The Gaza Strip has been under an Israeli blockade since the militant group Hamas seized control in June 2007. What gets in and out of Gaza, what has been the impact of the restrictions, and what has changed since the truce between Israel and Hamas in June 2008?
OVERVIEW For the past year, Gaza's 1.5m people have been relying on, on average, less than a fifth of the volume of imported supplies they received in December 2005. Some weeks significantly less than that has arrived.
Only basic humanitarian items have been allowed in, and virtually no exports permitted, paralysing the economy. Reduced fuel supplies and lack of spare parts have had heavy knock-on impacts on sewage treatment, waste collection, water supply and medical facilities.
In the wake of the Hamas takeover, Israel said it would allow only basic humanitarian supplies into the Strip. No specific list of what is and is not classed as humanitarian exists, although aid agencies say permitted items generally fall into four categories - human food, animal food, groceries (cleaning products, nappies etc) and medicines.
In September 2007, the Israeli government declared the Strip a "hostile entity" in response to continued rocket attacks on southern Israel, and said it would start cutting fuel imports. Israel maintains the blockade has at no point caused a humanitarian crisis - but in early 2008, a group of aid agencies described the situation as exactly that, and the worst situation in the strip since Israel occupied it in 1967.
FOOD About three-quarters of Gaza's residents rely on some form of food aid. Aid agencies operating in Gaza say they have largely been able to continue to transport basic supplies such as flour and cooking oil into the territory - except during a few short periods when all the crossings have been closed. Israel says it only closes crossings in response to Palestinian militant attacks or for other security reasons.
GAZA CROSSING POINTS
1. Erez: Closed to all but diplomats, aid workers and medical cases with special permits. Hit by mortars and rockets more than 200 times in last year (IDF).
2. Nahal Oz: Fuel crossing - closed for a few days in April 2008 after attack on nearby fuel depot
3. Karni: Main commercial crossing. Currently closed apart from conveyor belt for grain and animal feed. Israel says closure is because coordination is required to operate it and this cannot take place with Hamas.
4. Sufa: Small crossing, currently used for all truck deliveries
5. Kerem Shalom: Closed since 19 April suicide attack damaged crossing and injured 13 soldiers (IDF)
6. Rafah: Crossing to Egypt, currently closed. A 2005 agreement to allow Egypt and the PA to manage it with EU monitors no longer operating. The crossing is now controlled by Egypt and Hamas. Special cases, usually medical, are sporadically allowed through. Hundreds of thousands of people are thought to have crossed when it was breached in January 2008.
While most basic foodstuffs have generally been allowed into Gaza, a joint survey by three UN agencies in May 2008 found all Gaza retailers had run out of flour, rice, sugar, dairy products, milk powder, and vegetable oil on at least three occasions since June 2007.
Some 700,000 people rely on food aid from the UN agency for Palestinian refugees Unrwa for their staple foods. The rations provide about two-thirds of their daily nutritional needs, and must be supplemented by dairy products, meat, fish and fresh fruit and vegetables bought on the open market.
While availability of some of these has dropped - for example, according to the UN, commercial food imports were less than half the need in December 2007 - the main problem for Gazans is paying for them.
The bureaucracy of the import process and fuel shortages for transport, together with rising global prices, have pushed up costs, at the same time as the decline of the economy and rising unemployment have squeezed household budgets.
The UN survey found more than half Gaza's households had sold their disposable assets and were relying on credit to buy food, three-quarters of Gazans were buying less food than in the past, and almost all of them were eating less fresh fruit, vegetables and animal protein to save money.
And some items, the report said, including baby food, olive oil, nuts, chocolate, spices, juices and carbonated drinks had been in short supply since the early days of the closure.
Israel says food imports have generally been restricted by its ability to continue to operate the crossings in the face of Palestinian attacks targeting them, rather than Israeli imposed limits on any particular products.
FUEL AND POWER
Israel began restricting fuel imports in late October 2007. As well as shortages for drivers, many of whom have begun running their vehicles on cooking oil, the consequences have been far reaching:
Gaza's electricity supply is made up of 120MW from Israel, 17MW from Egypt and 55MW from an EU-run power plant in Gaza. The plant has been receiving only 2.2m litres of industrial diesel a week, but could generate 80MW if this was increased to 3.15m. It has also shut down completely twice. Most parts of Gaza have been receiving only 19-20 hours electricity supply. However, six weeks into the truce, fuel deliveries had increased a little - enough to allow the plant to generate 65MW.
Power cuts and shortages of fuel for back-up generators have meant Gaza's three sewage plants have been unable to secure the 14 days uninterrupted power supply required to treat sewage. Gaza's sewage treatment body has had less than 40% of the fuel it needs for much of the past year, and estimates it has been releasing 50-70m litres of raw or poorly-treated sewage into the sea daily during 2008.
Aid agencies say water pumping stations have also struggled with power and fuel shortages, as well as a lack of spare parts. In May, 15% of people had access to water 4-6 hours a week, 25% had it every four days, and 60% had it every other day.
70% of agricultural water wells require diesel for their pumps and many farmers have lost crops due to lack of irrigation, according to aid agencies. Other food production has also been affected - for example, rising fishermen's fuel costs pushed up the price of sardines, and one poultry farmer had to slaughter 165,000 chicks because he did not have the fuel for the incubators to keep them alive.
