A Surge of Humanitarian Aid Amid the Ceasefire—Gaza: The Human Toll

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This transcript is from a CSIS event hosted on February 3, 2025. Watch the full video here.

Stephen Morrison: Hello. I’m J. Stephen Morrison. I’m a senior vice president at the Center for Strategic and International Studies, CSIS, in Washington, D.C. This is the 22nd episode of the CSIS broadcast series entitled Gaza: The Human Toll. It’s a partnership among the CSIS Bipartisan Alliance for Global Health Security and my colleagues at CSIS in the Humanitarian Agenda Program, the Human Rights Initiative, and the Middle East Program.

We’re delighted today to be joined by Dr. Richard – “Rik” – Peeperkorn. Rik, since March of 2021, almost four years now, has served as the WHO, the World Health Organization, representative for the West Bank in Gaza. He has very kindly joined this production several times before and been very generous and forthcoming in describing to us what is happening. We’re delighted that he has come back at this particular moment.

Before I say a few more opening remarks, I’d like to thank my colleagues. Sophia Hirschfeld, who has coordinated and worked indefatigably to pull this session together. I want to also thank Dhanesh Mahtani, Dwayne Gladden, Alex Brunner, on our very expert production staff, for pulling this together.

A few words about where we are right now. The ceasefire in Gaza began on January 19th. It’s a 42-day phase one ceasefire, involves release of hostages and Palestinian prisoners or detainees. It involves a surge of relief after a very, very difficult period. We’ll hear more about that in terms of food, medicines, shelter, safe water, sanitation, fuel – all of the essential items that have been in acute shortages for a very, very long time. It calls for people to return home. And that process began in earnest last week, on the 27th. In the first day 370,000 people moved. We’ll hear from Dr. Peeperkorn in a moment what has happened in that passage – that remarkable passage.

Israeli forces have withdrawn except to the buffer areas. We have private U.S. security firms’ operational management of the corridor and the crossings. We have Gaza police returning. Looting and theft seems to have dropped. We’ll hear more from Rik on the security environment by which folks are able to come forward.

Rubble and devastation of the environment exceptionally important and we’ll hear more from Rik. There is a plan that has been prepared by the U.N., the Gaza Debris Management Framework. It’s pretty stark. Fifty million tons of debris to – it will take an estimated almost $1 billion to clear that in 20 years.

But there’s not 20 years to wait for this. There’s unexploded ordnance, there’s toxic chemicals, there’s asbestos, land mines, and an estimated 10,000 bodies buried in this rubble in this devastated, dystopian landscape.

Populations are moving in to both north and towards their homes in Rafah in the south. They’re moving into Gaza, Gaza City, north Gaza. Rik has visited in the recent days, spent time down over the weekend at Rafah in that area and has today been in Jabalia in the north. He’s coming to us today from Deir al-Balah, the office that WHO has in central Gaza.

I want to say a few words about U.S. policy here. He’s not here to comment on U.S. policy but I think it’s important that we put this in context. The Trump administration – Witkoff, the special envoy, played a big role in the ceasefire agreement.

We have Prime Minister Netanyahu here today and tomorrow. Arrived on Sunday. There’s talks about the second phase. The first phase of this 42-day first phase it’s very uncertain what happens in the second or third phase in terms of the governing arrangements, the security, and how this will be moving forward.

This is a fragile process that we’re going to hear from Rik today. There have been statements made by President Trump calling for the movement of populations out of Gaza to Egypt and Israel.

I’ll quote, “You’re talking about probably a million and a half people. We just clean that out, that whole thing, and say, you know, it’s over. It’s literally a demolition site right now. I’d rather get involved with some of the Arab nations and build housing in a different location where they can live in peace.”

That has stirred a very strong reaction from Egypt, from Jordan, from Saudi Arabia and other Arab states, most recently in a joint statement issued just in the last several hours.

But we’re going to hear more debate around this. This is a fragile and uncertain process that we’re seeing right now. UNRWA remains vitally important to the response but as – according to Knesset laws, two laws that were passed by the Israeli parliament as of the 30th of January, UNRWA could not operate on Israeli soil nor could it communicate with Israeli counterparts.

That has severe complications, potentially, in terms of approvals of permits to move people and material and to be able to go back and forth. It has grave complications in terms of communicating in what is still a war zone with the Israeli Defense Forces and their liaison organization COGAT. So there’s a big question hanging over that, of course.

