Erik Fosse, Mads Gilbert, and Dagfinn Bjorklid, the coordinator of the NORWAC (Norwegian Aid Committee) team, are following the devastating situation in Gaza in the news and through the messages that they receive from Palestinian colleagues.
They are impatient but also aware of the risks of working under Israeli bombardment and blockade in hospitals that are deprived of basic essentials and jammed with an endless flow of injured and traumatized Palestinians.
Fosse and Gilbert have for years been closely associated with the solidarity movement, working with Palestinians in the occupied territories and refugees in Lebanon. The pair have visited both Gaza and the West Bank many times on behalf of NORWAC since its launch in 1983.
Both Fosse and Gilbert are very worried about the humanitarian and medical catastrophe in Gaza. They talk about firsthand information they have been receiving from NORWAC associates about the lack of the most basic medical essentials to the extent that “some operations are now carried out without anesthesia; which means that many operations are not done at all.”
“It is just horrible for a medical doctor to be standing there with absolutely nothing to do for all these injured and wounded people being brought in and with all those already ill people just being there on the floor,” Fosse said.
Fosse and Bjorklid expressed shock at the failure of the international community to find a way to get essential medical equipment and medicines into Gaza. They are particularly worried because the non-stop bombing they are seeing now, with no sign of a humanitarian pause or ceasefire, is totally unlike anything they had seen before in Gaza, including during prior wars.
This is part of the reason Fosse and Gilbert are anxiously waiting to get the required permits to enter Gaza and be there with the Palestinian medical doctors, “because it will make a big difference for their morale at this very challenging moment.”
The Gaza Strip has more than 20 hospitals, including four large ones. One of these is Al-Shifa Hospital in the strip’s north, which Israel ordered evacuated a week ago, as part of wider Israeli orders for all of the north of the strip to be fully evicted.
“Naturally, the doctors declined these orders; to evacuate a hospital with so many critically ill people including some in the ICU, on ventilators or awaiting critical surgeries, would be fatal to these patients,” Fosse said.
Despite their meetings with officials at the Norwegian foreign ministry prior to their trip to the Middle East a little over a week ago and meetings with the Norwegian embassy in Cairo, Fosse has no idea when they will be allowed into Gaza, considering the firm seal Israel has placed on the strip.
Since its launch, capacity building has been at the heart of NORWAC’s work in the Occupied Palestinian Territories and in Palestinian refugee camps in Lebanon. However, as Fosse noted, when there is a war, NORWAC medics roll up their sleeves and get into the operating room to perform.
“It happened with the previous wars in 2008 and I suspect this time there will be a lot more to do in view of the tough situation of the health care system in Gaza and in view of the [gravity] of the war this time,” Fosse said.
Fosse argued that a good part of the problem with Gaza goes back to 2006 when Israel decided to put all of Gaza under blockade in the wake of Hamas’ electoral victory.
“Gaza was becoming an open prison…The living conditions in Gaza have been increasingly difficult since then,” he said.
NORWAC knows how difficult it was for the Palestinian medics they trained to work under a blockade that made it difficult to procure medicine and medical equipment, including oxygen concentrators. With support from the Norwegian foreign ministry, NORWAC has managed to reach out to Gaza all these years.
According to Fosse, the borders between Gaza and Israel were for the most part open prior to the 1993 Oslo Accords. After the accords, crossing the border started to become increasingly difficult for Palestinians.
However, he said, living conditions in Gaza got drastically worse in 2007 when Israel closed the border, restricting the movement of goods, people, and utilities like electricity.
Israel has attacked the Gaza Strip four times before over these 17 years. These attacks were a big challenge for doctors and patients alike. “We are not just talking about those injured during the [Israeli] military strikes but the situation for all patients, especially those with chronic medical problems.”
“Cancer patients in Gaza have no access to radiotherapy – unless they get out of Gaza; if they cannot get out, they cannot get this therapy. In addition, cancer drugs have been more and more difficult to access due to the Israeli blockade,” Fosse said. He added that the Palestinian Authority’s generally decent public health service dating from the mid-1990s was faced with numerous crippling challenges.
Fosse explained that some of these challenges relate to the increasing demand on the public health service, as private services became unaffordable for most Gazans following the deterioration of the economy. However, he added that the most pressing challenge related to the lack of essential medical supplies which became an acute problem after Israel imposed the blockade.
NORWAC is one of the few organizations that have been able to get into Gaza after the closure. They have been working to fill the gap as much as possible in cooperation with Norwegian and Palestinian authorities.
