COVID and conflict: Gaza’s hospitals strained on two fronts

By Nidal al-Mughrabi

GAZA (Reuters) – Gaza’s hospitals were already struggling to cope with the COVID-19 pandemic before the conflict with Israel erupted last week. Now, medics say, they are being stretched further.

“The Ministry of Health is fighting on two fronts in the Gaza Strip – the coronavirus front and the other front, which is more difficult, is the injuries and the wounded,” said Marwan Abu Sada, the director of surgery in Gaza’s main Shifa hospital.

More than a week into fighting, with Palestinians pounded night and day by airstrikes and Israelis racing for refuge from rockets as sirens wail, Gaza’s doctors are battling to keep pace.

At Shifa, the biggest health facility among the 13 hospitals and 54 clinics serving the crowded enclave’s 2 million people, the number of intensive care beds has been doubled to 32 as the toll of those wounded from the conflict mounts.

Like the rest of the system, the 750-bed hospital faced shortages of medicines and equipment before fighting erupted on May 10 – blamed by medics on a blockade led by Israel and backed by Egypt, which shares a border with Gaza. Israel says its measures aim to stop arms reaching militants. “The list of essential medications and medical disposables suffered an acute shortage,” Abu Sada said.

It’s not just medicines in short supply. Fuel for generators that power Gaza’s hospitals – with main’s power too intermittent to be relied on – is also running out.

Israel says its blockade does not aim to stop medicines or other humanitarian supplies, and any shortages are the result of actions by Hamas, the Islamist group that has run Gaza since 2007, when the blockade was imposed.

“Hamas constructed a network of underground terror tunnels in Gaza underneath the homes of Palestinians, using funds meant for their health & welfare to expand Hamas’ terror machine instead,” Israel’s Foreign Ministry said on Twitter Monday.

Hamas has rejected the accusation.

Palestinians say 201 people have been killed in Gaza since the fighting started, with hundreds more hurt, including those wounded by shrapnel or injured by collapsing buildings.

Israel has reported 10 dead in the rocket salvoes, with many more injured, some directly by the blasts and others when dashing to safety. Some are in a critical condition.

“We have a very bad time over here,” said Racheli Malka, an Israeli living in Ashkelon, a city north of Gaza repeatedly hit by rockets. “I hope it will finish fast.”

Nearby, Israelis celebrated the Jewish festival of Shavuot in a synagogue that had a hole caused by a rocket strike.

The Israeli military said Hamas – regarded by Israel, the United States and European Union as a terrorist group – and others militants had fired about 3,150 rockets in the past week.

‘OLD EQUIPMENT, OLD BUILDINGS’

Sacha Bootsma, the head of the World Health Organization in Gaza, said COVID-19 had strained the enclave’s struggling system.

“Before COVID, the health system could be categorized as fragile because it has very old equipment, old buildings, a shortage of properly trained health staff and, of course, a chronic shortage of essential medicines,” she said.

Gaza has reported about 106,000 cases of COVID-19, or about 5.3% of the population, with 986 deaths, health official say.

While Israel has rolled out one of the fastest vaccination programs in the world, fully inoculating about 55% of its 9.3 million people, Gaza received about 110,000 doses, or enough for 55,000 people, health officials say, to be distributed among one of the most densely populated areas in the world.

One ward at Shifa, still marked “Corona Isolation Department”, has had to be turned into an intensive care unit for those injured in the conflict.

“We require more urgent support from international and relief institutions,” said Ashraf Al-Qidra, spokesman for the ministry of health, calling for medicines and ambulances.

For those living near Shifa hospital, the sound of ambulances wears on their already shattered nerves. “As long as we hear sirens we know it is not over yet,” said Karam Badr, 57.

Yet, healthcare workers keep the creaking medical facilities going. WHO’s Bootsma said scarce resources were still reaching those most in need.

“The resilience of the health system is remarkable,” she said.

(Reporting by Nidal al-Mughrabi in Gaza; Additional reporting by Eli Berlzon in Ashkelon; Writing by Edmund Blair; Editing by Alex Richardson)

As Dorian nears, one in five Florida nursing homes lacks a generator: state agency

FILE PHOTO: Two days after Hurricane Irma, William James, 83, sits without power, food or water, in his room at Cypress Run, an assisted living facility, in Immokalee, Florida, U.S., September 12, 2017. REUTERS/Bryan Woolston/File Photo

By Scott Malone

(Reuters) – Only one in five Florida nursing homes plans to rely on deliveries of temporary generators to keep their air conditioners running if Hurricane Dorian knocks out power, a state agency said on Friday, short of the standard set by a law passed after a dozen people died in a sweltering nursing home after 2017’s Hurricane Irma.

