Interview with Action Against Hunger on the humanitarian situation in Rafah

The Water Diplomat has received feedback from Action Against Hunger on the humanitarian situation in Rafah following the development of complex and difficult conditions for humanitarian organisations.

The British Foreign Secretary, David Cameron, warned on the 12th of February that Israel would be in breach of international law if it fails to provide food and water to the people of Gaza. Israeli authorities, he stated, should ‘stop and think seriously’ before taking further action in Rafah. A World Health Organisation emergency situation update from the 30th of January highlights the fact that the lack of adequate, clean water and safe sanitation is leading to ongoing outbreaks of communicable diseases since October, amongst which 161,285 cases of diarrhea (of which 85,410 are children).

On the same date, a series of airstrikes in Rafah, where more than half (some 1,3 million) inhabitants of the Gaza strip have sought refuge, killed 67 people.  The attacks are endangering the local population and making the delivery of humanitarian aid to the area extremely difficult. Noelia Monge, Head of Emergencies for Action Against Hunger, stated to Reliefweb that If the military operations in Rafah continue and expand, Action Against Hunger will be forced to suspend its activities in the area. These include include water trucking, solid waste collection, cleaning services, and the distribution of hygiene kits and food. Doctors Without Borders, which is also distributing 1,100 litres per day to the area, reports that over half the water and sanitation facilities in Gaza have been destroyed or damaged by the war, and as a result, 70% of the population are currently drinking contaminated water. Hygiene is very much under pressure, with only one shower available per 4,500 people. Water supplies, which need to be above 50 litres per capita per day to ensure basic hygiene in addition to drinking water requirements, dropped to 3 litres per person several weeks after the hostilities commenced.

Martin Griffiths, the Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, stated on the 13th of February that the humanitarian response is currently in ‘tatters’. Humanitarian workers have been attempting to serve people in need for four months at great personal risk, and this effort has been undermined further by a gradual breakdown in law and order. In addition, humanitarian responses have been severely affected by the decision made by western donors to pause funding for the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).  The UNRWA works in Palestine, but also has humanitarian activities in Jordan, Lebanon and Syria, where many Palestinian refugees reside.

In January, Israeli intelligence reports, made public by the Wall Street Journal, accused UNRWA of having been infiltrated by Hamas, alleging that some 10% of UNRWA staff have links to terrorist organisations and that 12 employees had links to or were directly involved in the October 7 onslaught against Israel.  In response, Philippe Lazzarini, Commissioner General at UNRWA, stated that he immediately terminated the contracts of these staff members and launched an investigation to establish the truth of the allegations. In the two weeks following the allegations,  a total of nine countries announced that they would pause or review their contributions to UNRWA, representing a total financial pledge of U.S. $ 667 million. The countries currently involved in defunding UNRWA are Australia, Canada, Finland, Germany, the Netherlands, Switzerland, the United Kingdom, and the United States.

The following information has been obtained from Action Against Hunger (ACF) on the situation in Rafah and the broader Gaza strip:  

The Water Diplomat: Currently it is being reported that there is an increase in the outbreak of communicable diseases in the Gaza strip with 161,285 cases of diarrhea of which 85,410 are children. To what extent do you think this can be attributed to deteriorating Water, Sanitation and Hygiene conditions? What is Action Against Hunger's observation on the current WASH situation in the areas where you are working?

ACF: The increase of outbreaks of communicable diseases in the Gaza strip is directly linked to the fact that most people in the Gaza Strip have no access to clean drinking water, sanitation services are wholly ineffective, and people across Gaza find themselves surrounded by unmanaged solid waste, sewage and wastewater flooding the streets and coastlines. Almost 2 million Palestinians in Gaza are facing a public health catastrophe and one in four families are on the brink of famine, all whilst facing continued insecurity under the constant military attacks.

