• Access needed to address some of Gaza's health needs  - Laila Baker
Even the most resilient individuals and nations require political stability and socio-economic security to thrive.

• A call for a robust international presence  - Nomi Bar-Yaacov
What is missing is the political will to appoint a tough mediator with a powerful mandate and international backing.

• A conflict of the third kind  - Christian Berger
Humanitarian aid, crossing points...these are important albeit technical points that fail to address the underlying political issues.

• International acrobats around Gaza  - Ezzedine Choukri Fishere
Twenty months after Hamas seized power in Gaza, an international role has once again become a policy option.

• IDF humanitarian coordination  - an interview with Baruch Spiegel
When IDF ground forces entered Gaza, the humanitarian officers were with them at brigade level.

Access needed to address some of Gaza's health needs
 Laila Baker

When emergency strikes, we become obsessed with numbers: 1,300 Palestinians killed, 5,400 injured, 50,000 displaced. Though there is certainly merit to the numbers game in exhibiting the magnitude of a crisis, it is also easy to see how figures can be manipulated and detract from the issues related to breaches of basic human rights. Fortunately, over the last half-century, ideas about the relationship between population and sustainable development have evolved significantly to include human rights.

Critically, countries in crisis face even the greatest obstacles in maintaining the delicate balance between these variables while addressing humanitarian needs. In the particular case of the most recent bombing of Gaza by Israel at the turn of 2008, perhaps nothing illustrates the human rights point better than the case of "Fatima", 34, who was nine months pregnant with her fifth child when the incursion began. She prayed that the shelling would stop before she went into labor, but on day 17 of the offensive, in a particularly aggressive bombardment, her labor pains began.

After calling the emergency medical services several times, her husband secured an ambulance to transfer her to Shifa hospital. Torn between leaving her children behind in such circumstances or risking a home delivery with no trained midwife or doctor, she chose to pile her family into the ambulance alongside with her. Five minutes into the trip and as Fatima had just begun feeling more secure with her family in tow, the ambulance was shelled, killing her, the unborn child and all the other family members traveling with her.

Even for the other estimated 170 women giving birth every day in Gaza whose fate was luckier than Fatima, recent events have resulted in a severe deterioration of already precarious living conditions and have further eroded a weakened health system in the Hamas-controlled territory. With hospital facilities turned quickly into trauma units, maternity wards were not readily available and women delivering normally were put in corridors and sometimes released within half an hour of giving birth.

Among the 3,500 babies who are calculated to have been born during the 23 days of the Israeli offensive, the consequences for maternal and child morbidity and mortality are not yet clear. Shifa Hospital alone, the largest facility in the central Gaza region, has a reported 50 percent increase in neonatal death rates during the crisis, according to a UNFPA (United Nations Population Fund) reproductive health study conducted this month.

The state of the health services in Gaza was already precarious before the military offensive. The strict closure of the Gaza Strip since mid-2007 resulted in intermittent shortages of fuel, electricity and water and led to reduced services at both the primary care and hospital levels. Referrals for specialized care outside Gaza are nearly impossible. Materials needed for rehabilitating and building health facilities are still prevented from entering Gaza and access of people and goods remains the main obstacle to provision of any effective, systematic response for rehabilitation and recovery. Coupled with internal political turmoil and extensive health worker strikes, reduced health service delivery and public health programs capacity was inevitable.

Stress and losses, both human and material, in Gaza are also a risk factor for a wide range of mental health and psychosocial problems such as post-traumatic stress disorder. According to World Health Organization figures, the effects on mental health of the recent emergency in Gaza can be roughly estimated. Even with a conservative approach, it is reasonable to assume that 25,000 to 50,000 people will need some form of psychological intervention to address long-term effects of the violence recently witnessed. Staff dealing with psychosocial cases prior to the invasion have also become vulnerable to the same risk factors and cannot cope themselves at times. Difficulties in obtaining Israeli permission for qualified staff to enter Gaza, which requires lengthy and complicated procedures, mean less effective assistance to the most vulnerable population groups including those who have lost family and friends or are among the more than 5,000 injured and left disabled.

Experience shows that human beings are resilient and have a great capacity to cope even when faced with severe adversity. This is not the first crisis for the Palestinians in Gaza, nor is it, unfortunately, likely to be the last. However, even the most resilient individuals and nations require political stability and restoration of socio-economic security to thrive. Young people usually represent a nation's hope and future. What hope and future a damaged, besieged and politically isolated territory can offer the young people in Gaza remains to be seen.- Published 19/2/2009 © bitterlemons-international.org


Laila Baker is the United Nations Population Fund's humanitarian liaison specialist and was until recently the UNFPA assistant representative in Jerusalem.

