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Dwindling Fuel Supplies for Gaza’s Hospital Generators Put Premature Babies in Incubators at Risk 

Palestinians gather at the site of Israeli strikes on a house in Khan Younis in the southern Gaza Strip, October 23, 2023. (Reuters)
Palestinians gather at the site of Israeli strikes on a house in Khan Younis in the southern Gaza Strip, October 23, 2023. (Reuters)
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Dwindling Fuel Supplies for Gaza’s Hospital Generators Put Premature Babies in Incubators at Risk 

Palestinians gather at the site of Israeli strikes on a house in Khan Younis in the southern Gaza Strip, October 23, 2023. (Reuters)
Palestinians gather at the site of Israeli strikes on a house in Khan Younis in the southern Gaza Strip, October 23, 2023. (Reuters)

A premature baby squirms inside a glass incubator in the neonatal ward of al-Aqsa Hospital in the central Gaza Strip. He cries out as intravenous lines are connected to his tiny body. A ventilator helps him breathe as a catheter delivers medication and monitors flash his fragile vital signs.

His life hinges on the constant flow of electricity, which is in danger of running out imminently unless the hospital can get more fuel for its generators. Once the generators stop, hospital director Iyad Abu Zahar fears that the babies in the ward, unable to breathe on their own, will perish.

“The responsibility on us is huge,” he said.

Doctors treating premature babies across Gaza are grappling with similar fears. At least 130 premature babies are at “grave risk” across six neonatal units, aid workers said. The dangerous fuel shortages are caused by the Israeli blockade of Gaza, which started — along with airstrikes — after Hamas militants attacked Israeli towns on Oct. 7.

At least 50,000 pregnant women in Gaza are unable to access essential health services, and some 5,500 are due to give birth in the coming month, according to the World Health Organization.

At least seven of the almost 30 hospitals have been forced to shut down due to damage from relentless Israeli strikes and lack of power, water and other supplies. Doctors in the remaining hospitals said they are on the brink. The UN agency for Palestinian refugees said Sunday it has enough fuel to last three days to serve critical needs.

“The world cannot simply look on as these babies are killed by the siege on Gaza ... A failure to act is to sentence these babies to death,” said Melanie Ward, chief executive of the Medical Aid for Palestinians aid group.

None of the 20 aid trucks that crossed into Gaza on Saturday, the first since the siege was imposed, contained fuel, amid Israeli fears it will end up in Hamas' hands. Limited fuel supplies inside Gaza were being sent to hospital generators.

Seven tankers took fuel from a UN depot on the Gaza side of the border, but it was unclear if any of that was destined for the hospitals.

But will eventually run out if more is not permitted to enter.

Tarik Jašarević, a WHO spokesman, said 150,000 liters (40,000 gallons) of fuel are required to offer basic services in Gaza’s five main hospitals.

Abu Zahar worries about how long his facility can hold out.

“If the generator stops, which we are expecting in the coming few hours due to the heavy demands of different departments in the hospital, the incubators in the intensive care unit will be in a very critical situation,” he said.

Guillemette Thomas, medical coordinator for Doctors Without Borders in the Palestinian territories, said some of the babies could die within hours, and others in a couple of days, if they don’t receive the special care and medication they urgently need.

“It’s sure that these babies are in danger,” she told The Associated Press. “It’s a real emergency to take care of these babies, as it is an emergency to take care of the population of Gaza who are suffering from these bombings since the past two weeks.”

The hospital must care for patients in northern and central Gaza since several hospitals shut down, he said, forcing it to more than double its patient capacity. That also puts a strain on the limited electricity.

Nisma al-Ayubi brought her newborn daughter to the hospital from Nuseirat, where she was recently displaced from northern Gaza, after she suffered from oxygen deprivation and extreme pain, she said.

The baby girl was born three days ago but soon developed complications. “The hospital is lacking in supplies,” she said, speaking from al-Aqsa. “We are afraid that if the situation gets worse, there won’t be any medicine left to treat our kids.”

The problems are exacerbated by the dirty water many have been forced to use since Israel cut off the water supply. Abu Zahar says mothers are mixing baby formula with the contaminated water to feed their infants. It has contributed to the rise in critical cases in the ward.

In the al-Awda Hospital, a private facility in northern Jabalia, up to 50 babies are born almost every day, said hospital director Ahmed Muhanna. The hospital received an evacuation order from the Israeli military, but continued to work.

“The situation is tragic in every sense of the word,” he said. “We have recorded a large deficit in emergency medicines and anesthetic,” as well as other medical supplies.

To ration dwindling supplies, Muhanna said all scheduled operations were stopped and the hospital devoted all its resources to emergencies and childbirths. Complex neo-natal cases are sent to al-Aqsa.

Al-Awda has enough fuel to last four days at most, Muhanna said. “We have appealed to many international institutions, the World Health Organization, to supply hospitals with fuel, but to no avail so far,” he said.

Thomas said women have already given birth in UN-run schools where tens of thousands of displaced people have sought shelter.

“These women are in danger, and the babies are in danger right now,” she said. “That’s a really critical situation.”

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The Fragile Israel-Hezbollah Truce is Holding so Far, Despite Violations

Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)
Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)
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The Fragile Israel-Hezbollah Truce is Holding so Far, Despite Violations

Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)
Mariam Kourani removes a toy car from the rubble of her destroyed house after returning with her family to the Hanouiyeh village in southern Lebanon, on Nov. 28, 2024, following a ceasefire between Israel and Hezbollah. (AP Photo/Hussein Malla, File)

A fragile ceasefire between Israel and the Lebanon's Hezbollah has held up for over a month, even as its terms seem unlikely to be met by the agreed-upon deadline.