The other thing I want to mention is that the – President Trump in one of his earliest executive orders announced that withdrawal from WHO. That action had been taken in the middle of 2020. He’s come back to that.

This has grave implications for WHO in terms of budgeting, staffing, ability to carry out programs on the emergency side, and the like. There’s a 12-month period in which there’s the possibility for negotiations that would take place between the U.S. and the director general, that might correct the situation, restabilize, and permit this to go forward. Our hope is that that happens but the odds are not looking particularly great. There is currently a foreign aid freeze in place for the next 90 days, with a vague carve out for lifesaving programs that may permit some passage of continued humanitarian aid into Gaza. The U.S. emergency programs have been vitally important.

There’s been chaos in the recent days here in Washington over USAID. USAID is shut today. Its leadership have been dismissed. It is being targeted from a variety of directions. So there’s great uncertainty about the long-term status and continuity of USAID. So this conversation today is occurring at a moment of great uncertainty here in Washington itself. And I’m not raising these issues necessarily because I’m going to ask Rik Peeperkorn to speak to all of them. We really want to hear from Rik about what’s happening on the ground. But it is in this very poignant and charged moment in history that this is all happening. So we’re going to come back now to Rik.

Rik, you’ve had this remarkable set of experiences. Rafah just yesterday, southern border area, people flooding back to their homes today in Jabalia in the north. Why don’t you start by describing what you are seeing in this period? I think for our audience, what you were – you have a remarkable capability to inform us about what you are personally observing. Over to you.

Richard Peeperkorn: Thank you very much, Steve. Thank you very much for having me on the – on the program. Yeah, I’m here yet on another long-term mission in Gaza. And the last couple of days – so we concentrated, as WHO, with our team – we have an office in Deir al-Balah – that’s in central Gaza – but we concentrated on the south of Gaza and the Rafah area because that opened up for people to go back; and today, actually, to the north of Gaza, southern Jabalia area. And let me start – and then also we – really, we helped, together with the Ministry of Health and partners, to restart medevac, a very important component as well, since a couple of days.

Let me start with today. So today I was with my team. We have an office here also in Gaza City and from the south. So we traveled to the north of Gaza. I’ve been there many, many times before this crisis, before the war, but also during the war. I was there in the last couple of months of the 2024. In October, November, December, I think I was four or five times out to Kamal Adwan and al-Adwa Hospital, Indonesian Hospital, all in in Jabalia.

And I knew, we’ve seen, it was in the war, where, amidst bombardments and an active war, there was massive destruction then. But I think when you see today, today was a beautiful day in Gaza – beautiful sun, outside warm. But what we – what we witnessed was, I would say, really absolutely shocking. And the destruction in the Jabalia area in the north is – and the devastation is beyond belief. It’s all over. There’s hardly any house or building standing. Everything is destroyed or severely damaged. You still see many people, many families around – children, women, men – and actually, a number of them going back to see what’s left of their houses, camping either in their destroyed or, if they’re lucky, damaged houses, or in front of them in makeshift tents, et cetera.

We also went – of course, we went to the hospitals. We work so much with them, which we support all the time. And the first one was, of course, Kamal Adwan. And used to be, before this crisis, she was a pediatric – the pediatric hospital in the north. Then, during the crisis, it became a hospital overloaded with trauma patients, two to three of the trauma patients when I was there, a constant flow of that. Well, that hospital is – it was – we know that it was – it became completely nonfunctional. Late December, 27 of December, the last staff were forcibly evacuated and a number of them detained, still detained.

The hospital is severely devastated. It just, yeah, partly is completely destroyed, and the rest of it is completely damaged, I mean, and burned out. As I said, we went in the hospital. We saw some booby traps. We went all over the – if it is the emergency – the emergency ward, or the neonatal ward, neonatal intensive care, which we actually all supported, the malnutrition ward, all completely destroyed and damaged, burned out, et cetera, a complete, utter mess.

They were clearing some sites in front of that hospital and outside of the hospital where the plans are from the – partly Ministry of Health, WHO partly, so can we get something back there? Can we get a polyclinic or something like an outpatient or construction type of primary health-care facility, which will be needed? So that’s Kamal Adwan.

