The Spread of Covid-19 in Judea and Samaria (Updated to December 28, 2020)

Overview

• The situation in the Gaza Strip:
  • The number of active Covid-19 cases in Gaza is still very high. Between December 22 and 28, 2020, 4,735 new cases were detected. The number of active cases currently stands at 10,729. There have been 340 deaths, up from 271 on December 22. On December 28 there were 327 hospitalized patients, 195 in serious condition.
  • According to medical sources in the Gaza Strip, the actual incidence of infection is far higher than what has been reported, mainly because of public unwillingness to be tested. An increase in infection is expected in the coming weeks. Tawfiq Abu Na’im, deputy minister of the interior, said the weekend lockdowns would continue in their current format until the middle of January 2021. However, a full, general lockdown has not yet been imposed, although that may be considered if the Hamas administration loses control of the situation.
  • The most challenging problem for the public health system is supplying oxygen. Other problems include a shortage of hospital beds, the limited number of tests that can be administered daily and a shortage of medical personnel. Medical sources in the Gazan health system continue accusing Israel of delaying the delivery of medical equipment to the Gaza Strip.
• The situation in Judea and Samaria:
  • This past week the rate of infection declined slightly, but the number of active cases is still high. On December 28 the number stood at 11,322, down from 13,529 a week ago. Of the daily tests administered, 22.3% were positive, down from 23.3% a week ago. The Nablus district remains the district with the highest number of cases in Judea and Samaria, followed by the Ramallah-al-Bireh district.
  • According to the Palestinian Authority (PA), in the east Jerusalem neighborhoods 997 new active cases were detected, almost the same as last week’s 999. The number of active cases rose to 1,646 from 1,515 a week ago. The neighborhoods with the highest number of cases and the highest percentage of positive test results are Kafr ‘Aqab and Beit Hanina.
  • Christmas events were held in Bethlehem without local participants or tourists. The chairman of the foreign tourism association said the damage to the tourist industry was greater than $1.5 billion and 32,000 tourism workers were without a job.
  • In the meantime, the PA is taking steps to prevent the mutated coronavirus from entering its territories, and at the same time making preparations to purchase massive quantities of vaccine. The PA is reportedly in contact with a number of companies and agencies, but apparently no decision has yet been made (it would seem that rather than purchase the vaccine, the PA would prefer to receive donations).

Coronavirus-related deaths in Gaza Strip, Judea and Samaria, by district

The Gaza Strip

Extent of the Covid-19 infection

This past week the number of new active cases in the Gaza Strip remained high. Between December 22 and 28, 2020, 4,735 new cases were detected, bringing the number of active cases to 10,729 (up from 9,700 a week ago). There have been 340 coronavirus-related deaths, up from 271 a week ago. Of the 327 hospitalized patients, 195 are in serious or critical condition.

• Medical sources in Gaza estimate that the rate of infection is higher than what is reported, primarily because of public unwillingness to be tested. A further rise in infection is expected in the coming weeks. Statements to that effect were the following:
  • Majdi Dheir, head of the department of preventive medicine in the ministry of health in Gaza, said that in a random sampling of 5,000 tests the rate of infection was 16.6%, that is, one active Covid-19 case for every six Gazans. He said they expect the last week of December 2020 to be particularly difficult but the number of active cases will begin to decline from the middle of January 2021, although the epidemic will not be over (Filastin al-A’an, December 19, 2020).
  • Dr. Rami Haidar al-Abdallah, head of the department of infectious diseases in the ministry of health in Gaza, said the percentage of seriously ill patients provides an indication of the epidemiological situation in the Strip. He said many ill people do not get tested because they do not want to lose their income (Palestine Online, December 27, 2020).
  • Dr. Ashraf al-Qidra, spokesman for the ministry of health in Gaza, said the general rate of infection of all tests administered was between 35% and 40%. He added that epidemiologically speaking, the present time the most dangerous and sensitive, because the disease will probably peak between the end of December 2020 and the middle of January 2021 (Dunia al-Watan, December 23, 2020).
  • Dr. Yusuf al-Akkad, director of the European Hospital, said a significant rise in the number of active cases could be expected in the coming weeks. He said they were preparing for the worst and hoping they would not reach a stage where they would have to decide which patients to treat (al-Ra’i news agency, December 24, 2020).
  • Dr. Fathi Abu Warda, advisor to the minister of health in Ramallah, said the epidemiological situation in the Gaza Strip was still very serious, with 81% of the beds allotted to Covid-19 patients already occupied. He warned that patients’ conditions and symptoms would worsen in the coming weeks as the weather got colder (qudsnet.com, December 26, 2020).

