A brutal battle for southern Gaza beckons after the truce ends

A brutal battle for southern Gaza beckons after the truce ends The next stage of fighting will be harder and more controversial

The Economist, Nov 26th 2023 | DUBAI

THEY WERE rare moments of peace after weeks of agony. Dozens of Israelis, held in captivity for seven weeks, have been reunited with their families over the past few days. A brief halt in the Gaza war has allowed Palestinians to emerge from their shelters and search for food and fuel, for missing relatives, and for what remains of their homes.

Yet these moments were bittersweet: most of the hostages have not been freed, and most of the Palestinians who returned home found only rubble. They will also be short-lived. The truce is set to end on November 28th, after four days of quiet meant to facilitate the exchange of 50 Israeli hostages held in Gaza for 150 Palestinian prisoners in Israeli jails. It could last a few more days—but it will end, and the fighting that comes next could be worse than what came before.

Israel’s cabinet approved the hostage deal on November 22nd after hours of debate and weeks of indirect negotiations with Hamas. The first day went according to plan. Both sides stopped fighting on the morning of November 24th. That afternoon Hamas released 13 Israeli hostages, ranging in age from a two-year-old girl to an 85-year-old woman, and another 11 foreigners from Thailand and the Philippines. Israel freed 39 Palestinian prisoners from its jails, also women and children.

If the first day was smooth, though, the second was anything but. Hamas delayed the hostage release by hours, claiming that Israel had failed to honour its end of the bargain. Israel was meant to permit 200 trucks of humanitarian aid a day to enter Gaza each day during the truce. Only 137 made it through on the first day: there are long security checks at the border, which is not set up to handle a large volume of aid. But after mediation by Qatar, which helped broker the deal, the exchange went ahead.

The truce could be extended. After the four-day agreement is up, each ten hostages freed by Hamas will buy another 24 hours of calm. Egyptian officials say they have received “positive signals” that might happen, though neither Israel nor Hamas has confirmed anything.

Hamas would have obvious interests in doing so. A longer truce would give the group’s military commanders time to regroup and prepare, both to attack Israeli troops stationed in the northern part of Gaza and to defend the south, where the Israeli army has yet to make a large incursion. It would also lead to more pressure on Israel not to resume fighting. Families of the hostages would like to see the deal extended. So would America’s president, Joe Biden, who says his goal is to “keep this pause going beyond tomorrow”.

At some point, though, Hamas will run out of hostages it is willing to release in this round of negotiations. It will probably keep both soldiers and Israeli men captive, in the unlikely hope of striking a bigger deal that includes a permanent ceasefire and the release of many more Palestinian prisoners.

When the truce comes to its inevitable end, Israel will resume its fight against Hamas. Speaking from Gaza on November 26th Binyamin Netanyahu, Israel’s prime minister, said: “We have three goals for this war: eliminating Hamas, returning all our hostages, and ensuring that Gaza does not become a threat to the State of Israel again,” adding, “we will continue until the end, until victory. Nothing will stop us.”

In the next round of fighting Israeli troops will continue to scour the rubble of northern Gaza for tunnel entrances, rocket launchers and other military assets. They have yet to enter a few parts of the region, including Shujaiya, to the east of Gaza city. They will also begin turning their attention elsewhere. Officials are coy about how they might proceed in the south. They cannot easily send armoured units to dominate the area, as they did in the north, because it is so densely packed with civilians displaced from the north.

Instead they might seek to do it piecemeal: pushing into one area at a time, probably starting with the central city of Khan Younis, and trying to force Gazans into a designated “humanitarian zone” near the coast. This is fraught with danger, though. Civilians would have to choose between huddling on a desolate strip of beach and hiding in their homes or makeshift shelters; both could have appalling results. Fighting in densely packed areas without heavy armour will also be more dangerous for Israeli troops.

