The Spread of Covid-19 in Judea and Samaria (Updated to December 7, 2020)

Overview

• The situation in the Gaza Strip:
  • The sharp rise in the number of active Covid-19 cases in Gaza continues (10,647, up from 9,226 a week ago). The rate of positive test results round of escalation to approximately 38% (up from 30% a week ago). A senior medical figure in Gaza said the actual number of cases is far larger than the numbers publicly reported. The source predicted that the epidemic will peak during the second half of December 2020.
  • The lack of designated medical equipment has worsened. A spokesman for the ministry of health in Gaza said the central laboratory had stopped processing tests because they ran out of testing materials. Stopping or sharply decreasing testing means the extent of unidentified infection will increase. In addition, the lack of oxygen for patients on ventilators is increasing; drugs are running out and hospital beds are almost filled to capacity, especially beds for Covid-19 patients. That indicates further deterioration in the quality of the medical treatment for patients in general and Covid-19 patients in particular.
  • According to Israeli national information and knowledge center to combat Covid-19, the infection coefficient in the Gaza Strip (R) has been consistently >1 for almost two months.. At the end of November 2020 it set a new record of almost 1.5, that is, on average, every two people with Covid-19 infect three others.
  • However, despite the spike in the number of active cases, the Hamas administration still abstains from imposing a general lockdown. Instead, it has declared additional preventive measures, including a complete lockdown over the coming weekends; starting the nightly curfew at an earlier hour; closing the mosques, schools, universities and kindergartens; and preventing gatherings, including weddings and mourning tents.
• The situation in Judea and Samaria:
  • The sharp rise in the number of active Covid-19 cases continues. As of December 7, 2020, there were 14,210 active cases, up from 10,101 a week ago. Seventy-nine Palestinians died this past week, up from 44 a week ago. The rate of positive test results is between 20% and 30%, less than in Gaza but still high.
  • Nevertheless, the Palestinian Authority (PA) still abstains from imposing a general lockdown on Judea and Samaria. Instead, a series of new preventive measures was announced, including a full lockdown on four districts with a high rate of infection (the Nablus, Hebron, Bethlehem and Tulkarm districts). The night curfew continues and movement between districts has been banned for seven days.
  • The number of active cases also spiked in the east Jerusalem neighborhoods. According to the PA, as of December 7, 2020, there were 1,079 active cases, up from 799 a week ago. According to the Jerusalem municipality, there are 969 active cases. The neighborhoods with the largest numbers of cases are Bayt Hanina, A-Tor, the Old City and Kafr ‘Aqab. The rate of positive test results in those east Jerusalem neighborhoods is between 13% and 21% (according to the Jerusalem municipality).
  • Despite the Covid-19 crisis in the PA territories, Palestinians continue violating public health guidelines, in ITIC assessment, to a considerable extent. This past week the police and the Palestinian security services again closed various reception venues and businesses whose owners violated the guidelines. Hundreds of citations were issued to people who did not employ preventive measures. Weddings continue to be held in the villages around Jerusalem, including by residents of east Jerusalem, in ITIC assessment.

The Gaza Strip

Extent of the Covid-19 infection

In the Gaza Strip the number of new active cases continues rising sharply. Between November 30 and December 7, 2020, 4,946 new cases were detected, bringing the number of active cases to 10,647 (up from 9,226 a week ago); there have been 149 coronavirus-related deaths, up from 102 a week ago. Of the 350 Gazans who have been hospitalized, 147 are in serious or critical condition. The percentage of positive test results rose to 38% from 30% a week ago.

Positive daily test results

The increase of active cases in the Gaza Strip over the past month

• Majdi Zuheir, the deputy head of the general department for public health first aid, said that 90% of the populated areas of the Gaza Strip have been designated as red areas, and that every person has to consider someone he meets in the street as having Covid-19 (al-Ra’i news agency, December 4, 2020). Dr. Muhammad Abdallah Abd al-Mun’am, a specialist in respiratory diseases in the Shifaa Hospital in Gaza City, said that the actual number of people ill with Covid-19 is far greater than the numbers announced publicly. He said that if more PCR tests were given, a larger number of active cases would be found (Dunia al-Watan, December 4, 2020).
• Dr. Ashraf al-Qidra, spokesman for the ministry of health in Gaza, gave the following statistics for the incidence of Covid-19 patients in the Strip: Palestinians between 18 and 50 years of age account for 60% of all cases; people who became ill as a result of the crowded conditions in the markets, at weddings and in mourning tents account for 50% of the active cases; patients over the age of 50 or who suffer from chronic diseases account for 20% of the active cases; 75% of patients suffer from various symptoms of the disease and they are affected by the strength of their immune systems and the presence of underlying conditions. According to al-Qidra, this past week contact tracing revealed 17,000 people had been exposed to Covid-19. He said that according to statistic projections, the epidemic will peak in the Strip between December 15 and January 1, 2021. Therefore the immediate future will be the most dangerous because seasonal flu will also peak (Ma’an, December 3, 2020).

