Leisure ‘Forgotten’: Gaza War Drives Children to Work

Palestinian children break up stones collected from homes destroyed by previous Israeli air strikes, to sell them to make gravestones, in Khan Younis, southern Gaza Strip, 21 August 2024. (EPA)
Palestinian children break up stones collected from homes destroyed by previous Israeli air strikes, to sell them to make gravestones, in Khan Younis, southern Gaza Strip, 21 August 2024. (EPA)
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Leisure ‘Forgotten’: Gaza War Drives Children to Work

Palestinian children break up stones collected from homes destroyed by previous Israeli air strikes, to sell them to make gravestones, in Khan Younis, southern Gaza Strip, 21 August 2024. (EPA)
Palestinian children break up stones collected from homes destroyed by previous Israeli air strikes, to sell them to make gravestones, in Khan Younis, southern Gaza Strip, 21 August 2024. (EPA)

Some crush rocks into gravel, others sell cups of coffee: Palestinian children in Gaza are working to support their families across the war-torn territory, where the World Bank says nearly everyone is now poor.

Every morning at 7:00 am, Ahmad ventures out into the ruins of Khan Younis in southern Gaza, picking through the rubble produced by steady Israeli bombardment.

"We gather debris from destroyed houses, then crush the stones and sell a bucket of gravel for one shekel (around 0.25 euros)," the 12-year-old said, his face tanned by the sun, his hands scratched and cut and his clothes covered in dust.

His customers, he said, are grieving families who use the gravel to erect fragile steles above the graves of their loved ones, many of them buried hastily.

"At the end of the day, we have earned two or three shekels each, which is not even enough for a packet of biscuits," he said.

"There are so many things we dream of but can no longer afford."

The war in Gaza began with Hamas's unprecedented October 7 attack on southern Israel which resulted in the deaths of 1,199 people, most of them civilians, according to an AFP tally based on Israeli official figures.

Israel's retaliatory military campaign has killed at least 40,476 people in Gaza, according to the Hamas-run territory's health ministry, which does not break down civilian and militant deaths.

The UN rights office says most of the dead are women and children.

"Nearly every Gazan is currently poor," the World Bank said in a report released in May.

- 'Barefoot through the rubble' -

Child labor is not a new phenomenon in Gaza, where the United Nations says two-thirds of the population lived in poverty and 45 percent of the workforce was unemployed before the war.

Roughly half of Gaza's population is under 18, and while Palestinian law officially prohibits people under 15 from working, children could regularly be found working in the agriculture and construction sectors before October 7.

The widespread wartime destruction as well as the constant displacement of Gazans trying to stay ahead of Israeli strikes and evacuation orders has made that kind of steady work hard to find.

Khamis, 16, and his younger brother, Sami, 13, instead spend their days walking through potholed streets and displacement camps trying to sell cartons of juice.

"From walking barefoot through the rubble, my brother got an infected leg from a piece of shrapnel," Khamis told AFP.

"He had a fever, spots all over, and we have no medicine to treat him."

Aid workers have repeatedly sounded the alarm about a health system that was struggling before the war and is now unable to cope with an influx of wounded and victims of growing child malnutrition.

- Money gone 'in a minute' -

The paltry sums Khamis and Sami manage to earn do little to defray the costs of survival.

The family spent 300 shekels (around 73 euros) on a donkey-drawn cart when they first fled their home, and later spent 400 shekels on a tent.

At this point the family has relocated nearly 10 times and struggles to afford "a kilo of tomatoes for 25 shekels", Khamis said.

Moatassem, for his part, said he sometimes manages to earn "30 shekels in a day" by selling coffee and dried fruit that he sets out on cardboard on the roadside.

"I spend hours in the sun to collect this money, and we spend it in a minute," the 13-year-old said.

"And some days I only earn 10 shekels while I shout all day to attract customers," he added.

That's a drop in the ocean for daily expenses in a territory where prices for goods like cooking gas and gasoline are soaring.

In these conditions, "we only think about our basic needs, we have forgotten what leisure is, spending for pleasure," Moatassem said.

"I would like to go home and get back to my old life."



New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
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New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)

Scientists studying the new mpox strain that has spread out of Democratic Republic of Congo say the virus is changing faster than expected, and often in areas where experts lack the funding and equipment to properly track it.