Rate of Covid-19 infection in the Gaza Strip during the past week

The change in active cases in the Gaza Strip over the past month

Difficulties facing the Gaza Strip’s health system

• The greatest challenge facing the public health system in the Gaza Strip today is supplying oxygen. According to Majdi Dheir, head of preventive medicine in the ministry of health in Gaza, they urgently need a mobile oxygen station (Filastin al-A’an, December 19, 2020). Dr. Yusuf al-Akkad, director of the European Hospital, said that because of the shortage of oxygen, even though they had 300 Covid-19 beds, they were unable to admit more than 200 patients who needed oxygen. He said they were waiting impatiently for the arrival of additional oxygen stations. He claimed Israel was deliberately delaying their delivery to the Gaza Strip, as well as the delivery of other medical equipment (Palestine Online, December 27, 2020).
• Mahmoud Hamad, head of the department of administrative affairs in the ministry of health in Gaza, said the production capabilities of the oxygen stations in the hospitals were not suitable for the current epidemiological situation and the number of patients in need of ventilators. He said that only two companies in the Gaza Strip produced oxygen. He also claimed that Israel was the main obstacle to the delivery of the oxygen stations and canisters of liquid oxygen they had been waiting months to receive (Palestine Online, December 26, 2020).
• Other difficulties indicated by sources in the ministry of health were the following:
  • A lack of hospital beds: Dr. Ashraf al-Qidra, spokesman for the ministry of health in Gaza, reported that 500 beds had been allotted for Covid-19 patients. However, he said, with the rise in the number of serious cases the ministry of health has been forced to open coronavirus wards in the other hospitals (al-Araby al-Jadeed, December 21, 2020). Dr. Amid Mushtaha, head of the department of laboratories in the ministry of health in Gaza, warned that the beds in the European and other hospitals were becoming filled (Palestine Online, December 21, 2020). Dr. Yusuf al-Akkad, director of the European Hospital, said that almost all the hospital’s beds were filled (al-Ra’i news agency, December 24, 2020).
  • The limited number of kits available for Covid-19 testing: The Gaza Strip has one central laboratory with three appliances for DNA production and eight PCR machines. According to Dr. Amid Mushtaha, head of the department of laboratories, the central laboratory is capable of processing no more than between 2,500 and 3,500 tests per day (Palestine Online, December 21, 2020).
  • A shortage of medical personnel: Mahmoud Hamad, head of the department of administrative affairs in the ministry of health in Gaza, reported that so far 1,300 health workers had been infected. He said 50 employees of the ministry of health were being infected every day, and that many health staff members were in quarantine (Palestine Online, December 26, 2020).

Hamas administration preventive measures

• For the past three weekends a general lockdown has been imposed on the Gaza Strip. Before the lockdown at the end of last week Gazans crowded into local bank branches. According to Iyad al-Buzum, spokesman for the ministry of the interior in Gaza, that was because the banks were paying the allotments from the ministry of social development to tens of thousands of recipients (Dunia al-Watan, December 26, 2020).

   
Gazans crowd into local bank branches
(Facebook page of photojournalist Usama al-Kahlut, December 24, 2020).

• Senior figures in the health system said the weekend lockdowns in December had contributed to flattening the coronavirus curve and the decline in the number of hospitalized and seriously ill patients (Palestine Online, December 27, 2020). Dr. Yusuf Abu al-Rish, deputy minister of health, said that so far there was no need to enforce stricter measures, but rather the current measures would continue (Dunia al-Watan, December 24, 2020). Tawfiq Abu Na’im, deputy minister of the interior, said the preventive measures currently enforced in the Gaza Strip would continue at least until the middle of January 2021 (Filastin al-Yawm, December 24, 2020).
• On December 23, 2020, the Palestinian Legislative Council in the Gaza Strip passed a temporary law to combat the coronavirus epidemic proposed by the legal committee. The law gives executive authorities powers and tools to combat the epidemic on the medical, economic, financial aid and legal fronts, to arrange for elementary measures, and deal with problems stemming from disruptions in the activities of the courts regarding the preservation of the individual’s rights (website of the Palestinian Legislative Council in Gaza, December 23, 2020).

Foreign aid for Gaza

• Muhammad Abu Awad, head of the Palestinian economic council for development, said that in accordance with instructions from Mahmoud Abbas and PA Prime Minister Muhammad Shtayyeh, the council had received a shipment of $208 million worth of medical equipment for the European Hospital. He said it was the sixth delivery from the Kuwait Fund for the support of the health system in the Gaza Strip (Filastin al-Yawm, December 24, 2020).
• The W.H.O. sent the ministry of health in Gaza 100 testing kits, sufficient for 9,600 Covid-19 detection tests (Facebook page of the W.H.O. representative in the territories, December 26, 2020).

   
The W.H.O. test kits
(Facebook page of the W.H.O. representative in the territories, December 26, 2020).

