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Continuity: WHO Press Conference: Gaza Health Update - 21 December 2023

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21-12-2023

Press Conferences , Edited News | WHO

WHO Press Conference: Update on health situation in Gaza - 21 December 2023

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Shotlist Story

STORY: Gaza healthcare update – WHO

TRT: 3:09”
SOURCE: UNTV CH
LANGUAGE: ENGLISH
ASPECT RATIO: 16:9
DATELINE: 21 December 2023 - GENEVA, SWITZERLAND

SHOTLIST

Exterior wide shot: UN building with UN flag, UN Geneva.
SOUNDBITE (ENGLISH) – Sean Casey, WHO Emergency Medical Teams coordinator: “It's pretty unbearable to see people who are already victims of conflicts who are in what should be a safe place where they should be able to access care, where they're sitting, waiting to die unless something dramatically changes that will allow them to survive. And that required safe movement, it requires a huge uplift of fuel, it requires medicine, medical supplies, human resources. They're starving. They're dying of thirst.”
Cutaway: Medium shot, UN building with UN flag
SOUNDBITE (ENGLISH) – Sean Casey, WHO Emergency Medical Teams coordinator: “Patients were crying out in pain, but they were also crying out for us to give them water. It's pretty unbearable to see somebody with casts on multiple limbs, external fixator on multiple limbs, without drinking water and almost no IV fluids available.”
Cutaway: Medium shot UN entrance at Place des Nations
SOUNDBITE (ENGLISH) – Dr. Richard Peeperkorn, WHO Representative in the Occupied Palestinian Territory: “Over 20,000 people now have been killed in the hostilities in Gaza. This is actually almost one per cent of the entire population. WHO calls again for a humanitarian ceasefire. This is needed now to reinforce and restock remaining health facilities, deliver medical services needed by thousands of injured people and those needing essential care, and above all, stop the bloodshed and death.”
Cutaway: Wide shot, Ariana Park at UN Geneva
SOUNDBITE (ENGLISH) - Sean Casey, WHO Emergency Medical Teams coordinator: “We went through the courtyard where we stepped over a hole from shelling that had happened just a couple of days before, passed a row of bodies that had been wrapped in white, in plastic sheeting,”
Cutaway: Wide shot, UN flag with ICRC building in background
SOUNDBITE (ENGLISH) – Sean Casey, WHO Emergency Medical Teams coordinator: “What would be considered unnecessary amputations in the rest of the world where there is capability to save limbs, where there's orthopedic capability, where there is vascular capability, that's not there. There's no surgery happening right now in northern Gaza. And so actually, many of the patients that I saw yesterday will need amputation if and when they're able to access surgical care.”
Cutaway: Wide shot, UN building
SOUNDBITE (ENGLISH) – Sean Casey, WHO Emergency Medical Teams coordinator: “It's too late. We’re behind. There is not enough food. Every single person I speak to, everywhere I go in Gaza, is hungry. The time is now. We are dealing with starving people now, adults, children. It's unbearable. Everywhere we go, people are asking even in the hospital, I walk around in the emergency department, somebody with an open bleeding wound, with an open fracture, they ask for food.”
Cutaway: Wide shot, UN flag alley

Injured patients ‘waiting to die’ in northern Gaza as last hospital shuts down: WHO

There are no functioning hospitals in the north of Gaza and injured patients who need surgery and cannot be moved are “waiting to die”, the UN health agency said on Thursday, in a plea for a ceasefire to allow more aid into the shattered enclave.

The latest grave assessment from the World Health Organization (WHO) came after UN teams reached Al Ahli Arab hospital and Al Shifa hospital on Wednesday, amid reports of intensifying ground operations by Israeli Defense Forces and continuing airstrikes in the Gaza Strip, in response to Hamas’s 7 October terror attacks on southern Israel.

“Patients were crying out in pain, but they were also crying out for us to give them water,” said WHO Emergency Medical Teams coordinator Sean Casey, describing the scene at Al Ahli Arab hospital, where medical staff were struggling to cope with “no food, no fuel, no water”.

“It looks more like a hospice now than a hospital. But a hospice implies a level of care that the doctors and nurses are unable to provide…. It's pretty unbearable to see somebody with casts on multiple limbs, external fixator on multiple limbs, without drinking water and almost no IV fluids available.

“At the moment, it's a place where people are waiting to die unless we are able to move them to a safer location where they can receive care.”

Guterres aid call

Highlighting the need to relieve the deteriorating humanitarian crisis in Gaza, UN Secretary-General António Guterres on Thursday said that “intense fighting, lack of electricity, limited fuel and disrupted telecommunications” had severely restricted the UN’s efforts to provide life-saving aid to people in the enclave.

“Conditions to allow for large-scale humanitarian operations need to be re-established immediately,” the UN chief insisted in a tweet.

Growing hunger

The high-risk mission to northern Gaza involving the WHO, the UN aid coordination office, OCHA, the UN Mine Action Service (UNMAS) and the UN Department of Safety and Security (UNDSS) ensured the delivery of seven pallets of urgently needed medicines, intravenous fluids and supplies for surgery and to treat the wounded, along with equipment to support women giving birth.

Important though the delivery of medical supplies to the north is to provide some relief to patients, much more worrying is the growing and already widespread shortage of food and water.

“We are behind. There is not enough food, every single person I speak to everywhere I go in Gaza is hungry,” Mr. Casey said, speaking to journalists in Geneva. “The time is now. We are dealing with starving people now, adults, children, it's unbearable. Everywhere we go, people are asking us for food even in the hospital, I walked around in the emergency department, somebody with an open bleeding wound, an open fracture; they asked for food. If that's not an indicator of the desperation, I don't know what is.”

Crippling shortages

According to the UN health agency, only nine out of 36 health facilities in Gaza are partially functional; all of them are located in the south.

“There are no operating theatres (in the north) anymore due to the lack of fuel, power, medical supplies and health workers, including surgeons and other specialists,” said Dr Richard Peeperkorn, WHO Representative and now acting UN humanitarian coordinator in the Occupied Palestinian Territory, speaking from Jerusalem.

At Al Ahli Arab hospital approximately 10 staff – “all junior doctors and nurses” – have continued to provide basic first aid to some 80 patients now sheltering in a church within the hospital grounds, Dr. Peeperkorn explained. “Some of them are severely injured and have been waiting for surgery for two weeks or have been operated on but are now at risk of post-operation infection due to lack of antibiotics and other drugs. All these patients cannot move and need to be transferred urgently, to have a chance to survive.”

Heavy bombing and clashes

According to the UN aid office OCHA’s latest update on the crisis, “heavy Israeli bombardments from air, land and sea”, continued across Gaza on Wednesday.

The most intense shelling was reported in Beit Lahiya and multiple areas in Gaza city (north), eastern Khan Younis in the south and the eastern and western areas of Rafah city, also in the south.

OCHA also reported “intense ground operations” and continuing clashes between Israeli forces and Palestinian armed groups in northern Gaza, Gaza City, the Middle Area, and Khan Younis, along with the firing of rockets by Palestinian armed groups into Israel.

Latest casualty figures from Gaza’s health authorities from Tuesday shared by OCHA indicated that 19,667 Palestinians have killed in Gaza since 7 October, about 70 per cent are believed to be women and children. More than 52,586 people have been injured, according to the same source, which reported that many more were missing, likely buried under the rubble.

The UN update also noted that two Israeli soldiers were reported killed in Gaza between 19 and 20 December. “Since the start of the ground operations, 134 soldiers have been killed in Gaza, and 740 soldiers have been injured, according to the Israeli military,” OCHA said.

New evacuation order

The update also flagged a 20 December immediate evacuation order from the Israeli military covering about 20 per cent of central and south of Khan Younis city. The area was marked in an online map published on social media. Before the 7 October escalation, the area was home to nearly 111,542 people, according to OCHA, which noted that it also included 32 shelters housing about 141,451 internally displaced persons - the vast majority having been previously displaced from the north.

Teleprompter

so Good morning, everyone. Uh,

thank you very much for, uh, for joining us on a very short notice.

