The Spread of Covid-19 in Judea and Samaria (Updated to November 23, 2020)

Overview

• In the Gaza Strip the sharp rise in the number of active Covid-19 cases continues. As of November 23, 2020, the number stood at 6,004, up from 3,366 a week ago. The number of serious and critical cases has also risen, including among young people. Most of the districts in the Gaza Strip have now been classified red. Senior figures in the public health system warn that the hospitals are approaching the limits of their capabilities. They also complain of a lack of designated medical equipment (ventilators, drugs and stations to fill oxygen cylinders). Senior health officials warned that in the near future the public health system is liable to collapse and may lose its ability to care for all the serious and critical cases.
• The Hamas administration continues to combat the spread of the virus by increasing the severity of preventive measures and escalating punishments (such as thirty days imprisonment for violating the terms of home isolation). Meanwhile, senior figures in the public health system repeatedly warn that a continued rise in infection will lead to imposing a general lockdown.
• Hamas spokesmen blame Israel for making it difficult to deliver medical equipment and drugs to the Gaza Strip. Hamas spokesman Fawzi Barhoum also claimed that Israel would bear responsibility for the consequences of Israel’s alleged “continuing siege, escalation and aggression.” Coronavirus-related accusations and threats against Israel are an ongoing theme from senior figures in Hamas and Gaza’s health system.
• In Judea and Samaria as well the sharp rise in the number of active Covid-19 cases continues. During the past week 5,240 new active cases were detected, up from 2,811 a week ago. As of November 23, 2020, there were 7,009 active cases, up from 4,897 a week ago. There are currently 52 ICU patients, nine on ventilators. Fifty-nine Palestinians died this past week. As the numbers climb, the Nablus district continues as the district with the largest number of Covid-19 cases. Infection is also on the rise again in the Hebron district.
• Given the sharp rise in coronavirus infection the Palestinian Authority (PA) has imposed stricter preventive measures. The entire PA will be on full lockdown over the weekend (from Friday, November 27, 2020, to Sunday, November 29, 2020). A 14-day nightly curfew has also been imposed throughout the PA territories, between 19:00 in the evening and 06:00 the following morning.
• Despite the sharp rise in coronavirus infection and the increasing severity of preventive measures, the mass violations of health orders continue. That is especially true of wedding,. which continue to be held in the reception venues in the Jenin district and in the villages around Jerusalem, also by Israeli Arabs. In the village of Barta’a al-Sharqia all the schools have been closed because of the number of Covid-19 cases detected among the students.

The Gaza Strip

Extent of the Covid-19 infection

In the Gaza Strip the number of new active cases continues rising sharply. Between November 17 and 23, 2020, 4,472 new cases were detected (about 630 new cases a day, with a spike of 891 on November 21, 2020), compared with 2,245 a week ago. As of November 23 2020, the number of active cases was 6,004 (up from 3,366 a week ago); there have been 69 coronavirus-related deaths, up from 48 a week ago; and of the 268 Gazans who have been hospitalized, 92 are in serious or critical condition.

The increase of active cases inside the Gaza Strip over the past week

• Among the newly-infected are Yunis al-Astal, a Hamas-faction member of the Palestinian Legislative Council, and his family (Dunia al-Watan, November 20, 2020); and Khamis al-Najar, also a member of the Legislative Council. The ministry of health in Gaza reported that the two are in stable condition in the European Gaza Hospital (Dunia al-Watan, November 22, 2020).
• Senior figures in the ministry of health in Gaza warned of a worsening situation:
  • Dr. Fathi Abu Warda, advisor to the minister of health, reported that most of the areas in the Gaza Strip have been designated as red (palsawa, November 21, 2020).
  • Dr. Abd al-Nasser Sabah, director of the WHO office in Gaza, said that between 21% and 29% of the tests administered to detect Covid-19 came back positive. He said it reflected the public’s violations and lack of awareness of the importance of taking preventive measures (al-Ra’i news agency, November 22, 2020).
  • Dr. Iyad Abu Karash, head of critical medicine in the ministry of health, said the number of seriously ill patients had risen. He said that in the past 90% of the cases were mild, but now more than 40% are very serious or critical. He said that indicated the disease had peaked with the coming of winter (Palestine Online, November 21, 2020).

