Virus puts new strain on Gaza's overwhelmed health system

GAZA CITY, Gaza Strip (AP) — Dr. Ahmed el-Rabii spent years treating Palestinians wounded by Israeli fire during wars and clashes in the Gaza Strip. Now that the coronavirus has reached the blockaded territory, the 37-year-old physician finds himself in the unfamiliar role of patient.

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El-Rabii is the first Gaza doctor diagnosed with COVID-19 and is among dozens of health-care workers infected during the local outbreak, which was detected late last month. The spread among front-line workers has further strained an already overburdened health-care system.

Speaking from one of the two hospitals designated to treat coronavirus cases, el-Rabii said the threat in many ways is more terrifying than war.

During fighting, “you only fear being hit by shrapnel by mistake,” he said. “But with the virus, you constantly worry because you do not know how or from where it will hit you: from a patient, from your colleague, or by touching the elevator or any other surface.”

Since 2007, Gaza has been under an Israeli-Egyptian blockade meant to isolate Hamas, the Islamic militant group that seized control of the territory that year from the internationally recognized Palestinian Authority.

The blockade is believed to have played a key role in slowing the arrival of the coronavirus. Few people can move in and out of the territory, and Hamas placed anyone returning to Gaza into mandatory quarantine centers for three weeks.

Before last month, the handful of Gaza’s coronavirus cases were confined to the isolation facilities. But on Aug. 24, the first cases were detected among the general population, and the numbers have multiplied since.

Despite limited testing capacity, over 1,000 active cases have already been detected. Nine people have died.

The outbreak has been especially hard for Gaza’s medical workers. For more than a decade, they have been on the front lines treating injuries during conflicts with Israel. They have worked in an ailing health system gutted by the blockade and intra-Palestinian political feuding that left doctors, nurses and other medical workers with only partial salaries.

Now, the virus is straining medical workers physically, mentally and financially. Ahmed Shatat, a Health Ministry official, said at least 68 medical workers have been infected.

Experts have warned that a wider outbreak in Gaza, home to some 2 million Palestinians, could be catastrophic because of the fragile health sector.

“Gaza’s health system is woefully underequipped to cope with a large outbreak, with only enough intensive care beds and ventilators to cope with a few dozen serious cases,” the International Committee of the Red Cross warned last week.

Shatat said there already was a shortage of medical workers even before the outbreak.

To help alleviate a staffing crunch, the Health Ministry has shortened the mandatory quarantine times for doctors and nurses who may have been exposed to the virus, from three weeks to two weeks. But it is still struggling to sufficiently staff the quarantine centers and isolation hospitals. Hundreds of workers are in protective isolation due to possible exposure, and pregnant workers and those with underlying health issues are excluded.

“Advanced health systems in the world could not sustain the outbreak, so how could our fragile, besieged, aid-dependent health system stand up to the crisis?” Shatat said.

After graduating medical school in Egypt in 2008, el-Rabii returned home to Gaza to grim prospects, and the only jobs available were in the Hamas-run administration. In 2010, he was offered a job, but the cash-strapped government could not afford to pay his full salary.

“Mostly, we got 40% of our salaries. This makes the doctor look for extra work at private clinics and hospitals,” he said.

Before he caught the virus, el-Rabii used to work 24 hours in full personal protective equipment in the sweltering summer heat. He would go home for a two-day break and return to the hospital for another 24-hour shift. “It was exhausting,” he recalled.

“Now, with the coronavirus, everything has shut down, and work at private clinics has stopped so you are only left with the public job,” he explained.

El-Rabii has worked at Gaza’s main hospital, Shifa, for the last 10 years. After the coronavirus outbreak, he was assigned to a team treating people with respiratory disorders.

A female patient tested positive for the coronavirus. Immediately, all doctors and nurses were tested, and el-Rabii was found to be infected. “It was a shock, especially since we know little about the spread of the virus in Gaza," he said.

At a newly opened hospital funded by the Turkish government, el-Rabii spends most of his time confined in his room, reading the Quran, praying, and answering phone calls from friends and family members.

Haitham Ibrahim, a laboratory specialist, has been doing nonstop tests for the past two weeks at the lab of Khan Younis hospital in the southern Gaza Strip, the second hospital where COVID-19 patients stay.

He doesn’t do coronavirus tests, but the 34-year-old lab technician does regular blood exams to monitor the status of infected patients.

"I often fall asleep from extreme exhaustion,” he said in a phone interview. “We take rests between shifts, but when you get off the heavy protective clothes you feel as if your body has melted.”

Ibrahim says he sometimes believes the patients are in a better situation than the medical workers. “The patient comes for 20 days and he recovers, but we will stay under this pressure, unsure when the virus will hit you, indefinitely.”

Because of potential exposure during a two-week stint at work, Ibrahim is now spending two weeks in a quarantine center. When he returns home, he will have to remain in self-isolation for an additional 14 days before returning to the lab for another work cycle.

The lengthy separation from his family meant that he missed his youngest daughter’s first steps. “I have five children and when I call them, I evade their questions about when I will come back home,” he said.

Like most public workers, Ibrahim has only been receiving 40% of his base salary for years. This month, Hamas’ government announced a 10% pay increase -- giving him an extra 100 shekels, or $30.

“We hope our work will be rewarded after the crisis ends. Now it’s time to focus on the work and overcome the pandemic,” he said.