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Opinion: Half measures won’t work. What Gaza needs is a Marshall Plan

Editor’s Note: Dr. Zaher Sahloul, a pulmonary and critical care specialist, is president of MedGlobal, an NGO that provides medical relief to disaster areas, including Gaza. The views expressed in this commentary are his own. Read more opinion at CNN.

Imagine having to choose between death by starving or by drowning. That is the unspeakably desperate choice that some Gazans have been confronted with in their daily struggle to survive.

Dr. Zaher Sahloul - MedGlobal
Dr. Zaher Sahloul - MedGlobal

Most of us would not choose for one day to live the nightmare that Gazans have experienced for months now, with rudimentary medical care if they are lucky to have any at all, even as infectious disease spreads and as they struggle to survive amid the rubble of bombed out buildings or in open air settlements with tents and tarpaulins as their only shelter.

And with starvation looming, the people of Gaza are reduced to making a desperate scramble for the severely limited food aid that does get through, or to risk their lives trying to collect meals ready to eat (MREs) that the United States and other nations have dropped by air.

Those food drops were purportedly intended to ease the suffering of Gazans. Unfortunately, they are still woefully inadequate to meet the needs of Gazans. In one tragic instance, several people were killed when a pallet bearing food aid plummeted from the sky and landed on top of them.

Last week, the news related to these food drops became even more shocking still, when it was reported that at least a dozen Palestinians perished off the northern Gaza coast while trying to reach airdropped parcels that had landed in the sea.

Displaced Palestinians carry their belongings through a street in Khan Yunis in the southern Gaza Strip on March 6, 2024, amid the ongoing conflict between Israel and the Hamas movement. - AFP/Getty Images
Displaced Palestinians carry their belongings through a street in Khan Yunis in the southern Gaza Strip on March 6, 2024, amid the ongoing conflict between Israel and the Hamas movement. - AFP/Getty Images

I’ve been to many war zones in the relief work I’ve carried out over the years with the humanitarian organization that I co-founded, providing emergency response and health programs to vulnerable communities around the world. But in terms of the sheer scale of the misery I have witnessed, there has been nothing to compare to Gaza.

During my two-week mission to Gaza in January, living conditions were already horrific and in the succeeding weeks have gotten much worse. I’ve been appalled by the suffering I have witnessed and like other physicians and aid officials who have been on the ground there, I feel a sense of desperation to get the Biden administration to do everything in its power to bring it to an end.

To that end, I spent a good part of this month in Washington and New York, meeting with lawmakers in Congress, members of the US administration and UN officials, lobbying them to do what they can to bring about a humanitarian ceasefire that will allow Israeli hostages to be released and allow Gazans to receive the food and medical provisions they need. I can’t overstate how urgent it is that the Biden administration negotiate a ceasefire.

But as the situation in Gaza worsens, I’ve become convinced that a ceasefire alone will not be enough to address the deep-rooted challenges created by months of trauma, bombardments and privation. It is imperative for the Biden administration and Congress to approve a substantial aid package for the Palestinians.

The situation in Gaza necessitates a robust and comprehensive approach akin to the historic Marshall Plan that helped reconstruct a devastated Europe after World War II. But unlike the Marshall Plan that relied almost entirely on American knowhow and resources, this effort to stave off the humanitarian crisis and rebuild Gaza should enlist America’s international partners. Reconstructing the territory will require comprehensive coordination by the US, UN, international NGOs, and supporting countries, and will involve rehabilitating and reconstructing healthcare facilities.

The Biden administration already appears to be aware that the extraordinary challenges in Gaza will require a Herculean, multilateral effort involving nations from around the world. As USAID Administrator Samantha Power said recently in a statement on the humanitarian crisis in Gaza, “There must be a continued and sustained international effort to ensure the right type of assistance is getting to the most vulnerable.”