The question of rebuilding Gaza must be linked to a new approach to peace and stability in the region. Otherwise, there is no guarantee that after the Strip is rebuilt it won't be bombed again.

After the war in Gaza and the Israeli election, it appears that a majority of Palestinians and Israelis no longer believe bilateral negotiations will achieve peace. A growing number of Palestinians believe in resistance and a majority of Israelis voted for parties that do not believe in a two-state solution based on the 1967 borders. As the promise of a two-state solution looks increasingly remote, some advocate a one-state solution. However, the alternative to two states is not one state; it is regional instability, chaos and bloodshed.

The only way to achieve a two-state solution is to have a robust international presence in Palestine working with a forceful mandate on one clear goal, a sovereign Palestinian state, rather than the removal of a checkpoint here and an outpost there or the much necessary supply of food and nappies. The way to put an end to the occupation is to put an end to incrementalism.

International presence is not an alien idea to this conflict. Indeed, some think there is too much of it. Already present are the Quartet, composed of the United States, European Union, United Nations and Russia, with a mandate to oversee the peace process, and the UN Special Coordinator's Office, which coordinates the UN's multifarious efforts. The UN Office for the Coordination of Humanitarian Affairs deals with Palestinian welfare in general, UNRWA provides for Palestinian refugees, the US Security Coordinator helps train part of the Palestinian security forces and the EUCOPPS mission works with another part. Then there is the EU-BAM mission (currently suspended) monitoring the Gaza-Egypt crossing, the "Temporary" International Presence in Hebron which has been trying to maintain calm in the city for 15 years, World Bank and IMF missions advising on Palestinian development, economic and legal reform, a slew of international aid agencies and NGOs working on humanitarian, security, civil society and human-rights projects.

Yet all these efforts either focus narrowly on one aspect of the conflict or approach it in an incremental manner. What is missing is the international political will to appoint a tough mediator, with a powerful mandate and broad international backing, who could strike a comprehensive deal and implement it with the help of one robust international mission.

Such a mediator would have a mandate to negotiate the thorniest issues of the conflict--borders, settlements, Jerusalem, and refugees--from the outset. These should not be left for last as in the Oslo process that failed. Nor can peace be negotiated on the West Bank only; it has to include Gaza. Both territories need to be treated as one.

With a new administration in the United States and a seemingly open-minded, well-intentioned and ambitious new president, it would appear that the newly appointed US Middle East envoy is a logical candidate for this broader mandate. But he needs the backing of all parties concerned, a robust mandate and strong mission in order to implement a peace plan. George Mitchell, a Lebanese-American, was instrumental in negotiating the 1998 Good Friday accords that led to the end of the conflict in Northern Ireland.

The Arab peace initiative of 2002 should be used as a vehicle to rally the support of Arab states and form the framework for peace talks, coupled with existing plans on the table. The mediator's mandate should be endorsed by the UN Security Council, and the plan should have a strict timeline for Israeli withdrawal from the West Bank, a strong monitoring, verification and compliance mechanism and a built-in conflict-resolution mechanism, so that when one party accuses the other of violating the plan someone can resolve the dispute and implement a solution. There should be an international force with a Chapter VII mandate (the ability to intervene and separate hostile forces), as then UN Secretary-General Kofi Annan called for during the fighting in the West Bank in April 2002.

This requires a very strong coalition of international actors including the US, EU, Russia and Arab states--a coalition of the willing to help negotiate, mediate and resolve conflicts and implement an agreement. These countries may be reluctant to contribute the extra resources and troops; yet as things stand, the considerable contributions they are already making now are going into a black hole and could continue to do so indefinitely. Scattered confidence-building measures and good-will gestures will not achieve a solution.

The obvious objection to this approach is that neither side is ready to have a solution imposed. Israelis have just voted against a two-state solution, while the Fateh-Hamas conflict means there is no single, unified legitimate Palestinian leadership to negotiate with. There is little or no mutual trust. But these problems are just what a powerful international mediator could overcome by putting on the table an offer that neither side can refuse: a comprehensive solution addressing the entire region, and the muscle to make each side meet its commitments.

This effort, coupled with the promise of the Arab initiative to normalize relations with all Arab states once a Palestinian state is established, offers a huge incentive to Israel. Serious security and economic guarantees will have to be agreed for the removal of settlers and resolution of the Palestinian refugee question. Appropriate security and economic incentives should also be given to Syria and Iran. This approach would offer a new security architecture in the Middle East.

