GAZA IN THE VISE

by Omar Karmi

Five year-old Layan cupped her hands over her ears and screwed her eyes shut when she tried to describe the effect of a sonic boom. She said the sound scares her, even though her father, Muntasir Bahja, 32, a translator, has told her "a small lie to calm her" -- that the boom is nothing more than a big balloon released by a plane and then popped.

Muntasir said he illustrated the balloon-popping principle to his daughter, but his explanation has not stopped her from fearing the massively loud thunderclap caused when Israeli fighter jets break the sound barrier over the Gaza Strip, as they did 25 times (mostly in the wee hours of the morning) between June 25 and July 4, and as they continue to do. Layan's mother, Arish, 28, said her eldest child has also started wetting her bed again, something she had outgrown two years earlier. All three of her young children "are very frightened lately," she continued. "They are very tired and very upset and they get sick and vomit. They've lost a lot of their appetite. They are a little wild and I'm finding it more difficult to control them."

In the distance, from the direction of Beit Hanoun, a town slightly to the north of the home of the Bahja family in the Jabalya refugee camp, the sound of intermittent artillery fire can be heard. "That's the sound of a bomb," said Layan, somewhat dismissively, when asked. "That doesn't scare me."

Physician Thabit al-Masri has become adept at showing the media around. After the June 25 capture by three Palestinian groups of an Israeli soldier, Gilad Shalit, Gazans braced themselves for the Israeli retaliation. Journalists were the first to invade.

In crisp sentences, al-Masri went through the short history of his unit, the neonatal intensive care department of al-Shifa Hospital, the Gaza Strip's biggest medical care facility. With 30 incubators, the unit, which was built with foreign aid, handles a third of Gaza's premature births and all emergency cases, al-Masri explained. At the time of the visit, a warm, sticky July 4 afternoon, all incubators were occupied on the pleasantly air-conditioned first floor. All this equipment hummed along on the hospital's private generators, as Israel had bombed Gaza's only power plant on June 28.

"We shouldn't be operating at capacity," al-Masri said. "But we don't have much choice. In the past ten days, with the heightened tensions and the sonic booms, the stress on mothers has been tremendous." He said doctors have noticed spikes in admissions of pregnant women experiencing complications at times of increased stress and violence in the Strip. According to al-Shifa's senior obstetrician ÔAdnan Radi, the number of women admitted who miscarried or went into labor prematurely has risen from an average of two to four a day to as many as ten. Since June 28, when Israel commenced its military response to its soldier's capture, three stillbirths have been recorded, where normally doctors say they might see one every five or six months.

The doctors are unsure why there have been so many stillbirths. But, said Radi, the rise in miscarriages and premature births is not hard to understand. "The sonic booms, combined with all the other stresses, have a very bad effect on the health of pregnant women. The shocks can lead to premature contraction of the uterus, a ruptured membrane and premature delivery of the baby. Whenever there is this booming, the next day we see a rise in the number of premature deliveries and miscarriages."

Being subjected to a sonic boom is a profoundly distressing experience. Beyond the immediate shock of the explosion, there is a physical sensation caused by the vibrations as well as a momentary loss of orientation. The boom comes from above and, unlike artillery fire or a missile impact that can be located by the direction of the sound, it wraps itself around a person as if he is right in the middle. "Look at how people react when there is a sonic boom," psychologist Ahmad Abu Tawahina pointed out. "Either they start laughing or they almost try to jump inside themselves."

Abu Tawahina, senior clinical supervisor at the Gaza Community Mental Health Program, said Israel was engaging in a conscious strategy to reduce Gazans to a "state of learned helplessness." "The Israelis are trying to make trauma overwhelming, and that happens when it is unpredictable, unavoidable and uncontrollable. They never used sonic booms before disengagement" -- the August 2005 withdrawal of soldiers and settlers from the Strip -- "because their settlers were here among us."

Conventional models of diagnosis are hard to apply in Gaza, Abu Tawahina went on to say. "We're accumulating trauma. You talk of post-traumatic stress disorder but we've never experienced the Ôpost' bit, just the trauma, and that is ongoing. Now everyone talks of sonic booms. Before they talked about salaries. Even without the sonic booms and shells and bombs, life in Gaza is very stressful. People can't move in and out of the Gaza Strip freely. Some families have become fragmented in different parts of the world. All these things have a negative impact on psychological health."

Indeed, for all the justifiable concern about "humanitarian crisis" in the Gaza Strip since the capture of Shalit, the stresses on Gazans have merely grown in magnitude, rather than changed in kind. The post-June 25 sonic booms began occurring in the fall of 2005, and were discontinued after they drew UN criticism. Air strikes aimed at members of armed Palestinian groups have proceeded without interruption. From the beginning of 2006 until June 20, according to UN figures, there were a total of 142 missile strikes in the Gaza Strip.

A campaign of Israeli artillery fire, mostly at targets in the northern Gaza Strip, dramatically intensified in late spring, in response, according to the Israeli government, to the firing of homemade Palestinian Qassam rockets over the Gaza border at targets inside Israel. The campaign also came shortly after the formation at the end of March of the Hamas-led Palestinian government, eight weeks after the Islamist movement won parliamentary elections.

According to a June 21 report from the UN Office for the Coordination of Humanitarian Affairs, Israel fired 781 artillery shells into Gaza in the first three months of the year. The same period saw 417 Qassam rockets fired into Israel. From April to June 20, however, an extraordinary 7,599 Israeli artillery shells were launched at Gaza, compared to 479 Qassams shooting in the other direction. From June 9 to June 20, 31 Palestinians were killed in the Gaza Strip, including 10 children, six of them five years old or younger. Those numbers include seven members of the Ghalia family, who were killed on a northern Gaza beach on June 9. The killings caused outrage among Palestinians and made an icon out of Huda Ghalia, 10, the surviving daughter, who was caught on camera in the aftermath of the bombing crying out for her father next to his body.