The public health system in Gaza’s difficulties in coping with the rise in infection

• The sharp rise in the number of Covid-19 cases is a great burden on the public health system in the Gaza Strip, which is approaching the limits of its ability to care for patients. Abd al-Ra’waf al-Mana’ma, a member of the advisory committee for combatting Covid-19 in the Gaza Strip, said coronavirus patients are using 79 of the public health system’s 100 ventilators. He said that within ten days the health system would not be able to deal with the rise in the number of cases. It is possible, he said, that there will be no more room for patients in ICU wards. He added that the rate of death among coronavirus patients is 0.05%, but was liable to rise. Abd al-Nasser Sabah, responsible for medical emergencies in the WHO, warned that within a week the Gaza Strip could lose its ability to treat serious and critical cases (Reuters, November 22, 2020).
• On November 21, 2020, Yusuf al-Akkad, director of the European Gaza Hospital, the main epidemiological center in the Gaza Strip, said 64 patients were hospitalized in the ICU and in permanent need of oxygen, among them young people. He said the hospital was almost at full capacity, and that every day people with serious symptoms arrived. He warned that if the rise in infection continues, they may quickly reach a stage where they will be forced to decide whom to treat (Palestine Online, November 21, 2020).
• Another problem is providing patients with oxygen. According to Dr. Iyad Abu Karash, head of critical medicine in the ministry of health, the average intubated patient needs five liters of oxygen a minute, but a Covid-19 patients needs more than 20 liters a minute. He said the ministry of health is in contact with donor institutions to acquire mobile oxygen stations. He said that without oxygen, the conditions of the Covid-19 patients would deteriorate and they could raise the death rate to 80% of the patients in ICUs. (Palestine Online, November 21, 2020).

   
Right: A mobile station for filling oxygen cylinders in the European Gaza Hospital (Facebook page of the European Gaza Hospital, November 18, 2020). Left: Delivery of oxygen cylinders for the European Gaza Hospital, November 21, 2020.

Preparing more hospitals for Covid-19 patients and a change in hospitalization policy

• The health system is preparing for a massive influx of Covid-19 cases by expanding the capabilities of existing designated hospitals and preparing coronavirus wards and medical staffs in additional hospitals. According to Dr. Iyad Abu Karash, head of critical medicine in the ministry of health, medical teams in various hospitals in the Gaza Strip will enlarge the number of bed in ICUs to 180. He warned that might not be sufficient if the number of Covid-19 cases and hospitalizations continue spiking (Palinfo, November 19, 2020).
• In the meantime, the ministry of health in Gaza announced a change in hospitalization policy: Covid-19 patients will self-isolate at home where medical teams will visit and treat them. According to Dr. Mu’tassem Salah, director of quarantine centers in the Gaza Strip, doctors will visit patients on the second or third day to evaluate their condition and examine if their homes are suitable for self-isolation. They will visit again at the end of the quarantine period to verify that the patient is free of symptoms (Dunia al-Watan, November 16, 2020).

Increasing the severity of preventive measures

• The Hamas administration still enforces only local preventive measures and abstains from imposing a general lockdown. The ministry of the interior announced the closing of stores and businesses, etc., at 17:00 every day (al-Ra’i news agency, November 17, 2020). The authority for restaurants, hotels and tourist services announced that the government committee for combatting the Covid-19 crisis has allowed restaurants to remain open until 20:00. They can provide on-site service until 17:00, at which time they only provide take-out food (Facebook page of the authority for restaurants, hotels and tourist service in the Gaza Strip, November 19, 2020).
• Senior officials in the public health system in the Gaza Strip warn that a continued rise in infection will lead to the imposition of a general lockdown. According to Majdi Zuheir, head of the department of preventive medicine in the ministry of health in Gaza, if the curve continues rising, within a few days a full lockdown will be imposed (Dunia al-Watan, November 17, 2020). According to Dr. Rami Abadla, had of the department of infectious diseases in the ministry of health, if the number of new active cases rises and the ministry of health is incapable of dealing with them, there will be an unequivocal recommendation to impose a full lockdown on the Gaza Strip. Salama Maarouf, chairman of the government media information bureau in Gaza, said that if they reach a state where the ministry of health is unable to deal with the number of cases, a full lockdown is the only possible option (al-Ra’i news agency, November 17, 2020). Musa al-Sumak, deputy chairman of the government monitoring committee in Gaza, said delaying a full lockdown is meant to prevent another blow to the economy, but added that if the number of active cases rises, the government will obviously decide on a lockdown (Dunia al-Watan, November 18, 2020).

Public disregard of public health orders

• Despite the increasing severity of the preventive measures, the enforcement of public health orders and the threats of a full lockdown, apparently many Gazans ignore preventive measures. That can be seen from the statements of senior figures in Gaza, who implore residents to follow the public health guidelines. Every day the ministry of the interior in Gaza reports the detention of people who have contracted coronavirus and those who came in contact with them after they violated the conditions of their self-isolation. The ministry also reports the dispersal of crowds at weddings and in mourning tents, the detention of pedestrians who violated the nightly curfew, the closing of dozens of businesses and the issuing of hundreds of tickets to the drivers of cars whose passengers did not take preventive measures or who violated the curfew (website of the ministry of the interior in Gaza, November 21, 2020).
• The ministry of the interior therefore announced an increase in the severity of punishment, including imprisonment, of Gazans who do not take preventive measures, and especially those who violate self-isolation regulations. Anyone who comes in contact with an active Covid-19 case and violates the terms of self-isolation will be sent to prison for 30 days. Anyone with an active Covid-19 case who violates the terms of self-isolation will be send to prison for three months. The ministry of the interior also called on all store owners, shopping malls and service facilities to insist their employees and clients take preventive measures, wear masks and avoid crowding. The ministry stressed that the 20:00 curfew is still in force, and it is still forbidden to hold weddings and erect mourning tents (website of the ministry of the interior in Gaza, November 19, 2020).

