The stringent closure imposed on Gaza is having a serious impact on most people's daily lives and has stymied reconstruction efforts. Fishermen's and farmers' livelihoods have been destroyed. Unemployment and poverty are rampant. The availability of medical care is inadequate and water and sanitation services are run down.
"There has been scarcely any improvement in the situation since the end of the war in Gaza, mainly because of the tight closure, which is preventing reconstruction," said Pierre Wettach, the ICRC's head of delegation in Israel and the occupied territories. "Many Gazans feel despair as they have no prospect of living a decent life in the near future."
There are no signs that the 4.5 billion US dollars pledged by donor countries in March 2009 to help the Palestinian economy and rebuild Gaza have been put to use. In June, the ICRC again called on the States, political authorities and organized armed groups concerned to do what is needed to reopen the Gaza Strip and safeguard the life and dignity of its civilian population, but so far no significant action has been taken. The failure to heed the ICRC's repeated calls for an end to Gaza's isolation reflects the lack of political will to permit reconstruction.
The ICRC is again appealing for an immediate lifting of restrictions on the movement of people and goods. Sustainable economic recovery can be achieved only if the parties to the conflict take bold political steps towards a peace process.
Under international humanitarian law, Israel has an obligation to maintain conditions enabling the population to lead lives that are as normal as possible. While the ICRC fully recognizes Israel's right to address its legitimate security concerns, these must be balanced against the Palestinians' right to live a normal and dignified life.
Palestinians in the Gaza Strip are still paying a high price for the continuing hostilities between Israel and Palestinian factions and for intra-Palestinian confrontations.
Today, because of the closure, large-scale reconstruction remains impossible. Many families whose houses were totally or partly destroyed are still living in rented apartments or with relatives. Some have moved back into their partly destroyed homes which they have tried to patch up to protect against the cold and rain. A small number of families are still living in tents.
Building materials remain unavailable or too expensive. Those that do reach Gaza are mostly smuggled in and sold at high prices. Although the price of cement has edged downwards in recent months, it is still unaffordable for many people. Steel and glass are simply not available.
"Twenty-six houses in the neighbourhood, including my own, were completely destroyed in the shelling last year," said Said Abu Sharkh, a Palestinian living in Gaza City. "It would be an understatement to say that I was in shock when I found that our home and all of our clothes and furniture had been destroyed. My wife and I are poor, and we have seven children to care for. We could only afford to rebuild one room; we do not have enough money even for a proper roof or for window glass. My children ask me why water comes through the roof when it rains. The destruction of our home has been really hard on them. I used to earn a living repairing electronic equipment, but my little workshop was also destroyed. Now we survive with help from aid agencies. This is what real suffering is: not having work or a proper home."
Most families in Gaza are afflicted by unemployment and poverty. Food is available in shops and markets, but many families cannot afford a nutritious diet. Bakeries frequently have to shut down for lack of fuel.
Fishermen are among those hardest hit by restrictions on movement. Following Israel's decision last winter to cut the area open to fishing from six to three nautical miles off Gaza's coast, their catch during the first nine months of 2009 was 63 per cent lower than during the same period in 2008. The bigger fish and sardines that made up approximately 70 per cent of the catch before the smaller fishing zone was imposed are normally found beyond the three-nautical-mile limit. According to the fishermen's syndicate of Gaza, the average monthly salary of its members has plummeted to less than half of what it had been before the size of the fishing zone was reduced.
Fishermen are also at risk of being shot at by the Israeli navy. Several casualties have been recorded since the beginning of the year. Israel has confiscated about 20 fishing boats as well as engines and fishing equipment in 2009.
Safety is also a matter of great concern for farmers who own land near the fence separating Gaza from Israel. Some farmers can work freely within 350 metres of the fence, while others risk being shot at if they come within 1,200 metres. In some areas, such as east of the town of Jabalia, they cannot reach their farms at all. As farmers are still not allowed to export their produce through Israel, their harvest is sold locally, which provides little income. As long as the crossing points into Israel remain closed, agriculture is likely to decline further. To cut costs, many farmers now rely on their own family members to work the fields, thereby putting others out of work.
Inadequate health care
All too often, Gaza's medical facilities have to work in substandard conditions. Not only do they encounter problems with water supply and sewage disposal, but they are also subject to cuts and fluctuations in the power supply that can damage equipment which often cannot be repaired once it has broken down.
Essential medicines and medical supplies are still in extremely short supply or not available at all. At the end of November 2009, approximately 75 medicines out of 460 considered essential - for example antibiotics for treating lung infections - were lacking. More than 100 kinds of disposables out of 780 that should be available were also out of stock, forcing medical staff in maternity wards to re-use disposable items such as ventilator tubing, which can lead to life-threatening infections.
