Two months on, hope promised by Gaza ceasefire fades as urgent shelters and lifesaving medicine remain out of reach

On a small mattress inside a fabric tent covered with a piece of nylon, Hani Taher spends most of his time lying down or sleeping due to the consequences of missing medication he takes to treat severe thyroid insufficiency.

The man lights a small wood fire with help from his youngest son, ten-year-old Waseem, hoping to ease the extreme cold caused by the deepening low-pressure system over the Palestinian territories.

This sensation has doubled for 48-year-old Hani since being deprived of his treatment for six months.

Hani, father of seven children, the oldest being Iman, 27, who is married with two children, lost one son to Israeli forces in the first months of the war.

He has suffered for five years from a chronic disease related to severe thyroid gland insufficiency and dysfunction, requiring him to take regular medication to compensate for the deficiency in thyroid secretions.

But the man who works as a driver suffers significant consequences in his life from not taking his medically prescribed medication due to its unavailability in the Gaza Strip, whether in the government, civil, or commercial sectors, which has affected his declining health conditions and his ability to perform his daily tasks.

"I am among chronic patients who need to take this medicine daily and regularly to compensate for the gland insufficiency," Hani says.

"Starting from approximately last May, this medication is not available, while I used to get it for free from the Ministry of Health, and even when I bought it from the commercial pharmacy, its price did not exceed two dollars."

He adds: "I have not left any door without asking and searching for it, but to no avail. I was promised to bring it from abroad through Jordan with any patient returning to Gaza or a doctor who will come to it, and I pray to God day and night that this will be achieved soon."

He continues: "What is dangerous is that I take medicine at a very high dose exceeding 100%, while others with the same disease have doses ranging between 25 to 50% only, because the thyroid gland works for me very limitedly, which means my whole life is linked to this medicine."

Physical and mental deterioration without treatment

Hani explains that missing the prescribed medication can lead to regression and worsening of his physical, mental, and psychological health. This affects his daily life, reducing his ability to work as a driver and to fulfil his responsibilities as a father, husband, and fully functioning individual.

"My whole life is undisciplined, and I lose the ability to balance, and my physical and mental abilities are much weaker," he says.

"I suffer from general lethargy throughout the body, weak heartbeat, swelling in the eyes, weak concentration, general laziness, nausea, desire to sleep for long periods, sometimes constipation, joint pain, feeling that I cannot carry the body, and gradual vision weakness. Not to mention the mental consequences, such as memory weakness and intermittent forgetfulness, and sometimes psychological dissatisfaction."

Hani, whose home in central Khan Younis was destroyed by Israeli forces and who is now displaced in the Al-Mawasi area, says Gaza would have undergone a fundamental change after the ceasefire if two conditions had been met: medication became available, and essential goods could be purchased at reasonable prices — neither of which, he notes, has been achieved so far.

Amjad Al-Shawa, director of the Palestinian NGO Network, confirms there is a slight improvement in terms of quantities entering, but not in terms of required items to bring about the hoped-for improvement, whether on the food level, especially with Gaza lacking basic foodstuffs that were supposed to enter with aid, especially animal protein.

Amjad points out that Israel allows entry of this protein for the commercial sector and not aid, and it is sold at high prices that the majority of Palestinians cannot afford, especially knowing that 90% of the population suffers from unemployment and has no income. Therefore, the warning continues about famine and malnutrition, according to his assessment.

He also reveals that what Israel allowed to enter as shelter does not exceed 15% of the tent needs — about 40,000 tents out of more than 300,000 are required for tents alone, in addition to other requirements. He notes that tents are not a desired Palestinian solution, but they are currently available.

"There are terrifying problems that have not seen any improvement, such as the destruction of sewage and water networks from previous wars and their continuation during this war, causing sewage water to flow with 750,000 tons of waste along with rainwater, which means a major health and environmental disaster," he says.

He adds: "In addition to the shortage and prevention of entry of machinery, equipment, and bulldozers, we have a major problem represented by Israel's prevention of entry of suction trucks used to pump water from low-lying areas to which residents have returned, in addition to the severe shortage of fuel and entry of limited quantities, which limits the ability of municipalities and civil defense to work."

He considers that the primary reliance for improving humanitarian conditions is Israeli withdrawal from areas it occupies, to redistribute the population more easily and relieve pressure on small areas, to allow entry of heavy equipment to open roads and remove rubble, and to attempt to rehabilitate sewage and water networks.