Foreign aid for the Gaza Strip

• Dr. Ashraf al-Qidra, spokesman for the ministry of health in the Gaza Strip, said that in addition to the routine lack of drugs and medical equipment, they now have to cope with an unprecedented scarcity of drugs, including those for treating Covid-19. He said they were in contact with outside agencies to meet Gaza’s medical needs (al-Ra’i news agency, November 20, 2020).
• Dr. Fathi Abu Warda, advisor to the minister of health, said the PA would send a number of trucks to the Gaza Strip with medical equipment, including 15 ventilators (Sabaq24, November 22, 2020). Dr. Abd al-Nasser Sabah, head of the WHO’s Gaza office, said the WHO had delivered 15 ventilators to Gaza (al-Istaqlal, November 22, 2020). The WHO also delivered test kits sufficient for administering 4,800 Covid-19 tests (Facebook page of the WHO office in the territories November 17, 2020).

Accusations of Israeli difficulties

Senior Hamas figures accused Israel of delaying the delivery of drugs and medical equipment to Gaza. The Dunia al-Watan website, quoting “a UN source,” reported that Hamas had asked mediators to exert pressure on the Israeli government to deliver 40 ventilators to the Gaza Strip, and even said they had to arrive by this week (Dunia al-Watan, November 17, 2020).

• Senior Hamas figures had the following to say on the subject:
  • Bassem Na’im, a member of the Hamas bureau for international information, said the ministry of health in Gaza was facing two obstacles in combatting the coronavirus. The first was how to acquire the equipment necessary in light of the rise in the rate of infection. The second, he said, was Israel’s delaying tactics preventing the delivery of the drugs the Gaza Strip needed. He said they were in contact with international institutions dealing with the Palestinian cause in general and with humanitarian and medical matters in particular, and that often they had to overcome feeble Israeli claims, such as security or the procedures necessary for delivering medical equipment (al-Ghad TV website, November 22, 2020).
  • Hamas spokesman Fawzi Barhoum issued an announcement after the rocket fire from the Gaza Strip on November 21, 2020 claiming Israel prevents the delivery to Gaza of medical equipment and supplies for combatting Covid-19. Therefore, according to the announcement, Israel has to bear all the consequences of the continuation of its [alleged] “siege, escalation and aggression” (Hamas Telegram channel, November 22, 2020)

Judea and Samaria

Extent of Covid-19 infection in Judea and Samaria (updated to November 23, 2020)

This past week the number of active cases in Judea and Samaria continued rising with the detection of 5,240 new cases, up from 2,811 a week ago . As of November 23, 2020, the number of active cases in Judea and Samaria stood at 7,009, up from 4,897 a week ago. Fifty-two patients are in ICUs, nine of them on ventilators. Fifty-nine people died. According to the PA, 397 new cases were reported in the east Jerusalem neighborhoods, up from 296 a week ago. As of November 23, the number of active cases stood at 543, down from 620 a week ago. On November 22, 2020, the number of tests administered in Judea and Samaria was 3,066, with a positive return rate of 23.03%. On November 21, 2020, the number of tests administered was 2,039, and the positive return rate was 29.01%.

Covid-19 infection in Judea and Samaria since October 10, 2020

Given the rise in infection, PA Prime Minister Muhammad Shtayyeh announced that in coordination with instructions from Mahmoud Abbas, a full lockdown would be imposed on the PA from the morning of Friday, November 27, 2020, until Sunday, November 29, 2020. All stores will be closed with the exception of bakeries and pharmacies. A nightly curfew will be imposed from 19:00 until 06:00 for 14 days (Facebook page of the ministry of health in Ramallah, November 23, 2020).

• Dr. Kamal al-Shakhra, so for the PA ministry of health, warned that the number of Covid-19 cases would double with the beginning of winter and another wave of the virus if the Palestinian public does not obey the health rules and regulations, and continues participating in social events. He said in recent days the ministry of health increased the number of Covid-19 tests (Facebook page of the ministry of health in Ramallah, November 21, 2020). In the meantime the ministry of health expanded the information it provides to the Palestinian public by issuing short videos and using its Facebook page to post instructions to wear masks, employ preventive measures and maintain social distancing (Facebook page of the ministry of health in Ramallah, November 17, 2020.

