In 2005, as Israel dismantled its settlements and pulled out the army, Hamas covered the Gaza Strip in posters celebrating its “victory.” “Children’s Killer is Leaving,” some of these read, in awkward English. Such triumphalism has proven to be misplaced. Recent events have added to the ranks of “children’s killers”—with perpetrators this time drawn from within Palestinian ruling circles.
Ensconced in Ramallah, 82-year-old Palestinian Authority President Mahmoud Abbas embarked in April on an ongoing campaign to bring Hamas to its knees. Supporters view him as a secular nationalist determined to leave behind a Palestinian state as his lasting legacy. They say this can only happen if Gaza, which Abbas has labeled “an emirate of darkness” and recently toyed with proclaiming “a rebellious province,” can be returned to the fold so that a unified government is able to negotiate with Israel from a position of strength.
Abbas’s critics see him as a bitter and deluded autocrat driven by personal animus toward Hamas. The Islamist movement defeated him and his ruling Fatah party in a free and fair election in 2006. Backed by American money and weapons, and encouraged by Tel Aviv, Abbas then set out to annul the results, foment civil war, and eliminate his rivals by force. The attempted coup, described by Israeli journalist Tom Segev as “The Bay of Pigs in Gaza,” was crushed, leaving Hamas in complete control of the Strip.
Ever since, Abbas has brooded over this humiliation, biding his time to claw back power. He now sees a chance to act. During a joint news conference in May, he pandered to Trump: “I believe that we are capable under your leadership and your stewardship, your courageous stewardship and your wisdom, as well as your great negotiating ability, I believe, with the grace of God and with all of your effort…we can be partners, true partners to you to bring about a historic peace treaty.… Now, Mr. President, with you we have hope.” Abbas sought to gain favor with the White House as a man of strength prepared to take the fight to Hamas, a movement that remains fixed on the State Department’s list of “designated foreign terrorist organizations.”
Desperate conditions in Gaza appeared to offer ample opportunities to destabilize the regime. Over the course of a decade of suffocating blockade, periodic war, and declining quality of life, the situation for the Strip’s 2 million residents has never been worse. Squeezed from all sides and its coffers bare, Hamas could no longer rely on aid flows from regional donors like Qatar, which is itself now confronting an embargo by Saudi Arabia and the United Arab Emirates, with Bahrain and Egypt as junior partners. As it struggles to pick up the fiscal slack, Gaza’s Islamist government depends more and more on domestic income, generated in part by steep hikes in taxes and fees that place a further burden on a population already at the economic breaking point.
Aiming to intensify the crisis and spark mass protest, Abbas has slashed salaries by up to 70 percent for civil servants, stopped the return of VAT revenues on goods entering the Strip, halted the delivery of diesel fuel for the Strip’s only power plant, and officially requested that Israel cease transmitting electricity through its lines.
Since April, blackouts have become more chronic than ever, with electricity down to four hours a day or less, and with knock-on effects that prevent the supply of safe drinking water and cripple the operation of sewage-treatment plants. Every day, 90 million liters of raw waste flow into the Mediterranean. Israeli environmental groups warn that the pollution, which has fouled beaches as far north as Tel Aviv, represents “a ticking time bomb.”
For Mohammed Al-Sayis, the bomb has already exploded. Following a July day spent at Shaikh Ejleen, previously Gaza City’s most popular beach, the 5-year-old boy became ill with shigellosis, a bacterial infection caused by exposure to infected feces. After Mohammed fell into a coma, doctors urged treatment outside of Gaza. The boy’s father gave the following testimony to the Al Mezan Center For Human Rights:
I went to the Department for Treatment Abroad in Gaza City to request financial coverage for my son’s hospitalization. I provided all of the required documents, including the diagnostic report and the doctors’ recommendation for referral. I was asked to wait for an hour for the decision to be made by the responsible staff at the Ministry of Health in Ramallah. However, no matter how many times I asked, I was constantly told that no decision had been made or communicated. For a whole week, I kept trying to secure the referral to cover Mohammed’s medical treatment outside Gaza, and I sought the help of different figures to speed up the decision at the Ministry of Health in Ramallah to approve our request. Nevertheless, no approval was granted.
Mohammed’s condition continued to deteriorate. The boy died on July 29 at the Al Durra Children’s Hospital in Gaza City.
