In the neonatal intensive care unit at Al Shifa hospital in Gaza City, newborn babies lie in beeping plastic incubators as transparent tubes deliver oxygen and nutrients into their tiny bodies. Most of them were born prematurely, some weighing less than a bag of sugar with feet no bigger than dates.
These babies are the most vulnerable people in one of the most vulnerable places in the world, the Gaza Strip, a territory of two million that has been under Israeli siege for the past 10 years. Now, as Gaza sinks deeper into an electricity crisis — most households get four hours of electricity every 24 hours at latest count — these infants are at further risk. If the machines they are attached to lose power, they could lose their lives.
Al Shifa hospital uses generators as backup, but the system is not infallible. Any interruption in electricity will be a “catastrophe”, said Allam Abu Hameda, the doctor who oversees the neonatal intensive care unit, or NICU.
He had just finished checking on two infants lying on an open cot. It was a sweltering July day at the peak of a Middle Eastern heatwave, but the NICU was cool, one of the few rooms in the hospital where air conditioning is imperative for care.
Gaza’s blackouts are a humanitarian crisis caused by politics, part of the larger trend of “de-development” in the strip over the past 10 years of Israeli blockade and Hamas rule, as described by a United Nations report last week. In 2006, after Hamas kidnapped Israeli soldier Gilad Shalit — who was later released in a prisoner swap — Israel bombed Gaza’s power plant. Though it was later repaired, it never again reached full capacity. Electrical lines from Egypt and Israel supply additional power to the strip, but not enough to meet demand. For around the past 10 years, Gaza has been on a severe schedule of eight hours with power followed by eight hours without.
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Then in April, Gaza grew even dimmer after a Palestinian dispute over fuel tax closed down the power plant. Hamas, which runs the Gaza Strip, pays the West Bank-based Palestinian Authority to purchase fuel from Israel at a tax rate of around 100 per cent. When the PA refused Hamas’s request to reduce the taxes, the group stopped buying the fuel for the power plant. A recent shipment of fuel from Egypt provided temporary relief, but on July 12, the power plant shut down again.
Since April, the PA has been exerting pressure on Gaza with the aim of retaking control of the strip from Hamas, which ousted rival group Fatah and the PA in a bloody battle 10 years ago. As part of this effort, which also reportedly includes denying medical care to mortally ill Gazans who need to travel outside the strip, the PA asked Israel to cut electricity to Gaza. The Israeli security cabinet took up the issue and decided to incrementally reduce the power from around 120 megawatts to 80 megawatts, all but leaving Gaza in the dark.
Today, Gaza’s blackouts are the worst in recent memory, with the strip going dark for longer stretches than it did in wartime.
Hamas has warned that the electricity cuts could backfire on Israel if the pressure inside Gaza grows too great. "Hamas is not interested in an escalation" with Israel, Hamas spokesman Hazem Kassem told The National. "But the pressure, the stress due to the siege and [Palestinian president Mahmoud] Abbas's actions against Gaza may push the people to explode against the one who is imposing the siege."
Israel’s last war with Gaza, in 2014, devastated the coastal strip, killing more than 2,100 Palestinians, most of them civilians, and 72 Israelis, most of them soldiers. According to last week’s UN report, 171,000 homes were damaged or destroyed in the war.
The blackouts affect everyone. Without electricity to properly power the sewage treatment plants, untreated wastewater pours into the Mediterranean daily, poisoning the sea where Gazans swim. At home, food goes bad in non-functioning refrigerators. Gazans have had to adjust their shopping habits, buying only what they need for that day.
When the power does come, sometimes in the middle of the night, families rush to do laundry and charge mobile phones and batteries. Some neighbours have clubbed together to buy generators, each family paying to run a line to its home. Those who can afford it have installed solar panels but in many homes, candles or dim LED bulbs are the only light sources at night.
