Gaza Clinic a Lesson In Anatomy of Chaos

Here, Gunmen Roam Halls With Medics

GAZA CITY -- Few theaters have showcased as much of the Israeli-Palestinian drama as Shifa Hospital, a gated compound among food stands and flower vendors at the center of this city. Poor, crowded and governed by rules that no one follows, the Gaza Strip's primary public health center is a nearly perfect reflection of the rough world outside its walls.

Now, with Gaza's own gates shut more often than not, Shifa is suffering the debilitating consequences of official corruption, sealed trade passages and the recent victory of the radical Islamic group Hamas in parliamentary elections. Life in its cancer wards, operating rooms and outpatient clinics has become a regimen of compromise, diminished expectations and poor prognosis, the story of Gaza six months after the Israeli evacuation.

Elective surgery is being delayed to preserve anesthesia for emergencies. The staff of hundreds received last month's paychecks more than two weeks late, and prospects for this month are not encouraging. Patients must beg for blood as transfusions substitute for dialysis because of a lack of necessary drugs.

Chemotherapy has been reduced because of shortages, but sending cancer patients abroad for treatment has become a luxury for the nearly bankrupt Palestinian public health system. Gaza's gunmen have stepped into this unruly triage, demanding at rifle-point that friends and relatives receive scarce medications or costly transfers to Egypt or Israel for care. The deputy health minister reacted to recent threats by fleeing to the West Bank.

"There is no money, no medicine and no man higher up to sign my orders for more," said Ibrahim al-Habbash, Shifa's general director. "So the problems always return."

As foreign donors seek ways to keep the Palestinian Authority afloat without financing Hamas's political program, the public health system is sinking. Preserving it after Hamas installs its cabinet later this month will present a challenge to the Bush administration and other foreign donors now planning to channel future humanitarian aid to the Palestinians through nongovernmental organizations.

Foreign governments have demanded that Hamas, whose charter calls for Israel's destruction, renounce violence, abide by agreements backed by the defeated Fatah movement and recognize the Jewish state in order for nearly $1 billion in annual aid to continue. Hamas, known formally as the Islamic Resistance Movement, has refused to do any of this. As a result, Israel has halted monthly tax transfers to the Palestinian Authority, and the United States has frozen development projects.

Half of the Palestinian Health Ministry's $2 million monthly budget, excluding salaries, is covered by foreign assistance. But a recent U.N. humanitarian assessment stated that "it is not possible to transfer responsibility of the public health system to the U.N. or NGOs," while warning that a reduction in aid would "hamper service delivery and prevention activities including immunization and mother and child care."

Israel, citing threats of a possible Palestinian attack, has closed the main passage for goods and supplies to Gaza for more than five weeks this year. Following dire warnings from U.N. humanitarian monitors, Israel began allowing sugar, flour, cooking oil and other staples into Gaza for the first time in more than two weeks.

But the first trucks did not carry any of the two dozen items on Habbash's list of medications and supplies that have run out at Shifa or will in the next few days. And on Tuesday, the Israeli military closed the crossing again.

"The health system could collapse if we do not get money," said Ghassan al-Khatib, the acting health minister.

A tour of Shifa's wards last week provided ample evidence of the problems ahead, from the ethic of lawlessness apparent on the hospital grounds to the lack of resources available for the more than 600 patients who fill waiting rooms on a typical day.