It is hard to assess Hamas’s strength—most of its fighters are thought to be holed up in tunnels—but Israeli officers say that close to half of its units have suffered serious losses. On November 26th Hamas confirmed that Ahmed al-Ghandour, the head of its northern brigade, had been killed earlier in the war. A member of the group’s military council, and the head of one of its five regional commands, he is one of the highest-ranking militants known to have died since October 7th. There are reports of grumbling in the ranks, especially those deployed to the devastated north, where other Hamas commanders have been killed and conditions are grim. Still, Hamas is hardly close to surrender, and it will undoubtedly fight harder in the south, making what could be a last stand.

All of this makes America nervous. Mr Biden has yet to call for a ceasefire, but his team is worried about Israel’s plan for a major offensive in the south. “I’ve encouraged the prime minister to focus on trying to reduce the number of casualties while he is attempting to eliminate Hamas, which is a legitimate objective he has,” he said on the first day of the truce. “That’s a difficult task, and I don’t know how long it will take.”

America would like Israel to hold off on its southern campaign—especially since Mr Netanyahu has no plan for what happens in Gaza after the war. It may urge Israel to continue its offensive in the north and keep the south sealed off, for now, with an expanded flow of humanitarian aid via Egypt. Antony Blinken, the secretary of state, may visit the region again this week. So too will Emmanuel Macron, the French president, who has called for a lasting ceasefire.

If America pressures Israel to hold back, it could spare Gaza’s 2.2m people another round of fighting and displacement. But it would also leave them stuck in a crammed, desperate enclave even smaller than the one they lived in before, under a partially disintegrating Hamas regime: it is hard to know which outcome is more depressing. ■

‘We are overwhelmed’:

Southern Gaza’s exhausted doctors forced to leave children to die

A surgeon at one of the territory’s last functioning hospitals tells of desperate conditions amid an acute lack of medicine

Jason Burke in Jerusalem Fri 24 Nov 2023

In the crowded corridors of the European hospital in Khan Younis, exhausted doctors decide who among the huge influx of patients arriving from the north of Gaza should live or die.

Hundreds of casualties have moved south in recent days after the evacuation of hospitals in Gaza City, overwhelming medical staff already struggling with an acute lack of medicine, diminishing food rations and intermittent power and communications.

Injured people have joined thousands of displaced people seeking shelter and safety in medical facilities.

Paul Ley, an orthopaedic surgeon at the European hospital, said displaced people were sleeping in lifts, a small team was working round the clock in four operating theatres to amputate limbs infected after days without treatment, and there was an acute shortage of painkillers. Triage decisions had to be made instantly which, in one case, meant leaving a 12-year-old child to die with only palliative care in order to preserve dwindling resources.

Ley said the hospital had received 500 patients evacuated from hospitals in northern Gaza in recent days. Two female medics and a male doctor examining small child screaming in pain. A member of the Red Cross helps Palestinian doctors in Khan Younis to examine an injured child on Tuesday. Photograph: Mohammed Talatene/Avalon

“Many have not received treatment for nine or 10 days because hospitals there were non-functional even if they were open,” he said. “This is the situation that is happening here now. This is a functioning hospital but we are being overwhelmed. There is nowhere to evacuate to … There is no escape route. We are probably one of the last lines of defence.”

There was no independent confirmation of Ley’s account, but details match the accounts of other medical staff, as well as reporters in Gaza. Ley sent pictures of some of the injuries he described to the Guardian.

Israel launched its offensive on Gaza after Hamas, the extremist Islamist group which runs the territory, killed more than 1,200 people in southern Israel, mostly civilians in their homes or at a dance party, in an attack on 7 October.

Since then, more than 14,000 people have been killed in Gaza, most of them women or children, according to Palestinian officials.

In the burns unit of the European hospital are 78 patients, nearly two-fifths of them children under five.

“I have never seen anything like it,” said Ley a 60-year-old French citizen who arrived in Gaza with a team from the International Committee of the Red Cross almost four weeks ago. “I have been in many war contexts where the type of wounds are the same but the number is huge. We never leave the hospital. We work round the clock.”

Hospital staff hope the four- or five-day ceasefire between Israel and Hamas, due to begin on Friday, may lead to a durable end to hostilities – or at least the opportunity to receive supplies of humanitarian aid. However, they also fear the arrival of more patients as injured casualties are evacuated from northern Gaza during any pause.