Amidst all this destruction, we went to Al-Awda Hospital, the second hospital, which is the only partly functional hospital. So it used to be the MCH, the Modern Child Hospital, in the – in the North. Now it’s offering general service, including maternal and child health. Deliveries ongoing. It’s really good to see. Also damage to a certain extent, et cetera, and big needs. So WHO, we are providing fuel, medical supplies, consumables to Al-Awda, but much more is needed to also rehabilitate/restore.

And we went to the Indonesian Hospital, which is also nonfunctional. It has maybe a very small function, like first aid. And within Indonesian Hospital, the same massive damage, but also around. For example, an oxygen plant which is destroyed and a desalination plant which is destroyed, generators destroyed, utter destruction around. And it’s, of course, interesting to see that, especially today with the beautiful sunlight, that people out; they were there to welcome us and to talk to us, when I said, children, women, men, all around. So we really need to plan, and we are already doing – we’ll plan very quickly, and we’ll get back to that.

So yesterday in Rafah, it’s a little bit the same. Rafah is also a zone which – since the ceasefire, which became available again for people to move back. And the same in Rafah, and also in Rafah Mawasi, the south part of that, again, destruction. It looked like a demolition site in most places. The same thing: You see people moving back, families moving back, children, women, et cetera, and seeing what is left of their houses, trying to put a little campsite in front of that as well.

We also saw our own guest house, WHO guest house, where I stayed many, many times up till the siege in Rafah – when was that, in April/May? – many times – even our guest house completely flattened, like so many buildings. And that was actually a deconflicted guest house from WHO. But very sad to see all of that in this – in this beautiful kind of sunset.

In Rafah, as well, there were three hospitals in Rafah. Al-Najjar, which used to be a primary health-care center, became a hospital which was – also during this crisis, it became – when so many facilities became partly functional/nonfunctional, Al-Najjar became the key facility for dialysis. When I was there, visited there many times, there were 600 patients on dialysis machine. Well, the northern side of that hospital, complete destruction, internal walls damaged, essential systems. The southern side as well – the electrical network, medical gas systems, all are damaged or partly damaged. Boundary walls demolished, et cetera. It’s, of course, nonfunctional at the moment. Rehabilitation will need a huge debris clearance and structural stabilization, et cetera.

The other hospital we visited, Al-Helal Emirati. That was – it’s the Modern Child Health Hospital. This was the hospital, actually – maybe you remember – from when this crisis erupted, et cetera, that we had this – when the – when the patients and staff need to be evacuated for Shifa Hospital, including the so-called Shifa babies, I think the 33 babies. And this was hospital we – WHO, we brought the babies to, and now there’s nothing. We saw these incubator smashed and dialysis machines smashed and completely destroyed, operations theater, et cetera. So there as well.

Kuwaiti Hospital is the third hospital, also nonfunctional, partly destroyed. But it’s in the buffer zone still, so we were not allowed to visit. So the only hospital actually in the south is the – which is part – which is functional but a little bit difficult to access is the UAE field hospital for the south.

Now, with the Ministry of Health and partners, as I already showed, what is needed? If you look at the north of Gaza, roughly I think over 500,000 people have moved back. So you’re talking about a population in the north of Gaza which was 450,000, so plus 500,000, so over 900,000. So some people even estimated a million, but over 900,000. So everything, I mean, first and foremost, of course, shelter, food, wash, et cetera.

And I must say – let me say on a positive note the ceasefire has been the best news ever, and we all hope it holds and it will be transferred to a sustained peace process, and then – and then, let’s say, and then a roadmap to a sustained solution.

Now, the – initially, of course, all the focus, rightly so, was on food and on wash and on shelter. It still is. I mean, like, on – from the health side, we are – and I think thousands of trucks have come in. So that’s the good news. I’ve seen also, both in the south and the north, let’s say you see again shops, little markets, et cetera. Products are there. Wheat flour is there, vegetables, et cetera, eggs, et cetera. That has completely changed from the last time. So that’s the good news.

Of course, the reality sinks in for a lot of people who go back to their houses and they find nothing. They find their house destroyed or severely damaged or very difficult to repair, and without water and sanitation, et cetera. So the initial joy will turn very quickly into disappointment and even anger, and we all have to try to work how we can prevent it.

So on the health side, first and foremost we have to see how can we revive primary health care in all the areas I spoke about. How can we establish – help to establish Ministry of Health and partners, not just WHO. WHO is supporting that. How can we help to establish primary health-care facilities, temporary facilities, or actually quick renovations/rehabilitations of the existing facilities.

