In a fragile show of unity, the World Health Organization Executive Board approved a draft resolution calling for “immediate, sustained and unimpeded” humanitarian relief to beleaguered Gaza, including safe passage of health personnel and supplies, as well as ambulances and patients. 

The WHO EB move, which will clear the resolution for approval by the May World Health Assembly, represents the first-ever consensus statement on the charged conflict so far in a UN body. The draft resolution  on “Health Conditions in the Occupied Palestinian Territory” carefully sidesteps any direct references either to Hamas or Israel in a charged conflict where both Israeli and Palestinian leaders, and their allies, have accused each other of genocide and war crimes. 

Sunday’s approval of the WHO EB resolution came just two days after another UN Security Council resolution calling for a humanitarian cease-fire in Gaza was vetoed by the United States because it did not condemn the initial Hamas 7 October attack on Israeli communities, which led to the deaths of some 1,200 people, mostly civilians, and the taking of more than 240 Israeli hostages. 

US deputy ambassador Robert Wood had called Friday’s UN resolution “imbalanced”, saying that a cease fire that left Hamas in power in Gaza would “only plant the seeds for the next war.” 

The WHO EB resolution, in contrast, focusses on humanitarian relief, making only one reference in the preamble to the broader UN “appeal for a humanitarian cease-fire.” Along with general calls for the free flow of aid and relief to besieged Palestinians, it also mandates WHO to lay plans for the rebuilding of Gaza’s shattered health system.

Tedros: It is still possible to find common ground

“I commend you …. for being willing to collaborate and compromise … In our fractured and divided world it is still possible to find common ground on even the most difficult issues,” said Dr Tedros Adhanom Ghebreyesus at the close of the extraordinary day-long EB session. 

“Of course the adoption of this resolution is only a starting point. It doesn’t not resolve the crisis, but it’s a platform on which to build,” Tedros stated. 

Breaking with its own precedent in the UN Security Council, the US supported the resolution,  co-sponsored by Yemen, Morocco and Afghanistan – albeit with “reservations”.

Those reservations, said the US, also backed by fellow EB member Canada, included the omission from the text of references to the Hamas 7 October incursions, Hamas hostage taking, and its use of hospitals and civilians as shields for military activities – as well as the preamble reference to UN calls for an immediate cease-fire.

Convening an EB meeting devoted to a single health and humanitarian crisis was unprecedented in the annals of WHO. Although a resolution denouncing Russia’s invasion of Ukraine was approved by WHO’s World Health Assembly in 2022, it was addressed in the health assembly’s regular session, as were follow-up reports and motions in the February 2023 WHO EB meeting, and the May 2023 WHA session.

Gaza health system is ‘on its knees’ 

In the debate just prior to Sunday’s EB vote, senior WHO officials provided a detailed report of the current health and humanitarian situation in Gaza, including a first-hand report from Gaza City.  

“More than 17,000 people are reported to have died in Gaza, including 7,000 children and we don’t know how many are buried under the rubble of their homes,” said Dr Tedros, in a summary of the WHO findings.

“More than 46,000 injuries have been reported. 1.9 million people have been displaced. Almost the entire population of the Gaza Strip is looking for shelter anywhere they can find it but nowhere and no one is safe in Gaza,” Tedros said.

Fighting between Israel and Gaza’s Hamas regime resumed on 1 December after the breakdown of Qatar- and Egyptian-mediated talks over further release of the 137 Israeli hostages still held by Hamas against Palestinian prisoners in Israeli jails and detention centres, estimated at some 7,000 people – a number that has swelled since the conflict began. 

The seven-day humanitarian cease-fire in late November saw the release of some 114 hostages, mostly Israeli women and children but also including 24 Thai and Filipino nationals, in exchange for some 240 Palestinians released from Israeli prisons. Many of the released Palestinian prisoners were also women and teenage minors, including some who had been detained but not charged. 