Geographic distribution of COVID-19 epicenters

Overview

The Nablus district still has the steepest rise of Covid-19 infection, with 2,233 new cases this past week, up from 1,654 a week ago. Infection in the Hebron district has begun climbing again. The distribution of active cases in Judea and Samaria (7,009), by district, as of November 23, 2020, was the following: Nablus, 2,233; Bethlehem, 1,072; Hebron, 750; Ramallah, 679; Jenin, 617; Qalqilya, 385; Tulkarm, 383; Tubas, 261; the villages around Jerusalem, 228; Salfit, 202; and Jericho, 199.

The distribution of active cases in the various districts

Nablus district

The Nablus district still has the steepest rise in Covid-19 infection with 2,233 new cases this past week, up from 1,654 a week ago. On November 16, 2020, a nightly curfew was imposed between 19:00 and 06:00. On November 22, 2020, Ibrahim Ramadan, the Nablus district governor, announced the curfew would be extended by an additional 14 days. A full lockdown was imposed on a number of villages where Covid-19 cases were detected (Facebook page of the Nablus district governor, November 22, 2020).

• Dr. Dina Abu Jabr, head of the ICU ward in the al-Najah Hospital in Nablus, said the ICUs in all the district hospitals could no longer admit patients. She warned that there would not be enough ventilators and it would be necessary to prioritize patients (Shehab, November 21, 2020).

Number of active cases in the Nablus district

Hebron district

The Hebron district (which formerly had the largest number of active Covid-19 cases), is once again seeing a rise in infection, after several weeks when the numbers declined. As of November 23, 2020, the number of active cases stood at 750, up from 416 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

Jenin district

This past week the sharp rise in the number of active cases in the Jenin district continued. As of November 23, 2020, there were 617 active cases, up from 281 a week ago. The districts authorities currently impose only local lockdowns. Despite the rise in the extent of coronavirus infection, Palestinians continue holding large weddings where preventive measures are ignored.

• The emergency committee for combatting Covid-19 in Barta’a [al-Sharqia] announced the closing of the town’s schools after a number of students were found to be infected (Facebook page of the Barta’a municipality, November 18, 2020). The police broke up three wedding parties in the Jenin district (website of the PA police, November 21, 2020). Note: Israeli Arabs from nearby Wadi ‘Ara hold weddings in Barta’a al-Sharqia.

   
Right: A wedding in the village of Ra’i (Facebook page of Rotana Recording from Ra’i, November 19, 2020) Right: A wedding in the village of Yamun (Facebook page of alyamun.alhabeba, November 21, 2020).

Qalqilya district

As of November 15, 2020, the number of verified Covid-19 cases in the Qalqilya district rose to 385, up from 290 a week ago.

• Rafi’ Rawajba, the governor of the Qalqilya district, met with the clerics who deliver sermons and the imams of the district mosques and called on them to raise the level of public awareness to the dangers of Covid-19 and the need to strictly follow the preventive measures of the ministry of health (Facebook page of the Qalqilya district governor, November 18, 2020). The districts department of education decided to close the schools and kindergartens in one of the villages in the southern part of the district because active cases had been detected (Ma’an, November 19, 2020). The police and security services broke up three wedding parties in the district (website of the PA police, November 15, 2020).

The villages around Jerusalem

As of November 23, 2020, the number of active Covid-19 cases in the villages around Jerusalem rose to 228, up from 94 a week ago. This past week as well, weddings were held in the villages around Jerusalem. Presumably some of the guests came from east Jerusalem.

The East Jerusalem Neighborhoods

According to the PA, as of November 23, 2020, there were 397 new cases, bringing the number of active cases to 543, down from 620 a week ago.

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

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

Foreign Aid for the Palestinian Authority

• Given the alarming rise in Covid-19 infection, the ministry of health in Ramallah held a number of activities for professional training and procurement:
  • Mai al-Kayla, PA minister of health, and representatives from the ministry of health in Ramallah met with a delegation of doctors from Russia who specialize in treating Covid-19 patients. She said a delegation of specialists had arrived and would remain in the region for two weeks to help Palestinian medical teams treat Covid-19 patients (Wafa, November 16, 2020).
  •  The ministry of health held a course for treating Covid-19 patients, with the help of the WHO and the Augusta Victoria Hospital in east Jerusalem. Sixty doctors and first aid medical staff participated. According to an announcement the ministry will hold more courses for training 300 additional doctors and medical staff (Facebook page of the ministry of health in Ramallah, November 21, 2020).
  • Mai al-Kayla held a meeting of the PA’s national committee for combatting Covid-19. The meeting was attended by representatives of the WHO, UNRWA and UNICEF. They discussed the issue of the PA’s acquisition of anti-Covid-19 vaccines (Facebook page of the ministry of health in Ramallah, November 20, 2020).

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