This opportunity should be grabbed as a matter of urgency. It should not be missed, as the alternative is dire.- Published 19/2/2009 © bitterlemons-international.org


Nomi Bar-Yaacov is a foreign policy adviser on Middle Eastern affairs. She formerly headed the Middle East Conflict Management Programme at the International Institute for Strategic Studies.

When comparing the recent fighting in Gaza with other violent conflicts around the world, there is one striking difference: there was no escape for the local civilian population, there was no way out. The sea, the fence and the border to Egypt did not allow civilians to flee from the shelling and shooting. This is quite unique in recent history.

A less unique feature was the ever shrinking humanitarian space. Delivering humanitarian assistance became a daily challenge; it largely still is. Access constraints, a narrow definition of humanitarian aid, the danger of being caught up in the fighting--all drastically reduced the international agencies' capacity to deliver aid. With the international community mainly engaged through humanitarian aid, there are few other conflicts where the need to respect humanitarian space is so acute and probably even fewer where the politicization of aid is so intense.

The international community, including the European Union, kept making these points throughout the fighting and succeeded in setting up, together with the Israeli military, a coordination structure that tried to solve humanitarian problems in real time. This led to the introduction of humanitarian time slots during which the fighting temporarily came to a halt. Paradoxically, it also led to a higher quantity of supplies going into the Gaza Strip than during the 18 months prior to the fighting. However, this was no substitute for the most important goal: an end to the hostilities and the killing.

Today, more than one month after the fighting ended, we are still grappling with the fallout from the crisis. Unemployment levels have risen to be among the highest in the world (46 percent) as a result of the collapse of the private sector, with a corresponding effect on rising poverty and almost 80 percent of the population dependent on some form of humanitarian assistance. The black market is booming with all its adverse consequences, ranging from skyrocketing prices to the lucrative smuggling enterprise at Rafah. This is compounded by a lack of cash permitted into the Gaza Strip that is crippling the banking system and does not allow for regular payment of assistance to vulnerable families and the payment of salaries of employees dependent on the legitimate Palestinian government.

The definition of humanitarian aid remains restrictive: the items allowed in are determined on a day-to-day, case-by-case basis. Needs estimates made after the Israeli disengagement from Gaza in 2005 have long been outdated by a prolonged period of import restrictions that has led to a depletion of stocks and lack of spare parts. Also, the demand for building materials and other basic items one takes for granted in daily life has exponentially grown in the wake of the recent fighting.

The international community and Palestinian engineers are now engaged in assessing the damage. They are drawing up a recovery plan to be discussed at a conference in Sharm al-Sheikh in early March. But is all this heightened activity really the answer? Will it lead to a solution? Humanitarian aid, crossing points, lists of items that can or cannot be imported ... these are important albeit technical points that fail to address the underlying political issues.

First among these are efforts to bring about Palestinian unity. The political divisions within Palestinian society make it difficult if not impossible to improve the quality of life of Palestinians. Our efforts will bring only limited benefit if Palestinian unity in pursuit of peace is not achieved.

Second, continuation of the peace process--or, rather, bringing the peace process to a successful conclusion.

Third, Gaza must not overshadow the problems of the West Bank. It must not jeopardize the real achievements that the Palestinian Authority, in partnership with the international community, has made in delivering greater security, greater--albeit modest--prosperity and a better quality of life for the Palestinians of the West Bank.

Fourth, implementation of the 2005 Access and Movement Agreement negotiated by then Quartet envoy James Wolfensohn. This entails the full opening of border crossings for imports and exports, the beginning of construction of a seaport, preparing the reopening of the airport and establishing a transport link with the West Bank.

The people of Gaza do not deserve the imprisonment that hatred, fanaticism and conflict bring in their ugly wake. The people, and in particular the children, of Gaza instead deserve reason, hope and an explanation of what was done to them during the hostilities. They deserve freedom from fear, freedom from want, freedom from hatred and freedom from the hazardous and irresponsible acts of others.

It is time that Gazans no longer have to worry whether goods that are not deemed strictly humanitarian in nature like macaroni, candy and fruit juice can be imported, let alone fuel, cement, reinforcing steel and glass panes. It is time that Gazans no longer have to worry whether or not their children can go to university abroad and their sick be treated in hospitals abroad, or whether or not they can entertain the outlandish thought of going on vacation abroad. Isn't this the way matters should be?