And also thanks, uh,

to our colleagues in the UN information Service for facilitating this, uh, uh,

press briefing.

Uh, some of you have seen, uh, the post from our director general,

Dr Tedros, last evening,

Uh, on different platforms

about the visit that,

uh, WHO made to two hospitals in north of Gaza.

Uh, and, uh, and what they have seen. So what?

What we wanted really, is to share with you exclusively. Uh, this morning,

Uh what? Uh, what, uh, our teams have, uh, have seen.

And what's the current situation? So, as you have seen in the

in the media advisory, we have, uh, uh, doctor

por

that, you know, uh, very well, by by now, uh, who is, uh, joining.

And he's also joined, uh, by by, uh, Sean Casey,

who was in the in the in the WHO team visiting hospitals.

Uh, yesterday he is leading emergency medical teams, Uh, for for Gaza.

So let's start immediately with Doctor por,

uh, and, uh, And then we will hear also from Shan

Doctor por,

um, Thank you very much. Uh, good morning. Can you hear me?

Yes, we can hear you.

OK,

so let me start with this. So yesterday on 20 December,

um, in another high risk joint mission,

a team from the World Health Organisation All the UN partners, the UN, uh,

United Nations office for the Coordinations of Unitarian Affairs or

and the United Mine Action Service. Um Ma

and the United Nations Department of Safety and Security, UN DS

reached Al

Ahli

Arab Hospital and Al Shea

hospitals in north of Gaza.

So the initial plan

was to deliver fuel to both facilities,

but we had to shift to supplies due to the

lack of safety guarantees in place and clearance issues.

Uh,

our teams delivered seven pallets of

medical supplies for surgery wound treatments,

supplies to support women during birth, delivery, IV fluids and medicines.

And they witnessed the impact of the recent attacks

on both health facilities and the level of destruction.

So our staff are running.

You will hear later from them, are running out of words to describe

the beyond catastrophic situation facing remaining patients and health workers.

WHO and and actually, I just come back from Gaza.

I spent more than two weeks and I was part of that mission. We visited the

Ari Hospital over a week ago,

and then I think I reported on that. It

already looked like it was utter chaos. It was completely

congested, Uh,

and we described it as a disaster zone,

but it was still

operational,

partly operational, but it had been working Operation Theatre

and and and some medical,

two medical specialists and constantly busy with trauma and trauma surgery.

Now al

Ali is a shell of hospital. Until two days ago,

it was the only hospital where injured people could surgery in northern Gaza,

and it was overwhelmed with patients needing emergency care.

There are no operating theatres anymore.

Due to the lack of fuel, power, medical supplies and health workers,

including surgeons and other specialists. It completely stopped functioning

and

and is only operating as a hospice currently

with no

or very little care.

Only nine out of 36 health facilities are partly functional in the whole of Gaza.

All of these in the south

there are actually no functional hospitals left in the north. Al

Ali was the last one, but is now minimum functional

and

still treating patients but not admitting new ones along with

Shea

Ada and Al Sahaba

Hospital.

So these hospitals are still sheltering. Also, thousands of displaced people

at Al

Ali about currently about 10 staff,

all junior doctors and nurses continue to provide basic first aid

pain management

as much as possible. Wound care and trauma stabilisation services.

80 injured patients. So that's what, uh, a week.

More than a week ago there were still two and 50 patients there.

80 injured patients, including elderly women and small Children,

are sheltering in a church

and

and and

as well and on the wards within the hospital grounds.

And it's orthopaedic section.

Many of these patients have lost family members and

don't have anyone to bring them water or food.

Some of them are severely injured and have been waiting for surgery for two weeks

or have been operated on but are now at risk of post operation infection.

Due to a lack of antibiotics and other drugs. All these patients cannot move

and need to be transferred urgently to have a chance to survive.

Bodies from recent attacks are lined up in a courtyard,

and they can't be given safe and dignified burials.

More than 20

Ari hospitals were arrested on 18 December 6

were released and port to go south from the other 40.

There is no information currently regarding their detention,

and WHO reiterates his call for all parties to the conflict.

To respect international Unitarian law and for the protection of health workers,

patients, health facilities and ambulances at all times.

WO will keep striving

to supply health facilities in the northern Gaza,

but without fuel

staff.

In order to essential these medicines,

it won't make

Yeah, medicines won't make a difference and all patients will

die slowly and painfully.

Over 20,000 people now have been killed in the hostilities in Gaza.

This is actually one

almost 1% of the entire population.

The

calls again for a humanitarian cease fire.

This is needed now to reinforce and restock remaining health facilities,

the liver medical services needed by thousands of injured people

and those needing or essential care and above all,

stop the bloodshed and death.

I would like to hand over now to my colleague Sean

Casey,

who

was the team lead

of the mission yesterday to Al Al

Ahli and Al Shean

hospitals.

Thank you, Doctor Pepper.

And just, uh, before we hear from Sean, uh uh,

We will share, uh, remarks of Dr

Peppercorn

I. I also put in a chat. The

for those who have not seen the the comments, uh,

by Director General last night on this visit.

Uh, Sean, please. The floor is yours.

Thanks very much. Good morning. Colleagues from

from Gaza. I'm currently in Rafa.

Um, in the past few days, we've undertaken,

uh, two missions to the north, uh, one on Saturday,

uh,

als shea, uh, medical complex,

which is the the largest referral hospital in in the Gaza Strip.

Um, and so

really un

unbelievable condition in the emergency department in a hospital full of internal

person.

And,

uh, what we were told then was that the hospital was running out of fuel.

It had almost no staff.

Um, hundreds of patients and they were sending their

their surgical cases

to Al

Ahli. Uh, Arab hospital, um, which,

uh, instigated our, uh, mission there yesterday.

so we we we planned this mission,

uh, initially to take fuel to several hospitals.

Um, the security situation did not allow for that, uh, and instead, we,

uh,

dispatched, uh, trauma kits, trauma supplies, surgical supplies, IV fluids,

um, other medicines, clean delivery kits from UN FP A as well

Ahli. And,

um, we had hoped to go to as the Haba maternity Hospital,

but there was active conflict in that area.

And so we we redirected the mission,

uh, to, uh, return to,

oh.

Shea

Hospital, Uh,

still in Gaza City.

So we travelled north, um, for about two hours to reach

loly hospital.

Uh, when we arrived, it was very different from what, uh,

doctor Rick

porn had seen just a few days before.

Um, it was mostly empty when we pulled up in front of the hospital. The

the largest building in the the building at the front,

um, had been blown out. Um,

I believe that was from,

uh, activity, military activity. Um,

that happened in October.

Um, and there was a lot of debris,

uh, blocking, blocking the entrance.

A number of people came out and helped us to unload the truck and and do

a chain, uh uh

of passing boxes to

bring these medical supplies into the hospital grounds.

Um, we met with a couple of the doctors and nurses outside who told us

that they only had five doctors and five nurses remaining

on site and that they had 80 patients who were sheltering

uh or, uh,

admitted, if you can use that term in the in the church, uh, on on site,

Uh, and the ne orthopaedic building.

There was a lot of damage to the hospital itself.

but the church, uh, was still intact,

and the orthopaedic building was still intact.

So we went, uh, through the courtyard where we, uh, stepped over,

uh, a hole from shelling that had happened, Uh, just a couple of days before,

uh, past a row of bodies, Um, in,

uh, that have been wrapped in wipes. Uh, plastic sheeting.

that the doctors told us had been there for four days because it was so unsafe to move.

Um, and actually, I should say, as we were pulling up to the hospital,

there was gunfire.

uh, automatic gunfire and small arms fire

in the area with a crowd dispersing maybe a few 100

metres from from where we pulled up to the hospital.

Uh, we walked through the courtyard and into the church. Um,

where we found

a really unbearable scene. Um,

uh,

and you can see the pain in the eyes of the

doctors and nurses who are trying to care for these patients,

but it hurts with,

uh, 30 or so, uh, patients. Um, almost none of the ambulatory so

bedridden patients, some of them with, um,

serious trauma wounds.

Uh,

some of them had

had been lucky to have surgery,

uh, before the operating theatre went down.

