PRESS BRIEFING BY THE UNITED NATIONS INFORMATION SERVICE

19 April 2024

Impact of Attacks on Healthcare in Gaza

Dominic Allen, United Nations Population Fund (UNFPA) Representative for the State of Palestine, said that he had just returned from his latest 10-day mission in Gaza. Six and a half months of Israeli military operations in Gaza had created a humanitarian hellscape. Tens of thousands of people had been killed. Two million Palestinians had endured death, destruction and continued to suffer from despair.

Fear remained ever present, as a military incursion in Rafah would compound the humanitarian catastrophe. Mr. Allen said he was terrified for the one million women and girls in Gaza right now, and especially for the for the 180 women giving birth every day in inhumane, unimaginable conditions.

One man who Mr. Allen met at Al Aqsa hospital had lost 50 of his extended family members, who were killed from an airstrike which collapsed a building in which they were living. He said that his mother and brother’s bodies and hearts were broken. Mr. Allen had also met with a youth leader who had helped to set up a camp on the sand in Rafah and to deliver shelter, food and water. Her parents had been killed two months ago, but she had been able to continue supporting her community.

Mr. Allen also recounted the look in the eyes of Iman, a humanitarian worker who worked with the UNFPA team, upon seeing the burnt-out carcass of the home he had built with his wife, which encapsulated his family's dreams and his personal aspirations for the future. These people, and all the incredible Gazans enduring so much, had no choice but to go on. They were all calling for a ceasefire now.

During his mission, Mr. Allen visited around 10 hospitals, many medical points and gender-based violence safe spaces. Some of those hospitals were laying in ruin and some were being rebuilt to support the health system, which was hanging by a thread. Hospitals were a lifeline for the pregnant women of Gaza.

In Eastern Khan Younis, the level of destruction was difficult to describe. It was very similar to the destruction in Gaza City. One hospital in Khan Younis was being restored and would start to provide a semblance of emergency medical services soon.

In Al Amal Hospital, the second most important hospital across the Gaza Strip, what Mr. Allen saw broke his heart. Medical equipment, such as ultrasounds, had cables that had been cut and screens smashed. The wanton destruction in the maternity ward was purposeful. UNFPA and international non-governmental organization partners were working to restore electricity and safe water in the hospital and reestablish this medical lifeline.

Mr. Allen said he had stood beside a warehouse of Nasser Hospital, to which UNFPA delivered supplies many months ago, which was literally burning. He had had to avoid unexploded ordnances on his visit to Al-Khair Hospital, a referral hospital for maternal care. It was unrecognisable from two months ago – there was seemingly no working medical equipment, the maternity ward and birthing rooms stood silent and there was an eerie sense of death.

Phenomenal, heroic work had been done by doctors in Gaza City to create a small primary healthcare focal point for UNFPA amidst the rubble of a half blown-out building. It had antenatal care and postnatal care and was providing basic medical support. The maternal healthcare centre in Shifa, the most important hospital in terms of its tertiary care and for UNFPA, stood in rubble. Workers were trying to rehabilitate some of the emergency rooms to get it up and running again, but it would not be used for maternity care again.

The one hospital referring all safe births in North Gaza was the Al Sahaba Hospital, which UNFPA was supporting with supplies since the end of October. This was the only place pregnant women were able to go in North Gaza. The Al Awda Hospital was overwhelmed with trauma cases and was not supporting maternity care.

The Emirati Hospital was the major lifeline for women in Gaza. Right now, it was supporting around 50 or 60 births a day, including 10 to 12 caesarean sections. In this visit, UNFPA delivered lifesaving oxytocin to the hospital. There was a sense of fear about what might happen at Emirati, given its importance for pregnant women in Gaza.

UNFPA had delivered a 40-foot mobile maternity unit, which International Medical Corps UK would operate as part of its maternity work in Gaza. It would be delivering five other units to the organisation and others soon to ensure safe births.

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was the backbone for the humanitarian response in Gaza. Mr. Allen visited three UNRWA schools, where there were emergency medical points operating. UNFPA was deploying midwives in these schools to hear the needs of pregnant women. It would soon deliver more midwifery kits to these schools. The work of UNRWA workers on the ground was inspiring.

Mr. Allen had also visited the UNFPA Youth Advisory Panel. They had become positive humanitarian agents in Rafah, building shelters for 300 people, delivering water and supplies. They were afraid of what a Rafah military operation would bring, and they demanded an immediate ceasefire.