Then we need to talk about – we need to establish some trauma stabilization points wherever is needed – in the south in the Rafah area, but also in the north in Jabalia area. So how can we expand some of the services to hospitals which are still minimal partly functional, like where I just came from in the north, Al-Awda, but also how can we help to build up Kamal Adwan will take a long, long time. But Indonesian Hospital, for example, how can we help to build that up and focus on the key services needed?

What is – for WHO what we are currently focusing on, let’s say in the north, we are working around the clock. Overall, we received more than 89 trucks for WHO only since the ceasefire, and that is significantly more than in the past. And of course, health is always smaller, more trucks are lined up and coming through the north and the south. We dispatched as WHO supplies from our existing and new stocks to cover the needs of over 1.6 million people, supplies to cover the treatment of trauma, malnutrition, but also noncommunicable diseases – vaccines, et cetera, supporting of MCH, surgeries, et cetera.

Mental health is, of course, a huge challenge for all. No one – I mean, like, no one is not affected in Gaza by mental health. We need to do that differently. And I think I want to stress there as well that before the war, we – there was a – there was – sorry to say, yeah, there was a mental health hospital, there were six community health center for mental health; they’re all not there anymore. So we have to look differently as well.

We are looking at an expansion of Shifa Hospital with additional beds, but also at Nasser Medical Complex. It’s 200 beds at Shifa, additional hundreds of beds in Nasser Medical Complex in the – in Khan Younis and European Gaza Hospital. After the expansion of the bed capacities, getting more partners, specialized partners. We have emergency medical teams, specialized medical teams in. We are planning – we are trying to get prefabbed health facilities in, as well, for the north and the – and the center. And of course, specialized team.

Last point I want to say is disease surveillance. That was always a problem, and it’s always a difficult component, the whole public health intelligence. So we’re taking time for that. How do we improve and expand on that early warning alert, response systems, et cetera?

And last is the medevac, the medical evacuation.

Over to you.

Dr. Morrison: Thank you. Thank you so much, Rik, for that very compelling and very comprehensive explanation of what’s happening and what you’ve observed.

I must say, I mean, this is very powerful proof of just how critically important WHO is in these emergency settings like this, and I thank you for everything you and your colleagues at WHO have done. You’re really an essential lifeline here, and you have been throughout this crisis, and now playing this expansive role in trying to restabilize the situation with your other partners – with your Gazan partners, other international organizations, and other international NGOs, and Palestinian NGOs that are working with you. So we’re in your debt. And this is this very critical, critical moment.

I think one of the propositions that’s on the table right now is that you can have this massive shift of populations: half a million people or more moving north, hundreds of thousands moving back into the southern home areas. They’re entering devastation. But the proposition is that with a surge it will be possible to bring some minimal viability so that this is not a catastrophe – another form of catastrophe in terms of stability, ability to get basic primary care, begin to restore hospitals, and bring the other elements that are needed in terms of power, fuel, water – clean water, some form of sanitation.

Do you – are you of the mind that the pieces are beginning to come into place that will put that minimal floor in place in the midst? We’re not going to clear 50 million tons of rubble overnight. We’re not going to reconstruct people’s homes and businesses overnight. We need a strategy that will raise hope, give people hope in a(n) incremental way, but put a minimal floor in place. Tell me what you think. I mean, I think that the calls for deporting people are premised on this idea that the situation is too far gone and that’s needed. There’s suspicion that there are other motives that come into that, but in order to continue to draw support externally for what’s this remarkable transformation that is beginning now people need to have confidence that this is not going to end in people being just terribly disappointed, frustrated, angry, and dejected. But that we can – we do have the means to move here. What can you tell us on that central question?

Dr. Peeperkorn: Well, I think, first of all, the ceasefire needs to hold. That’s the first, I think, premise. And the ceasefire need to be transformed into a sustained peace process and a way forward, a roadmap to a solution. If the ceasefire is not holding, I think then we are back to square one. So that is the most important thing, ceasefire holds. Transformed into a peace process and to a roadmap and a way forward, that people see some – though I hate to use that word – see some light on the end of the tunnel, I mean, like, that they see somewhere to go.

Then all the areas – I mean, and I will focus on health, because that’s my area of expertise. But all the areas, peace has to get together. So, first and foremost, of course, shelter will be incredibly important, and temporary shelter, and how to expand that as rapidly as possible, specifically where people go and where people move. That’s one. And related to shelter is, of course, wash and all the water and sanitation facilities. The non-food items and food. Now, a lot of food has come in. We have seen that, et cetera. Wash – I think shelter needs to be much better facilitated and supported.