Israel denied that its artillery fire caused the explosion, a claim disputed by a subsequent Human Rights Watch investigation. A day after the explosion, Hamas' armed wing, the ÔIzz al-Din al-Qassam Brigades, announced an end to the ceasefire it had upheld since March 2005. The Brigades, along with the Popular Resistance Committees and a group called the Army of Islam, were involved in the attack that ended with Shalit a prisoner of the militants.

Meanwhile, and in contravention of the Agreement on Movement and Access brokered by Secretary of State Condoleezza Rice in November 2005, Israel has closed the crossings into Gaza several times since pulling out its settlements in the Strip. The Karni crossing, Gaza's only transfer point for goods, was closed for 60 days from the beginning of 2006 through the end of June, or 43 percent of the time. With no other means of bringing in commodities, Gaza was already suffering shortages of staples such as bread and rice, and hospitals and pharmacies feared running out of medicines, before the lockdown of late June. With no other export avenue, and with international funding cutoffs after the Hamas-led cabinet took office in March, the economy was hit by a double whammy: no salaries and virtually no revenue from agricultural exports.

From June 25 to July 6, the Karni crossing was closed almost completely, opening on July 2 and 4 for imports only. According to the World Food Program (WFP), on July 4 there were two days' supply of sugar and eight days' stores of animal feed. Supplies of milk and other dairy products were available in minimal quantities. On July 6, the crossing closed again. There is no telling how long the closure might last, with Israeli tanks remaining in parts of Gaza and Israel refusing Palestinian Prime Minister Isma'il Haniyya's call for a ceasefire, and with Shalit's captors so far declining to release him without a corresponding release of Palestinian prisoners from Israeli jails. Israeli Prime Minister Ehud Olmert told his cabinet that Israel has entered a "war in which it is impossible to set time limits."

On June 28, Israeli aircraft bombed the power plant, which generated electricity for more than half of the Strip's population of 1.4 million. The Gaza electricity company is currently load sharing the power it receives from the Israel Electricity Cooperation in an attempt to supply most households with six to eight hours of electricity per day.

The lack of power has compounded the food problem. With little electricity, refrigeration is intermittent and there is an inevitably high loss of perishable foods. With the sea also closed to fishermen, the WFP has voiced its concern that fish, a vital source of protein, is disappearing from the local market. At al-Shifa Hospital, doctors say they are seeing an increase in the number of patients with symptoms of gastroenteritis as a result of decreasing food quality.

All Gaza Strip hospitals rely mostly on generators. Generators need fuel, and fuel supplies are running low, though Israel did reopen pipelines on July 1, after a five-day closure. Water treatment and sewage plants now rely on generators, but some apartment blocs are finding it difficult to pump water up to tanks on roofs, again because of the shortage of fuel for the motors.

Al-Shifa Hospital has three generators, and the fear of running out of fuel or losing a generator to malfunction, is pervasive. "It would only take a few minutes without power," said Radi, "and we'd have a room full of dead babies." According to JumaÔ al-Saqqa, the hospital's director of public relations, as of July 4 the hospital had seven days worth of diesel left. Five thousand liters a day are needed to power the generators.

Refrigeration remains a problem, and al-Saqqa said bloodlines in particular were at risk, because they are unusable if not kept at the right cool temperature. With al-Shifa Hospital already suffering shortages, "If we see large numbers of casualties, we won't be able to cope." Beyond that, maintaining morale among the 1,400-strong staff at the hospital is a problem. "The staff are completely depressed," said al-Saqqa. "I am one of them. We aren't being paid because the rest of the world has cut us off. We ourselves don't have food to eat. We don't have electricity at home. There is no fuel for the cars and people have to decide whether to pay for a taxi or feed their families." Still, the staff, unpaid for months, turns up at work. "How can we ask the outside world to restore humanitarian aid if we don't help ourselves?"

Psychologist Abu Tawahina works with children between the ages of three and 18. One of his patients is Huda Ghalia. She suffers, he said, from the whole spectrum of behavioral, emotional and cognitive disorders.

But all children are affected. Abu Tawahina's phone kept ringing during our interview on July 4. It was, he said, his own children, "seeking reassurance." "We tell parents that when there is a sonic boom, the first thing they should do is gather their children in their arms to make them feel safe. But we know from talking to the children that they can feel that their parents are afraid. When parents are afraid, to children it means everyone is vulnerable. This leads to a lack of respect for authority. It is something we have seen since the first [1987-1993] intifada. Palestinian children fight authority. They will go and throw stones at Israeli soldiers. But then they will come home at night and wet their beds."

Muntasir and Arish Bahja are doing what they can to calm their children and keep them out of harm's way. With Muntasir's parents in the flat downstairs, the children are never left alone, a great help for Arish, who at the moment mostly has to wash the family's clothes by hand. ("Don't ask me about the ironing," she grimaces.) They have also kept their children off the streets since June 28, making them stir crazy, says Muntasir.

But even these two educated and careful parents can't think of everything. "Baba! Baba!" Layan suddenly cries out, collapsing in a fit of laughter at her father's side. "Do you know what she's doing?" he asked, before answering his own question. "I tried to prevent them from seeing the footage, but it was on all the time. She's acting out the scene on the beach with Huda Ghalia." "Sometimes," added Arish, "she calls herself Huda."