Uh, we're struggling with post-operative infections.

Some of them had been injured days or weeks ago.

Uh, with no surgery,

uh, to, uh, stable limbs and, uh, and suffering enormously.

Uh, we saw,

um, a young girl who had been educated, who lost her own family,

and she lost her Her leg, uh, above her knee, um, or sorry below her knee.

Uh, we saw,

um, many patients who had said they hadn't,

uh, bathed or changed their clothes in weeks.

Uh,

the hospital staff,

uh, told us that many of their colleagues had

and taken to,

uh, taken away,

uh, two days before

and, uh, that they were struggling to maintain

and keep

the

baby patients

with no

no food, no fuel, no water.

Um, patients

were crying out in pain, but they were also

crying out for us to to give them water.

Um, it's it's pretty unbearable to see somebody with,

uh,

you know, cast on multiple limbs,

external fixators on multiple limbs who are just asking for a drink of water.

almost no IV fluids available.

Uh,

it it's a place. Um,

that, like Rick said, it looks more like a hospice now than a hospital.

Um, but it's it's a

hospice implies a level of care

that the the

five doctors and five nurses are simply unable to provide,

given the circumstances and what they have at their disposal.

Um, so at the moment, it's the place where people are waiting to die unless we

are able to move them to a safer location where they can receive care.

We visited the orthopaedic ward, which is where other patients are being held.

Um uh,

There the building is intact. One man was in a stretcher under the stairs.

Um, inside the ward, there were beds, uh, one next to the other. Um,

with people crying out, actually desperate for us to,

uh, hear their stories. They really wanted to tell us what had happened to them,

How they struggled to receive care.

Um, many of them were women and Children.

Um, a woman told us that, uh,

her whole family had been killed and and sh she couldn't get out of bed.

She had nobody to bring her food.

An elderly man started weeping when I spoke to him. Uh,

he had been shot in the in the chest in the right chest,

uh, several weeks ago and has still not received surgery.

Uh, so he he's he was shot and still only bandaged.

Um, a really horrifying scene.

Uh, and the health workers

are mostly young. Uh, those that I saw

in their twenties or early thirties, Uh, some of them junior doctors.

They said that there is no specialist left.

They they can't perform surgery, and they have no place,

uh, to

send these people at this at this moment in time. So we we delivered supplies there,

but it it was an unbearable the, uh, a

huge amount of suffering.

And we're now looking into how we can help

try to evacuate these patients to another facility.

But there's no place to evacuate them to in Gaza City. So the only option is,

to to bring them south. And even here in the south, the hospitals are are

very, very full

and of both patients and ID,

PS and the the The method of doing that is very challenging.

Uh, we we've tried to do that in the past. We've done it in the past

and had, um,

a paramedics, ambulance drivers detained and and and face challenges doing that.

So,

um, a number of barriers and hurdles to become.

We then proceeded to,

uh, Al

Shifa

Hospital

after delivering the supplies to

Ali,

uh, where we saw

a situation not unlike what we had seen a few days before on Saturday,

Uh, a

very, very full hospital with hundreds of patients,

uh, screaming in every day, many of them

with severe trauma being brought in in ambulances.

There are a few ambulances operating in Gaza City,

but mostly self presenting.

If they can walk, they come on foot.

If they can't walk, they're brought by donkey cart.

some of them are brought in on trolleys

and wheelchairs carried in by family members on be

fees.

Um or sometimes carried in on people's back.

Uh, the emergency department, Um, as I as I said on Saturday, uh, and

and Doctor

Pedro

tweeted It's really a blood bath.

it's,

uh,

got so few staff, almost the same number as

a Oxley hospital

caring for hundreds of patients.

And

thought

the the hospital grounds are sheltering

thousands of internally displaced person. So the surgical building,

uh, most of the the wards are occupied by ID PS

While we were at

Shifa this time, uh, we delivered medicines and supplies,

including clean delivery kits that we had hoped to take to

Alba Maternity Hospital,

Um, which we weren't able to access. The good news is that,

uh, the

Shifa medical staff said that they would be able to transfer

those clean delivery kits to the maternity hospital. Uh, when it's safe to do so,

Uh, so we hope that they'll reach there.

Uh, but there are also deliveries happening at,

uh, al

FIFA, so they will be used there.

Um, the the we talked about the deployment of emergency medical teams, which, uh,

will we hope will help to support health service delivery and resumption of,

uh, surgery in

the hospital

and also help to, um,

relieve the pressure on the emergency department.

Uh,

we have some teams that are willing to go,

but the hospital leadership did indicate that

bringing medicine bringing

doctors and nurses,

uh,

will not be enormously helpful if they don't have fuel to run the generators.

And if they don't have water and food for their patients

Um, so we need the full package. We need an interagency,

uh uh, and larger scale effort to to get

Shifa functioning again to resuscitate

FA.

As one of the doctors from

Shifa said on Saturday, it's a hospital in need of resuscitation.

Um, so it needs additional human resources, which we're working to mobilise.

We're providing medicine, fluid, surgical supplies.

Um, but we really need to get fuel in there. It uses 10,000 litres of fuel per day.

Uh, so it requires a huge uplift of fuel.

Um, and there are thousands of people there who are in need of food and water.

Um, what we also saw in Shifa

on this trip was

a surgical building that had been, uh, that had come under attack two days before

the 12 people lost their lives

on the grounds of the hospital.

Uh, two days before our visit,

uh, and,

uh, I walked through the building.

Uh,

I stepped on the rubble in the third floor

on the third level of the surgical ward myself,

um, and saw where some of those people lost their lives. Um, and and where,

uh, part of the building is now inoperable.

Uh, there were bullet holes, uh,

in the surgical building in the bridge that connects the city.

and we were also told that the person was

killed in the courtyard of the hospital yesterday morning

before our arrival by a sniper.

Um, so obviously, health facilities are coming under attack.

There's a huge level of suffering within the health facilities.

The health workers themselves are suffering.

Um, and what we're doing right now is trying to provide some level of relief,

uh, for the suffering with the provision of supplies.

By urging in additional support,

uh, we hope to do fuel delivery in the coming days,

Um, and also, uh, to support some of the other hospitals that have,

uh, ceased functioning for the most part or completely.

And see how we can help to To restart services in some of those locations.

Um, after they, uh, are no longer, um

uh, seeing military activity close by

or fighting in the area.

Uh, but what we really need is a cease fire. We need a a cessation of hostilities.

Health health facilities need to be safe places.

It's

it's pretty unbearable to see people who, uh,

are already victims of conflict who are are in what should be a safe place.

Um, where they should be able to active care,

uh, where they're sitting

waiting to die unless something dramatically changes that,

um will allow them to survive.

That and that requires,

uh, safe movement requires a huge uplift of fuel.

Requires medicines, medical supplies, human resources.

Uh, they're starving.

They're dying of thirst.

Um, one woman wanted to cry out to me and speak to me yesterday,

and she was unable to because she was so dehydrated.

I've never seen suffering, like, just

particularly avoidable suffering like this.

Um, so we need

urgent action.

Uh, we need to stop these Children and women and elderly people from, uh,

dying in a place where they should be safe

and where they should be cared for.

uh, we're we're trying our best,

uh, as WHO and as the United Nations,

uh,

community and the community of nongovernmental

organisations to provide some relief.

Uh, but it's not enough.

Uh, I'll stop there and I can come

back

to you.

Thank you.

Thank you, Sean, for sharing this, Uh,

it's even difficult just to listen to everything. What? What you are saying? Uh,

thanks. Thanks for being the witness.

Uh, we are sending, uh, you the the the the remarks of Dr

Pakorn

shortly. You will have it in your email. Um,

doctor

porn is, uh, speaking from Jerusalem. And Sean is speaking from

Rafa. We don't have a remarks. Uh, from, uh,

from, uh, from Sean. He's just, like, really telling us what he has seen.

Not something that has been prepared. So let's go for questions now,

Uh, starting with Imogen, uh, from, uh, BBC. Imogen.

Yeah. Thank you very much.

Both of you,

For for sharing that you said that you wanted to take fuel over the weekend.