Hospitals and medical facilities, in addition to housing, is where much of this rebuilding effort should begin. Gaza has 36 hospitals, at least 24 of which have shut down because of bombings, forced evacuations, and shortages of supplies. The other dozen are only partially operational.

Palestinian children in Rafah wait to receive food distributed by a charity kitchen amid severe food shortages of food supplies. - Mohammed Salem/Reuters
Palestinian children in Rafah wait to receive food distributed by a charity kitchen amid severe food shortages of food supplies. - Mohammed Salem/Reuters

About half of Gaza’s 2.2 million people are under the age of 18. These children have been forcibly displaced and torn away from their homes, schools and communities. Their experiences are marked by profound loss, as they have witnessed the deaths of their parents, siblings and friends. Undoubtedly, intensive psychological care will need to be part of any program to address the suffering they have endured.

While in Gaza, I observed the triage of trauma patients at Nasser Hospital in Khan Younis. After one of the many mass-casualty events that our team witnessed, doctors kneeled on the floor of the bursting emergency department. More than 30 patients were brought in within 10 minutes. Several were dead on arrival.

One child, Mohammed Abu Shahla, who I saw die of his injuries, might have survived had there been anything remotely approaching adequate medical care. Mohammed was born in 2011 and had witnessed several wars in his short life. He was displaced with his family and took shelter in a school with a few hundred families which had been considered safe. He was playing near Nasser Hospital, where I was working, when an Israeli missile hit the site. Mohammed suffered brain damage during the blast and never woke up.

The following day at our clinic, I met Lama, a five-year-old from Khan Younis who has been displaced with her family to Rafah. She lives in a storage facility with 16 other displaced people, and is relatively lucky to have any shelter at all as many families are in the streets or live in rudimentary tents. She presented to the clinic with bloody diarrhea. In fact, many children in Gaza have diarrhea due to the lack of clean water and poor sanitation. If this problem persists, there is a severe risk that thousands more young children could die of cholera. The worsening starvation and malnutrition is compounding the problem.

This picture taken from Israel's southern border with the Gaza Strip shows parachutes of humanitarian aid dropping over the besieged Palestinian territory in late March. - Jack Guez/AFP/Getty Images
This picture taken from Israel's southern border with the Gaza Strip shows parachutes of humanitarian aid dropping over the besieged Palestinian territory in late March. - Jack Guez/AFP/Getty Images

It is incumbent on all of us to make sure that the children in Gaza, like all children on earth, have the right to a better future. Every time I go into a war zone, I ask children: “What would you like to be when you grow up?” I mean with this question to imply my hope — and silent prayer — that they will indeed grow up to fulfill their most fervent dreams and perhaps to have children of their own.

One school I visited in Rafah had been repurposed as a displacement center, and was overwhelmed by an influx of children suffering from skin conditions resulting from poor hygiene, as well as frequent outbreaks of diarrhea and hepatitis. There, in an overcrowded classroom, I met a 12-year-old named Abdallah.

When I asked about his aspirations for the future, the boy mumbled: “What future?” The extent of unspoken trauma was evident on his face and echoed by his words. How long will it take to heal the hidden wounds of those who are lucky enough to survive?

Still, there is hope. A majority of the children I met told me, in fact, that they hoped to practice medicine when they grow up. Perhaps that career choice is not entirely surprising, given the magnitude of the grievous bodily injuries many will have seen, and their understanding that there are inadequate medical resources to cope with them.

But there’s another possible reason why, amid the chaos and suffering, so many of Gaza’s children dare to dream of the future: The territory boasts some of the highest education rates in the region, with a literacy rate prior to the start of the war of 97.7%, according to UN statistics. Many of these children would likely have been on paths that might have led them to professions in medicine and other fields, probably in service to their community.

Gaza’s children might still have the ability to nurture those dreams. But the international community will need to construct homes, businesses, hospitals and other facilities that they desperately need before Gazans are able to reconstruct their lives.

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