Under threat of military incursion, Palestinians in Rafah face feces-infested waters, illness: WHO official

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Aid workers are concerned about what will happen to the Gaza Strip's already fragile health-care systemif Israel follows through on invading Rafah.

"What we worry about if the incursion happens, then the health care that's available here would no longer be available," Nyka Alexander, a communications officer with the UN's World Health Organization, toldThe Current'sMatt Galloway.

"So we're working on making sure that the hospitals that are nearby to Rafah would be able to take in more patients should something happen in Rafah."

Prime Minister Benjamin Netanyahuon Tuesday said Israelwould carry out a ground incursionof Rafah,with or without a hostage deal. The U.S. government, which provides military and diplomatic support to Israel, has saidit opposes a military offensive in Rafah without a humanitarian plan.

More than 34,000 Palestinians have been killed by Israel since their bombardment on Gaza Strip began in October, according to Palestinian health officials. The war has driven around 80 per cent of Gaza's population of 2.3 million from their homes, caused vast destruction in several towns and cities and pushed northern Gaza to the brink of famine.

Since October, Palestinians have been forced to flee south to escape Israel's military assault, with Israel indicating Rafah would be a safe haven.Israel has since carried out airstrikes in the city, which currently hosts more than a million Palestinians.

Alexander has been in Rafahfortwo weeks. She spoke to Galloway about what Palestinians are facing in Rafah andthe state of health care in the city. Here's part of that conversation.

Give us a sense as to how people in Rafah are feeling right now, given the idea of this escalation of a ground incursion hanging over their heads.

Many people are just living in tents or not even tents. They're just shelters, pieces of wood.People have torn apart, for example, wooden pallets to make the walls that they then strung the tarp on.

They're surrounded by garbage. They're surrounded by dirty water. They're surrounded by, essentially, open air toilets. And they're just tired and scared and don't want the next bad thing to happen on top of the other bad things that have already happened to them and their families.

With a million people moving into the city what does it look like when a city sees that sort of influx?

Imagine all the sidewalks covered in tents and in these makeshift shelters. Imagine the streets flowing with greeny, bluey, black water that is feces mixed with garbage. Imagine there's no garbage cans, there's no garbage collection. There's just piles of garbage.

People have tried their best. You can see that they've set aside areas where that community wants to put their garbage. But there's not a lot of organized garbage collection.

The flies are everywhere as well, and they're very aggressive. They want to go in your eyes, they want to go in your mouth.From a public health point of view, it's a really disastrous situation.

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When you describe, I mean, the open air toilets and the kind of green, blue, black water that's flowing through with the flies swirling around ... that leads to real concerns around sanitation and public health, especially as the weather gets warmer.

That's right. We had a couple of days of really hot weather last week. It almost hit 40 [degrees]. It was just warm enough in the nice little house that I'm living in. And I kept thinking about what is it like for the people who are in tents under full sun all day long, just roasting.

The other concern is the flies land on the feces,then they fly right next door to where you have your food. You don't have good, clean running water to clean your food, and that's how the disease spreads.

We have a lot of jaundice right now, which is an inflammation of the liver. Sochildren are getting sick, adults are getting sick with jaundice on top of already being sick and weak from not very good food supply.

There's a lot of diarrheal diseases that are spread that way as well, and you don't want a kid who's already not eating well to not be able to hold any of the nutrition in because it's just going in one end and out the other.

And then, of course, with people living so close together, there's all the respiratory infections you can imagine them getting as well.

What is the state of health care right now? How prepared are the remaining hospitals and health centres to deal with what you're describing?

What I find amazing is the health system has not collapsed, but it sure is on its last legs.

About a third of hospitals are still functioning and WHO supplies them. Actually, WHO supplies the majority of the medicines that are received across the Gaza Strip, that comes through WHO and UN partners.

So the hospitals that are able to function are still able to function somewhat, but they're not fully functional. People who would normally get their diabetes medications or cancer treatment are not getting it.

They're almost like emergency points. People with wounds will come in. Women about to birth to give birth will come in. So it's the people in the most dire situations that are able to get some help if they're in an area where they can get some help.

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If this incursion is to happen, what are you doing so that whatever infrastructure might be available is ready for that?

Shoring up the hospitals that are still able to function now,working with the emergency medical teams that have set up field hospitals near those hospitals or independently to make sure they have the supplies they need.

We'veactually moved supplies from our warehouse in Rafah to another one further up, so that we'd still be able to access them should something happen.

So it's a lot of that coordination work, working with all the other health partners the people who have come internationally, but especially the health workers who are here, to see what do you think needs to be done, who needs help, and just to make sure that there's health services, wherever the people are.

Is your sense that there is anywhere for those people to go?

It's already incredibly crowded, right? You've got a million people in a town here that wasn't meant to have this many people in it.

The shelters are hugely overcrowded. There's a shelter here that's built on a logistics baseand they have 44 toilets there for 50,000 people. So you can just imagine the scale of the people who are there right now. So there isn't a lot of place for people to move to. That's one of the problems.

With files from The Associated Press and Reuters. Produced by Ben Jamieson. Q&A has been edited for length and clarity