The continuing outbreak of the novel coronavirus, also called COVID-19, in the West Bank has raised a number of concerns and dilemmas among Israeli officials about how to contain the virus in the Palestinian territories, and especially in the Gaza Strip.

What will Israel do, for example, when the first coronavirus patient is discovered in Gaza? One Israeli official told Haaretz that Israel is weighing the possibility of evacuating the patient and treating them in Israel, as Gaza has a shortage of hospital beds. Not doing so could risk the spread of the virus among Gazans – a situation which could lead to mass infection and a severe strain on the Strip's healthcare system.

The official said that Israel has not yet discussed the possibility of accepting coronavirus patients from the West Bank, in part due to the fear that the Israeli healthcare system will face its own shortage of hospital beds for Israeli patients if the outbreak worsens.

He noted that while Israel and the Palestinian Authority have joint procedures in place to deal with natural disasters, there are no guidelines in place for a crisis like the coronavirus. “In a natural disaster, you rely on aid from other countries, or the fact that Israel is strong enough to take care of its neighbor as well," the official said. "But we know this is not the case when it comes to the coronavirus."

Open gallery view Palestinians in the northern West Bank city of Nablus, March 2020. Credit: Mohammed Turabi

As of Friday, there are 35 coronavirus patients in the West Bank and no reported coronavirus infections in the Gaza Strip as of yet. Both Israel and the Palestinian Authority believe that the number of confirmed cases will rise considerably. Two patients have been hospitalized in isolation in the West Bank following their return from Rafah in the southern Gaza Strip, but neither is currently displaying symptoms of the virus. In addition, 1,400 Gazans are in home quarantine, which is being enforced by Hamas.

On Thursday evening, the IDF’s Coordinator of Government Activities in the Territories, together with representatives of international organizations, held a meeting to evaluate the situation. At the helm was Col. Sharon Biton, the head of the civil affairs department of COGAT, who said after the meeting that “COGAT and the PA are cooperating closely and effectively to manage the outbreak of the virus.

These coordination efforts [with the PA] and the international community are a necessary part of emergency preparedness and safeguarding the territories of the Palestinian Authority and Israel.”

Chosen to lead the effort to curb the virus' spread was Jamie McGoldrick, the humanitarian coordinator for the Palestinian territories at the UN Office for the Coordination of Humanitarian Affairs. McGoldrick will coordinate between Israel, the PA and Hamas.

Open gallery view Health workers wearing masks stand at a quarantine zone installed by the Palestinian health ministry in Gaza to test incoming travelers at the Rafah border crossing with Egypt, on February 16, 2020. Credit: AFP

Critical condition in Gaza

Qatar has pledged $10 million to the Palestinians to deal with the outbreak, and the World Bank has transferred a donation of $7 million to address the coronavirus crisis in the PA, said an Israeli official who is familiar with the details. These donations are intended for Gaza and the West Bank. The Palestinian territories are experiencing a lack of protective gear for hospital medical teams as well as testing kits, the Israeli official said.

Two weeks ago, Israel transferred 2,500 testing kits to the Palestinian Authority. Another shipment of the same size is expected to arrive soon from the WHO, and positive tests will be sent to central Israel's Sheba Medical Center for examination. Israel also transferred 200 testing kits to the Gaza Strip for the first time on Friday. But the most serious shortage, the Israeli official said, is among medical personnel in Gaza.

If the Gaza Strip is hit by an outbreak of the disease, given the critical condition of the enclave's medical system, there will be a need to declare a mass home quarantine for Gaza residents. The Turkish hospital, which was built two years ago in the Strip, is under consideration to be used to treat coronavirus patients exclusively, but the hospital has not yet in operation and has no staff.

A field hospital has been set up at the Erez Crossing between Israel and Gaza with funding from an American organization, but it has not yet been hooked up to infrastructure, and is also expected to face a medical staff shortage. The officials also pointed to the Trump administration’s decision to end American funding for the USAID and the UNWRA Palestinian refugee agency is another factor weakening the Palestinian healthcare system.

In order to treat coronavirus patients, Gaza will need to use materials that Israel has banned from being brought into the Strip. Israel has not yet been asked to ease or temper its policy on importing goods, the official said. Israel may have to consider the entry of “dual-use” goods – civilian materials that can be used for military purposes. For example, Israel imposes limits on hydrogen peroxide, which in addition to its use as a medical disinfectant can at certain concentrations be used to manufacture explosives.

No closure, but a reduction

Israel also has to make decisions about the entry of Palestinian workers into Israel. On Thursday, the Purim holiday closure on the Gaza Strip and West Bank ended. During that period, only those with humanitarian entry permits were allowed in, as occurs on holidays such as Passover, Purim and Yom Kippur. When the holiday ended, Israel decided to extend its closure on Gaza and reduce the number of Palestinians entering Israel.

The idea behind the decision to reduce the numbers and not completely close down entry was statistical, similar to most attempts to prevent the spread of the coronavirus. At this stage, Israel decided to leave the closure of the Gaza Strip in place and continue to bar the entry into Israel of Palestinian workers from Bethlehem and nearby Beit Sahour and Beit Jala.

An estimated 8,700 Palestinians from the Bethlehem area work in Israel. In addition, Israel decided that only Palestinian workers under the age of 50 be allowed to enter Israel. The official said the decision is intended to both reduce the number of Palestinians coming in and also because this is the group most at risk from coronavirus infection.

Among future steps being weighed by Israel is limiting of the movement of the workers by allowing them to sleep in Israel from Sunday through Thursday, or alternatively by limiting the sectors in which they work, such as hospitality, agriculture and construction. The official said that many Palestinians work in hospitals and nursing facilities, where they are particularly essential at this time.

As of now, there is no reason to prevent Palestinians from working in the settlements, and the defense establishment understands that it would be difficult, if not impossible, to separate the Palestinian and the Jewish population in the West Bank.

Palestinians and settlers share common spaces such as gas stations and supermarkets in a number of places in the West Bank, and settlers travel freely to Israel and are treated in hospitals in Israel. The defense establishment believes that due to this mutual dependence between Israelis and Palestinians in the West Bank, there would be no way to instate a full quarantine.