the West Bank, as well as its own staff. Therefore, Doctors of the World is calling on States with influence over the parties to the conflict to take concrete actions, beyond mere condemnation, to ensure an immediate and permanent ceasefire, at-scale, and unimpeded humanitarian access, and respect for international humanitarian law across the entire Occupied Palestinian Territory.

About Doctors of the World in Palestine

Doctors of the World has been working in the Occupied Palestinian Territory since 1994. In the Gaza Strip, Doctors of the World is currently providing an emergency medical response to address the health needs of the population amid the destruction of healthcare infrastructure, shortages of water, food, and medical supplies, and dire conditions of displacement, which have had a severe impact on health and have increased the risk of epidemics. Doctors of the World is directly operating four primary healthcare centres and is supporting nine medical points operated by local Palestinian partners, providing primary healthcare, sexual and reproductive healthcare, mental health and psychosocial support (MHPSS), nutrition, vaccines, and basic emergency responses such as wound dressing.

In the West Bank, Doctors of the World is providing MHPSS emergency response services to Palestinian victims of the occupation violence. The organisation is operating a mobile medical clinic to improve access to health for vulnerable populations. Doctors of the World is also reinforcing the healthcare capacities of ten primary healthcare clinics, by providing emergency stocks, setting up emergency rooms, and building local capacity.

The obstruction to our operations presented in this report have been further heightened by the restrictions imposed by the Israeli authorities on access by humanitarian workers to the Occupied Palestinian Territory. All INGOs working in the Occupied Palestinian Territory are experiencing restrictions on access imposed by the Israeli authorities on the entry of expatriates into the country and access to different areas of the Occupied Palestinian Territory by national staff. Since 7 October 2023, Israeli authorities have no longer renewed work visas for international staff or permits for national staff, rendering access to the country extremely difficult and submitting staff to potential arbitrary refusals at the border. Between October 2023 and September 2024, two Doctors of the World’s humanitarian workers were refused access at the border and two others were arbitrarily issued tourist visas for only one week. Many expatriate staff are forced to work from outside the country due to this restricted access for humanitarian workers to the Occupied Palestinian Territory.

References

¹  Geneva Conventions Common Article 3, Additional Protocol I Articles 70-73.

²  Fourth Geneva Convention, Article 55, 58.

³  As of 12 September 2024, out of 14,510 patients for whom medical evacuation had been requested since October 2023, only 5,130 (35%) had been evacuated abroad, and only 219 patients had been allowed to leave Gaza by Israeli authorities since the closure of the Rafah crossing in May 2024 (OCHA).

⁴  On 1 December 2023, the Israeli military produced an interactive grid-based displacement map for Gaza, dividing the Strip into 623 “blocks”. Using this grid, the military began issuing displacement orders to Palestinians in various locations throughout the enclave. This grid has been shown to be imprecise, inconsistent, and sometimes contradictory, disorientating civilians and creating panic. (See Forensic Architecture, Humanitarian violence in Gaza, 14 March 2024).

⁵  INGOs operating in Gaza have consistently reported precise examples of the obstruction of aid since July 2024 (Humanitarian Snapshot of 15 July 2024; Humanitarian Snapshot of 30 July, Humanitarian Snapshot of 13 August, Humanitarian Snapshot of 30 August, Humanitarian Snapshot of 10 September).

⁶  Coordinating humanitarian movements with the Israeli authorities consists in giving the reason for the movement and the departure and arrival times, but also the times of each stop (including in the case of Doctors of the World, 15 stops to pick up humanitarian workers), the GPS position of each stop, the identity numbers of the drivers and of each person in the vehicle, and the satellite photo of the route. It is necessary to await the response and if the outcome is negative to suggest an alternative approach in hopes of obtaining validation from the Israeli military authorities.

⁷  In June 2024, Doctors of the World published a case study examining how Israeli military barriers are imposing a stranglehold on Palestinian villagers’ access to healthcare. Doctors of the World, Locked Out of Health, 6 June 2024, accessible at: West Bank: Locked out of health – Médecins du Monde (medecinsdumonde.org)