Mr. Allen also visited several women-led organisations. Women in Gaza feared for their safety and dignity. Through UNFPA staff, there were reports of growing intimate partner violence and child marriage. There was also a lack of menstrual health management supplies.

UNFPA had concerns for the healthcare system overall. Pregnant women could only go to give birth at three of the ten partially functioning hospitals. UNFPA was working to ensure that life-saving health supplies could be delivered and was working with local partners to help gender-based violence survivors to seek support. It was also delivering dignity kits, hygiene kits and menstrual hygiene management kits. Psychological first aid, mental health and psychological first aid remained a priority. UNFPA was also engaging with youth to support their own communities.

There was a sword hanging over Rafah, Mr. Allen said. There was palpable fear about what would happen if ground military operations started in Rafah. Rafah was a haven for 1.2 million Gazans. Where would the people living under plastic sheets and shelters in indescribable conditions go? Where would they get access to food, water, to shelter and health care?

There was a way to stop Gaza from further plunging into a deeper abyss. There needed to be a massive influx of aid and assistance delivered safely to people in need. An immediate humanitarian ceasefire was the only solution to the huge catastrophe in Gaza.

In response to questions, Mr. Allen said it was unclear who had damaged medical equipment, but it had clearly been purposefully damaged. There had been several reports from doctors that there were not sufficient supplies of anaesthesia for carrying out C-sections. Because the health system was crippled, women were giving birth and having to be discharged within a matter of hours. UNFPA wanted to increase midwives in the region and provide more post-natal care. There was an increased number of complicated births; some doctors had reported a doubling in complications. This was due to dehydration, malnutrition, and fear. One doctor said that he no longer saw normal-sized babies. The looming famine would have a direct impact on women. Fear increased stress and other complications that led to more pre-term births.

Mr. Allen said he travelled to Gaza regularly. For the most recent mission, he was there from 8 until 17 April. The mission was conducted with the World Health Organization (WHO) and UNRWA. The inter-agency humanitarian country team, which included United Nations agencies, had daily contact with Israeli authorities. The United Nations had been very clear regarding the danger of a ground offensive in Rafah.

In general, aid could be delivered through a very narrow pipeline only. Thus, the number of dignity kits was currently insufficient. While there were other entry points opening for food, those could not be used for dignity kits. Midwifery kits were opened at crossings and torches were removed. The oxygenator unit included in the mobile maternity unit could also not be delivered. Other agencies were also having difficulty delivering equipment such as generators.

Getting data on maternal and infant mortality was very difficult. UNFPA coordinated with partners working on reproductive health to collect what data it could. Anecdotally, it was hearing reports of an increase in still births, but there was no data on the situation thus far.

Rolando Gómez, Chief of the Press and External Relations Section at the United Nations Information Service (UNIS) in Geneva, said United Nations Secretary-General António Guterres had spoken yesterday to the Security Council, calling for an immediate ceasefire as well as the immediate release of all hostages held in Gaza. Ending hostilities in Gaza would significantly diffuse tensions across the region, he said.

Philippe Lazzarini, Commissioner-General of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), had two days ago spoken about why the agency existed, in lieu of a State that could deliver critical public services to people in Gaza.

Concerns over Rising Tensions in Rakhine State, Myanmar

Jeremy Laurence for the Office of the United Nations High Commissioner for Human Rights (OHCHR) said intensified fighting in Rakhine state between the military and the Arakan Army, alongside tensions being fuelled between the Rohingya and ethnic Rakhine communities, posed a grave threat to the civilian population. There was a grave risk that past atrocities would be repeated.

Since the year-long informal ceasefire between the two sides broke down last November, 15 of Rakhine’s 17 townships had been affected by fighting, resulting in hundreds of deaths and injuries, and taking the number of displaced to well over 300,000.

Rakhine state had once again become a battleground involving multiple actors, and civilians are paying a heavy price, with Rohingya at particular risk. What was particularly disturbing was that whereas in 2017, the Rohingya were targeted by one group, they were now trapped between two armed factions who have a track record of killing them. We must not allow the Rohingya to be targeted again.

The military had been fast losing ground to the Arakan Army throughout northern and central Rakhine. This had led to intensified fighting in the townships of Buthidaung and Maungdaw, ahead of an expected battle for the Rakhine state capital, Sittwe. The two townships were home to large Rohingya populations, putting them at grave risk.