Since Ramallah’s policy of collective punishment went into effect, more than half of patients requiring urgent care outside of Gaza have had permits denied or delayed—and not just by Israel, but by Palestinian Authority (PA) officials in Ramallah, whose sign-off is a prerequisite for most. June statistics from the World Health Organization indicate an 80 percent reduction in referrals for Gaza patients from Ramallah’s Ministry of Health compared to the monthly average for 2016—even while the PA flatly denies any change in policy. Unable to access treatment that might have saved them, at least 14 cancer patients have died this year, including five in August alone, setting a new record. In one week in July, two babies in need of specialized surgery died after their transfer to an Israeli hospital was blocked. “Someone appears to be taking some steps at least to slow down the approval process,” said Robert Piper, UN humanitarian coordinator for Gaza. “That’s very troubling indeed.”
For its part, Israel’s Coordinator of Government Activities in the Territories (COGAT), which ultimately issues exit permits, said in March of the then–40 percent overall drop from the 2016 average in exit permits of any kind that “the figures do not reflect reality.… In urgent medical cases we immediately coordinate entry for life-saving medical treatment.”
According to information received by Physicians for Human Rights–Israel (PHRI), “Medications in Gaza are at high levels of scarcity, with a third of necessary medications and more than 270 items of medical equipment needed for surgery unavailable.” The Jaffa-based NGO blamed the shortages on the Palestinian Authority’s slashing of funds: $4 million per month used to be transferred for the regular operation of 13 government hospitals and 54 primary-care centers. In April, the sum was down to $2.3 million, and in May it fell to just $500,000, the organization said.
“You’ve come to the front line of resistance,” jokes Dr. Allam Abu Hamda as he makes rounds in his neonatal intensive-care unit, which is attached to Shifa Hospital, Gaza’s main medical facility. Rumpled and informally dressed, the 48-year-old pediatrician beamed with pleasure as he moved between the incubators. “This baby came in weighing 550 grams, and look at him now: after two months with us, he’s almost a kilo and half, and about ready to be released to his parents.”
In 2013, Abu Hamda returned home to Gaza after decades of work in Dubai. “My salary was $12,000 a month. Here it is $2,000, but I had to come back. There was so much that needed to be done.” The system he inherited was obsolete. For babies designated “extremely preterm” (those born before 28 weeks), mortality hovered at 30 percent. Abu Hamda put in place new protocols, recruited additional staff, revamped in-service education, and lobbied for funds to upgrade machinery and equipment. Since his arrival, the rate has dropped by two-thirds. “We’ve saved 600 babies. Here, we fight for life.”
In 2016, nearly 60,000 children were born in Gaza. Abu Hamda says that 45 percent of deliveries were premature, an unusually high figure he attributed to a combination of risk factors. Poor maternal health, overcrowded and unsanitary living conditions, poverty, food insecurity, chronic stress, and severe environmental pollution, from contaminated drinking water to carcinogens leached from munitions deployed in recurrent Israeli attacks, all take a toll.
“We work miracles, but the problems are complex and the overall situation continues to deteriorate,” he said. “We should have one-to-one care. During the day, it’s one nurse for four babies, and at night it’s one to eight. We don’t have enough staff. And doctors and nurses are prevented from traveling outside of Gaza for advanced training.”
“I need six more monitors. And look at this: five premies in one incubator. It’s unacceptable. Do you know how easily infections can spread? What do I say to a mother who comes to me and says, ‘You killed my baby’?”
In March, Hamas established an “administrative committee” to run affairs in Gaza and to compensate for Ramallah’s perceived neglect of the Strip. (The latest reconciliation attempt, initiated October 2 by the PA prime minister’s first visit to Gaza since 2015, began with Hamas announcing its willingness to dissolve this committee and to hold national elections.)
Responsibility for the health sector belongs to Dr. Basim Naim, a German-educated physician. “Yes, of course there is a deep split between Fatah and Hamas, but it is unacceptable to use sick people as pawns,” he says. “What does Ramallah seek to achieve by withholding shipments of medicine to our hospitals or stopping patients from going outside of Gaza for critical care? Tightening the blockade and making life harder is meant to increase opposition to Hamas and bring about an uprising, Failing that, the aim is to create a situation of chaos which sparks another war with the IDF so that Mahmoud Abbas can return to Gaza on the back of an Israeli tank. He wants to send a positive message to Trump, but the message isn’t being received. The Europeans and the Americans know that Hamas is not the Islamic State. Abbas is a calcified old man behaving like a vengeful child.”