Judea and Samaria

Extent of Covid-19 infection in Judea and Samaria

This past week the number of active cases in Judea and Samaria declined; 5,625 new cases were detected, down from 7,471 a week ago. As of December 28, 2020, the number stood at 11,322, down from 13,529 a week ago. There are 123 patients in ICUs, 29 on ventilators. During the past week 94 people died, down from 100 a week ago, bringing the total number of deaths to 992. In Judea and Samaria 3,305 tests were administered, with a positive infection rate of 22.3% (down from 23.3% on December 21). The PA reported 997 new cases in east Jerusalem. On December 28 there were 1,646 active cases in east Jerusalem, up from 1,515 a week ago. According to the Jerusalem municipality, the number of active cases was 1,398, up from 1,3838 a week ago.

• Mai al-Kayla, PA minister of health, expects the coronavirus infection to peak during the next two months, towards the end of February 2021. She said the ministry of health in Ramallah was prepared to deal with developments in the state of infection and that a plan had been formulated for opening new coronavirus wards in the hospitals and to increase the size of the ICUs (Facebook page of the ministry of health in Ramallah, December 27, 2020).
• Dr. Kamal al-Shakhra, responsible for public health in the ministry of health, said the epidemiological situation in the PA territories was very bad. He said many local residents did not abide by the limitations imposed by the government and violated the bans on movement between the districts. He added that many stores and other businesses remained open in violation of government orders. He said the number of new infections and of coronavirus-related deaths was high and that the percentage of positive test results fluctuated between 15% and 35% (al-Quds, December 26, 2020).
• Mai al-Kayla said that one measure to prevent the entrance of the coronavirus mutation into the Palestinian territories would be that every Palestinian returning from Britain, Holland, Spain and Australia would be tested. They would also have to remain in the quarantine facility in Jericho for 14 days (Facebook page of the ministry of health in Ramallah, December 23, 2020).

Covid-19 infection in Judea and Samaria (according to the PA)

The spread of Covid-19 infection (according to the PA)

Preparations for acquiring vaccines

• The PA is making urgent preparations for acquiring vaccines, following instructions from Mahmoud Abbas (Mahmoud Abbas’ Facebook page, December 22, 2020). According to the minister of health, the PA is in contact with a number of companies (Facebook page of the ministry of health in Ramallah, December 27, 2020).
• Dr. Kamal al-Shakhra, responsible for public health in the ministry of health, estimated the vaccines would be available in the PA within the coming two weeks. He said they were in contact with international pharma companies and with the W.H.O. to provide the vaccine as soon as possible. He added that they still did not know which vaccine they would get and the ministry of health was in contact with the four companies manufacturing the vaccine (al-Quds, December 26, 2020).

Damage to tourism

• Khaled al-Asili, minister of the Palestinian national economy, said the tourism industry was the sector hit hardest by the coronavirus. He said that beginning in June 2020 there had been an economic revival in a number of sectors in the Palestinian economy and it had returned to between 70% and 80% of its pre-coronavirus status quo (Palestinian TV, December 27, 2020).
• Tony Khashram, chairman of the foreign travel association, said the damage to the Palestinian tourist industry since the outbreak of Covid-19 had topped $1.5 billion. He said the tourist industry was the Palestinian economy’s most important branch and the one that had been hit hardest. He added that 32,000 tourism workers were without a job. He called on the PA to compensate any tourism worker who had been harmed and to provide tax cuts and other relief measures for Palestinian hotels (al-Hayat al-Jadeeda, December 28, 2020).

Geographic distribution of COVID-19 epicenters

Overview

The Nablus district still has the highest number of Covid-19 cases, with 3,564 new cases detected during the past week, down from 3,834 a week ago. According to ministry of health in Ramallah, the distribution of active cases by district, as of December 28, 2020, was Nablus, 3,834; Ramallah, 1,753; Hebron, 1,309; Jenin, 1,049; Tulkarm, 862; the villages around Jerusalem, 749; Bethlehem, 732; Qalqilya, 412; Salfit, 360; Tubas, 318; and Jericho, 214 (Facebook page ministry of health in Ramallah, December 28, 2020).

The distribution of active cases in the various districts

Nablus district

The Nablus district still has the highest number of Covid-19 cases in Judea and Samaria although the number declined somewhat. As of December 28 there were 3,564 active cases, down from 3,834 a week ago.

Number of active cases in the Nablus district

• Mai al-Kayla, PA minister of health, said the Red Crescent Hospital in Nablus would begin admitting Covid-19 patients during the first week of 2021. It has 70 beds, 20 of them in an ICU (Facebook page of the ministry of health in Ramallah, December 27, 2020).