"If you live in Gaza and have a broken arm, that can of course be fixed. But if you suffer from kidney failure, for example, there is always a risk that you will miss your regular dialysis treatment because drugs or other essential supplies are lacking," said Palina Asa Asgeirsdottir, an ICRC hospital project manager working in Gaza. "Or the machines may be broken and will have to wait to be fixed because it's so hard to get spare parts into Gaza. Missing a dialysis treatment can be devastating for the patient."
"If you suffer from cancer there is no guarantee that you will receive the urgent treatment you need," added Ms Asgeirsdottir. "Sometimes hospitals do not have all of the drugs needed for chemotherapy. For radiotherapy you have to leave Gaza and go to a specialized hospital in Israel or East Jerusalem. Getting the exit permit each time you need treatment is long and complicated, and involves the Hamas authorities, the Israelis and Palestinian Authority health officials in the West Bank. It's tough to have to go through long procedures and travel to far-away hospitals when you are seriously ill."
This situation is further aggravated by a standstill in cooperation between Palestinian authorities in Ramallah and Gaza.
The import through Israel of spare parts for medical equipment is subject to such long delays that other ways need to be found to get essential equipment repaired. For example, the ICRC has sent defective parts of dialysis machines to Europe for repair, a process that will probably take at least a year to complete.
It has taken as long as eight months to bring in spare parts for ambulances. For the past year, the ICRC has tried unsuccessfully to import radio equipment for ambulances that would enable them to communicate with each other and with hospital emergency rooms. The ambulance service in Gaza cannot function properly without this kind of radio equipment.
Because of the closure it remains very difficult to provide training for medical personnel. Few medical staff are allowed out of Gaza for this purpose and few specialists or other experts capable of providing training are allowed in. Although it has been possible in some hospitals to set up video links with training institutions in countries such as Egypt, the need for specialized training is not being met.
Water and sanitation infrastructure in a dilapidated state
Key infrastructure in Gaza is run-down. The population lives under constant threat of a collapse of water, sanitation and electricity services.
The closure is paralysing any new construction. With few exceptions, such as water pipes imported by the private sector, no building materials have been allowed through the Israeli crossing points in 2009.
"We are still not allowed to bring in most of the materials required for the maintenance of water and sanitation infrastructure," said Javier Cordoba, the ICRC's water and sanitation coordinator. "In order to make even small repairs we have to struggle to find alternatives: either materials that we can buy locally or recycled items. It's really very sad that we are seeing no change for the better on the ground."
The main aquifer in Gaza is under serious threat from overpumping, which increases the level of salinity of the water. In addition, the lack of proper sanitation and certain agricultural practices are polluting the aquifer, resulting in drinking water containing high levels of nitrate and salt. Those who can afford it buy drinking water from companies supplying desalinated water.
Urgent measures, such as building desalination plants and upgrading sewage networks, need to be taken to address this problem. However, this would require the import of massive quantities of construction materials.
Improvements planned for wastewater treatment plants in Rafah and Khan Yunis should help ease some of the strain. At both plants, it will soon be possible for treated wastewater to seep into the aquifer through new infiltration basins instead of allowing untreated waste to be discharged directly into the sea.
Despite daily blackouts that can last as long as eight hours, the electricity supply is now better than it was earlier this year.
ICRC activities in Gaza in 2009
In partnership with the Palestine Red Crescent Society, the ICRC has provided some 32,000 people whose houses were fully or partially destroyed during the conflict with basic household and hygiene items, as well as with plastic sheeting to repair shattered windows. Between January and October 2009, the ICRC assisted more than 2,300 unemployed people with 15,000 dependents by enrolling them in cash-for-work activities and in various programmes involving land reclamation, greenhouse refurbishment and road upgrades.
Despite the closure, the ICRC has been able to carry on with the construction of wastewater treatment plants in Rafah and Khan Yunis - often by using unusual materials, such as concrete segments of the old Rafah border wall that lay abandoned after its partial demolition. The plants have improved sanitation for some 320,000 people. The ICRC has also upgraded storm sewer networks in both areas, which should prevent or mitigate the flooding of residential neighbourhoods during winter.
The ICRC has provided about 230 tonnes of drugs and disposables to eight government hospitals in Gaza. It has also continued to provide support for the Artificial Limb and Polio Centre in Gaza City, where about 1,500 patients, including nearly 700 amputees, have received treatment. Around 75 amputees from last winter's conflict, some of whom have been fitted with artificial limbs, are receiving physical rehabilitation at the centre. It will take some time, however, before all amputees can be fitted with artificial limbs.
The ICRC and the Palestine Red Crescent Society are working together to improve emergency preparedness. In particular, three workshops on practical measures for reaching conflict victims in greater safety have been attended by 120 emergency medical staff.
The ICRC has 100 staff permanently based in Gaza, of whom 18 are expatriates.