“We had been working during peacetime on our capacity-building to help health care workers on the ground be prepared and capable to handle crisis during [times of war],’ said Bjorklid. However, he added that he could not imagine that any previous training would suffice to prepare the medics of Gaza for the kind of crisis they are facing today.
According to Fosse, the war this time is much worse than any of the previous wars since 2008. The number of casualties during the first ten days of the attack has surpassed the total number of killed and injured in the four previous wars together.
“It is also particularly disturbing that one-third of the injured and killed in Gaza are children,” he said.
In the wake of the previous wars, there have been discussions about the weapons used by Israel. According to Fosse, the main problem of the Israeli attacks is the targeting of civilian houses and schools where people have sought refuge, regardless of the type of weapon.
By 2014, Fosse said, it was impossible to miss the fact that the Israeli wars were leaving “lots of crippled people.” Israel was also crippling people outside of wars, he added. During the 2018-2019 Great March of Return, he noted, peaceful protesters in Gaza walking to the borders with Israel were being “shot in the legs” by Israeli soldiers. With this realization, Fosse explained, NOWAC supported efforts to increase the orthopedic capacity at Al-Shifa Hospital as well as meet the increased demand for rehabilitation.
“To be crippled in Gaza where the unemployment rate is almost 50 percent is extremely challenging,” he said. Fosse nodded “yes” to a question on whether shooting-to-cripple was a deliberate Israeli military strategy.
With the start of the current crisis, Bjorklid said, “it was clear that things were going to be very difficult at the medical facilities in Gaza.” Consequently, with funding from the Norwegian foreign ministry, NORWAC decided to send the surgical team of Fosse and Gilbert and to acquire necessary medical supplies as fast as possible.
“During the first week, we purchased all available medical supplies from local companies inside Gaza and transferred it to the major hospitals. Through the Palestinian Red Crescent Society, NORWAC further managed to provide drugs and other medical supplies in Egypt that were part of the cargo of the Egyptian Red Crescent society trucks that were allowed to enter Gaza on 21 October.”
However, getting Fosse and Gilbert into Gaza has been much more difficult as the Rafah border is closed for people. So far, Israel is not allowing any medical teams into Gaza.
Bjorklid lamented the meagre trickle of medical aid that has been allowed into Gaza through Rafah – 20 trucks at the time of the interview – since the crossing was sealed when the war began on 7 October.
“The situation is already very difficult [with 17 years of blockade] and the Western world is turning a blind eye to what is happening and what has been happening in Gaza,” Bjorklid said. “There is no safe place for people to go to seek medical help or to seek refuge and people are so scared as they are being bombed as they have never been before,” he added.
Fosse agreed that these trucks will not be able to do much to arrest the rapidly deteriorating health services in the Gaza Strip, especially in light of the Israeli blockade on fuel and electricity. “The people of Gaza need thousands of trucks; the world should demand that relief material be allowed in; this is what international humanitarian law is about,” he said.
“The lack of food, clean water, and electricity now put the entire population in Gaza at risk. The lack of fuel for the electrical generators is now threatening the running of hospitals. With no electricity, vital equipment like incubators for newborns, ventilators, X-ray machines, dialysis equipment, and other critical technologies are no longer working. Thus the demand, for fuel to be allowed into Gaza is extremely important.” Fosse said.
“Several smaller hospitals are already falling out of service and we are not sure how long the bigger hospitals will be able to hold on in view of the severe energy crisis,” he said.
“During the first two weeks of the attack, more than 13,000 were injured and the hospitals were completely crowded. It is therefore an urgent need to evacuate patients out of Gaza for treatment and to relieve the Gaza hospitals.”
NORWAC, Fosse said, is planning to send more medics into Gaza, especially with a looming Israeli ground operation that would inevitably come with more intensive bombing. “A ground operation means more injuries from more intense shelling and gunshot wounds; there is no way that Gaza could put up with this under the current circumstances,” he stressed.
Both Fosse and Bjorklind expressed dismay at the choice of leading Western countries to support the ongoing Israeli attack on Gaza under the banner of self-defense or retaliation for Hamas’ 7 October attack. “Of course, everybody has to be safe and nobody has to die – but this should also include the Palestinians,” he said.
“This is not retaliation; this is a completion of a policy to empty the land from its people; and what is happening in the north of Gaza is not evacuation but [forced] deportation,” Fosse said.
Israel, he stressed, needs to end “its occupation apartheid policy.” “If it does not, then the world needs to deal with Israel upon the regulations of international law so that at least it would treat Palestinians as human beings”.
“The whole situation is not sustainable and I think it is safe to say that the people of Gaza feel that they have been left behind and forgotten by the world,” Bjorklid added.
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