And then when it comes to health, so we have to make sure that the Ministry of Health, WHO, and partners, that we provide health, and at least basic health, as much as possible, as close to the families as possible, where the people are. And that starts again with, OK, what is the – for example, in the north – there’s no primary health care facility currently in north Gaza. There’s just one partly functional hospital. Now, first and foremost, so what can we do on primary health care? And how can we – how can we push that and make this – make that work again?

Then, related to that, we talk about referral pathways. And the referral pathways – well, first, currently we still talk about 18 of the 36 hospitals which are partly functional. So how can we look at, first of all, which hospitals could expand? Which hospital have that capacity? And where is it most needed? And already work is going on there at the Ministry of Health, WHO, and partners: Which hospital? Where can small rehabilitation already do a lot of good? Where could hospitals be expanded? In which areas do we need trauma stabilization points, for example, for – and at least a minimal referral pathway? How can we assist PRCS with their ambulance structure, et cetera, to make that – make that work?

I would say, in general, mostly for WHO, what we, I think, will look forward to for years to come is that we continue with humanitarian support and the humanitarian support in areas – first, delivery of essential health services, and how do we – how do we support that, in which way? What’s the best way? Primary health care, including referral and referral hospitals. That’s one.

Two, how do we strengthen the public health intelligence, the early warning, and the prevention and control, health information, anything related to that?

Three, what underpins all of that is, of course, the supplies and logistics support, which WHO has done massively from the start of this crisis. And we have to continue doing that.

Four is coordination. They are currently in the health cluster – which is co-led by WHO – there are 72 partners – Palestinian partners, international partners. How do we coordinate? And of course, when there would be – and when the ceasefire holds and it would transform into a peace process, there will be more partners. How do we coordinate as good as possible? And how do we make sure – under the leadership, of course, of a government – governance structures in place, et cetera. How do we focus that as good as possible? And in the meantime, when the ceasefire holds and we move into a peace process, we can focus much stronger what we are now doing on a small scale in what we call early recovery, rehabilitation. And then we can look at – also at proper reconstruction.

Well, for all this – all these processes, finally, what, of course, is needed is a Palestinian solution, or Palestinian solutions, because if you take them, if you then break it down – and we discussed a little bit about mental health, for example. Mental health we will need to tackle not just in a medical way – in a medical way like, oh, and a psychiatric hospital, and a few community mental health clinics will do the job. No. That should be completely different, in a more creative way, community based, together with a referral system within the health sector and the health fields, et cetera. We have to think differently.

There’s also, of course, a chance to – and, again, I don’t like that word – to build back better – to build back better, because there’s so much to build. I mean, the devastation is so immense. But, of course, there should be an analysis, a good analysis – again, led by government, assisted by WHO partners, like, OK, what is a health system, you know, which works best for Gaza?

And when we always talk about primary health care. Do we actually really prioritize primary health care? And how do we prioritize primary health care? And how do we make sure that referral pathway – that the right referral pathways are in place? And that should be addressed as well. It will be a huge – you know, this is also part of the WHO operational response plan for 2025. And, of course, what is needed for that is massive support and a lot of flexible funding. Not just for WHO, for the broader health sector at large. Over to you.

Dr. Morrison: Thank you. I want to ask you a couple of specific questions. The security situation seems to have turned around pretty rapidly. From a distance it looks to me like what was a terrible situation – I mean, not too long ago we had a convoy of a hundred trucks picked clean by gangsters with no security provided. The policing had collapsed in the north and no one was taking responsibility for the security.

But I’m not hearing those stories. I’m not seeing stories of that. I’m seeing pictures of Hamas – I’m seeing pictures of Gazan police. I’m seeing reports of people moving up the corridors with security. Say a bit about the security environment.

Dr. Peeperkorn: I think the security environment has definitely improved, because I have been here also when, of course, it was highly insecure because of the war and the widespread bombardments everywhere. I mean, from all sides and all places. I mean, that’s the first level of insecurity. And we all know about the 46,000 people killed and the more than 110,000 people injured, and 25 percent that will have lifelong – will need lifelong assistive technology and rehabilitation. And this is an underestimation. You saw The Lancet studies, or other studies that is an underestimation. And the indirect – and we don’t even talk about the indirect death, the people who would normally not die when they would have access to proper health care or to their medication, et cetera. And that runs also in the thousands, and we will get more.