The deal struck on Nov. 27 to halt the war required Hezbollah to immediately lay down its arms in southern Lebanon and gave Israel 60 days to withdraw its forces there and hand over control to the Lebanese army and UN peacekeepers.

So far, Israel has withdrawn from just two of the dozens of towns it holds in southern Lebanon. And it has continued striking what it says are bases belonging to Hezbollah, which it accuses of attempting to launch rockets and move weapons before they can be confiscated and destroyed, The AP reported.

Hezbollah, which was severely diminished during nearly 14 months of war, has threatened to resume fighting if Israel does not fully withdraw its forces by the 60-day deadline.

Yet despite accusations from both sides about hundreds of ceasefire violations, the truce is likely to hold, analysts say. That is good news for thousands of Israeli and Lebanese families displaced by the war still waiting to return home.

“The ceasefire agreement is rather opaque and open to interpretation,” said Firas Maksad, a senior fellow with the Middle East Institute in Washington. That flexibility, he said, may give it a better chance of holding in the face of changing circumstances, including the ouster of Syria's longtime leader, Bashar Assad, just days after the ceasefire took effect.

With Assad gone, Hezbollah lost a vital route for smuggling weapons from Iran. While that further weakened Hezbollah’s hand, Israel had already agreed to the US-brokered ceasefire.

Hezbollah began firing rockets into Israel on Oct. 8, 2023 — the day after Hamas launched a deadly attack into Israel that ignited the ongoing war in Gaza. Since then, Israeli air and ground assaults have killed more than 4,000 people in Lebanon, including hundreds of civilians. At the height of the war, more than 1 million Lebanese people were displaced.

Hezbollah rockets forced some 60,000 from their homes in northern Israel, and killed 76 people in Israel, including 31 soldiers. Almost 50 Israeli soldiers were killed during operations inside Lebanon.

Here’s a look at the terms of the ceasefire and its prospects for ending hostilities over the long-term.

What does the ceasefire agreement say? The agreement says that both Hezbollah and Israel will halt “offensive” military actions, but that they can act in self-defense, although it is not entirely clear how that term may be interpreted.

The Lebanese army is tasked with preventing Hezbollah and other militant groups from launching attacks into Israel. It is also required to dismantle Hezbollah facilities and weapons in southern Lebanon — activities that might eventually be expanded to the rest of Lebanon, although it is not explicit in the ceasefire agreement.

The United States, France, Israel, Lebanon and the UN peacekeeping force in Lebanon, known as UNIFIL, are responsible for overseeing implementation of the agreement.

“The key question is not whether the deal will hold, but what version of it will be implemented,” Maksad, the analyst, said.

Is the ceasefire being implemented? Hezbollah has for the most part halted its rocket and drone fire into Israel, and Israel has stopped attacking Hezbollah in most areas of Lebanon. But Israel has launched regular airstrikes on what it says are militant sites in southern Lebanon and in the Bekaa Valley.

Israeli forces have so far withdrawn from two towns in southern Lebanon - Khiam and Shamaa. They remain in some 60 others, according to the International Organization for Migration, and around 160,000 Lebanese remain displaced.

Lebanon has accused Israel of repeatedly violating the ceasefire agreement and last week submitted a complaint to the UN Security Council that says Israel launched some 816 “ground and air attacks” between the start of the ceasefire and Dec. 22, 2024.

The complaint said the attacks have hindered the Lebanese army's efforts to deploy in the south and uphold its end of the ceasefire agreement.

Until Israel hands over control of more towns to the Lebanese army, Israeli troops have been destroying Hezbollah infrastructure, including weapons warehouses and underground tunnels. Lebanese authorities say Israel has also destroyed civilian houses and infrastructure.

What happens after the ceasefire has been in place for 60 days? Israel's withdrawal from Lebanese towns has been slower than anticipated because of a lack of Lebanese army troops ready to take over, according to Lt. Col. Nadav Shoshani, a military spokesman. Lebanon disputes this, and says it is waiting for Israel to withdraw before entering the towns.

Shoshani said Israel is satisfied with the Lebanese army's control of the areas it has already withdrawn from, and that while it would prefer a faster transfer of power, security is its most important objective.

Israel does not consider the 60-day timetable for withdrawal to be “sacred,” said Harel Chorev, an expert on Israel-Lebanon relations at Tel Aviv University who estimates that Lebanon will need to recruit and deploy thousands more troops before Israel will be ready to hand over control.

Hezbollah officials have said that if Israeli forces remain in Lebanon 60 days past the start of the ceasefire, the militant group might return to attacking them. But Hezbollah Secretary General Naim Kassem said Wednesday that, for now, the group is holding off to give the Lebanese state a chance to "take responsibility” for enforcing the agreement.

Over the final two months of the war, Hezbollah suffered major blows to its leadership, weapons and forces from a barrage of Israeli airstrikes, and a ground invasion that led to fierce battles in southern Lebanon. The fall of Assad was another big setback.

“The power imbalance suggests Israel may want to ensure greater freedom of action after the 60-day period,” Maksad, the analyst, said. And Hezbollah, in its weakened position, now has a “strong interest” in making sure the deal doesn't fall apart altogether “despite Israeli violations,” he said.

While Hezbollah may not be in a position to return to open war with Israel, it or other groups could mount guerilla attacks using light weaponry if Israeli troops remain in southern Lebanon, said former Lebanese army Gen. Hassan Jouni. And even if Israel does withdraw all of its ground forces, Jouni said, the Israeli military could could continue to carry out sporadic airstrikes in Lebanon, much as it has done in Syria for years.