Palestine Brief No. 172
By Will Youmans
Palestine Center Fellow
As President Barack Obama assumes office, his first diplomatic overture to the region should be to immediately address Palestinian suffering in Gaza. Treating Gaza's health care crisis with action would go a long way to address the urgent medical needs of Gazans and re-position the United States, whose image suffered tremendously due to the government's complicity in the recent Israeli offensive, as a force of good in the region.
As Palestinian hospitals and doctors struggle to care for the wounded, any medical relief steps by the United States would help fill an urgent shortage in medical care, and send a powerful message to the Arab world. Amjad Atallah, director of the Middle East Task Force at New America, proposed early on that the United States should "do something to show everybody, the Arab world, the Muslim world, that the US cares and empathizes with the casualties that have resulted from this conflict."[1] He recommended the United States set up a field hospital on the Egyptian-Gaza border with the International Committee of the Red Cross shuttling the injured out of Gaza.
One of the most powerful and visible symbols of American empathy with those in disaster-hit areas is the USNS Mercy, the leading hospital ship in the U.S. Navy. As a ship committed to emergency medical care, it is one of America's most notable tools of medical diplomacy, having gained attention for its humanitarian contributions in tsunami-hit Asia in 2006. It would provide more capacity for health care and make a more prominent public diplomacy statement to the Arab world.
The Need in Gaza
The Gaza Strip's medical system is in crisis. With at least 5,000 Palestinians injured since the start of the Israeli offensive three weeks ago, the need for proper health care is beyond capacity. There is a shortage of space, lack of money for personnel, supplies and equipment, and no capacity for treating the worst injuries. Recently, the worst cases have been sent off to neighboring countries. While this helps a few, Gaza's health system needs more relief.
"Emergency rooms, intensive care wards are already at maximum capacity. In terms of beds we are almost there," said Tony Laurance, head of the World Health Organization office in Gaza.[2] As the fighting subsides, hospital and care facilities will likely increase intake as those with less serious injuries seek treatment and those who could not make it to hospitals begin to arrive. Similarly, people are being injured from rebuilding and previously unexploded armaments going off.
Hospitals were damaged by the fighting. Sixteen health facilities were hit with shelling and other weaponry. Gaza is left with only 2,000 hospital beds to serve 1.5 million people.[3] According to Laurance, 13 medical workers have been killed and 22 wounded, and 16 ambulances were destroyed, worsening a pre-existing shortage. The Arab Medical Union has sent 25 new ambulances to Gaza and Arab states have pledged 70 more[4], indicating the scope of Gaza's need for assistance.
Another challenge for Gaza's medical system is that the types of injuries are untreatable in the underequipped facilities. Some of the injuries have never been seen before by Gazan doctors. Nafiz Abu Shabaan, the head of Shifa hospital's burns unit in Gaza, reported that 60 to 70 burn patients died in his unit. Many, he suspects, have been hit with White Phosporous from Israeli shells, leaving smoldering material inside wounds. Abu Shabaan said, "I have been here since 1985 working in the burns unit and head of department for 15 years and I have never seen something like this."[5] Doctors struggle to treat the injuries and have no experience with such burns.
Another reason for American assistance is that Gaza's health system faces long-term care priorities even as it struggles to provide immediate treatment. As Laurance, observed, "We have an extensive number of serious injuries, amputations and head injuries that will have serious long-term repercussions." The emergency needs of recent injuries lessened the ability of hospitals to treat outstanding cases of cancer, heart disease and diabetes. According to the World Health Organization, pregnant women do not have proper access hospital beds. An off-shore hospital ship could relieve both short-term or long-term medical cases as the health care system rebuilds.
Groups such as Doctors Without Borders are building temporary hospital units[6], but are unlikely to provide the extent of care available in a hospital ship such as the USNS Mercy.
Finally, the risk of a serious disease outbreak requires systematic preparation. The head of the World Health Organisation (WHO), Margaret Chan, said, "right now, we very sadly see ideal conditions for outbreaks of disease."[7] She referred to the diminished ability of medical workers to provide immunizations, as well as health and sanitary dangers stemming from Gaza's broken sewerage pipes, scarce and dirty drinking water, and lack of proper garbage disposal. A deployed navy hospital ship would be invaluable for dealing with any widespread epidemic.
The cessation of hostilities in Gaza has not diminished the vital need for enhanced medical care. While some may argue that a naval hospital ship in unnecessary, they are not considering the risks of an epidemic. Treating the Gazan health crisis in the wake of Israel's bombardment and invasion as an urgent priority justifies a move of this magnitude. American outreach to the Arab world would be greatly enhanced by such an American medical diplomacy mission to Gaza.