State officials are also racing to check some 120 nursing homes and assisted living facilities where they are unsure if generators or contingency plans are in place, Governor Ron DeSantis told a news conference.

The state’s residents, meanwhile, scrambled to board up their windows and stock up on food ahead of the storm, which is forecast to grow into a potentially deadly major hurricane before it roars ashore early on Tuesday.

The generator question is a matter of urgency in Florida, an aging state where some 190,000 people live in nursing homes and assisted-living facilities. DeSantis’ predecessor, Rick Scott, signed the March 2018 law requiring all nursing homes to be able to keep their temperatures at or below 81 degrees Fahrenheit (27°C) for at least 72 hours after losing power.

The law followed pervasive problems in the wake of 2017’s Hurricane Irma, which knocked out electricity to a wide swath of the state. Police in Hollywood, Florida, earlier this week charged four nursing home employees with causing the deaths of 12 patients in the sweltering heat of a post-hurricane power outage.

“There are going to be site checks, there are going to be phone calls to make sure that they have a plan to deal with folks that are in their care,” DeSantis said.

State data shows that just 41.8% of Florida’s 687 nursing homes have permanent generators in place, with 36.4% having temporary generators on site. Some 21.4%, or 147 nursing homes with beds for 17,754 people, have arrangements in place to have temporary generators delivered if they lose power, while three with the capacity to house a total 338 people, would evacuate if they lose power.

The picture is brighter among the state’s 3,061 assisted-living facilities, which can house 106,086 people. Fully 94.3% of those sites have permanent generators in place, according to Florida’s Agency for Health Care Administration.

State legislative records, however, show that hundreds of nursing homes have received waivers allowing them to operate with temporary generators, even though the 2018 law intended for all sites to have permanent generators in place by the start of last year’s hurricane season.

The agency, which oversees nursing home and assisted-living facilities in the state, said it was working to ensure that all those sites complied with the law.

“Our Agency remains committed to making sure long term care facilities can support safe conditions during loss of power,” AHCA Secretary Mary Mayhew said in a statement on Friday. “Agency staff are also conducting outreach activities for facilities without current generator information.”

(Reporting by Scott Malone in Boston; Editing by Dan Grebler)

Backstory: Reporting from the dark in Venezuela

Locals gather at a street food cart during a blackout in Caracas, March 29. REUTERS/Ivan Alvarado

(Reuters) – Backstory is a series of reports showing how Reuters journalists work and the standards under which they operate.

Two waves of major electricity outages plunged Venezuela into darkness last month, putting even more strain on a nation struggling with food shortages and hyperinflation.

With a diesel-powered generator in their Caracas bureau, Reuters staff are better-placed than most Venezuelans to cope with the blackouts.

But reporting from a darkened city and making sure all journalists and support personnel are safe present multiple obstacles.

“Everything will go down for a minute or two, the TVs and screens will turn off, then maybe a minute later, the power generator will kick in,” said Brian Ellsworth, Reuters senior correspondent in Caracas.

That is when the problems start.

No electricity means pumps do not work, leading to shortages of clean water. Cell networks cannot operate, meaning mobile phones are useless. Bank networks go down. Transport is unpredictable.

“At first, we weren’t totally prepared for it,” said Ellsworth, who has come to accept short outages as normal after 15 years reporting in the country’s capital.

Once it was clear that March’s first blackout would be longer than usual, the bureau immediately stocked up on water and bought food for the team as payment systems collapsed.

Only the bureau has a generator, not the building it is housed in, which makes getting into the office more complicated. To make it easier, a staff member slept in the newsroom most evenings, opening the emergency staircase from the inside so reporters could start work early the next day.

Gathering the news gets more difficult to coordinate.

“Cell reception comes in and out. We can make calls over WhatsApp but we can’t call anyone in the country because no one has a functioning cell line,” Ellsworth said. “We have to rely on short-wave radios which function to about 3 km (1.9 miles), but that can be really fuzzy.”

UNCERTAINTY CLOUDS EVERYTHING

With phones unusable, Venezuelans are cut off from one another and from sources of news and social media.