And this wasn't possible for the for security reasons that basically

you were told you couldn't take fuel

or it was too dangerous to carry fuel.

I just want to Were you just told that can't be part of your convoy?

That's my question.

Yeah, I think

Sean might want to add This is Rick speaking from Jerusalem. So

just coming back from Gaza,

I think the decision was made because there was

a lot of military activities just north of that,

And this mission was also supposed to go

Ottawa.

Sorry, Uh, Saha

Hospital, the NC, a hospital and and Al

Sabah

hospital.

And that didn't go there because there were a lot of military activities and,

of course, then bringing few,

you know, urine, additional risks. So that was the reason, um,

fuel was not taken and and the focus was on medical supplies.

Maybe Sean wants to add on this.

Uh,

Yes, thanks. So we we had planned a fuel delivery following our previous

mission to Shifa.

Uh, but we

decide.

Well, the mission to deliver the fuel was aborted for several reasons.

One is that we didn't

have

assurances in pine

to be able to get

up to, uh,

from the from the from the parties to the conflict to

be able to get up to the hospital and back.

Uh, within the time that is available within daylight hours and,

clearing checkpoints and and proceeding

through very challenging road conditioning.

I must say, when when I travelled up to Fi

on Saturday, it took 4.5 hours

to go about 40 kilometres.

and that was with, uh, a flatbed truck with not a huge amount of supplies on it.

we were going to take 20,000 metres of fuel, so we needed it to be,

um, a co-ordinated movement with the parties to the conflict and also,

ensure that we had a safe routes to path with 20,000 metres of fuel, which is all,

obviously a a volatile commodity.

And, uh, and we haven't done fuel deliveries to the north

in the last three weeks since the since the pause.

Um, there were also concerns that it's a high value item, uh,

in a population that's very, very desperate,

uh, and that there could be, um, potential for,

uh,

some kind of,

uh, engagement along the route. So,

um, it was decided that we needed to

validate the route a bit more.

Um, which we did yesterday. We provided those supplies and we hope to deliver fuel on

in the coming days.

the fuel needs are enormous. Um, as I said, our

people

runs on about 10,000 litres a day.

The truck that we were planning to take is 20,000 litres. So even if we had made that

trip, that would be two days worth of fuel for the one referral hospital.

Um and then and then the other facilities we were targeting,

we would not have been able to access because

of activity in the area fighting in the area for

a number of challenges. But we think that we've been able to mitigate some of those,

and we'll give it another try in the coming days. Over.

Thank you. Thank you. Uh, so

next question, uh, Mohammed from Anadolu

News Agency. Mohammed

Tariq. Thank you so much for taking my question.

Yesterday, Minister of Health in Gaza announced that the Israeli army tortured

Kamal Edwin Hospital Director Kahlo

and detained him. Hundreds of health care workers have died in Israel attack since

7 October and Israel is detaining now

8093 healthcare workers inhuman conditions.

Uh, my question is, is

WHO what do you plan to do

to protect healthcare workers from Israeli attacks. Thank you.

Thank you very much. Mohammed.

As as you know, we have been always, uh, calling for healthcare to be protected.

But doctor

porn, Would you like to speak about this?

Yeah, I think WHO, I think. Let me explain again.

One of the roles WHO when it comes to, um, attacks on health care.

And it is a mandate for WHO, uh,

provided by the World Health Assembly by all the member states.

So WHO in every conflict an active conflict, an acute conflict,

chronic long conflict

WHO is obligated to monitor and analyse and report on attacks

on healthcare.

And that's what we are trying to do.

So we we always try to verify when we cannot

verify.

We will always say, Like, who reported those attacks, and then we will verify as

as as good as possible.

Uh,

what, of course.

Uh, the EHO. Makes a point that that

that any, uh, detention of health workers,

a R

of health workers is an attack on healthcare.

And we expect that anyone who gets arrested and detained,

including health workers, is treated

according to internationally returned law

and

and and and and, uh um, the

families,

they

well, they apart and should be, of course, informed

on on this. We are extremely worried

that we have seen numbers of health workers. And I just want to,

uh, also remind you that WHO was leading a mission to O

Shea

that is now weeks ago

and that six health workers were detained on that mission.

Two were released. There are still three health workers,

three for the Ministry of Health and one P CS.

A colleague,

uh, were detained and we know nothing about their work or about

the family. Of course, is extremely W worried.

Their colleagues are extremely concerned, and and also, we in the WHO are very,

uh concerned.

not so in, In, in in. In that sense. Yeah.

WHO, uh, has a system in place on attacks on healthcare

and

regularly reports on on on this, uh, including anybody.

Uh,

and we will keep doing this,

and we will keep raising this and just to

give you some figures since the seventh of October,

So we have documented 493 attacks on healthcare

in occupying

Palestinian territory

of 246 in Gaza Strip,

and they resulted in 582 fatalities and 7700 and 48 injuries.

So the attacks have also affected 61 health care facilities,

including 26 hospital damage out of 36

it affected. Also, 76 ambulances,

including

38 with sustained,

uh,

with sustained damage

over to you.

Thank you very much. Uh, the

people

I just, uh,

shared in a in a chat the link to our portal on attacks on health care where you can,

uh, look for the

period and the country, Uh,

and, uh, and have her latest numbers on, uh, on on what

Dr. P

was just explaining. What is the role of WHO Next question. Uh, Nina Larson from a FP.

Nina?

Yes. Hi. Thank you for taking my question.

Um, first, I just wanted to clarify, uh, something you just said,

Doctor Peppercorn,

Um, on the health workers that were detained. Um, last month,

you S you said two were released, and then you said three remained in detention.

I was just wondering I I wasn't quite clear on the numbers. Um,

is it three or four who remain detained? Um

and

I saw that amnesty yesterday was asking for, uh, for investigations into, um,

enforced disappearances.

Uh, in Gaza. Would you consider these enforced disappearances? Um,

sorry. That was That was my clarification.

And I have a question, but you can answer that first if you want, uh, or I can

Yeah, I can. So, I I mentioned on that mission,

which is now, almost a month ago.

So six initially

on the way back, Uh, from Shiva

to the

south,

six health workers were detained.

There were, um

uh, three from the Ministry of Health

and three from PR CS.

Two were released from PR CS.

Four remain detained, So three from the Ministry of Health

and one

P or CS colleague. So four people remain detained.

And there's we, uh, the their families, their colleagues,

including us WHO

we have We don't know anything about their whereabouts and, of course,

are extremely concerned.

That applies, of course, to all

the health workers.

And and we are trying to to get a better overview of that health workers,

we get detained.

And when there's no information about that,

we will constantly raise that over to you.

Thanks. Uh, Nina you have a question?

Yes. Thank you very much. So, um, I wanted to ask about, um uh,

Israel has, uh, accused, uh,

people of turning a blind eye to the use of the hospitals by Hamas.

And some hostages have also said

that they were detained

in or near the hospitals. Um, is that something that you've seen?

Uh uh, on the ground. Do you think there that's credible? And if so,

um, why haven't you condemned that? Thank you.

uh, Nina? No.

Uh, I think we in our missions have not seen anything of this on the ground,

but we cannot verify.

We are not in a position to to ascertain how any hospitals being used.

Uh, other than a health facility. We cannot verify that.

And I want to make that point as well. It always comes back on a tax on health care.

So attacks on health care again. I say the role of WHO

is to monitor, analyse and report.

We are not attributing

the attacks on health care. We are not a crime investigating organisation.

I think that should be very clear.

Thank you. Over to you.

Thank you very much. Uh, I'm just looking at the zoom. Uh, do we have, um,

any more questions from, uh, from reporters?

Ah, here. We, uh We have a nick coming. Bruce from New York Times. Nick.

Yeah. Thank you. Um,

I wanted just to check. Um

uh, you you've indicated that water is in acute short supply.

I mean, what is is any water at all reaching any of

Ahli

or Al

Shifa? Um

and, uh,

you know,

this must be one of perhaps one of the most critical shortages. It's a any emergency

deliveries that you can foresee in

becoming days. Um, that can alleviate that. Um,

And then a question that my colleague John Zac

Costas has often asked.