As part of our work and as a member of the WASH Cluster, Action Against Hunger is leading a mapping process of the areas where humanitarian actors, the Palestinian Water Authority and UNRWA are distributing water. Only one in three Mekorot water pipelines from Israel is currently operational, with Bani-Saeed operating at just 47% of its full capacity. Only two out of three main water desalination plants are partially functional, none of which are operating in the North. Only 17 percent of groundwater wells are operational, with 39 destroyed, 93 severely or moderately damaged, and 48 possibly damaged. Reports say there are areas still not covered, and even if served, amounts are of less than 3L/p.d. This is due to a range of issues such as lack of fuel, accessibility, and security. The quality of the water distributed is not being tested without an operational lab in the strip. Not a single wastewater treatment system is working. Access to water and sanitation are internationally recognised human rights, essential to the health, dignity, and prosperity of all people. Action Against Hunger teams are working relentlessly to distribute safe drinking water along the Gaza Strip since the beginning of the conflict, as well as installing latrines, managing solid waste, and distributing hygiene kits.

The Water Diplomat: There have been reports of increased attacks in the Rafah area where many civilians are seeking refuge, and humanitarian organisations are stating that it is becoming difficult to operate. Action Against Hunger is quoted as stating that if the strikes continue it will become very difficult for the organisation to continue to provide humanitarian support. I assume that currently the organisation is still providing support, is that the case? How and when would you take a decision to stop operations?

ACF: Our teams in Rafah are still providing support despite being part of the more than 1.3 million people that have sought refuge there and are now facing military attacks, hunger, and disease. In the last 4 months, we have been able to provide fresh and dry food baskets, cash assistance and water, hygiene, and sanitation projects to some 320,000 people trapped in Rafah, a place where more than half a million people are suffering from a catastrophic food crisis. The continuation of military operations where was supposed to be a safe haven for Gazan puts at risk our activities, and the scarce humanitarian aid entering Gaza by trucks from Egypt and Jordan continues to decrease, are continuously analysing the feasibility of our activities based on access to providers, basic items, and the safety conditions. Our hope, and what we’re calling for, is that an immediate and permanent ceasefire is reached so we can not only not pause our activities but scale them up to provide a meaningful humanitarian response at the scale required to meet the needs of the population in Gaza.

The Water Diplomat: According to Doctors without Borders, the water supply infrastructure has deteriorated to the extent that 70% of the population are drinking contaminated water. Do you have any evidence to support this from the field work that you are doing?

ACF: No water quality tests are being conducted without operational labs or availability or entrance into the area of the required equipment. The outbreaks of diseases such as diarrhoea and hepatitis A are clear indicators of the severe health crisis in the Gaza Strip due to poor water and sanitation conditions. According to the World Health Organization (WHO), from October 16 to February 13, 2024, there have been 312,693 reported cases of acute respiratory infections, 222,620 cases of acute watery diarrhoea (of which 117,989 are children under 5 years old), 74,712 cases of scabies and lice, 49,052 cases of skin rashes, 6,625 cases of chickenpox, and 8,829 cases of acute jaundice. These figures far exceed the incidence of previous years. The inability to detect, diagnose, and report infectious disease outbreaks masks the true extent of the public health emergency. Furthermore, disease spread is a significant concern: for instance, individuals with hepatitis A may have been contagious for several weeks.

The lack of clean water, safe sanitation, shelter, health infrastructure, and humanitarian supplies exacerbates the situation, hindering adequate response and prevention efforts for outbreaks, including the need for isolation to prevent spread and contamination.

The Water Diplomat:  I understand that the work of Action Against Hunger is focused on water trucking, solid waste collection, cleaning services and the distribution of hygiene kits. How is the necessary equipment currently being brought into the area and are there currently limitations on your supplies compared to some months ago?

ACF: We have been working in Gaza since 2005 and, for more than four months, Action Against Hunger has been working in extreme and dangerous conditions to provide clean water in water trucking, distribution of hygiene and shelter items and fresh food to Gazans, both Internally Displaced Persons (IDPs) and host communities. We have also implemented cleaning activities and solid waste management services for IDP shelters, and construction and provision of showers, latrines and hand-washing facilities. Despite this unprecedented situation, our teams were able to reach 340,000 people in total in Gaza - approximately 60,000 families - from 18 October to 21 December 2023. Almost half of them (48 per cent) were children.

As soon as there is a ceasefire and a humanitarian corridor into Gaza, Action Against Hunger will be able to scale up our emergency response. Until then, the funding we obtain from public and private donors is allowing us to work with all the contractors we already know inside Gaza who still have materials and services available thanks to our extended experience, even now that the cost of these has skyrocketed. We are planning to preposition materials at border crossings, which will help us to be ready and deliver more aid as soon as that’s possible.