Ellsworth reported on a rally in eastern Caracas to protest President Nicolas Maduro’s handling of the nation’s crisis.

“How did you know about the rally?” he asked one protester. The answer: she did not. She was looking for her mother. “When I got to her building, they told me she was here, so that’s why I came.”

Hospitals cannot perform some vital functions without electricity. Already scarce food starts to spoil. Schools are closed during power outages, which means looking after children becomes an added burden.

“All of that affects us as a bureau because people have to take care of their own homes,” Ellsworth said. “We try to make sure that all those folks have what they need,” he said.

During busy news periods, the Reuters team in Caracas can include as many as 25 people, from reporters, photographers and television staff to security, cleaning and transport crews. The bureau also tries to provide meals for the building’s security guards who are not formally linked to the company.

“They have the same problems, they are stuck here for 24 hours, and when they leave here they don’t know how they are going to get home, if they will have power at home. They don’t have a way to communicate with their families,” said Ellsworth.

“Reuters needs to look out for people that are helping us maintain the operation.”

Maduro and ruling Socialist Party officials have offered a wide range of explanations for the blackouts, including electromagnetic sabotage by the United States and opposition-linked snipers firing on the country’s main hydroelectric dam.

Opposition leader Juan Guaido, who is recognized by most Western nations as the country’s head of state, says it is the result of a decade of corruption and mismanagement.

As Ellsworth walks up seven flights of stairs to his family’s apartment to light candles in the darkness, he reflects on the state of uncertainty he and 2 million other inhabitants of Caracas now face as a matter of course.

“They don’t give clear answers as to when power is going to come back on, people don’t really believe them when they say the power’s about to come back on, and when it is back, people don’t really believe it will stay back on,” he said. “The uncertainty starts to cloud everything.”

(Writing by Bill Rigby; Editing by Howard Goller)

In Puerto Rico, acute shortages plunge the masses into survival struggle

Local residents wait in line during a water distribution in Bayamon following damages caused by Hurricane Maria in Las Piedras, Puerto Rico, October 1, 2017

By Robin Respaut and Nick Brown

FAJARDO, Puerto Rico (Reuters) – Brian Jimenez had burned through dwindling supplies of scarce gasoline on a 45-minute drive in search of somewhere to fill his grandmother’s blood thinner prescription. He ended up in Fajardo, a scruffy town of strip malls on Puerto Rico’s northeastern tip, where a line of 400 waited outside a Walmart.

The store had drawn desperate crowds of storm victims who had heard it took credit or debit cards and offered customers $20 cash back – a lifeline in an increasingly cashless society. Store employees allowed customers in, one by one, for rationed shopping trips of 15 minutes each.

Then, at noon, the store closed after its generator croaked and before Jimenez could get inside to buy his grandmother’s medicine.

“Every day we say, ‘What’s the thing that we need the most today?’ and then we wait in a line for that,” said Jimenez, a 24-year-old medical student from Ponce, on the island’s southern coast.

By Saturday, 11 days after Hurricane Maria crippled this impoverished U.S. territory, residents scrambled for all the staples of modern society – food, water, fuel, medicine, currency – in a grinding survival struggle that has gripped Puerto Ricans across social classes.

For days now, residents have awoken each morning to decide which lifeline they should pursue: gasoline at the few open stations, food and bottled water at the few grocery stores with fuel for generators, or scarce cash at the few operating banks or ATMs. The pursuit of just one of these essentials can consume an entire day – if the mission succeeds at all – as hordes of increasingly desperate residents wait in 12-hour lines.

As criticism mounts about a slow disaster response by President Donald Trump’s administration, residents here in Fajardo said that had seen little if any presence from the federal government. Across the island, the sporadic presence of the Federal Emergency Management Agency or the U.S. military stood in sharp contrast to their comparatively ubiquitous presence after hurricanes Harvey and Irma recently hit Texas and Florida.

The severe shortages have thrown even relatively affluent Puerto Ricans into the same plight as the hundreds of thousands of poor residents here. The broad humanitarian crisis highlights the extreme difficulty of getting local or federal disaster relief to a remote U.S. island territory with an already fragile infrastructure and deeply indebted government.

Even those here with money to spend now cannot often access it or find places open and supplied to spend it as stores are shuttered for lack of electric power, diesel for generators, supplies or employees.