At Al Shifa hospital, the staff work around the clock to ensure there is no interruption in care in the most critical wards, such as the NICU and the kidney dialysis centre, while other wards manage with limited electricity or none. With electricity from the Gaza grid available for only a small part of the day, the hospital uses massive generators the size of army tanks to power the campus. UPS (uninterrupted power supply) devices ensure there is no lag in electricity between when the power goes off and the generators come on.
“We are working under emergency conditions,” said Ashraf Al Qidra, the spokesman of the ministry of health in Gaza. The light and air conditioning stopped abruptly at one point in the interview and then started again.
“This happens in the hospitals. When there is overload, the generator stops,” he said. It is the patients who pay the price, he added.
In the NICU, for example, the machines do not always work properly with the constantly switching electricity sources. At least once a week, an incubator falters and reduces the oxygen flow to an infant, said Mr Abu Hameda. The staff on hand must be quick to notice the change in pressure and hand pump oxygen until the machine works properly again. He recalled an incident last week when a nurse rescued an infant who was losing oxygen. Thankfully, he said, the baby was unharmed and is now back with its parents.
“If one baby is missed it can be fatal,” he said.
At Al Rantissi Hospital, a children’s hospital in Gaza City, there was a full-blown emergency last month when for 10 minutes there was no power after the electricity shut off, said Muhammad Abu Selmya, the hospital director. Doctors and nurses rushed into the intensive care unit and began hand pumping oxygen to patients, using their cell phones to light the room until the generator power kicked in.
At the ministry of health, Mr Al Qidra said there was one clear answer to the crisis.
“We want Israel to lift the siege,” he said. “When there is no siege we will be able to give good health services and develop our health care system and our human resources and build more hospitals since we have more people now.”
Israel claims the blockade is crucial to its national security, to prevent Hamas from arming against Israel. But Gazans say the measure is collective punishment.
Mr Al Qidra called on the United Arab Emirates and Saudi Arabia to step in to solve the electricity crisis in a sustainable way.
Some Gazans blame Hamas for the lack of electricity in the territory it controls.
Kemeleya Satary, a 33-year-old mother from Khan Younis in southern Gaza, is in no doubt.
“I blame Hamas — they control the Gaza strip, they have to take care of it,” she said. Her nine-year-old son Raafat needs dialysis four times a week. It means a 25-kilometre taxi journey from Khan Younis in the south of the Gaza strip to Al Rantissi hospital. Raafat’s older brother died from the same condition 11 years ago and without a kidney transplant, dialysis is his only hope of survival.
The power cuts make it difficult to care for Raafat at home. Without power, his mother cannot charge the battery to run the fan to keep him comfortable. Instead, she fans him with her hands, and asks her daughter to take over when she gets tired.
A high-ranking Hamas official in her area has a generator, and charges neighbours 160 shekels (Dh165) a month to hook up to it, Ms Satary said. She occasionally plugs in, such as when she needed to cook the iftar meal during Ramadan. She wondered why Hamas could not set up such machines for the public.
Ms Satary and many others in Gaza saw hope in Mohammad Dahlan, the former Fatah leader in the territory who grew up in Khan Younis. Once an enemy of Hamas, Mr Dahlan is now making overtures to the group, and many in Gaza speculate that he could come back to rule the strip. According to Hamas spokesman Mr Kassem, Mr Dahlan is engaging in a process of “social reconciliation” with Hamas in order to compensate families who lost loved ones or property in the 2007 Battle of Gaza when Hamas ousted Fatah and the PA from the strip.
One of Mr Dahlan’s real tests will be whether he can help turn back the power on — and not just temporarily. So far, the solution has eluded Gaza’s leaders.
“You know we have a problem when the government increases the power from three hours to six hours and calls it a victory,” said Ms Satary, as she left the dialysis centre. “It should be on 24 hours.”
Meanwhile at Gaza’s hospitals, the backup plan is now the standard operating procedure. Generator power was supposed to be “Plan B”, said Mr Abu Selmya of Al Rantissi, not for every day use.
Now he also has a “Plan C”, a smaller generator to fall back on in case the big ones fail.
“Don’t ask about 'Plan D',” he said. “There is no ‘Plan D’.”