But I think the other insecurity we have seen, the widespread looting and, indeed, like, kind of gang violence, that has largely been reduced. We see a few incidents, but it’s no comparison to what it was. So widely improved. And I think it shows us as well what is possible with a bit of policing, et cetera, on the ground. Over to you.

Dr. Morrison: Yes. I wanted you to say a bit also about our updated understanding of the health status of this population. Lancet just put out a piece that indicates that in their estimations life expectancy in Gaza has dropped from pre-October 7th when it was at 75 ½ years on average life expectancy to just over 40 years today.

Now, the picture in terms of infectious diseases, injury – I mean, the overall picture of the population how has that changed? How has our understanding of that changed as we’ve entered this period of a ceasefire for at least 42 days?

Dr. Peeperkorn: Yeah, so actually today in the partly functional hospital in Al-Awda, it was good to see that that place is not flooded at the moment by trauma patients. Like that there were some – there were – it was, again, a 40-bed hospital. And let’s say half the beds were occupied, and some by trauma, but a lot by other diseases as well. So that was actually good to – good to see.

Now, you refer to the – to The Lancet study, and then the estimate that life expectancy nearly cut in half here, minus-46 percent since the war began, and I think from a prewar average of 75.5 years to 40.5 years in the period from October till September 2024. And, as expected, higher for men, minus-51 percent, dropping from 73 years to 35.6 years; and from woman from 77 to 47 (years). Now the – and they actually – they conclude that the estimation of this life expectancy losses is even conservative, and taking into consideration the indirect effects of the war on mortality such as lack of access to health care, which we just discussed. And the – noting that the actual losses are likely higher, the study indicates that the war generated a life expectancy loss of more than 30 years during the first 12 months of war.

And I think we need to – I mean, there will be more studies like that, including what I said on the – on the indirect deaths, because, first of all, I think also the other study, even less, pointed out that they estimate that it’s not 46,000 deaths but most likely more in the areas of 70,000 deaths, and that is not even including the indirect deaths. So this crisis, the war, has had incredible impacts on Gaza. I mean, like, we – I think in the past we had said 7 percent of the population was either killed or injured, et cetera. That that will go up, even, that figure.

Now, coming to what we see, I mean – and maybe the – when we look at the data from the medevac – and maybe it’s good to discuss a little bit medevac as well. But when we look at the data of medevac, some of the data we had – and that was for 480 – there are 480 patients. So when we did the medevac before the Rafah crossing closed, 6th of May 2024, something like 4,700-4,800 patients were medevaced into Egypt, and then from Egypt I think 2,000 in Egypt and mainly to other countries in the region – a lot to the UAE, and Oman, and Qatar, et cetera.

Now, since the Rafah crossing closed, so WHO has actually managed and supported all the 480 patients which were then medevacked. And what we find out then, that the top five diseases from that group was cancer, almost 38 percent; trauma, 25 percent; congenital anomalies, 10 percent; cardiovascular disease, 8 percent; and then ophthalmological disorders, 15 percent. And if you looked at the children patients – because most of the – of those group, 480, I mean, close to half of them were children – then it was trauma, 32 percent; and then cancer, 21 percent; and congenital anomalies, 42 percent.

What we, of course, have seen – and specifically during this whole crisis, we’ve seen a huge increase also – and you talked about infectious diseases, acute respiratory infections. We talked in the past about hepatitis A, a huge increase in hepatitis A, explosion almost; diarrheal diseases, skin diseases, et cetera. Now, so this is the overview. On medevac, we can discuss a little bit further detail if you want.

Dr. Morrison: Please do.

Dr. Peeperkorn: OK.

Dr. Morrison: Please tell us a bit more about the scale of demand, the real scale of demand that you’ve determined.

Dr. Peeperkorn: OK. So, first of all, so we – really, as WHO, we welcomed the resumption of the medical evacuation via Rafah. So the first one took place – it’s now three days ago. Since the ceasefire began, it was the first medevacs through Rafah. And WHO, we – together with the ministry and our great partners, the Palestinian Red Crescent Society, collected patients from Shifa in the north, from Nasser Medical Complex in Khan Younis. And there was a group – the first group was on 1st of February 37 patients and with 39 companions. And most – I think 34 of them were children in that first medevac. On the 2nd February, so 34 patients and 33 companions also evacuated. This is supported by WHO.