The USNS Mercy
The USNS Mercy is a naval hospital ship that has been deployed on humanitarian missions in the past. During its deployment over the course of five months, the ship’s medical staff treated more than 60,000 patients in tsunami-hit Southeast Asia in late April 2006. As part of Operation Unified Assistance, they performed 1,000 surgeries, passed out 16,000 pairs of eyeglasses, and administered more than 19,000 immunizations.[8]
The ship is well-equipped to provide services to the Gaza Strip, a coastal territory. It has 80 beds in intensive care wards, 20 beds in recovery, 280 bed for intermediate need patients, and 120 for light care. Limited care patient beds total 500. The total patient capacity is 1000 beds, nearly half the total number of beds in Gaza. With 12 operating rooms, radiological services, physical therapy and burn care services, it could provide essential relief to overburdened medical facilities in Gaza.
The USNS Mercy, which is docked in San Diego, was recently on a humanitarian tour in Southeast Asia and Oceania. During its "Pacific Partnership 2008" tour, a 4-month humanitarian and civic deployment, it made an emergency trip to the Bay of Bengal. It was positioned to provide immediate assistance to cyclone victims in Burma.
The USNS Mercy is currently in its homeport and is in reduced operating status with a five-day activation.
Sending a Message through Medical Diplomacy
Tommy Thompson introduced the concept of "medical diplomacy" as Secretary of the U.S. Department of Health and Human Services. The basic idea is that the United States could better its relations with the people of other countries through the provision of medical services. According to Thompson, the United States should "integrate health policy into foreign policy, so that America might better present itself to the world and improve the health and well being of people around the world."[9]
In a 2006 speech, Karen Hughes, the Under Secretary for Public Diplomacy and Public Affairs at the time, said, "medical diplomacy, medical outreach, is one of the most effective ways that we can reach out people to people across our world."[10] Surveys showed that sending the USS Mercy to Bangladesh after the tsunami improved feelings towards the United States among 90% of Bangladeshis.
Thompson and other advocates of medical diplomacy argue that it "must be made a significantly larger part of our foreign and defense policy."[11] By enhancing American medical and humanitarian assistance to vulnerable populations, the United States will create goodwill and signify an important break from the Bush administration's foreign policy, which at least partly enabled this latest crisis.
Conclusion
Scenes from crowded Gazan hospitals and the gruesome imagery of injuries are common in news reports around the Arab world. The fact that much of the Israeli weaponry used against Gaza was manufactured or provided by the United States is not lost on the Arab and Islamic world that the United States has been striving to win over through its "public diplomacy" efforts.
For many, the Israeli offensive on Gaza was primarily an assault on the Palestinian people. The United States was at best complicit in Israel's actions in Gaza. Its abstention on the United Nations Security Council Resolution 1860 vote, which called for an immediate "durable and fully respected" ceasefire, makes this point undeniable.
For a Barack Obama administration looking towards a new path of engagement with Arab and Muslim countries, sending substantive direct medical help to the people of Gaza would be both a significant gesture and a useful intervention to relieve mounting health care demands. The USNS Mercy and other hospital ships could perfectly fit such a mission, and they have in the past elsewhere. While this may not erase the harm done to American credibility during the Bush administration, it would be a visible step in the direction of re-positioning the United States -- a departure from the previous President's reckless disregard for civilian life.
Although getting anything accomplished in this time of political transition will be difficult, decisive action by the new Commander-in-Chief would go a long way towards alleviating the image of the United States in the region. While many look forward to Obama's presidency as a time of change, it will be difficult for him to produce tangible measures as significant and efficient as deploying emergency medical help to Gaza. Without much political cost, Obama could take an easy step towards re-establishing American prestige.
Thompson described the aim of medical diplomacy in terms that resonate with Barack Obama's electoral message heard around the world. He said the value of delivering medical relief is that it in actuality, it is "delivering hope."
Will Youmans is a fellow at the Palestine Center in Washington, DC.
The views expressed in this information brief are those of the author and do not necessarily reflect those of The Jerusalem Fund.
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[1] http://yglesias.thinkprogress.org/archives/2009/01/what_we_could_do_for_palestinians.php
[2] Quinn, Patrick and Tamer Saliba "UN says Gaza hospitals in crisis" Associated Press, January 16, 2009
[3] "WHO chief says Gaza vulnerable to disease outbreak" Reuters, January 19, 2009
[4] Zhongwen, Yu and Wang Zhiqiang "Humanitarian aid waiting for entry into Gaza at Egyptian border" Xinhua January 21, 2009
[5] McCarthy, Rory "Gaza doctors struggle to treat deadly burns consistent with white phosphorus" Guardian (UK), Januray 20, 2009
[6] Doctors Without Borders November 20, 2009
[7] "WHO chief says Gaza vulnerable to disease outbreak" Reuters, January 19, 2009
[8] http://www.navysite.de/ships/mercy.htm
[9] Thompson, Tommy "Shrugging diplomatic responsibility" Marketwatch March 23, 2007
[10] Hughes, Karen "Medical Diplomacy" Why Mercy Matters Conference, Washington, DC, November 16, 2006
[11] Thompson, Tommy "The cure for tyranny" Boston Globe, October 24, 2005
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