Many of the casualties arriving at the hospital were injured days before, meaning wounds have become infected. Ley said some people’s dressings had not been changed for 10 days, so their wounds were full of worms. In other cases, surgeons were forced to amputate limbs that may otherwise have been saved.

Another problem is a lack of anaesthetics and painkillers.

“We do operations with minimal anaesthesia. If we run out, we can’t operate but there is no clear line. There are a lot of people crying, screaming with pain, but we don’t have enough analgesics. We keep them for the kids or very severe cases. [So] normally we would change dressings on patients with 40% burns with them under sedation and minimise the time by using more attendants … [Now] it has to be done with a lot of pain.” Bus and people outside hospital at night A screengrab of evacuated patients from the Indonesian hospital arriving at the European hospital in Khan Younis on Thursday. Photograph: European hospital/Reuters

In the grounds of the hospital compound, thousands of desperate families are packed into wooden or cardboard shelters. Israeli airstrikes have not targeted the hospital and respected the zone around the facility – though shrapnel has struck the building, and the blast from bombing has shattered windows.

Israeli military officials say they make every effort to avoid civilian casualties and observe international law. They say Hamas is using Gaza’s 2.3 million inhabitants as a human shield and claim to have found evidence of Hamas military facilities in or under hospitals, schools and homes.

On Thursday, the Israeli prime minister, Benjamin Netanyahu, said: “The whole laws of war, humanitarian law, which we’re committed to completely, makes a simple distinction … They say on one line are combatants, and the other line are non-combatants. You can target the combatants … but don’t deliberately target the non-combatants. They can be hurt, unintentionally. That accompanies every legitimate war.

“[Hamas] deliberately implant themselves in hospitals, in schools, in residential areas, in UN facilities. They fire their rockets from there. Thousands of them. They deliberately target civilians and they deliberately hide behind civilians and use them as a human shield. That’s a war crime.” Young girl with bandaged leg on chair with others in background.

A screengrab of injured patients from the Indonesian hospital waiting for treatment at the European hospital on Thursday. Photograph: European hospital/Reuters

Elsewhere in Khan Younis, tens of thousands of people have crowded into shelters run by the UN. In one, a vocational training centre before the war, more than 35,000 people share 48 toilets and four showers, administrators there told the Guardian this week.

“Conditions are appalling. All the children are getting sick with coughs or stomach problems. There are fights over sleeping spaces and food,” said an administrator, who did not have authority to talk to the media.

Since the Hamas attacks on 7 October, Israel has imposed an almost total blockade of Gaza. Food supplies from the UN have dwindled to about a kg of flour and a single tin of tuna or beans each day, one administrator said, leaving families to survive on flat “bread cakes” made of flour and water cooked on scavenged metal sheets over open fires.

“There is no food in the shops and no fuel. Even wood is rare and expensive, so people are chopping down trees in the streets. Salt is really rare. No one has any and if you have a bit, you can trade it for a lot of food,” the administrator said. People on camp beds and chairs.

Ley said the hardest thing for doctors was to make triage decisions. “We do our triage … [asking] are we going to take this patient because they will have a good chance of surviving rather than doing desperate measures on a patient who will die in two or three days? That sounds nice on paper, but when you have to make the decision it is different. There’s a 12-year-old with 90% burns so we won’t treat him except for pain control that is not enough,” he said.

“We try to keep our heads cool and steady, but for local staff this is their families, friends, their people. They never want to amputate. They say: ‘I can’t do it any more’ and so I say: ‘OK I will do it, don’t worry,’ and you can feel the relief”.

Ley said he had been shocked at how passive many patients were, such as one 35-year-old woman whose husband and children had been killed when the family’s home was destroyed, and who appeared unmoved when told both her legs would need to be amputated. “So many just don’t care any more,” he said.

But amid the devastation, there were moments of slender hope. Recently, Ley treated a 32-year-old man with shrapnel injuries to his abdomen, left leg and a “fist-sized hole” in his right forearm. The patient’s young sister thanked Ley, saying she was proud of her brother and happy he was alive. She wanted to be a surgeon whens she was older, she said.

“So that was very poignant,” Ley said.

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