Difficulties facing the Gaza Strip’s health system

• The most pressing problem facing the health system is the lack of coronavirus testing materials. On December 6, 2020, Dr. Ashraf al-Qidra announced that the central laboratory had stopped coronavirus testing because it had run out of materials. He called on all agencies involved to intervene urgently to provide testing materials to support the work of the laboratory (Dr. Ashraf al-Qidra’s Twitter account, December 6, 2020).
• According toa report, the ministry of health in Gaza recently informed the ministry of health in Ramallah, the W.H.O. and other international organizations that the Gaza Strip had used almost all of its laboratory supplies but received no response. The ministry of health in Gaza claimed Israel is responsible, alleging (falsely) it does not permit the delivery of the supplies to the Gaza Strip. He said that if Israel does permit a delivery, it is of only small quantities which are sufficient for a few days. He added that changes were recently made in the testing protocols but now all testing has been stopped (Dunia al-Watan, December 6, 2020).
• Additional reports about the difficulties of the ministry of health in Gaza were the following:
  • Dr. Yusuf al-Akkad, director of the European Hospital, said the health system’s most serious challenge is providing oxygen for patients on ventilators. He said a number of mobile oxygen stations were brought in and there are now five, which provide oxygen for current patients, but if more patients arrive the challenge will be more serious (Dunia al-Watan, December 5, 2020).
  • Muneir al-Barash, head of the general department of pharmacology in the ministry of health in Gaza, said the ministry of health lacked 44% of the drugs it needed, 32% of the equipment and drugs necessary to combat Covid-19, 26% of basic medical services, such a emergency medicine, 61% of general health services and 48% of maternal and child health services (Sabaq24, December 6, 2020).
  • There is a lack of hospital beds in general and ICU beds in particular. Interviewed on December 2, 2020, Dr. Ashraf al-Qidra said 311 patients are hospitalized in the European Hospital and in quarantine centers, and they occupy 56% of the beds, while critically ill patients occupy 88% of the ICU beds in the Gaza Strip. He said only 20% of the beds for seriously and critically ill patients are available (Shehab, December 2, 2020). On December 3, 2020, he held a press conference where he said that 61% of the beds in quarantine wards were occupied, including by seriously and critically ill patents (Ma’an, December 3, 2020). He added that the ministry of health was making an effort to increase the number of ICU beds from 100 to 200 (al-Ra’i news agency, December 5, 2020).
  • Majdi Zuheir, the deputy head of the general department for public health first aid, said there was a lack of qualified, trained medical teams (al-Ra’i news agency, December 4, 2020). Dr. Yusuf al-Akkad, director of the European Hospital, said the number of medical personnel was small, adding that the ministry of health had trained dozens of doctors for ICUs, internal medicine and nursing, and that they were working day and night (Dunia al-Watan, December 5, 2020).

Continuing preventive measures

• Iyad al-Buzum, spokesman for the ministry of the interior in Gaza, said they had evaluated the situation and decided not to impose a general lockdown at this stage but that new restrictions would be imposed: as of December 5, 2020, all the mosques, schools, universities and kindergartens would be closed, with the exception of the 12^th grades and the day-care centers. There will be a general lockdown every weekend from December 11, 2020, until the end of December. The nightly curfew will begin at 18:30 instead of 20:00, as of December 5; all stores will close at 18:00. The weekly markets will not open and preventive measures will remain in place in the regular markets (especially preventing crowding). Enforcement of preventive measures will be increased by service providers in all sectors and businesses. The ban on gatherings will continue, including the ban on weddings and the erection of mourning tents (ministry of the interior in Gaza website, December 3, 2020).
• Tawfiq Abu Na’im, deputy minister of the interior, told al-Kofiya TV that imposing a general lockdown was still being discussed, but he added that “we are not close to a general lockdown.” He said that if the ministry of health says the situation is dangerous the ministry of the interior will impose a general lockdown. He said that the weekend general lockdown was recommended by the ministry of health (Watania news agency, December 7, 2020).