That means there are numerous unknowns about the virus itself, its severity and how it is transmitting, complicating the response, half a dozen scientists in Africa, Europe and the United States told Reuters.

Mpox, formerly known as monkeypox, has been a public health problem in parts of Africa since 1970, but received little global attention until it surged internationally in 2022, prompting the World Health Organization to declare a global health emergency. That declaration ended 10 months later.

A new strain of the virus, known as clade Ib, has the world's attention again after the WHO declared a new health emergency.

The strain is a mutated version of clade I, a form of mpox spread by contact with infected animals that has been endemic in Congo for decades. Mpox typically causes flu-like symptoms and pus-filled lesions and can kill.

Congo has had more than 18,000 suspected clade I and clade Ib mpox cases and 615 deaths this year, according to the WHO. There have also been 222 confirmed clade Ib cases in four African countries in the last month, plus a case each in Sweden and Thailand in people with a travel history in Africa.

"I worry that in Africa, we are working blindly," said Dr. Dimie Ogoina, an infectious diseases expert at Niger Delta University Hospital in Nigeria who chairs the WHO's mpox emergency committee. He first raised the alarm about potential sexual transmission of mpox in 2017, now an accepted route of spread for the virus.

"We don’t understand our outbreak very well, and if we don't understand our outbreak very well, we will have difficulty addressing the problem in terms of transmission dynamics, the severity of the disease, risk factors of the disease," Ogoina said. "And I worry about the fact that the virus seems to be mutating and producing new strains."

He said it took clade IIb in Nigeria five years or more to evolve enough for sustained spread among humans, sparking the 2022 global outbreak. Clade Ib has done the same thing in less than a year.

MUTATING 'MORE RAPIDLY'

Mpox is an orthopoxvirus, from the family that causes smallpox. Population-wide protection from a global smallpox vaccine campaign 50 years ago has waned, as the vaccinating stopped when the disease was eradicated.

Genetic sequencing of clade Ib infections, which the WHO estimates emerged mid-September 2023, show they carry a mutation known as APOBEC3, a signature of adaptation in humans.

The virus that causes mpox has typically been fairly stable and slow to mutate, but APOBEC-driven mutations can accelerate viral evolution, said Dr. Miguel Paredes, who is studying the evolution of mpox and other viruses at Fred Hutchison Cancer Center in Seattle.

"All the human-to-human cases of mpox have this APOBEC signature of mutations, which means that it's mutating a little bit more rapidly than we would expect," he said.

Paredes and other scientists said a response was complicated by several mpox outbreaks happening at once.

In the past, mpox was predominantly acquired through human contact with infected animals. That is still driving a rise in Congo in clade I cases – also known as clade Ia - likely due in part to deforestation and increased consumption of bushmeat, scientists said.

The mutated versions, clade Ib and IIb, can now essentially be considered a sexually transmitted disease, said Dr. Salim Abdool Karim, a South African epidemiologist and chair of the Africa CDC’s mpox advisory committee. Most of the mutated clade Ib cases are among adults, driven at first by an epidemic among female sex workers in South Kivu, Congo.

The virus also can spread through close contact with an infected person, which is likely how clusters of children have been infected with clade Ib, particularly in Burundi and in eastern Congo’s displacement camps, where crowded living conditions may be contributing.

Children, pregnant women and people with weakened immune systems or other illnesses may be at greater risk of serious mpox disease and death, say the WHO and mpox scientists.

Clade I has typically caused more severe disease, with fatality rates of 4%-11%, compared to around 1% for clade II. Ogoina said data from Congo suggests few have died of the new Ib version, but he feared some data is being mixed up.

More research is urgently needed, but three teams tracking mpox outbreaks in Africa say they cannot even access chemicals needed for diagnostic tests. Clade Ib can also be missed by some diagnostic tests.

Planning a response, including vaccination strategies, without this is difficult, the scientists said.

Karim said around half of cases in eastern Congo, where Ib is particularly prevalent, are only being diagnosed by doctors, with no laboratory confirmation.

Getting samples to labs is difficult because the healthcare system is already under pressure, he said. And around 750,000 people have been displaced amid fighting between the M23 rebel group and the government.

Many African laboratories cannot get the supplies they need, said Dr. Emmanuel Nakoune, an mpox expert at the Institut Pasteur in Bangui, Central African Republic, which also has clade Ia cases.

"This is not a luxury," he said, but necessary to track deadly outbreaks.