Hebron district

In the Hebron district coronavirus infections again decreased. As of December 28 the number of active cases stood at 1,309, down from 1,710 a week ago. The Hebron district currently has the third highest number of cases in the PA territories.

Number of active cases in the Hebron district

Bethlehem district

There was a significant decrease in the number of active cases in the Bethlehem district. As of December 28 there were 732 active cases, down from 1,153 a week ago.

• Christmas events were held in Bethlehem without participants or the tourists that usually flood the city during the Christmas season.

Jenin district

The number of active cases in the Jenin district decreased this past week. As of December 28 there were 1,049 active cases, down from 1,753 a week ago.

• Senior figures in the Jenin district health system called the situation difficult, saying hospital bed occupancy is high (Wafa, December 22, 2020):
  • Mustafa Hamarsheh, medical director of the government hospital in Jenin, reported that 22 of the 25 beds in the Covid-19 ward in the hospital were occupied. In the ICU, all 11 beds are occupied. Six patients are hospitalized in the quarantine ward, where there are 15 beds. He voiced concern, saying that given the ongoing rise in infection and the infection of his medical staff, they will not be able to carry on much longer with the means they have at their disposal (Wafa, December 22, 2020).
  • Wissam Sabihat, head of the department of health in Jenin, said the ordinary wards are full and the ICUs are 95% full. He added that there are 1,623 active cases in the district, 41 of them hospitalized, but he estimated that the number of cases is three times what has been reported. He said the number of tests has been halved, from 1,200 per day to 600 per day, because local residents refuse to be tested. That is for a variety of reasons, he said, including the measures imposed by Israel preventing Palestinian workers who are sick, or who came into contact with people who were Covid-19 positive, to enter Israel (Wafa, December 22, 2020).
• The Palestinian police and the security forces operating in Jenin closed dozens of stores and issued citations to dozens of Palestinians not implementing the preventive measures decreed by the ministry of health (PA police website, December 2020). Several Palestinians were detained after they attacked Palestinian police and security force operatives who were trying to enforce preventive measures (PA police website, December 21, 2020).
• On December 20, 2020 the ministry of health in the Jenin district received a donation of medical equipment and PPE from the Korean Agency for International Cooperation (Facebook page of the governor of the Jenin district, December 20, 2020). According to the ministry of health, the equipment included surgical masks, gloves and ventilators, face masks and intubation equipment, and it is intended for personnel in the front line infirmaries combatting Covid-19 (Wafa, December 20, 2020).

The Qalqilya district

As of December 21 the number of active cases in the Qalqilya district continued declining, standing at 412, down from 585 a week ago.

• A number of government offices in the Qalqilya district closed because employees were detected with Covid-19. Rafi’ al-Rawajba, governor of the Qalqilya district, said 18 Covid-19 patients were hospitalized in Azoun, four in the ICU, and in the near future the hospital would receive an additional 30 beds (Wafa, December 21, 2020).
• The Palestinian police closed dozens of stores, restaurants and cafés, and issued citations to Palestinians who not employing preventive measures (website of the PA police, December 2020).

The Ramallah district

In the Ramallah district the number of active cases declined somewhat. The district now has the second highest number of cases in Judea and Samaria. As of December 28 the number of active cases stood at 1,753, down from 1,824 a week ago.

• Dr. Bassel Bawatna, director of the Hugo Chavez Hospital, said many Covid-19 patients suffer from serious symptoms that necessitate hospitalization. He said all the beds in the hospital are occupied. He added that there are 28 patients, eight in ICUs (Wafa, December 21, 2020).

The villages around Jerusalem

As of December 21 the number of active Covid-19 cases in the villages around Jerusalem was 749, down from 754 a week ago. Weddings and other mass events continue to be held, some of them, in ITIC assessment, by residents of east Jerusalem.

• Mai al-Kayla, PA minister of health, paid a visit to the villages around Jerusalem, including Abu Dis and al-Sawahra. She met with the heads of the local councils, the deputy governor of the PA’s Jerusalem district and local medical teams. She said the Jerusalem district received a great deal of attention from the Palestinian government, adding that Mahmoud Abbas had given instructions to provide the hospitals in the district with all the equipment necessary to combat the coronavirus (Facebook page of the ministry of health in Ramallah, December 22, 2020).

The East Jerusalem Neighborhoods

According to the PA, as of December 28, 997 new active cases were detected, down from 999 a week ago. The number of active cases was 1,646. According to the Jerusalem municipality, on December 28 the number of active cases was 1,398, up from 1,383 a week ago. The neighborhoods of Kafr ‘Aqab and Beit Hanina continue to have the highest number of active cases and the highest percentages of positive test results.

The number of active Covid-19 cases in east Jerusalem, according to the PA

The extent of Covid-19 infection in east Jerusalem, according to the Jerusalem municipality, December 13, 2020

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