Today I don’t have the final numbers yet, but the idea was to start with a rate of 50 patients per day. We rather would see that maybe two or three times a medevac happens, and that you talk then about substantial numbers, like 200 patients per day plus companions, et cetera, and through Rafah.

Now, when you talk about, why do we say that? I mean, we’ve said that for months now. Because we estimate as WHO that between 12(,000) and 14,000 people are in need for medevac. And of that, we estimate that approximately 5,000 are children of this 12(,000) to 14,000. And I told you that before the – before the Rafah closing, 4,700-(4,)800 were medevacked. And since then, only 480. So, if we – if we continue at this pace, even the pace we have now, it will take a decade to medevac.

So, we need to use all possible medical corridors out of Gaza. And the two most important ones, I want to stress, is the current one we are using now from Gaza into Egypt, using the Rafah crossing. But for everyone, the most important one is the traditional referral pathway from Gaza to East Jerusalem and the West – and the West Bank hospitals. The East Jerusalem hospitals and the West Bank hospitals, they planned for this and they are ready to receive those patients. It’s, unfortunately, not yet allowed. That medical corridor needs to open as soon as possible. And we need to expand that, including through Egypt.

And then both from the West Bank and East Jerusalem, and Egypt when it is needed, to third countries, and of course, if these countries are ready to receive these patients. And when I say that the patients is a variety, it’s – a lot of them are trauma. I would say 40-50 percent is trauma. And then we’ve seen so much horrific trauma patients – of course, amputees, also among children, is a big group; but also burns; spinal injuries; patients which needs additional operations and rehabs, specialized rehab which they cannot get in Gaza currently; and then, of course, the group of what always used to be part of a referral patients from Gaza, oncology and specific cardiovascular diseases, et cetera.

Dr. Morrison: Thank you. I want to ask you two additional questions in the time that we have permitted. You made a very compelling case that we need to hope and push hard for this ceasefire to be continued, to be sustained. And that we enter phase two of negotiations, and that there be continuity in the ability to move forward. On the assumption that that happens, let’s just assume for the moment that we get a phase two, and it’s possible to move forward, and confidence begins to climb a little bit that this is going to hold and not be suddenly reversed.

You know, we’re in this exploratory, experimental phase – very fragile, very uncertain. But if we can move beyond that – if we move beyond that, what would your – what would you see as the three or four topline strategic things that need to happen? You’ve made a very good case for scaling the medevac. So I would put that in that – in that category. But what would be the strategic priorities going into this next phase, in addition to scaling the medevac?

Dr. Peeperkorn: Well, I think – from the health perspective, I think we have to realize, I mean, the devastation and destruction is so huge and so enormous. So, we have to be really – I mean, also thinking realistic and pragmatic.

So, first, we need to continue our humanitarian support. And for health, that means that we need to continue to focus, how do we expand essential health services? And that’s from primary health care to referral hospital, referral pathways, and everything related to trauma, but also noncommunicable diseases, mental health, and what I said, many of that in a different way, a more creative way, et cetera. That’s the first, essential health services.

From the health perspective, we definitely have to – if we want to plan better, our public health intelligence needs to be better. Our health information systems need to start working again. And based on that, we constantly adapt our planning and way forward. But also, when you talk about infectious diseases and epidemics, early warning, prevention, and control, very much.

Then, of course, the whole supplies and logistics. When you talk about building and strengthening hospitals, and even think about early recovery and a bit of rehabilitation, you think about medical equipment. At the moment, I think there’s only one CT scan working in the south and one in the north, or one MRI. So, we need this key medical equipment, which is needed for any health sector and health system. We need to get that in as well.

This was always a problem before the crisis. I know the WHO, for example, we struggled to get 12 mobile X-rays into Gaza. It took us almost two or three years to get them into Gaza, way before this crisis. Well, every referral hospital in wherever – in my own country, in the Netherlands, or in the U.S., et cetera – there’s multiple mobile X-rays which drive to the – so it’s insane that that took already us a long time. All those – that needs to – that whole thinking needs to change, so if you talk about medical imaging and all kinds of other medical equipment.