I just wonder, Wanted to check if you had any update on it.

And that is on the scale of amputations that is being conducted. And perhaps

whether you can provide that in relation to one hospital or in relation to many,

that that would be useful.

Thank you.

Ok, um,

if you let me start and I'm sure that Sean will want to compliment on this as well,

because they are discussing this, of course, with the one UN.

Yeah, the one UN in Gaza and parts of Gaza on your last question, Nick on the level.

Amputations. No, we don't have an overview of that. The only thing I could say it's

it's everywhere.

When I was there for more than two weeks,

I visited most hospitals in the South and specifically also the larger one.

The the European Gaza Hospital, the

NASA

medical complex. But

but actually all the hospitals, including Al

Ali.

And when I visited Al

Ali, the the

the incredibly sad thing was there were then still two medical specialists,

an orthopaedic surgeon and

and a general surgeon, which we both worked with the

WHO. We did training together. We know them very well,

but

they left,

and I reported

on that they elect a vascular surgeon. So

they they indicated they occasionally had to do amputations which

normally would not be needed if there would be a vascular surgeon.

We see a lot of, uh, we everywhere around a

lot of, um, empties, men, women, Children as well.

Lots of Children, lots of Children.

And we don't have an overview. We should get an overview.

We working trying to work on that,

uh,

I also want to make a point on what you said about water,

and Sean will get in

on that

currently. And this is, I think is also a current and real problem.

We talk about getting more aid,

humanitarian aid into Gaza and there's a little

bit of good news with the opening of Ker

Shalom.

But it's still

not enough.

It's absolutely no no.

The big problem is getting it then specifically to the north.

These missions, as Sean already described they. They need a lot of planning.

They need a lot of deconflicting and even then it's not completely deconflict.

They need

constantly to change routes and and and and and roads and very bad roads

going over 40 kilometres and sometimes taking 45 hours, et cetera.

That's reality checkpoints, etcetera.

So it's very difficult to organise this

these missions and that is why why, of course,

a humanitarian ceasefire is incredibly important, but also to

make sure

that those missions can take place not once a day or once every two days. But

there will be multiple missions to the north.

That's that warehouses can be set up in the north

that the storage facilities can be set. And from there

you can distribute food, water,

and and and and and other supplies that's not there at the moment.

So it's all haphazard.

And And

I would say, the UN doing what they, uh, what they can do.

Uh, maybe Sean, you want to add on this a little bit?

How you currently discussing this

short,

Over to

you.

Thanks.

Yes. So,

first on the water, Uh, I'll I'll speak about water and food.

Um, because even within the hospitals,

patients who were severely injured

um, are crying out to us, um, for water and food. So, uh, and and even as we

walk on the streets, we're we're at, you know, in the hospital yard,

everybody's asking for water and food.

And and yesterday, when I was in Al

FFA,

uh, I was asked, they said, Oh, you're back again, Sean, uh, by

the

people who happen to be in the courtyard And they And they said,

um, it's great that you're bringing medical supplies.

Uh, but we need food and water.

the challenge

the challenges are many, uh, one is that,

the The level of desperation is huge. And the numbers of people in need are huge.

And so doing orderly

distribution of food or water is very challenging.

There's lots of security concerns around shooting that,

um, the planning, uh, that rick mentioned,

um, is the complex, and the scale, uh, is is enormous. And so

we can bring

tank truck tanker trucks with water.

Uh, but it will be a a drop in the bucket relative to the need.

Uh, one of the efforts that's underway, uh, by UN colleagues is to, uh,

put fuel delivery to the desalination plant in the north

so that some water flow can be established.

Uh, potable water flow can be established there,

uh, through that also working to address the sewer system in the north so that,

um, the water sources can avoid being contaminated.

on a on a related point on water

in Gaza, a lot of the groundwater is has high salinity and

healthy.

Uh, so even with filtration systems,

uh, it's not potable. Um, and so there's there's an

an issue in terms of the water sources here,

Um uh, and in terms of the scale and complexity of delivering,

uh, particularly to places like northern Gaza,

on amputations. Um,

I think what Rick said is correct. Um,

we we see as it is,

everywhere we go, Um uh, and unfortunately, many of them are really unnecessary.

What would be considered unnecessary amputations in,

uh, the rest of the world.

And where there's capability to save limbs Where there's Orthoplast,

there's

vascular, uh, surgical capability

that's not there. But there's no surgery happening right now in in northern Gaza.

And,

uh and so actually, many of the patients that I saw yesterday

will need amputation

when they are if and when they are able to,

uh, access surgical care.

Uh, but

we saw limbs that are not salvageable.

Um, and people may die of the infections that they have

because their limbs are infected.

Um, uh, and we saw patients who are septic and and dealing with the serious,

complex infection.

So,

there are a huge number. We don't have a a clear tally.

Um, many of them, unfortunately are,

uh, last resort amputations, Uh, just to save a life. Um, if it if you can save a limb,

Uh, and it just as Rick said, speaks to the need to

have a humanitarian pause. So that we can,

uh,

bring in the the teams and the supplies and the fuel to make the surgery possible.

Evacuate these cases to a place where they can be safe, Um, A.

And

and hopefully save some of these lives and save some of these ones. But

this is not. It's not just about the number of amputations. It's also

that we're talking about small Children

who have lost their legs,

who lost both of their lives. We're talking about,

um, elderly people who have lost them, who have nobody to care for them.

They can't move.

They're they're really

bound to their bed and they can't.

Even if there was a lot of distribution, Even if there was a food distribution,

they would struggle to get to it.

So there's there's really layers to this, but, um, it's a It's a horrible scene

where there's lots of amputations.

There's lots of amputations that are becoming infected

because there isn't even water to to manage the post op, the post operative care.

I'll stop there.

Thank you very much. Uh, I'll just go in the order of hands that we have.

So we have more questions coming. Uh, Lisa

Schlein Voice Voice of America.

Tari. Yes. Good morning. Um, thank you. To you and to you gentlemen.

Um, a

couple of questions. One. There have been

in increasing warnings

about, uh,

people at risk of starving to death

because of lack of, um, food

and water

and also that it's likely that more people will die from disease than from bombs.

The longer the, um, conflict goes on,

I'd like to, uh, ask for your response to that whether you believe that,

uh, sorry to use this phrase, but

whether this is a ticking time bomb, uh, how much time

actually is

available is left to respond to the needs of

the people before it does reach a point of,

uh, well, horrible. No return. Thank you.

Thank you, Lisa.

let me start. And then maybe Sean might also add to that, uh, you know, like

we already

just coming back to Jerusalem and and what I witnessed,

and I want to make that point very clear.

Uh, so

Gaza, before this crisis had a reasonably functioning health system, I

told them as well we had also in the case part and neighbours.

Also, when you look at nutrition?

Yes, there were some

some

some groups of the population with what we call food insecure, but it was limited.

We mainly talk from the health point of view.

We talked about micronutrients deficiency

in some areas. Uh, iron et cetera,

uh, pre

women and I iron deficiency et cetera.

Uh, but they were very limited.

Um, and already what I saw over the last couple of weeks,

you could see that that,

uh, that

the food insecurity

was becoming a major is becoming a major topic.

I understand that the I BC and FRC will will actually

raise much more and much more detailed information about that.

And hopefully today, or at least in the coming days,

they are experts on that.

But what we already see that and and you can you've seen it also on the news from WFP

uh, they

that this rapid food security assessments following a significant

deterioration of food security situation in the south of Gaza

and also the large influx of IDPs. 1.95 million people are IDPs

and and with research

of hostilities

and very,

very high levels of hunger, levels and, uh were reported so on let's say extreme

and and large uh, part of the population. Extreme food is insecure

and we will get more data

on on this

now the,

and the proportion of of IUP households

not only ID P households Also

ID P households, I say

going to sleep hungry or maybe have access to one

small meal a day is increasing and it's increasing from the ID.

P from, uh was already increasing 34 to 50%. So it's

a it's a it's a major, a major concern. And that's in combination of what you

what you actually said with

the

the the huge number of

not only in the UN run shelters but also in the nation.

