As countries shut borders, enforced curfews and suspended much of daily life, Gaza – under a blockade for years – was somewhat isolated from the coronavirus pandemic. But as it has with so much of the rest of the world, Covid-19 found a way.

In the early hours of Sunday morning, Palestinian health officials announced the first two cases in Gaza, from travellers returning from Pakistan via the Egyptian crossing. They were part of a trickle of people heading into the strip, around 1,300, who were placed into quarantine facilities, mostly in empty schools and hotels.

Medhat Abbas, the general director of primary care in Gaza, said that other people the pair were in contact with had also been quarantined. “There is no need for panic at this stage,” Abbas said.

“We can deal with existing cases and limited numbers, but if the pandemic increases, as happened in some countries, we will need international intervention,” he said. Gaza had only 40 intensive care unit beds, or 100 under emergency conditions, he added – far fewer than would be needed in an outbreak.

For almost a decade and a half, this tiny slice of land has been in an artificial state of lockdown – locals call it a “siege” – under a crushing Israeli-Egyptian blockade.

“We have become used to isolation,” said Ahlam al-Madhoun, 45, as she shopped in a supermarket for food. “Will the world understand that the isolation they live in for 14 days is the same as what we have been living under for 14 years?”

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While the blockade may have cut off Gaza from the pandemic, or at best delayed its entry, it is also blamed for what could be a catastrophic outbreak if the virus spreads.

On Monday, the Israeli human rights group B’Tselem accused Israel of turning the strip into the “biggest open-air prison in the world”, one that is uniquely unsuited to deal with the pandemic.

“Israel will not be able to deflect the blame if this nightmare scenario turns into a reality that it created and made no effort to prevent,” it said.

Years of tight restrictions on people and goods have not only destroyed the economy but damaged almost every aspect of life. Meanwhile, three devastating wars between Israel and Hamas, a militant group that rules inside the strip, have entrenched the crisis, as have often-violent rivalries between competing Palestinian factions. More recently, a bloody Israeli crackdown on protests near the frontier has left thousands with bullet wounds, putting significant stress on hospitals.

Profile What is the World Health Organization? Show Hide The World Health Organization (WHO) was founded on the 7 April 1948, a date celebrated annually as World Health Day. As an agency of the United Nations, the organisation has developed into an international establishment which involves 150 countries and employs 7,000 people. WHO is responsible for the World Health Report and the World Health Survey. Since its establishment it has played a fundamental role in the eradication of smallpox, and currently prioritises diseases including HIV/AIDs, Ebola, Malaria and Tuberculosis. WHO takes a global responsibility for the co-ordinated management and handling of outbreaks of new and dangerous health threats - like the Covid-19 coronavirus. The current WHO director general is Dr Tedros Adhamon Ghebreyesus, elected for a five year term in 2017. Prior to his election, Dr Tedros served as Ethiopia’s minister for foreign affairs. He also served as minister of Health for Ethiopia from 2005-2012 where he led extensive reform to the country’s health system. WHO's handling of the global pandemic has been criticised by US president Donald Trump, who announced in April that the US will no longer contribute to funding the agency. Grace Mainwaring and Martin Belam

Gaza’s healthcare system was collapsing even before the pandemic, Michael Lynk, the UN special rapporteur for human rights in the Palestinian territories, warned last week.

“Its stocks of essential drugs are chronically low. Its natural sources of drinkable water are largely contaminated. Its electrical system provides sporadic power. Deep poverty amid appalling socio-economic conditions is prevalent throughout the strip,” he said. “Gaza’s population is also a physically more vulnerable population.”

To block Covid-19, authorities in Gaza shut down wedding halls, banned weekly markets and asked people to stay at home.

Ibrahim Raida, 31, a graphic designer, questioned whether the measures were enough. “They thought they are immune, but after the two cases … Gaza is a small place, and overpopulated, the virus can be easily spread.”

The World Health Organization has sent in testing kits, personal protective equipment and goggles but said it might not be sufficient without additional international donations.

The head of the WHO office for the occupied Palestinian territories, Gerald Rockenschaub, was in Gaza during the weekend and said containment was still possible. However, preparations for an outbreak should be ramped up immediately, he said.

“What we need to do is to now move quickly to strengthen the capacities of the health system,” he said. “There are shortages everywhere.”

Israel argues the blockade is a security measure needed to restrict its enemy Hamas, which has often fired rockets out of the strip. The UN, however, says its policy constitutes collective punishment on the strip’s roughly 2 million residents.

Cogat, the defence ministry body responsible for coordinating Israeli government activity in the Palestinian territories, said it had mostly closed its foot traffic crossing into Gaza, although a separate entrance for trade was open. Israel had provided “hundreds” of Covid-19 test kits for Gaza, it added, without specifying.

It would agree to exit for “life-threatening situations” and other extraordinary cases, a Cogat official said. Asked if Israeli authorities would allow Palestinians who might contract the virus into the country for treatment if Gaza’s health system were overburdened, the official replied: “This is under assessment.”