Gazans ignore public health guidelines

   
Right: Palestinians crowding at the entrance of the Palestinian Islamic Bank in the Nuseirat refugee camp. Left: Palestinians crowding at the entrance to (apparently) the Palestinian Islamic Bank in Rafah (Twitter account of journalist Muhammad Qushta from Rafah, December 3, 2020). The crowding was apparently caused by an announcement on December 3, 2020, from the PA ministry of the treasury about the payment of the salaries of public sector employees.

Foreign aid for Gaza

• On November 29, 2020, the W.H.O. delivered 15 ventilators to the Gaza Strip, funded by Kuwait (Facebook page of the W.H.O. representative in the territories, November 30, 2020).

Judea and Samaria

Extent of Covid-19 infection in Judea and Samaria (updated to December 7, 2020)

This past week the number of active cases in Judea and Samaria continued to spike with the detection of 10,475 new cases, up from 5,948 a week ago. As of December 7, 2020, the number of active cases in Judea and Samaria stood at 14,210, up from 10,101 a week ago. Seventy-six patients are in ICUs, 18 of them on ventilators. Seventy-nine people died this week, up from 44 last week. On December 7, 2020, the number of tests administered in Judea and Samaria was 6,200, with a positive return rate of about 20%. According to the ministry of health in Ramallah, on December 7, 2020, there were 1,079 active cases in east Jerusalem. According to the Jerusalem municipality, the number of active cases was 969.

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

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

New PA preventive measures

• PA Prime Minister Muhammad Shtayyeh told a press conference held before the beginning of the weekly government meeting in Ramallah on December 7, 2020, about a series of new preventive measures (Wafa, December 7, 2020). They included the following:
  • A seven-day general lockdown will be imposed on the Nablus, Hebron, Bethlehem and Tulkarm districts beginning at 19:00 on December 10, year. All stores and services will close, with the exception of vital services. Schooling in the aforementioned districts will be distance, and workers will remain in their places of employment during the lockdown.
  • During the lockdown (December 10 to 17) movement between districts will be forbidden with the exception of the transport of agricultural yields, services and food.
  • Government institutions, NGOs and private institutions in all districts will switch to emergency operations. During the general lockdown the number of employees at any given time will not exceed 30% of the work force.
  • The night curfew will continue for ten days in all districts.
  • All prayers in all districts will be held at home.
  • Weddings, mourning tents and all other forms of gathering are banned in all districts.
• The head of the preventive medicine department in ministry of health in Ramallah reported that the ministry’s epidemiological committee recommended to the PA government that it impose a general lockdown on the West Bank for a period of two weeks, with an option to extend it. That was because many Palestinians do not follow the ministry of health’s guidelines. The government is expected to make a decision about the recommendation at its meeting on December 7, 2020 (Dunia al-Watan, December 6, 2020).

Geographic distribution of COVID-19 epicenters

Overview

The Nablus district still has the largest number of Covid-19 cases. During the past week the rise in infections spiked, with 3,675 new cases, up from 2,964 a week ago. The distribution of active cases by district, as of December 7, 2020, was the following: Nablus, 3,675; Bethlehem, 2,030; Hebron, 1,920; Jenin, 1,616; Ramallah, 1,438; Tulkarm, 1,048; Qalqilya, 728; Tubas, 548; Salfit, 545; the villages around Jerusalem, 4989; and Jericho, 1829.

The distribution of active cases in the various districts

Nablus district

The Nablus district still has the steepest rise in Covid-19 infection with 3,675 new cases this past week, up from 2,964 a week ago.

Number of active cases in the Nablus district

Hebron district

In the Hebron district Covid-19 infections continue. As of December 7, 2020, the number of active cases stood at 1,920, up from 1,082 a week ago. The Hebron district currently has the third largest number of cases in the PA territories.

Number of active cases in the Hebron district

Bethlehem district

This past week the sharp rise in the number of active cases continued in the Bethlehem district, whose number is second to that of the Nablus district. As of December 7,2020, there were 2,030 active cases, up from 1,263 a week ago.

• On December 5, 2020, a ceremony attended by only a few people was held to light the Christmas tree in front of the Church of the Nativity. A few priests and nuns attended and the number of participants was limited. PA Prime Minister Muhammad Shtayyeh participated via video conference.

 
Right: The small ceremony held for lighting the Christmas tree in front of the Church of the Nativity, Bethlehem. Left: PA Prime Minister Muhammad Shtayyeh watches the tree-lighting via video conference (Wafa, December 5, 2020).