Facing defeat, the military had outrageously started to forcibly conscript, bribe and coerce Rohingya into joining their ranks. It was unconscionable that they should be targeted in this way, given the appalling events of six years ago, and the ongoing extreme discrimination against the Rohingya, including the denial of citizenship.

Some reports said the military was forcing the Rohingya recruits or villagers to burn ethnic Rakhine homes, buildings, or villages. Ethnic Rakhine villagers had allegedly responded in kind by burning Rohingya villages. The United Nations Human Rights Office was trying to verify all reports received, a task complicated by a communications blackout throughout the state.

Disinformation and propaganda were also rife, with claims that “Islamic terrorists” had taken Hindus and Buddhists hostage. This was the same kind of hateful narrative that fuelled communal violence in 2012 and the horrendous attacks against the Rohingya in 2017.

Since the start of the year, the Arakan Army had positioned itself in and around Rohingya villages, effectively inviting military attacks on Rohingya civilians.

On 15 April, the Médecins Sans Frontières office and pharmacy were torched in Buthidaung, along with some 200 homes. Hundreds had fled and were reported to be taking refuge in a high school, the grounds of the former hospital, and along roads in Buthidaung town. With both the Maungdaw and Buthidaung hospitals having been shut by the military in March and with the conflict intensifying, there was effectively no medical treatment in northern Rakhine.

The alarm bells were ringing, and we must not allow there to be a repeat of the past. Countries with influence on the Myanmar military and armed groups involved needed to act now to protect all civilians in Rakhine State and prevent another episode of horrendous persecution of the Rohingya.

In response to questions, Mr. Laurence said OHCHR did not have a presence in Myanmar but was engaged through normal diplomatic channels with the Arakan Army and the Permanent Mission of Myanmar in Geneva.

OHCHR was aware of reports that Aung San Suu Kyi had been moved. Its position was that she and all 20,000 political prisoners in Myanmar needed to be released.

Rolando Gómez, Chief of the Press and External Relations Section at the United Nations Information Service (UNIS) in Geneva, said the Secretary-General had recently appointed Julie Bishop of Australia as the Special Envoy on Myanmar to replace Noeleen Heyzer of Singapore. The United Nations also had the Independent Investigative Mechanism on Myanmar, which was very active in Geneva. This was a dire situation that the United Nations was looking at from various angles.

Attack on Iran by Israel

In response to questions, Jeremy Laurence for the Office of the United Nations High Commissioner for Human Rights (OHCHR) said OHCHR was aware of reports of an attack on Iran by Israel. It was hard to gather real information from both sides involved.

It urged all parties to take steps to de-escalate the situation and called on third States, particularly those with influence, to do all in their power to ensure that there was no further deterioration in an already extremely precarious situation. It was deeply worried by the potential humanitarian and human rights cost if this escalation led to a wider conflict in the Middle East.

Rolando Gómez, Chief of the Press and External Relations Section at the United Nations Information Service (UNIS) in Geneva, said the Secretary-General was also calling for de-escalation of the situation. Earlier in the week, he issued a statement strongly condemning the escalation of the situation caused by the large-scale attack on Israel by Iran.

Update on H5N1 Situation Globally

Dr. Wenqing Zhang, Head of the Global Influenza Programme, World Health Organization (WHO) said recently, avian influenza H5N1 viruses had been detected in dairy cows and goats in the United States. Since March 2024, infections in 29 herds in eight different states had been reported.

On 1 April, the United States notified WHO of a laboratory-confirmed human case of H5N1 in Texas. This person worked at a dairy cattle farm, where he was exposed to cows presumed to be infected with the virus. So far, the H5N1 viruses identified in cows and the human case remained avian viruses and showed no increased adaptation to mammals.

Avian influenza H5N1 first emerged in 1996 but since 2020, there had been an exponential growth in the number of outbreaks in birds. In addition to birds, an increasing number of mammals had been affected, such as minks, seals, sea lions and foxes.

Now there were multiple herds of cows affected in an increasing number of states of the United States, which showed a further step of the virus spill over to mammals. Farm workers and others in close contact with cows needed to take precautions in case the animals were infected. The virus had also been detected in milk from infected animals. While investigations were ongoing, it was important for people to ensure safe food practices, including consuming only pasteurised milk and milk products.