Shelters are bring 1.95 million people.

The water and sanitation conditions are

are completely below par

and the water consumption, I mean, like an unsafe sources, etcetera persist

and even more in the north, as just described by Sean and myself and where the water

desalination plants are not working, et cetera,

Uh,

so what we what we also have seen and we try to monitor and I must say U NRW

is trying to assist as good as possible.

It's difficult to monitor,

but what we have seen is loss of acute respiratory infections.

We're talking about 170,000 cases, a lot of scabies and mice,

50,000 cases of diarrhoea over 125,000

under 5, uh, 61. 62,000, which is way, way more than normal this time.

Skin rash. Uh, chickenpox, Uh, J

dish close to 4500 which is actually very worrisome for hepatitis I like.

Is it hepatitis A or is it E, which is much more grave

and no lab capacity

to actually, because it's all destroyed. Nonfunctional.

So WHO has just got in some some lab kits that testing kits, and we will try the UN W A

to set up an early warning and response system.

the routine surveillance system, which was working pretty well in Gaza,

has been completely hampered.

It's not working currently,

and and many of these people of the people who need

no access will go undiagnosed. So the situation is probably worse than it seems.

An area of vexing vaccination,

routine vaccination. Gaza

had a

fantastic operational routine vaccination better than most

countries around the world close to 100%

now.

So at the moment, that's maybe not

a risk, but very quickly that will become a risk.

And think about measles epidemics, what you get and when

when this is not, uh, not addressed.

So, yes, we are very concerned. We have not yet seen major

outbreaks. But of course we are.

We are actually simply waiting for that. If this doesn't change,

if the excess is not improving,

if the supplies are not improving, if the

the the

shelter conditions are not improving if the water

and sanitation conditions are not improving if the access

to health services and health care is not improving,

I don't like to phrase what you mentioned.

Uh, yeah, taking time bomb. Yes, but it definitely is

over to you.

Maybe. Sean, Do you want to add something from the field? Correct.

I'll add one brief point, which, uh,

addresses the question of when is when is it too late?

And I think it's too late.

were behind. There is not enough food.

Every single person I speak to everywhere I go in Gaza

is hungry.

It's

the time is now. We we we are dealing with starving people now

adults,

Children

and

it it's it's

unbearably Everywhere we go, uh, people are asking us for food,

even in even in the hospital.

As I said,

I walk around an emergency department. Somebody with an open bleeding wound.

Open fracture.

Um, they ask for food.

if that's not an indicator of the desperation and the

I mean, I don't I don't know what it is. We we We

move around Gaza to deliver medical supplies,

and

people rush towards our trucks hoping that it's food.

Um, and when we say that it's medical supplies, actually,

they clear the way for us. They they help move debris out of the road.

Um, but everybody is just constantly on the lookout for for food.

So there's efforts underway with with the one UN to

look at cash options in some parts of God's, where there is food on the market.

But nobody has money to buy it in other parts.

There's really nothing on the market,

and there's an urgent need to bring in flour and and basic food stuff. So

yeah, II, I think, um, we're we're behind on a lot of things here in

Gaza and there are trucks. There are hundreds of trucks

sitting in Rapa

Rick said it is good that you

shalom

is open.

Um, but we need more food to come in,

uh, the private sector. The commercial trucks also need to come in.

Um, cash needs to be put in people's hands,

and that will address some of the food prices.

But we're seeing the consequences of it already in the hospitals

and and in our daily interactions with people across across the

country.

Yeah, and I want to add all that. There is what Sean said There's no economy going.

So the private sector

is, of course, key to get it reactivated again.

And And we've raised this by the way many times over the last couple of weeks.

I mean, if this is not a real big indicator, every hospital you go,

so there's a lack of food for patients.

But there's also a lack of food for health workers.

So health workers they have to scavenge around,

and they have to to to spend their time at the moment, probably.

We estimate that less than 30% of the of the

25,000 health workers in Gaza is actually operational because everyone

and that's including from our own staff. The WHO staff we have,

and one third is still incredibly operational.

But a lot of other people I just say they are. They are in a mode

of, of, of surviving.

They're focusing on surviving and focusing on. What can we get from the market?

There is no money around, so there's even there are still some farming done.

I've seen some farming in the middle area and Southern area, et cetera, but,

of course, and there is no economy

people cannot cannot access. So it's

everywhere.

There's talk about foods and people ask for food and water.

And and every time we broke in a truck of medical supplies up north in the south,

etcetera,

we had to protect those trucks

and constantly raise out our voice.

These are Dawa.

These are medicines. These are medical supplies for hospital, a

hospital Y, because people jumped on those trucks to see if we were not.

If we were in a line. If we were, you know, if there may be more water in supply and

that truck would be empty in no time.

That is the reality in the ground. And I think sometimes I feel that

it's voices are not heard enough.

The misery is so much large, larger than than I think. What people?

What people think,

Obviously.

Thank you. Thank you both.

Uh, let's, uh we have, uh, three more questions for your hands.

Uh, Jamie Keaton, Associated Press. Jamie.

Hi, Tarek. Thank you very much.

Um, I just wanted to know if you thank you very much for all the detail about the, uh,

food, uh, and and water situation

Could do you have any numbers about, uh,

the people that have actually been treated for malnutrition?

Is there any sort of, uh, metric or gauge? It could, uh, indicate, uh, we did it.

And And if if it does bear repeating, um, the numbers that, uh, that WFP has provided,

of course.

Which, uh, you know, the other day saying that

you know, 90% regularly go an entire day without a meal. Um,

and, uh, and a half of Gazans are starving.

Uh, you know, is there are we getting close to a a famine like situation there?

I mean, that sounds like it could be, uh

uh and the offer with those kinds of numbers.

Um, so So basically, my question for you really is just

about the, uh, about the the the treatment for, uh, for malnutrition And, uh,

and anything you might say about those figures, those other figures.

Thank you.

Yeah, I say it's a very good question.

Um and, um,

at the moment.

So I think you also say that the even the one UN and the one UN the various clusters,

etcetera.

We talk about relatively small numbers with their partner trying

to focus on the priority for WO the priorities.

How do we make sure that the hospital, uh uh, health system, which is on it? Knees.

How how do we make sure it's

at least

keeps on providing basic health services? That's our key priority.

That's what we focus on. And

we try to to get a sustained supply

supplies, medical supplies, essential medicine, etcetera

to those facilities, which is already incredibly difficult to

do.

Now, uh,

with this

with this, uh uh,

with these figures coming out and what we have

observed about the situation around hunger and malnutrition,

food insecurity, extreme food insecurity,

Yes, the both the health cluster and nutrition.

They they want to work first. With that, the primary health care facilities is just

what always should be done.

And and under five clinics that you do middle upper arm circumferences

et cetera that you separate the system

that you also do that and try to get them do that in some sentinel sites in, in, in,

in some of the shelters and some of the makeshift makeshift shelters.

Plans are made currently to do that to

to each other.

But first, the first priority should be that

there should be sustained flow of food

and water

and reaching everywhere

within the south. Within the north, that should be the

the the key priority. And, yes, we need to, uh, to get

to get to, uh, to get better data on on on this,

uh, work is being done by the nutrition cluster and the house cluster show.

You might want to add something on this,

and I'll say, I mean,

we're struggling with numbers on a number of fronts

because communications was down for much of the last,

uh, week. I mean, we have

very often no cell signal

people in the north, actually, when When I go to the North,

people ask me what's happening because they don't have

Internet access. They don't have cellular service. They don't have

any visibility on what's happening outside of

a small area where they're staying, where it's safe to to to, to exist.

and as a consequence of that,

you know, we have limited reporting.

We have people who are unable to access

services to even get screened for malnutrition.

Um, we we have challenges in transporting

the therapeutic foods to the North because, uh,

supplies are sometimes compromised.

Trucks are,

uh,

looted is I. I hate using the word looted because looted

implies criminal intent.