Nowhere to flee

The renewed fighting has seen a new Israeli thrust into Hamas strongholds deep in southern Gaza, where most of the enclave’s 2 million people fled during the first phase of hostilities, and are now living in tents, schools and on the streets. 

“As more and more people move to a smaller and smaller area, overcrowding combined with the lack of adequate food, water, shelter and adaptation are creating the ideal conditions  for diseases to spread,” Tedros said.

“As I have said repeatedly, I deplore the barbaric and unjustifiable attacks by Hamas on Israel on the seventh of October, which killed more than 1,200 people. 

“I’m appalled by reports of gender based violence during the attacks and by the mistreatment of hostages,” added the WHO director general, with reference to Israeli claims that women killed or kidnapped by Hamas on 7 October were raped and sexually abused.

“And I repeat my call for the remaining hostages to be released. I will understand the anger, grief and fear of the Israeli people following the horrific attacks two months ago,” he continued. 

“I also understand the anger grief and fear of the people of Gaza who had already suffered through 16 years of blockade and are now enduring the destruction of their families, their homes, their communities, and the life they knew. 

“It’s stating the obvious to say that the impact of the conflict on health is catastrophic. The Gaza health system is on its knees and collapsing.”

Gaza casualties still rising

While the majority of Israel’s 1,297 casualties were incurred during the initial Hamas attacks on Israeli communities on 7 October, within Gaza “the trend of fatalities continues to rise, placing a tremendous burden on the already weakened health system,” said Teresa Zakaria, WHO Health Emergencies official, reporting on the casualty trends.  

“The largest proportion of fatalities recorded were amongst children, 45%, and women, 30%,” Zakaria added, referring to the Hamas breakdown of Palestinian casualties. “The number of children killed in the three weeks following 7 October, surpassed the annual number of children killed in [all] conflict zones since 2019, she asserted, citing a recent Save the Children, report. 

There have also been over 250 fatalities amongst Palestinians in the Israeli-occupied West Bank, and 94 fatalities in Lebanon as the conflict spills over regionally, Zakaria noted. 

Hospital functionality and humanitarian aid

Against the flood of injuries, only 14 of Gaza’s 36 hospitals are still operating, and that only partially, Zakaria said.  Of those, 12 hospitals are in the southern part of the enclave, where most people have fled. Only three have surgical capacities, while other aspects of functionality are limited by lack of fuel supplies, food and clean water.  In addition several field hospitals are operating, under the auspices of foreign donors. 

According to Tedros, there have been a reported 449 attacks on health facilities in Gaza and the West Bank and another 60 attacks on health facilities in Israel.  

Added Zakaria, “the WHO surveillance system does not have a mandate to investigate attribution of attacks,” referring indirectly to critics who have said that some of the attacks on Gaza health facilities, attributed to Israel, involved misfired Hamas or Islamic Jihad missiles.  

The combined factors of displacement and crowded conditions, lack of adequate water and sanitation, and lack of medical capacity is leading to a rising level of respiratory and water-borne illness, meningitis, Zakaria added.

While humanitarian flows have increased, with a total of 3,000 aid trucks crossing into Gaza via Egypt’s Rafah cross since aid flows began in late October, “this is not nearly enough,” Zakaria said. 

“We needed 500 trucks per day. And even during the [humanitarian] pause only 220 trucks passed for one day to meet needs, we require more crossings,” she said, concluding that WHO is “glad to hear” that the Kerem Shalom border crossing between Israel and Gaza may reopen for humanitarian convoys.  

Scenes of devastation seen first-hand

Speaking from Gaza, WHO representative to the Occupied Palestinian Territories, Dr Rick Peeperkorn, described the “scenes of utter devastation,” he had observed during his mission Saturday to Al Ahli Baptist Hospital, located in the epicentre of Gaza’s most war-battered northern district, which Israel now largely controls. 