Gazans have the right not only to mere survival, but to a decent and normal life. The absence of a political breakthrough keeps postponing the one thing Gazans desperately need: a return to normal life.- Published 19/2/2009 © bitterlemons-international.org


Christian Berger is European Commission representative in the West Bank and Gaza Strip. Previously he served as EU representative on the team of Quartet Special Envoy James Wolfensohn, and was responsible for crisis response and peace-building in the European Commission. This article reflects his personal views and not necessarily those of the European Commission.

The recent Israeli attacks on Gaza resuscitated the debate over a possible international role in the besieged Strip. What capacity, if any, can the international community fill in order to help run Gaza's crossings, patrol its borders, ensure equitable distribution of humanitarian assistance and support imminent reconstruction efforts?

This debate is as old as Israeli unilateral withdrawal plans. In 2003, many United Nations officials suggested that an international force along Gaza's borders was the best way to ensure stability and security for both Israel and the Palestinians after Israel's withdrawal. They took their case to world capitals and the region, arguing that such a "presence" could, inter alia, patrol the border and territorial waters to prevent smuggling and illegal passage, train and assist Palestinian Authority security forces to enhance their capacity to enforce law and order, facilitate the crossings' operation and communication between the parties and assist in the reconstruction effort.

The UN prepared an operational plan for this presence, including various options for its mandate, command and control structure as well as its "exit clause". While American officials showed openness to the proposals, the Israeli government and its supporters in the US stood firm against it. Instead, Israeli officials focused their attention on persuading Cairo to play an expanded role in Gaza's security. Ultimately, Egypt declined such a responsibility, and the UN-led presence idea was nipped in the bud.

Twenty months after Hamas seized power in Gaza, an international presence/role has once again become a policy option. The difficulty this time is greater: to establish an international presence in Gaza, one needs the consent of those whom that presence is de facto targeting. No Egyptian, Arab or international force can be deployed in Gaza against the will of Hamas. For more than a year and a half, concerned parties have been trying every acrobatic move possible in order to avoid this simple fact: Hamas is in control of the Gaza Strip. Its consent--and protection--are necessary to run crossings, distribute aid, reconstruct or simply organize the visit of a foreign dignitary. This is the plain fact that the international community needs to recognize.

The question then becomes two: 1) what would it take for Hamas to give its support to an international role; and 2) what is the role that the international community would want to play in the shadow of Hamas? The answer to the first question is easy: recognition. The second is more difficult to answer.

On the one hand, the international community does not want to engage with Hamas or to help it strengthen its grip on the Strip as long as Hamas refuses to accept the principles of a two-state solution. Far from that, an international role is often presented as a tool to undermine Hamas' rule. Yet there is little the international community can do to achieve this goal. The suffering of the civilian population in Gaza hurts both Hamas and the international community almost equally, and therefore neither can leverage it. The siege certainly exhausts Hamas, but it will not make it kneel. Neither will further death and destruction.

Consequently, the international community has only two options related to Gaza. One is to operate in the Strip in cooperation with--or in the shadow of--the Islamic movement. The other is to gear its involvement toward a genuine Palestinian reconciliation.

The first option is self-explanatory: the international community can, most likely through the UN, launch a humanitarian relief and reconstruction operation under the gaze of Hamas leaders and with their blessing. The UN can become the interface between the world and Hamas; UN tradition and regulations allow its officials to engage with any force on the ground. This role can be expanded to include crossings management and security-related matters, where the UN would serve as interface between Israeli and Hamas representatives (as it did on the Israeli-Lebanese border for some time). The downside of this option is that the international community would acquiesce to and indeed strengthen Hamas' rule over Gaza, albeit without politically recognizing Hamas.

The other option is to gear the international role toward--and gauge it upon--Palestinian reconciliation. In practice, this means that the international community would carry out four tasks.

First, it would consolidate its plan for humanitarian assistance and reconstruction. Second, it would agree with the concerned parties on possible assistance in running all of Gaza's crossings. Third, it would decide whether it would be prepared to deploy forces along Gaza's borders that would not only prevent smuggling but also provide the Palestinian population with protection against future Israeli attacks. And fourth, it would then present these plans as a heavy incentive package that would lubricate and compliment Egyptian efforts aimed at reconciling the two warring Palestinian factions. Such a role would give all concerned parties the needed assurances regarding their most important interests: security and political survival.- Published 19/2/2009 © bitterlemons-international.org


Ezzedine Choukri Fishere is an Egyptian writer and academic. He now teaches political science at the American University in Cairo.