On the ground in Rafah: UNICEF reports ‘lethal’ lack of water, services

This article is published in association with United Nations.

Almost 3,000 malnourished children are at risk of dying before their families’ eyes in Gaza, where the eight-month-long war continues, according to the UN Children’s Fund (UNICEF) as spokesperson James Elder told UN News on Saturday about the situation on the ground in the besieged and bombarded enclave.

Speaking from Gaza, Mr. Elder described a dire landscape, with a focus on child malnutrition and the devastating impact of the ongoing conflict amid growing concerns of famine.

Tweet URL

The destruction of health facilities, including specialised centres that are critical for staving off malnutrition, has severely hampered efforts to address severe hunger among children against a backdrop of constant bombings and attacks alongside the “lethal” lack of access to basic necessities that have already left children physically and psychologically scarred.

The UNICEF spokesperson emphasised the urgent need for a ceasefire to address the humanitarian crisis, get the hostages home and allow for the delivery of aid, education and medical care.

The interview was edited for length and clarity.

James Elder: If we focus on the nutritional situation, it was an immense effort from colleagues and partners over the last months to create stabilisation centres to address malnutrition. When that massive offensive came into Rafah [last month], forcing another million people who surely had already moved three, four or five times, we lost those stabilisation centres. The thousands of children who were being given the nutrition they needed suddenly disappeared again into the community. That’s perilous in a place where we know there’s a lethal lack of water and a dangerous, dangerous lack of sanitation.

So, now we start again. We have incredible partners. I’ve got amazing colleagues. All other agencies rally around. But, it’s again about now getting stabilisation centres and nutrition points into what are the tented camps so we can identify mothers who are desperate to get the support. But, they need to know it’s there. That’s the nutritional side, just one angle to which children are under attack. They’re under attack on the ground from that lack of nutrition, lack of sanitation, consistent restrictions on aid and very much so still from the skies.

I know it’s been 250 days. I know there’s a great risk of normalisation of this. There is nothing normal about the constant these children here are living, and there’s nothing normal about the last three nights of relentless bombardments. Drones surely meant no child could sleep there. There’s certainly nothing normal about the horrific wounds of children that I saw just a few hours a day in Al Aqsa Hospital. I spoke to families of children where they were in a sleep at five in the morning on the third floor and suddenly, in a moment, they’re under rubble. Mothers and children were killed or wounded or children have lost a mother. This has been continuous for 250 days. Children and their families really now are physically and psychologically just holding on.

UN News: How many hospitals are working now in the areas you were able to visit?

James Elder: We are now at a handful that are partially functioning from a previous total of 36 hospitals and healthcare centres in Gaza. Al-Aqsa Hospital [in central Gaza] took the brunt of those people after the [military] operation on Saturday. It was already overflowing because they’re in a state of war.

I visited on Tuesday, when there were scores of people with brutal wounds of war on the floors, mattresses, anywhere they could find. They needed attention. There were children with blast injuries, with burns, these awful injuries. Remembering a bomb blast picks up anything and everything, from bricks to tiles and shrapnel and does terrible things to a child’s body. As a doctor said to me, there are no hospitals in the world that could manage what we’re doing.

At the same time, there is the immense spirit of people here, of the Palestinians of Gaza. Nassar Hospital, which was the second biggest hospital was gutted inside after Khan Younis had been devastated, and it’s been restored and is partially functioning. That’s just on the back of people’s resolve, strength and determination. However, we have seen the systematic devastation of these health care system, and it too is holding on by a thread.

Many children in Gaza are showing signs of severe acute malnutrition and drastic weight loss.

UN News: Now only two of the three specialised nutrition stabilisation centres in Gaza remain open. Does UNICEF have any alternative plans to fill this vacuum?

James Elder: Absolutely. It is to get another stabilisation centre up and running in Rafah as well as smaller centres. Yesterday, I was at a tented camp and there was, with a partner, not a stabilization centre, but a smaller centre where they are doing testing, giving, therapeutic food to mothers and doing outreach in the community to make sure people come to them. Word spreads very quickly.

That’s the sort of thing we can do. On Wednesday, I was in a convoy trying to get aid to distribute to our partners while training them. It sounds strange to train partners in malnutrition screening and response, but that’s because before this war, Gaza didn’t really have a severe malnutrition problem.

So, there’s training, supply delivery and then, as best we can, trying to set up those bigger stabilisation centers. Again, even though knowing this, this war keeps moving and people keep being forced from their homes. Our operations, like all other agencies, keep being disrupted.

More than one million people in Gaza face severe food insecurity.

UN News: You took to social media to discuss the challenges that UNICEF faces in delivering supplies to the children of Gaza. Can you please elaborate on that? 

James Elder: This specific example was Wednesday. We had a truck of malnutrition and medical supplies for 10,000 children. We had all the approvals, which is normal terrain. Yet, when we moved on Wednesday, what was basically a 40-kilometre round trip took 13 hours, with eight hours stuck at checkpoints or nearby. There were great discussions over whether we had a truck or whether we had a van.