In January 2008, Israel's Supreme Court dismissed a challenge by human rights groups to the practice of restricting fuel supplies.
The court set minimum thresholds that fuel deliveries should not fall below - compared with before the restrictions, these were 63% of industrial diesel supplies, 18% of petrol and 57% of diesel imports.
But figures monitored by international agencies show fuel deliveries dropped even below these minimums at several points in the first half of 2008.
Israel has also closed off fuel supplies completely in response to specific attacks - once to a Palestinian militant attack on a fuel depot near the Nahal Oz fuel crossing point, another to mortar attacks on a crossing itself. Both times the UN has come close to suspending food aid deliveries.
The first time the power plant was shut down, in January 2008, Israel said there was enough fuel in Gaza and accused Hamas of faking a crisis, but officials from the EU, which runs the plant, said at the time that fuel supplies were "very low".
Israel has also accused Hamas of exacerbating fuel shortages, as fuel workers have at times refused to distribute any fuel in protest at the limited levels of imports.
OTHER IMPORTS
Few items other than food and medicine have entered Gaza in the past year, according to aid agencies. Restrictions on construction materials, particularly cement, and spare parts for machinery have taken a heavy toll on projects ranging from water treatment to grave digging.
Israel says many of these items are considered "dual use" and could be used for weapons manufacture. There are concerns, for example, that water pipes and fertiliser could be used to make rockets, and cement used for constructing smuggling tunnels.
Unrwa says a lack of construction materials have prevented it providing accommodation for 38,000 people living in inadequate conditions
All factories making construction materials have shut down (13 making tiles, 30 concrete, 145 marble and 250 making bricks)
The construction and maintenance of roads, water and sanitation infrastructure, medical facilities, schools and housing/re-housing projects have largely been on hold.
Lack of paper and printing materials meant school books were distributed four months late for the 2007-8 school year, Unrwa says, although Israel says it has facilitated access for school supplies and blamed delays on the Palestinian side.
Small amounts of cement and spare parts for specific projects have been allowed in at certain points during the year. In the six weeks after the truce, a limited number of trucks of cement and gravel entered Gaza, as well as a few shipments of clothes, shoes and refrigerators.
EXPORTS
The closures have devastated the private sector of Gaza's economy. Nothing, apart from a small number of trucks of strawberries and flowers, has been exported since June 2007.
Combined with the lack of raw materials, and agricultural inputs such as fertilisers, this has left approximately 95% of Gaza's industrial facilities closed or operating at minimal levels.
Before the closure, up to about 750 trucks of furniture, food products, textiles and agricultural produce left Gaza each month. This was worth half a million US dollars a day.
By December 2007, 75,000 of Gaza's 110,000 private sector workers had been laid off and 3,500 of its 3,900 factories had closed, according to a UN report.
Some 25,000 tonnes of potatoes and 10,000 tonnes of other crops have perished or been sold at a fraction of their value, it said. Farmers burned and fed to livestock the flowers they could not export for Valentines Day.
The UN says the economy has suffered "irreversible damage", and that 37% of breadwinners are now unemployed, with on average 8.6 dependents per employed person.
MEDICAL
Medicines have generally been allowed into Gaza, but Physicians for Human Rights (PHR) say the health system is "collapsing" and has suffered a "severe deterioration" under the pressure of shortages of equipment and spare parts, fuel and trained staff.
According to the WHO, Gaza health authorities said in April 2008 that 85 urgently needed drugs and 52 items of medical supplies (items such as swabs) were out of stock. The WHO says that the shortages cannot be directly attributed to the Israeli restrictions, but other humanitarian organisations say the bureaucracy of gaining permission for imports has affected the supply chain.
Aid agencies say medical institutions have been largely unable to import spare parts for equipment. The UN said that by December 2007, the majority of diagnostic equipment, such as X-ray machines and MRI scanners, in municipal facilities was no longer functioning. But Israel says it has never limited access to spare parts for medical equipment and blames any lack of equipment on funding shortages on the Palestinian side.
PHR says the inability to send staff outside Gaza for training is also a problem, giving the example of a new radiotherapy facility that could not be used because there were no trained staff to use it.
Fuel shortages have also affected hospitals, with ambulances running out of fuel at points in early 2008, and back-up generators - needed during power cuts - running low on fuel and lacking spare parts.
Patients in need of urgent medical care are allowed through Erez crossing points, but PHR says the number of patients being granted permits has dropped from 89% in January 2007 to just over half in June 2008. Rafah crossing has been closed since June 2007, although urgent cases are sporadically allowed to pass through it. A few hundred patients have left Gaza since then, and more than 3,000 Gazans have returned, according to PHR.
PHR says 200 patients died while waiting for permits in the past year. The WHO attributes at least 20 such deaths, in a two month period, to the fact the patients could not leave the Strip for treatment.
Israel says extensive security screening is necessary, as it says three people with permits to leave for medical reasons have been found to be planning attacks in Israel. It also says it has offered to facilitate passage through Israel to Jordan for Palestinians it refuses permits to on security grounds.
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