“Gaza City has changed beyond belief,” Peeperkorn reported. “It’s utter devastation. It’s like a wasteland, even though there are still many people, children, old men and women around. There are not only patients in the wards, but also in the library, and even the church is crowded with patients on the floor, on stretchers, on chairs. 

“Having worked for more than seven years in Afghanistan, I’ve seen some grim situations.  I’ve never seen this before,” he said, describing doctors forced to perform amputations on wounded Palestinians because they lack the necessary surgical capacity, equipment and medicines to otherwise save the limbs. 

Palestine health minister: Israel targeting ever aspect of life in Gaza 

Palestinian Health Minister Dr Mai el-Kaila, described the situation as an “unparalleled humanitarian catastrophe that defies international law and shatters the very sense of our shared humanity.”

“Israeli military occupation forces have relentlessly targeted every aspect of life in Gaza, sparing no one – from women, children, and disabled individuals to schools or hospitals, shelters, facilities and ambulances,” said el-Kaila, speaking from Ramallah, the seat of the Palestinian Authority, which has rallied to the side of its rival, Hamas, in the Gaza emergency. 

“Even the so-called safe corridors have not been spared, resulting in the loss of hundreds, of thousands of severe injuries, to forcibly displaced individuals,” el-Kaila said.  

She noted the risks posed by the degraded sanitary conditions where 160 people, on average,  share the same toilet and 700 people share a single shower.  

 “Some 400 tons of garbage per day are accumulating,” she noted, and “medical waste at hospitals is not removed. These factors lead to increased public health threats.

She called for the “unconditional and immediate entrance of humanitarian aid including food, water and medical supplies”; cessation to the “targeting [of] essential services such as health facilities, medical personnel, water, electricity and emergency services,” and a broader UN enquiry into the conduct of the war. 

“The international community must end impunity for Israeli occupied forces, and call the perpetrators accountable for the brutal actions and crimes. Now is the time for this action;  the word cannot stand neutral while innocent lives are lost and the basic rights of the Palestinian people are compromised,” she said. 

Israel: Hamas broke the ceasefire on 7 October 

Meanwhile, Israeli Ambassador to the UN in Geneva, Meirav Eilon Shahar, denounced what she described as the double standard being displayed by many countries, when it comes to Israel. 

“Today’s session is the only session ever convened here in Geneva on a specific conflict,” she said. “No special session was called on the health situation in Syria, Yemen, Sudan or many other situations. Did the victims of these conflicts matter less or does the world play by a different rulebook when it comes to Israel?” she asked. 

“The reality  is that on October 6, there was a ceasefire with Hamas. On October 7, we woke up to a new reality when thousands of terrorists entered Israel and systematically tortured and mutilated, murdered women, men and children on an unimaginable scale. 

“They entered with one directive, spare no one, capture innocent people, rape women and girls. They directly targeted Israeli medical personnel, first responders. More than 240 people were taken hostage and 137 still remain in Gaza, including 11 months old Kfir Bibas, and his four-year-old brother, Ariel. 

“Since October 7 over 11,500 rockets have been fired indiscriminately at Israeli cities, and this continues every day, hitting hospitals, schools and residential buildings.  In response to October 7, Israel declared war on the terrorist organisation Hamas. Our operation is directed towards Hamas. It has never been against the Palestinian people. 

“I recognise the suffering in Gaza. Let there be no mistake. However, Hamas is responsible for this suffering… Israel is operating against the terrorist organisation, which operates from within, underneath, and adjacent to hospitals, schools and UN facilities. 

The Israeli ambassador also called out WHO: “Even after the scope and scale of Hamas brutality was exposed on October 7, many in the international community, including the World Health Organization, continue to give Hamas a massive free pass. WHO has shamelessly reiterated that it only knows what is happening above ground in the Al Shifa Hospital and not what is happening below…

“If this EB session serves any purpose, it will only encourage Hamas actions,” she concluded. “It  gives them a green light to use Gazans as human shields… It is a reward for Hamas disdain for the sanctity of human life. If we stop now, Hamas will carry out another October 7. They say so publicly….  This is the reality that the [EB] decision … will blatantly ignore.”