In the end, that truck with nutrition and medical supplies for 10,000 children was returned. We weren’t able to get it through. Now, we will get it back and make that trip again, remembering such is the precarious, dangerous state of trying to deliver aid in the Gaza Strip. More of my UN colleagues have been killed during this eight-month war than in any other conflict in the history of the United Nations.

More of my UN colleagues have been killed during this eight-month war than in any other conflict in the history of the UN

It’s not so easy as just turning around the next day. We require two armored vehicles every time we move. UNICEF distributes tents as well as deliver fuel for desalination plants. We also have a lot of programmatic work. That was hugely disappointing. That was supplies that needed to go to those partners and children.

Even as we waited for hours near one of those checkpoints called a holding point, I was watching fishers. No doubt they had previous professions as accountants, lawyers and other jobs, but now all jobs and economies are being battered. Here they were fishing just using a single net, throwing it and trying to catch some fish for their family.

Suddenly a tank came, and the next thing, there was firing from the position from the area around the Israeli military checkpoint, and two fishermen were shot. We didn’t know if they were dead. A WHO paramedic colleague radioed the authorities to ask if we could possibly get these two people to see if we could give them medical care. That was denied. That care was denied.

Eventually, half an hour later, other fishers returned with body bags and we discovered that the two men were in fact dead. One had been shot in the back, and one who had fishing net still around his foot was shot in the neck.

Over 330,000 tonnes of waste have accumulated in or near populated areas across Gaza, posing catastrophic environmental and health risks.

UN News: People are running for their lives, but many schools in Gaza have been destroyed due to this war. What do you think the long-term consequences of this?

James Elder: The world should be terrified of the long-term consequences. Because we know that the longer a war goes on, the more damage it does psychologically to children. UNICEF knows that from a Yemen or Afghanistan. We are in uncharted territory when it comes to the mental health of children here.

We are in uncharted territory when it comes to the mental health of children here

At the same time, while as long as this continues, this is no place for a child to get treatment. I’ve sat with children. A little boy, Omar, who was sort of doing his own psychological treatment for himself. He would shut his eyes and try and remember his parents. His mother, father and twin brother were killed in their home. He would close his eyes to try and remember them. He didn’t want to lose them in his memory as he lost them on the ground.

I saw Omar in November and saw him again two days ago. He’s no longer able to recall what his parents looked like. Children are having to do their own mental health care. The reason the world should be concerned about this is that any economist, any demographer will tell you with a young population like Gaza’s, give them the right skills, the right education, the right opportunity and you get a demographic boom. You know, it’s the envy of aging countries well, but you have to give them those skills.

The opposite of that is happening right here: lasting violence. Children are being denied the most basic rights and are seeing death. There is nowhere near any education or universities as well. I think there are reports of hundreds of professors having been killed.

Again, this all comes back to a ceasefire. A ceasefire enables children to go to school, enables us to get aid safely and gets the hostages home. A mother said “I could go to bed if there was a ceasefire and promise my daughter that she will wake up tomorrow morning.”

Parents cannot do that right now.

UN News: You’ve been consistently emphasizing the urgent need for a ceasefire. To address this, humanitarian crisis in Gaza, yet war continues. What’s your message to the world? 

James Elder: I think the message has to be, as we’ve heard from the Secretary-General, from my own executive director, from the start, a ceasefire gets hostages home and stops the bombardment. Those parties that have the power over the ceasefire have to be connected with the suffering of people here. It would seem that that’s not happening.

This is and has been a war on children. We do not say that lightly. We do not say that is a headline. We say that based on evidence, based on the disproportionate impact this war is having on boys and girls. So, a ceasefire is the only solution. As my executive director said many months ago to the Security Council, the killing of children in Gaza and the devastation of Gaza will not bring peace to children or the region.

More than one million people, most displaced several times, have been forced to flee once again in search of safety.

UN News: This is your second mission to the Gaza Strip. Have you seen any signs of hope or anything different during this time in Gaza?

James Elder: It’s my third trip after being here in November and March. Now, I’ve seen the opposite of hope. I’ve seen hope extinguished. I’ve seen hope rise with the Security Council resolution in March, and I felt that in the air. I spoke to people and the sense that the war may be coming to an end was an amazing feeling and sense to see.

Then that literally got bombed away. So, there are a mix of people. There are those who will say to me that all they have left is hope after their home was destroyed, husband and children killed and they can no longer feed regularly their other children and they lost their job.

There are others who will say to me, there have been so many Security Council resolutions, I’ve lost count, more fearfully, more heartbreakingly. There will be others, like more than a handful of young people who tell me that they hope a missile hits their tent and ends this.

This is the perilous psychological state people are in right now. We cannot allow the world to turn away. We can’t allow the normalisation of this. There is nothing normal about this malnutrition crisis. There is nothing normal about the relentless bombardments and all the horrors that I see in hospitals. There is certainly nothing normal about children and their families living in a constant state of fear.