Jenin district

The sharp rise in the number of active cases in the Jenin district continues. As of December 7, 2020, there were 1,616 active cases, up from 1,036 a week ago. The Palestinian police in Jenin reported that over the weekend they had closed 132 businesses and two reception venues. In addition, they gave more than 480 citations to people who did not take preventive measures as directed by the ministry of health in Ramallah (Palestinian police Facebook page, December 2 and 4, 2020).

• On December 2, 2020, the Jenin district governor attended an emergency meeting in the government hospital in Jenin to discuss the hospital’s ability to admit the growing number of Covid-19 patients (Facebook page of the Jenin district governor, December 2, 2020). After the meeting he said the hospital could not admit more Covid-19 patients. He said the number of Covid-19 patients had multiplied by three and was now 1,200. The hospital director said they were cancelling planned surgeries as of this week. Hospital visiting hours were also cancelled (Wafa, December 3, 2020). Dr. Naji Nizal, head of the hospital department in the ministry of health in Ramallah, said the wards in the hospitals and medical centers in Jenin were full, which meant that all planned surgeries in all hospitals would be cancelled (Wafa, December 5, 2020).
• Akram al-Rajoub, the governor of the Jenin district, decided to impose a lockdown on several towns and villages, among them Qabatiya and Arabeh. All the institutions, schools, banks and public institutions will be closed and there will be no public transportation; stores will be partially open (Facebook page of the Jenin district governor, December 1, 2020).

The Qalqilya district

There was a significant rise in the number of active cases in the Qalqilya district. As of December 7, 2020, the number of cases was 728, up from 632 a week ago. The Palestinian police reported that during the past week they had closed 68 stores in Qalqilya and in several towns (Palestinian police Facebook page, December 2 and 4, 2020). The governor of the Qalqilya district suspended studies in a number of high schools where active cases of Covid-19 were verified.

The Ramallah district

The number of active cases continues rising, and as of December 7, 2020, stood at 1,438, up from 1,013 a week ago.

•  On December 4, 2020, the Palestinian media reported the death of a Palestinian youth during a clash with Israeli security forces northeast of Ramallah. On the same day a mass funeral was held for the youth in his village, al-Mughayir. Many mourners were without masks, violating the public health guidelines issued by the ministry of health in Ramallah (Wafa, December 5, 2020).

 
Right: The mass funeral held for Ali Abu Alia, from the village of al-Mughayir near Ramallah. Left: The funeral procession in al-Mughayir (Wafa, December 5, 2020).

The villages around Jerusalem

As of December 7, 2020, the number of active Covid-19 cases in the villages around Jerusalem was 498, up from 299 a week ago. Despite the sharp rise, violations of the health guidelines continue, mainly in the reception venues and businesses. It can be assumed in some of the reception venues events are held by residents of east Jerusalem.

• On December 4, 2020, Palestinian police, in conjunction with the Palestinian security services, dispersed five weddings in al-E’izariya and Abu Dis. They also closed many stores whose owners violated the state of emergency declared by the PA government (Palestinian police website, December 5, 2020).
• The Palestinian police, supported by the security services, closed 45 stores northwest and southeast of Jerusalem while checking how strictly the local residents observed the 19:00 curfew (Palestinian police website, December 1, 2020).

Foreign aid for the PA

• On November 30, 2020, a ceremony was held for the delivery of medical equipment from Turkey to combat Covid-19. Present were the Palestinian minister of health and foreign minister, the Turkish consul in the PA and the director of the Palestinian branch of Turkish organization TIKA. Mai al-Kayla, PA minister of health, representing Mahmoud Abbas and PA Prime Minister Muhammad Shtayyeh, thanked the Turkish president for the aid and for Turkey’s support of the Palestinians (Facebook page of the Palestinian minister of health, November 30, 2020).

 
The ceremony held for the delivery of medical equipment from Turkey
(Facebook page of the Palestinian minister of health, November 30, 2020).

•  On November 30, 2020, the Palestinian ministry of health received 21 ventilators from the W.H.O., funded by Kuwait. Mai al-Kayla, PA minister of health, said an additional shipment of 20 ventilators would arrive later and be transferred to the Gaza Strip (ministry of health in Gaza Facebook page, November 30, 2020).

The East Jerusalem Neighborhoods

The number of active cases in the east Jerusalem neighborhoods continues rising sharply. According to the PA, as December 7, 2020, there were 1,079 active cases, up from 799 a week ago. According to the Jerusalem municipality the number of active cases stood at 969 on December 6, 2020.

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, November 29, 2020

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