Cuba denounces alleged Israeli ‘war crimes’  

Responding to Israel’s remarks, Palestine’s Ambassador to the UN in Geneva, Ibrahim Khraishi, denied Israeli reports of Hamas missile misfires on Gaza hospitals, and Hamas tunnels and weapons caches in and around health facilities, homes and schools as “lies.” 

But he contended that Israel’s position in the conflict was not parallel to that of the Palestinians in any case. 

 “It all comes down to self determination and self-defence,” Khraishi said. “Self defence does not exist for Israel because it is an occupying power.”

During the hours’ long debate, over two dozen other nations, including India and Pakistan, Malaysia and Turkey, South Africa, Namibia and Angola, and states across the Middle East and North Africa, weighed in on the conflict, mostly focusing on Israel. 

Said South Africa, “These developments tragically form part of an ongoing pattern of over 75 years of oppression, occupation and conflict.” 

Cuba described the Israeli military actions as “genocide and a crime against humanity.”

“Namibia is deeply concerned over the increasing escalation of violence and the collective punishment of the Palestinian people by the occupying forces,” said Namibia’s delegate to the special EB session. “Basic infrastructure like housing have been reduced to rubble… The cutting of basic utilities has been weaponised to inflict further suffering on top of the bombs and bullets – and the insecurity of civilians being ordered at short notice from one place to the other, none of which are suitable for human habitation.

“But the gathering momentum is undeniable,” the delegate added, of the global political pressure being applied on Israel. “It is Namibia’s hope, having lived under similar conditions as the Palestinians are currently enduring, that justice will manage to prevail.”

US: Hamas has further genocidal intentions 

Meanwhile, the US and Canada, as well as European countries such as Germany, Denmark and Paraguay, expressed varying levels of dismay, in turn, over what they described as insufficient criticism of Hamas actions in the WHO resolution. 

“We agreed not to block consensus on the text, but we do not agree with preambulatory  paragraph 8,” said US Ambassador to the UN in Geneva, Bathsheba Nell Crocker. She stressed that calls for a cease-fire,  “are not only unrealistic but dangerous. A ceasefire would simply leave Hamas in place and able to regroup and repeat what it did on October 7. Hamas does not dispute this.” 

Added the US in closing remarks: “Hamas actually does have genocidal intentions against the people of Israel, and have said so explicitly, that they would like to see Israel wiped off the map.”

Said Denmark, “We regret the resolution was not more balanced on the matter of hostages and the use by Hamas of hospitals as shields.”    

Added Germany, which described itself as the world’s largest donor to the Gaza emergency response: “Like any other state, Israel has the right to defend itself in accordance with obligations under international law.

“Hamas must unconditionally and immediately release all hostages and stop its rocket attacks, and refrain from using civilians as well as civilian infrastructure for military purposes, especially medical infrastructure, like hospitals or ambulances. We do regret that these aspects are not reflected in the current resolution.” 

Tedros’ conclusion: The medicine most needed is hope 

Despite the bitter polarisation seen, the WHO governing body remains the first in a UN fora to have made a consensus statement on the crisis, said Tedros in closing remarks following the vote by the 34-member body. But no resolution by the global health body can really address the deeper roots of the conflict, which are fuelling the crisis, he stressed. 

“I understand Israel’s need to protect it’s people from further and future attacks, and to live in peace and security,” Tedros said. 

“And I likewise understand the need of the Palestinian people to live in peace and freedom. 

“We must continue to believe that these are possible and not mutually exclusive.

“As always, the medicine that the people of Israel and the occupied Palestinian territory needs the most is not one we can deliver in a truck, or administer in a syringe.

“It’s the most precious medicine and often the most rare: hope.”

Image Credits: WHO report to the Executive Board , WHO/EMRO .