The link to this is coordination and coordination of the partners. And I hope that we get a strong governance structure which WHO can support, and WHO and partners can support, and that we focus jointly that – you always get when there’s crisis and post-crisis, that multiple partners, a lot of overlap, et cetera, and it is really difficult to coordinate. So, the coordination will be – coordinate our scarce investments as good as possible. That should be – and it should be linked, if you talk about health – critically important – should be linked to what is an essential health package.

And I must say, I really credit also the WHO and partners with the Ministry of Health, for example, in Gaza. They worked during this war and crisis with the so-called minimal health package, all right? That’s where they focused on. That’s where they focused also the essential medicine, the supplies, et cetera. Now you need to expand that. The moment you get a ceasefire and peace, what is the essential health package? A lot of work has been done. We don’t have to reinvent wheels.

In Palestine, there were – just before this crisis, WHO helped with the senior MOH officials from both the West Bank and Gaza. We were redesigning an essential health package which was on the table from 2013. It lacked a lot of noncommunicable diseases, mental health should be strengthened, trauma, et cetera, all included. So, a lot of that is there already. And you want to invest in an essential health package and everything related to that.

My last point on – of course, on health, is, what can we do on the – and that’s – and it should all go in parallel. We cannot say we do this and we do that. So this is – what I talk now is mainly a lot of that is still humanitarian support. In parallel, we have to really speed up the so-called early recovery. What is smart rehabilitation? Where and how? There needs to be proper assessments, because some of the hospitals I’ve been in – if it is yesterday in Al-Najjar or today in Kamal Adwan – you need some really proper engineering assessment if those hospitals – some parts of the hospital can be rehabilitated and can be reconstructed, or it should be completely demolished and done differently, et cetera. That’s part of that.

Now, that is definitely a long-term process. And now I’m just talking about health. I mean, all the other key areas – I mean, think about shelter. And so temporary, but much better and proper shelter for the Gazans should be the top priority. Of course, the constant flow of food, wash and wash facilities, and non-food items, et cetera.

I want to stress as well, like, for health, for example, Gaza, I don’t say it had a perfect health system, but it had a health system which worked relatively well. It had the – and public health, technically, if it was a routine immunization. But also, life expectancy, it was pretty OK; you talk about 75 years, 76 years, et cetera. With a lot of – and the health workers, if it’s in Gaza or the West Bank, I mean, most of them extremely well-trained, a lot of capacity there. So how do we make sure that those health workers get back to what they should be doing, working in the health system? Many are still working. Many are not working there. How can we get them back? How can we assist with emergency medical teams? Links to the – as much as possible to the existing systems. I mean, and already, I think, within government and partners there’s a lot of how can we work from the existing systems, and then strengthen them, and then – and then continue and rebuild and refocus. And maybe we have to avoid what you sometimes see, that all kind of parallel systems are built up by goodwill in partners from outside, et cetera, where sometimes you think, hey, you have to look also over the longer term, over the coming five or 10 years.

Dr. Morrison: Thank you. Thank you, Rik.

We’re getting to the end of our hour. You’ve been extremely generous to us. A very realistic and sobering assessment, but also one that has a – has a ring of hope to it in your looking ahead. I do think our audience here will benefit enormously from having heard from you, and so my thanks on behalf of everyone here at CSIS for you taking this time to be with us, and for the courage and commitment that you and your WHO colleagues are showing. You’re a(n) essential lifeline in a terribly difficult situation, and I do hope that things do stabilize and that we enter a phase two. We’re not quite at the halfway point of the 42 days. Maybe we’re close to that. But it’s moving fast. And as I said, the discussions begin today in the White House around phase two, and let’s pray that there is a prospect for a larger settlement. The fate of Gaza is tied to the possibility of having a larger peace accord. Pressure is on to sort of come up with something that’s a workable solution there. So, I just want to thank you.

For our audience members, this video will be posted immediately on the CSIS homepage, CSIS.org. In a few hours, a transcript will be added to that later today. I want to thank again Rik for your courage, your determination, your leadership, your generosity to us over this period of more than, well, almost a year and a half in this period of crisis since the Hamas massacre of October 7th. We’re encouraged that hostages continue to be released, that prisoners and detainees continue to be released. That is fundamental to this – holding this thing together, and a continued sort of unity or consensus around Qatar, Egypt, the United States, and the – and the belligerents, the parties themselves, the Israelis and the Gazans, in coming to a solution for this. And I hope we can come back again, Rik, in the future and update ourselves, and again ask your support and assistance. Thank you.

Dr. Peeperkorn: Thank you very much.

 (END.)