Amjad also speaks about significant dangers related to buildings at risk of collapse that residents resort to due to a lack of alternatives, in addition to the possibility of flooding, sewage and rainwater collection ponds if low-pressure systems deepen — all this due to Israel not allowing entry of required needs.

While he describes current inputs under current conditions as a "catastrophe leading to further collapses in food and humanitarian conditions and discovery of more malnutrition cases with deteriorating health, psychological, shelter, and drinking water conditions," he warns of increasing chances of winter diseases turning into epidemics given the current destroyed health sector reality and severe shortage of medicines and medical supplies.

"Israel has not allowed entry of production inputs for various sectors such as agriculture, which in most of its lands is already under direct Israeli control," he says.

"The conclusion is that the improvement is very slight and does not rise to the level of the catastrophe Gaza is experiencing."

Only 38% of the agreed-upon aid trucks entered

Dr Ismail Al-Thawabta, director of the Government Media Office in Gaza, reveals that Israel allowed entry of only 38% of the number of trucks agreed upon according to the humanitarian protocol in the ceasefire plan, totalling 13,511 trucks out of 36,000 trucks that should have entered the Strip, with a daily average of 226 trucks.

He considers these numbers absolutely insufficient, attributing this to the fact that quantities allowed to enter are much less than the level required to ensure the minimum level of food and pharmaceutical security.

Dr Ismail confirms that, with the onset of winter and successive low-pressure systems, the humanitarian crisis is exacerbated by the absence of shelter and heating materials, weak shelter, disrupted infrastructure, and the lack of materials necessary to protect the displaced.

The Palestinian official confirms that this means current trucks do not provide any stability in livelihoods, do not stop the reality of famine, and do not limit the spread of seasonal diseases, according to his assessment.

"This serious breach of the agreement represented a direct obstacle to providing basic food and medical needs for the population and kept the humanitarian situation at a dangerous level, and practically frustrated the essential goal of the ceasefire represented in alleviating the humanitarian catastrophe," he says.

He adds: "In addition to the continued Israeli prevention of entry of dozens of vital items that the Gaza Strip needs, foremost among them: building materials, medical parts and devices, electrical and operational equipment, therapeutic nutrition materials, toilet seats, basic food items, in addition to civilian goods that Israel falsely classifies as 'dual-use.'"

He describes these prohibited materials as "representing the lifeblood of daily life and a pillar for initial reconstruction, and restarting bakeries, hospitals, water and electricity networks. Preventing their entry doubles the suffering of families, keeps thousands of patients without treatment, disrupts infrastructure rehabilitation, and leads to exacerbation of malnutrition rates that are rising dangerously."

Regarding the health sector, Dr Ismail explains that during the two months, what entered the health sector did not exceed 3% of the total trucks entering, a tiny percentage that does not allow any fundamental improvement. Therefore, the health sector has not improved at all and remains in a dangerous state of paralysis, lacking basic work components, according to his statement.

He speaks about Israel committing a series of serious violations that exacerbated the health collapse, most notably: preventing the Red Crescent from reaching northern Gaza and preventing rehabilitation of health facilities there, preventing entry of international medical teams and health cadres and experts, detaining and destroying shipments loaded with medicines and basic surgical supplies.

He points to Israel not entering scheduled quantities of medicines, medical solutions, and therapeutic food for patients, and preventing X-ray machines, kidney dialysis, artificial respiration, infant incubators, oxygen cylinders, and generators, in addition to preventing electrical equipment necessary to operate care and emergency departments, and preventing building and maintenance materials to restart damaged hospitals.

Dr Ismail considers what is clearly and directly required is Israel's full commitment to what it signed in the ceasefire agreement and humanitarian protocol, foremost among which: lifting restrictions on prohibited items, entering full quantities of food, medicine, and fuel, opening roads and crossings safely and continuously, securing access for medical teams, and ensuring flow of thousands of trucks according to actual need.

The Palestinian official does not count on the second phase of the ceasefire. "That is exclusively dependent on the extent of Israeli commitment, and the current experience proves that Israel has not committed to anything," Dr Ismail shares.

"Any subsequent phase will remain without effect unless international guarantor mechanisms are imposed that prevent Israel from continuing the policy of engineering starvation that has become a systematic policy to keep the population in a state of need."

Mohamed Solaimane is a Gaza-based journalist with bylines in regional and international outlets, focusing on humanitarian and environmental issues

This piece is published in collaboration with Egab