However misbegotten and ineffectual Abbas’s plans may turn out, the crisis he has sought to exploit shows no signs of abating. Hamas teeters on the abyss, the desperation of its plight signaled by talks revealed in July with Mohammed Dahlan, who as the Palestinian Authority’s intelligence chief in Gaza spearheaded a crackdown against Islamists during the 1990s, complete with torture and “death squads.” The once mortal enemies have begun to explore a tactical alliance based on a convergence of interests.
Expelled from Fatah in 2011 for allegedly plotting Abbas’s overthrow, Dahlan was fined $16 million on charges of embezzlement and received a three-year prison sentence in absentia. Based since then in Abu Dhabi, Dahlan has emerged as an influential power broker with close ties to regional players, and with long-established links to US and Israeli intelligence. Still politically ambitious, the 56-year-old Dahlan sees Gaza as his gateway to the West Bank and to a renewed leadership challenge against Abbas.
Discussions with Hamas representatives have explored a possible deal: the opening of the Rafah border crossing to Egypt, which has been hermetically sealed for the longest consecutive period since the blockade began; funding by the United Arab Emirates for a new power station; and Dahlan’s envoys being installed in Gaza and invested with administrative responsibilities. Such a scenario has been put on hold by the current “reconciliation” with Hamas that it cornered Abbas into accepting. It would allow Dahlan to rebrand himself as a humanitarian benefactor rather than a ruthless strongman, thereby broadening his constituency, burnishing his media image, and setting the stage for a comeback.
Whether Hamas and its former nemesis will be able to forge an antagonistic collaboration remains as much in doubt as the durability of a formal reconciliation process with the PA, whose leadership Hamas has routinely portrayed as a gang of spies and traitors. Thwarted and boxed in, the Islamists have made largely cosmetic concessions in favor of pragmatic compromise that might produce a respite to Gaza’s unbearable collective anguish. Hamas represents a movement with deep roots in society. Preserving that base means meeting the needs of the people. If current political and diplomatic developments prove feckless, then military violence becomes the default mode, seen as a way to cut the Gordian Knot and create a new dynamic on the ground.
Devoid of a coherent long-range strategic vision, Israel’s approach toward Hamas is premised on the existence of what security analysts Efraim Inbar and Eitan Shamir term a “protracted, intractable conflict,” one that can never be resolved but only kept on a low burn. Successive prime ministers have sought to isolate and impoverish Hamas, degrade its military assets, and subvert its capacity to deliver successful governance and consolidate its power. At the same time, they have desisted from efforts to force the regime’s collapse out of fear that more radical enemies might fill the void. (The August 17 suicide bombing by a jihadi Salafist that killed 28-year-old Hamas commander Nidal al-Jaafari suggests who might be waiting in the wings. Hamas vowed in a statement to “fight the alien deviant ideology without concession.”)
But despite a continued rhetorical commitment to conflict management (“We have no beef with Hamas,” said Israeli Defense Minister Avigdor Lieberman this past March. “Let them look to their own turf”), the logic of Israel’s behavior is at odds with its declared policy. No one would have been surprised, least of all Israel (which largely controls the context), if a cornered Hamas, with less and less to lose, sought escape from an impossible predicament with one roll of the dice. Should this still happen, Israel is well-prepared for an eventuality it has done much to produce. In 2016, Lieberman issued a warning: “In Gaza, like the Iranians, they intend to eliminate the state of Israel.… If they impose the next war on Israel, it will be their last. I would like to emphasize again: It will be their last confrontation because we will completely destroy them.”
“Gaza is off everybody’s screen until we begin to start having discussions about why we’re going to have another war,” observed retired US foreign service officer Lara Friedman, a panelist at an August 3 conference convened by the Washington, DC, Middle East Institute under the title “Gaza Approaching a Boiling Point?” She said, “There have been lots of wars, and each time, it’s as if we’re watching a car accident in slow motion, and no one has any agency to stop the cars from colliding or driving into a wall.… Gaza is not a pot to watch boil or a lawn that needs to be mown. Tania Hary, my friend who runs [the Israeli NGO] Gisha, says we’ve turned Gaza into the largest controlled human experiment in history, testing the behavior and breaking point of 2 million people as increased pressure is exerted over time. And that is a fundamental challenge to all of us in this room.”
Friedman echoed ex-Mossad chief Tamir Pardo, who, at a Netanya conference in March, deplored that “Israel has chosen not to choose, to close its eyes and walk forth in the hope that the conflict will work itself out. Maybe the Arabs will disappear one day, a cosmic or divine miracle will occur.”