On March 22, Gaza’s health authorities announced the first two cases of the novel coronavirus in the Strip. The confirmed cases were of two men who came back from Pakistan and entered Gaza through the Rafah crossing with Egypt. They were detected upon entrance and are held in a field hospital near the border. In theory, this means they do not jeopardize the rest of the population. But now the count is up to nine cases, with the seven new cases apparently security officials who interacted with the first known infected individuals at the Rafah field hospital.  Experts suspect that there are more undetected sick Gazans and even if not, an outbreak in Gaza is only a matter of time. And while the rest of the world struggles with this unprecedented pandemic, Gaza presents unique challenges that could make an outbreak there especially dangerous.

First, Gaza is one of the most densely populated places on earth with large families living together, many in refugee camps. This is an ideal environment for any epidemic outbreak. Unlike highly developed countries with comparable density, such as Singapore, Gaza lacks the infrastructure to enable abiding by basic recommendations of social distancing. Second, Gaza lacks water not only for drinking and cooking but also for hygiene and sanitation. As an example, on average, there is one handwashing facility for every 130 students in Gaza (versus every 71 students in the West Bank), whereas health officials’ guidelines (including Palestinian guidelines) call for one handwashing facility for every 30 students. To cope with water shortages, even hospitals reduced their level of sanitation. Water shortages make it hard to follow yet another basic recommendation: to repeatedly and thoroughly wash hands. Moreover, while the rest of the world also has insufficient testing kits, protective equipment, and ventilators, Gaza in addition suffers from an acute scarcity of hospital beds, medical supplies, and basic disinfectants. Gaza also has a shortage of medical staff, with a steady decline of physicians and nurses relative to the population size in the last decade. Even worse, many of the medical personnel are poorly trained, partially because they are unable to travel outside of Gaza for professional development and educational purposes.

Gaza’s overall humanitarian situation is also unbearable. In 2012, the UN warned in a report that by 2020 Gaza could be “unlivable” unless fundamental changes occur. It depends on how one defines “livable,” but sadly, as of the first quarter of 2020, Gaza has indeed become an unlivable place. Without the international community, most of the population would not survive. Over 80% of the population is aid dependent. More than 50% live on less than $3.50 per day and rely on food aid. Unemployment is close to 50% and over 60% among the youth population. After a devastating period in which electricity was available for only 3-4 hours per day, it is now available half of the time, thanks mostly to Qatari funding that if stopped would darken the Strip again. Most of the aquifer water is undrinkable and waterborne diseases are common. On some metrics, the situation improved since 2012—the fishing zone was expanded substantially and access and movement have improved to accommodate more exports, exit permits to laborers for work in Israel, and entrance of construction materials into the Strip. However, these measures have not translated into improvement in the real economy with unemployment and GDP remaining virtually unchanged. The public health sector, as mentioned, is teetering on the brink. Under these circumstances, it is clear why a COVID-19 outbreak would push Gaza into a complete collapse.

This is a nightmare scenario that everyone is dreading. And so, if there is one silver lining to the corona crisis, it is that it has led to unprecedented cooperation between the Palestinians, Israel, and the international community,  cooperation we can only dream of during normal times. Each party is doing its best. The international community, led by the World Health Organization (WHO), is providing protective equipment, testing kits, medical supplies, and is training medical teams on how to test and provide care properly, prevent infection, and communicate risk to the public. This is a step in the right direction but hardly enough. An interagency response plan budgeted at $6.5 million builds on this initial response both in Gaza and the West Bank. However, close to 80% of the funds are still missing, hindering the ability to prevent the spread of the virus and scale up the health systems.

Israel is donating in-kind tests and disinfectants, working closely with the international community and the Palestinian Authority, and monitoring the situation closely. For Israel, the interest is clear. It wants to prevent a total collapse of Gaza that would leave the Strip for Israel to handle; ensure there is no humanitarian crisis for which the international community blames Israel; and avoid mass marches of Gazans, healthy or sick, who would approach the border with Israel not in protest but in request for help. All of these scenarios would present Israel with no good options.

Hamas closed down Gaza schools in early March and ordered the shutdown of all public places on March 22. Before that, travelers from outside were forced into quarantine for 14 days. In addition to the field hospital by Rafah, where the first two confirmed coronavirus cases are quarantined, Hamas set up 21 quarantine sites in health facilities and schools, where 1,400 people are now staying. The Palestinian Authority, although mostly concerned about the outbreak in its West Bank territory, has relaxed its sanctions on Gaza and is working closely with Israel and the international community to facilitate the entry of supplies into the Strip. Most of the Palestinian public (70%) supports this cooperation with Israel to prevent the spread of the coronavirus, according to a March 24 poll. The political aspirations of the Palestinian public, both in the West Bank and in Gaza, are now pushed aside, and as long as the corona crisis persists, it is unlikely that there will be any protests on the Gaza border or major violent attacks on Israel.

As all parties work to contain the outbreak, the crisis in some way is also an opportunity. Although Israel and the Palestinian Territories, Gaza and the West Bank, are separate political entities, they comprise one geographical unit. The cliché that disease has no borders could not be truer there, illustrating the importance of Israeli-Palestinian cooperation on environmental and health issues even in times of political deadlock. The collaboration that exists now needs to be sustained and improved upon in routine situations when the coronavirus crisis is over. Israelis and Palestinians, and ideally also Egyptians and Jordanians, should create a regional pandemic task force to curb the impact of a future disease outbreak and implement containment. Further, donors and practitioners need to prioritize investment in upgrading the public health services in Gaza and invest in public health risk mitigation initiatives. As a first step, basic investments in hygiene and sanitation systems and practices, including education campaigns, are simple and not costly. Moreover, Israel and the international community should work to extend the current halt in large-scale violence into a long-term cessation of hostilities, and formalize the yet-to-be-achieved “understandings” between Israel and Hamas. The PA should be brought on board as well. That would pave the way for investment and advancement of large scale projects that would improve living conditions in the Strip. Ideally, the close coordination between Israel and the PA could be built on to restart a meaningful peace process and one day, maybe, the return of the PA to Gaza.