But there are desperate people who are looking for food who will, as Rick said,

jump on the trucks and and and they're desperate to eat something.

we have challenges just in the security and transport of therapeutic foods for

for young Children and infants

and, um,

uh, challenges in getting information and challenges for

patients themselves for mothers to take their babies,

parents to take their their small Children

to a clinic.

Uh, because there's fighting in the area.

Uh, and they don't feel safe moving from whatever location they happen to be in.

Uh, that's all up.

Thank you. Thank you both. Uh, next question. Kathrine

Jan

Campo conga

from France.

Van

Katrine.

Thank you, Tariq. And good morning.

Uh, thank you to both doctors for, um, meeting us this morning.

Um, I have two questions. Um, the first is to Doctor Sean

Kei. Uh,

he spoke about amputations that could

have been avoided in normal circumstances.

So, uh, doctor, could you give us a percentage

of the amputations that could have been avoided

if we were, um, in a place where, uh, people could get access to a normal, um

uh,

hospital, Uh, services or doctor Richard? Uh, uh, paper,

one of both of you. And I'd like also to know

if, um you have, um, some more Children

that have been evacuated.

Uh, could you please um,

give us more details on on that one? Thank you

to both of you.

Thanks, I. I can comment on the the amputations. I mean, the the

simple

answer is no, I don't have the numbers.

Um uh of limbs that could have been saved.

I think the hospitals that are functioning, particularly in the north But even here

in the southern part of, uh, the Gaza Strip in, uh,

in ho,

they're absolutely overwhelmed. Um,

I mean, hundreds of patients coming in every day,

uh, with serious injury

and staff who were not able to access the hospital. So

not long ago, I was at European Gaza

Hospital where they said

the staff who live across the road, you know, 500 metres away

are unable to get to the hospital. And consequently, they're unable to perform

Uh, some of these very simple procedures, actually, not just amputations.

Simple procedures

that would save lives. So people are dying.

The doctors told us that European Gaza Hospital and a doctor medical complex

in communists and and as as well as in health facilities in the north,

that people are dying

because there are not the providers in place

to provide care for basic,

um, illnesses and injuries that would otherwise be very treatable.

Um, so we don't have a hard number,

but I can tell you in every in every hospital that I've been to in the last 2.5 weeks,

and

I've seen patients who have had amputations.

Um who? Uh

um lack access to care.

Uh,

simply because the providers are no

longer available because they've been displaced.

Um, they've had to flee,

Um, because they are,

um, scared to to go to work.

Or they're scared to leave their families to go to the hospital

and that they may never return.

They may not be able to get back across the room.

so no, no firm numbers on it, but, uh,

it's it's a common,

uh, a common occurrence. Unfortunately, that we're seeing,

um, that people are really struggling to access basic care, and

and they're dying of things that they shouldn't die from.

Uh, and they're losing them that they should have to lose

because of these, um, access constraint.

And because of ongoing conflict,

uh, I'll hand over to To Rick. Maybe on the evacuation.

Yeah, And maybe to add one thing on the amputation, I think it's for me.

It was more than telling that two

incredibly well trained medical specialists, um, a week ago when I was in this Ala

hospital

straight away told me that, like, Hey, I'm an orthopaedic surgeon, my colleague,

and we know them as a general surgeon, we do not have the skills.

I mean, like, we are not sexual surgeons.

So we have done and will be doing amputations

when

that should not happen.

That's I think is for me more than more than telling on the

on the Effi operation of patients. Uh

SWHO political. We think that many more patients should be evacuated out of Gaza

and we know that that Egypt is ready for

that and they they raise Egyptian government and EFC

as such. And we are very grateful for that. But

it has to

speed up and increase

and including the There are other countries in the region

uh, which

which which are willing to also assist with with, um, accepting

patients and their companions. Uh, you know, when there are needs for referral.

Uh,

and I'm really literally thinking about hundreds,

maybe even thousands of patients over the next month, which should be referred,

uh,

the way

we were together with, uh with the Egyptian government

That was already a couple of weeks ago, where we facilitated with SDU Hospital the

transfer of a number of I think, 30 Children with cancer

and and

to Egypt and from Egypt to other places,

but much more is needed. I also want to remind everyone that

before the crisis that on average 50 to 100 patients a day, five days a week would go

would go for referral care to East Jerusalem hospital or

east or east to East Jerusalem, to the hospitals there or to the West Bank.

40% of that was oncology related, paediatric oncology, adult oncology, etc.

Those patients we we don't even talk about anymore.

We only focus on trauma and say therefore

because it's so overwhelmed. But that's

another group of patients, uh, the

the the patients with

nonchronical diseases which cannot be treated in, uh,

in in in in Gaza

uh,

oncology patients, etcetera, which

so we need to. What is needed is a much better

medical evacuation

outside Gaza into Egypt, and

and they needed from Egypt to other countries in a more organised way. And

there's literally a need for hundreds, probably thousands, of patients.

This would also help to decompress the completely over

health care system.

Every hospital we talk about 33 times as many patients as their normal vets

and and all the IC U

and and the last point, which I've never seen in any conflict. But

the many patients which could be discharged

patients are afraid

to be discharged.

They don't want to be discharged because they are

afraid to go back to where they come from.

So they later around in this hospital and

like some of the hospital, said it is very difficult to

to get rid of these patients

over to you.

Thank you. Thank you both, Uh, we have two follow up questions from Nick and Katrine.

So let's do those and try to be short. Nick,

this is a very short one, and perhaps the answer is rather obvious.

But maybe you could just explain

what are the constraints on evacuation of patients at this point?

How much of this is is down to the fundamental

insecurity and and and continuing conflict and how much of it is due to,

um, if you would like bureaucratic procedure or or or political will. Thank you.

OK,

I would expect the political will is there, and people talk about it all the time,

so I think it has to be implemented.

I mean, like, I hear this from all sides. The political will is there to

to organise a better medical effi situation.

I think it's a lot of the procedures that has to do partly with,

uh with security and screening, etcetera.

But for me, that's not I don't want to go there. I mean, we see what is needed.

And many more patients need to be evacuated on a regular and a more organised way.

What we hear and see is like 20 to 40 patients, sometimes a day that is way too 20.

That's way too little.

We've seen lists of patients which are much longer than that,

and it should be facilitated. I understand everywhere where when I listen

that the political will is there that that the resources are there,

that's the,

uh, the hospital facilities are are there on the other side.

So let's just do it.

That would be my, uh,

plea.

Thank you. And, uh, let's go to to last follow up question from Katrine. Katrine.

Uh,

thank you, Tariq.

Um, in fact, the follow up is is regarding the French floating hospital.

That was, uh, initially, uh, supposed to to dock off the coast of Gaza.

So I'd like to know if, um you work with, um, this hospital.

And I know that the hospital is in Egypt for the moment.

Um, is it possible for any, uh, boat,

uh, to dock off the coast or, uh, did, um, the isra

Israeli bombing damage? Um, in fact,

uh, the Gaza port.

Yeah, OK,

I'm gonna I'm not a docking specialist or the specialist of ships and boats,

etcetera,

but, uh,

first of all,

the issue is not about balls in front of the Garza coach.

That's not going to help

the evacuation.

The medical evacuation to Egypt can be organised and should be organised

from there. That's the second step.

Can Egypt,

Egypt And and I think they'd be very grateful

that they are ready to receive many more patients.

Hospitals are ready. And if there's need to refer from Egypt to other countries.

And there are many countries in the region which we have offered

that we heard from from Qatar and from Iraq and from the UAE

and Turkey, for example.

They are already we heard from some European countries that they are ready to

to to if needed to accept. So

then maybe, I don't know, maybe they can go from from from Egypt to that. Bo,

I don't care. But I think there is, uh,

there is

there is. The best way possible is to get out of Gaza into Egypt and from Egypt.

Either remain into Egypt.

There's a lot of good services available in

Egypt or when either go to other countries.

Certain places

that should be the focus.

Thank you, Doctor

Phan. Uh, Sean, would you like to add something to that?

Thanks. Yes, I'll just just add. I mean,

as Rick said, it's about getting It's about getting out,

and there's plenty of destinations.

But the I think the fundamental point at the moment within Gaza is that we have,

20 or so percent of hospital bed functioning.