Jimenez’s failed trip to Walmart came after chasing groceries at a store near Yabucoa, near where his grandmother lived. He planned to spend the next day in one of the miles-long gas lines that snake from stations onto highways and up exit ramps.

At the beginning of many lines were stations already out of gas – but motorists still waited, hoping a fuel supply truck would eventually arrive.

“We wasted gas getting here and going back,” Jimenez said as he watched police usher dejected customers away from Walmart’s entrance. “The gas lines are ridiculous. Fifty cars is wonderful. Most are 100-plus cars.”

Another customer turned away from the Walmart, Daniel Santiago, 51, said he had waited in a gas line for 12 hours one day and 14 hours the next. Neither attempt had been successful, so he, his wife and three daughters had walked three miles to the Fajardo shopping complex, where they waited in line for the Econo grocery.

“We have to do this every day,” Santiago said. “Yesterday, we came down walking. The day before that, we walked up a really big hill to try to get a signal to contact our family.”

That had not worked either.

 

UNFORTUNATE REALITY

Even before the storm hit and knocked out the island’s dilapidated electric grid – an outage expected to persist for months – Puerto Rico was suffering through a growing economic crisis that dates back to 2006. The island has an unemployment rate more than twice the U.S. national average and a 45 percent poverty rate.

The island had earlier this year filed the biggest bankruptcy in U.S. municipal history in the face of a $72 billion debt load and near-insolvent public health and pension systems.

In an interview with Reuters on Saturday, Puerto Rico Governor Ricardo Rossello said relief efforts were still focused almost solely on saving lives; restoring basic necessities to the masses would come later.

“We’re not at the phase where we are focusing on comfort,” Rossello said. “Unfortunately, that’s the current reality that we’re dealing with.”

His team was still scrambling to open roads to communities blocked by landslides, and to deliver food, water, medicines and generators to remote homes and hospitals.

The island’s battered infrastructure left Manny De La Rosa, 31, to crisscross the island with his pregnant wife, Mayra Melendez, also 31. They were trying to find places to spend the $40 in coins they had extracted from the family piggybank.

“All of our money is held up in the bank,” De La Rosa said.

They live in Luquillo in the northeast, but found an ATM in Humacao on the southeastern coast. Their cell phones vibrated to life for the first time alongside a stretch of highway in Isla Verde, nearly an hour west of their home.

Now, they were in line in Fajardo, hoping to buy supplies with a credit card to conserve their cash.

“We see these lines, and we think, ‘We’re not even going to make it before the money runs out,’” Melendez said, standing in front of the Walmart.

A military helicopter flight over a residential area following damages caused by Hurricane Maria near Caguas, Puerto Rico, October 1, 2017

A military helicopter flight over a residential area following damages caused by Hurricane Maria near Caguas, Puerto Rico, October 1, 2017 REUTERS/Carlos Barria

DOWN TO $14

In the economically depressed agricultural town of Salinas, an hour-and-a-half drive from Fajardo on the island’s southern coast, 93-year-old Lucia Santiago sat outside in a lawn chair and rested her swollen legs.

Her son, Jose Melero, 67, brought her food that had been delivered by the town’s mayor on a golf cart.

“We have to be out here, because we’d die from the heat in there,” he said, gesturing toward the house.

The two had started eating less every day to conserve provisions. That day, they had split a can of ravioli and a piece of bread.

Melero was down to $14 of cash without the means to withdraw more.

“I have no idea how I’m going to get through the next few days,” he said. “We have money, but we just can’t get to it.”

Others in isolated areas struggled to find medicine. U.S. Army veteran Sandalio DeJesus Maldonado, 87, took a 7 a.m. ferry from his home on Culebra, an island off Puerto Rico’s eastern coast, to Fajardo, to refill blood pressure and prostate medications.

The hurricane had shuttered Culebra’s only pharmacy, DeJesus said.

In Fajardo, DeJesus waited at an overcrowded Walgreens because he did not have enough gas to drive to the Veterans Affairs hospital where he normally filled his prescriptions.

As he waited in line late Saturday morning, DeJesus fretted that he would not be able to return to Culebra until after 5 p.m., when the only scheduled ferry was slated to depart.

“All I need is a few pills,” he said.

 

 

(Additional reporting by Jon Herskovitz; Writing by Brian Thevenot; Editing by Mary Milliken)