The case in Texas was the first case of a human infected by avian influenza by a cow. Bird-to-cow, cow-to-cow and cow-to-bird transmission had also been registered during these current outbreaks, although many were still under investigation. These suggested that the virus may have found other routes of transition than those previously understood.

While this might sound concerning, it was also a testament to the strong disease surveillance which allowed WHO to detect the outbreak. WHO was working closely with the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (WOAH), its “One Health” partners, on updating a joint risk assessment for H5N1, which it would publish in the coming days.

Human infections with H5N1 remained rare and were tied to exposure to infected animals and environments. Since 2003, close to 900 human cases of H5N1 infection had been reported. Infections in humans ranged from mild, even asymptomatic, to severe.

Any time there was a human case of infection with an animal influenza virus, countries were required to report it to WHO under the International Health Regulations. Detailed investigations took place to prevent potential further transmission, to allow for understanding of the source of infection and characterisation of the virus, and to inform clinical management of sick persons and other pandemic preparedness activities. This allowed WHO to ensure that the risk that H5N1 and other avian influenza viruses posed was carefully managed.

WHO used virus characterisation and other available information to update the risk assessment and “candidate vaccine virus” as part of pandemic preparedness. Having candidate vaccine viruses ready allowed WHO to be prepared to quickly produce vaccines for humans if this became necessary. For this particular H5N1 virus detected in dairy cows, there were a few candidate vaccine viruses available from the WHO Global Influenza Surveillance and Response System (GISRS).

While WHO and partners were reviewing and assessing risks for H5N1 avian influenza, they called on countries to remain vigilant, rapidly report human infections if any, rapidly share sequences and other data, and reinforce biosecurity measures on animal farms.

In response to questions, Dr. Zhang said the virus had only been detected in cows in the United States. There was a high virus concentration in raw milk, but it was unclear how long the virus could survive in raw milk. WHO was recommending that people consumed pasteurised milk and milk products.

There had only been one human case associated with the outbreak and was most likely transmitted through direct contact with cows. A report suggested that it was transmitted though milking devices. FAO had developed guidance on the consumption on dairy products and the effects of the pasteurisation process.

The United States case had led to only mild conjunctivitis symptoms. Around half of the 900 human cases were fatal. The cases reported in Europe and North America were all mild. There was a need to investigate in detail the morality caused by the virus.

WHO could not predict whether the virus would spread to cows in other countries. However, the virus had crossed several continents through birds. Vigilance was needed, including surveillance of both humans and animals.

Countries were equipped to detect the virus if it appeared. There were a couple of candidate vaccines for this variation of H5N1 that could be distributed if a pandemic were to develop. Member States needed to notify WHO of novel human infections within 48 hours. There had been delays in the past due to the confirmation process.

H1N1 and H3N2 were seasonal influenza viruses. There was also a variation of influenza in swine that WHO was monitoring for transmission to humans. There were different clades of H5N1, and there were other subtypes such as H5N6 and H3N8. In these subtypes, human infection was very rare and usually picked up in hospitalised cases.

WHO had found that there were no new changes associated with the susceptibility of the currently available antivirus.

Announcements

Rolando Gómez, Chief of the Press and External Relations Section at the United Nations Information Service (UNIS) in Geneva, said the Committee on the Elimination of Racial Discrimination (112th session, 8-28 April, Palais Wilson), was concluding this morning its review of the report of Moldova.

The Committee Against Torture (79th session, 15 April – 10 May) would begin next Tuesday morning its review of the report of Azerbaijan.

The Conference on Disarmament would open the second part of its 2024 session on the 13 May, still under the presidency of the Islamic Republic of Iran.

On Monday, 22 April at 10:30 a.m., the International Labour Organization would hold a press conference to launch the report “The impacts of climate on occupational safety and health,” which was embargoed until 22 April at 11:30 a.m. Speaking would be Manal Azzi, Senior Specialist on Occupational Safety and Health, and Balint Nafradi, Technical Officer on Occupational Safety and Health Data.

On Monday, 22 April at 1:30 p.m., OHCHR would hold a briefing on the health situation in Gaza. Speaking would be Tlaleng Mofokeng, Special Rapporteur on the right to health.

Mr. Gómez also congratulated the newly elected committee for the Association of Accredited Correspondents at the United Nations, and said he looked forward to working with them throughout the year.