We have a huge reduction of staff available.

Um, there

even there are basically no bed available.

There's there's no room for patients to move within.

The,

um, the the biggest referral facilities

in the South in the South, which are still functioning, are 203 104 100% capacity,

so internal referrals are occasionally possible. Very complex,

but international referrals

are absolutely needed. We're we're scaling up bed capacity.

My role here as emergency medical team coordinator is to help

bring in field hospitals and expand bed capacity within the hospitals. We have

the IC RC at European Gaza Hospital,

adding beds within the hospital and adding a field hospital next door.

We have a number of

emergency medical team setting up additional beds,

but it's not even coming close to the number of beds that we've lost.

And we're so we've lost beds and at the same time notified

the number of injured and ill who need a hospital bed so the

they can't wait.

The people that I saw yesterday

and on Saturday in

yesterday at all

A. They can't wait for

two weeks or three weeks for additional beds to open or new hospitals to to be built.

They need to be evacuated. Now they need

they need care immediately. So we're working on

some,

you know, extreme cases. If we can move them,

uh, to a hospital here in Rafa,

for example, that can step one or two patients.

That's great for those one or two patients,

but there's hundreds or thousands more behind them.

Uh, and there will not be enough bed

in the short term to meet that need especially

uh, with,

um as we've alluded to some of the very complex surgical

cases that need care that require vascular surgery Orthoplast surgery.

Uh,

reconstructive surgery. We've seen

serious burns. Um, those are very complex

cases that just can't be cared for within Gaza at the moment.

There's no hospital that has that capability.

Yeah, maybe, Uh,

sorry if I may add to what she

raised. I think this is what we have tried to, uh,

to to push for,

uh, for weeks. Is that of course, the

the

what? We what we call

a of the protection of health care.

And I think what What has happened in the North

can absolutely not be a blueprint of the South.

So in the north, we talking now about four

well minimal,

barely functioning hospitals there are more like first aid centre. So

we we need to help

to make those hospital functional again because there's

between two and 600,000 people in the north.

And the first focus is, of course, to make sh

a research state

hospital again. So that's that should be

that should be happening, should be allowed. And then you talk about fuel,

you talk about medical supplies, but you also talk about emerging medical teams.

And emerging medical teams are willing

to go to CIA

and to assist

the current staff.

that's that is, for the North. That should happen

immediately as soon as possible.

Make sure that there is a minimal level basic

level of health care available in the North to serve

the many thousands of remaining people now in the South.

We currently talk about seven hospitals

extremely overwhelmed, but they are the backbone of this

1.92 million,

uh, people. They are now the backbone of the health systems,

and and we have to make sure that not only to keep them functional and to rest

stop. Uh, we also have to make sure that

Ban is trying to do and help to get

emerging medical team

come in and are linking up to those hospitals. We have a good example.

IC IC is in the European Gaza Hospital

and and and and they are pledged to extend that hospital with another 150 beds

that needs to happen in Nassar

close to NASA medical complex. The Jordanian seven

field hospital.

Even NA

Medical Complex

needs an emergency medical team to assist to expand

the number of deaths

as a Nassar

medical complex. And the European

hospitals are

like, What, what she

was for the whole of Gaza Strip.

They are the

the third level hospitals, and they need to be functioning constantly.

Now we are very concerned

that we also see much more military activities in Khan Yis

very close to NA

complex. And we already saw one

of the ST

Shell landing on on

National

complex killing actually an amp

girl

in that hospital.

Uh,

and

there's many IUPS as well in this in that area.

Now

they're getting concerned. They say, Oh, it's the Shiva

scenario repeating here

and and and, you know, do we have to even move further

the same. And if you talk about middle area, the middle area and and and around Al

Aksa Hospital, uh, there

and and Arabella

thousands, hundreds of thousands of ID PS.

so, there's two things This hospital's infrastructure,

this vulnerable hospital infrastructure on his knees

needs to be supported and strengthened

with additional hospital beds with EMTS,

but also and I want to say to to help improve beyond trauma,

care to help improve the access to reproductive, maternal,

newborn and child health treatment of

comical and the non

comical diseases. And we don't even talk about mental health or psycho

psychological support services.

We have to

this in a in a much broader way

and and very concerning that MI

military activities are continuing in this area.

Communist,

they come to the mill area.

We will probably see more influx of ID PS coming from those areas to the south.

And then and then

uh, well, we can all describe the situation in

Arafa, a

town of 230,000 people normally.

And they have over a million people,

probably more than a million IEPs already sheltering in in that town.

All these makeshift shelters,

There's no space.

So I can understand why people don't want to go because there's no space.

Where do you want to go?

What is what is safer? So what? There is nothing safer.

So you don't want to go in a in a place where where you don't have any shelter

and and you have to say problems, so this should be prevented and

the the

almost a plea from us that health care services need to be protected in the South.

And we need to get it going again

in the north, starting with

with making Shea

again at least work as a first level hospital and maybe

then after that again to a 2nd and 3rd that hospital

over for me.

Thank you. Thank you, Rick.

I understand that, uh, Sean has to leave, so, Sean, we will let you go.

We are well beyond the hour and, uh, and 15 minutes now.

And we don't really want to abuse also the hospitality of our colleagues that you

information that I have one hand from John Z

Costas. So, Sean, if you have to leave, uh, please just, uh go.

And Sean, uh, John, please ask you a question. If it's possible just to be very brief.

Uh,

yes. Good morning. Uh,

uh, Doctor peppercorn.

I was wondering if you could give us, uh, a bit of a an outline.

What is your relationship with the Israeli authorities?

And what responses are you getting when you're asking

for

the access to the various facilities?

What are their responses? Just to give us a bird's eye view. Thank you.

Well, not just my relationship. It's the It's the one UN.

And I think the one UN is is is coordinating is coordinating

with with all parties to the conflict as as good as possible,

as good as possible. And that is on a very,

uh, I would say direct and in an intent way.

So that's

that's happening at levels above me. But it's

and and we are also all operational.

UN agencies are are constantly reaching out. We do this in a coated

fashion with um,

with the one UN and in Gaza UN, W

and and

OSHA leading leading in these processes both in in in in Gaza as well in in Jerusalem.

So there's a whole system in place

that the issue is what I what I, I think, said that from the from the start

that

specifically going up north

when there's a lot of military activities,

when there is

a roads are destroyed.

When, um

when there's a lot of insecurity

for any convoy,

and specifically when we talk about larger convoy convoys

which we would like to set up north convoys,

which would include fuel, food,

water medical supplies. It becomes incredibly difficult to

to plan for that.

There's constant planning, ongoing. There's constant interaction,

but the reality on the ground is that

we we we plan for the convoys. They often get delayed

or they take a lot of time

and they are very high risk.

So these convoys need to be properly deconflicting. It should happen,

uh,

in corridors that they can move quickly. So

there's a lot of work on that. Some progress has been made, but it has to be much,

much better.

And we struggled, for example, with larger Cold wars.

We at once we tried to plan a Cold War, both the medical supplies

and

and with with food and water, and

it is difficult to move around.

So the final decision was We have to keep this convoy small and and and and and agile.

It's another issue, for example, that

when the UN is struggling, something very, very simple. The number of a V vehicles

we need to increase our our our armed people to do those things.

We struggle to get them in

to get permission for that and to get a close

flow

PPS

as that it's absurd that such a large and there's such a large need.

And this is going to be such a large humanitarian operation that we struggle to get a

and PP etcetera and get more starving. And that, of course, has everything to do.

All of that is related to the to the volatile security environment

over to you.

Thank you very much. Uh, Doctor

Peppercorn. And thanks to all the reporters who were with us, uh, this morning, uh,

sorry.

I need to leave as well.

Yes.

Well, thank you. Thank you very much. We are. We are. We are really, uh, concluding.

Thank you, Doctor

Peppercorn. Thanks. Also to

To Sean Casey who, uh, had to leave as well. Reporters, uh,

thanks to reporters who were with us and, uh,

thanks to our colleagues from UN Information Service for facilitating,

uh, this, uh,

this press briefing. I wish you all a

nice rest of the day