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Destruction of the Gaza Strip healthcare system

"systematically destroying Gaza’s health infrastructure in order to drive Palestinians out of their homes." "It’s not just about targeting the buildings, it’s about systematically destroying the infrastructure of the hospitals. Destroying the oxygen tanks at the al-Shifa hospital, deliberately destroying the CT scanners and making it much more difficult to rebuild that infrastructure. If it was just targeting Hamas militants, why are they deliberately destroying the infrastructure of these institutions?" The UN says none of Gaza’s 36 hospitals is fully functional. A dozen are partially working and the others are destroyed. On Monday, the Israeli military again raided the al-Shifa hospital in Gaza City. Medical staff said the IDF killed and arrested Palestinians inside the hospital. The crisis in the hospitals has been compounded by the killing or arrest of hundreds of healthcare workers by the Israeli military.[1] Palestinian medical staff in Gaza have told the BBC they were blindfolded, detained, forced to strip and repeatedly beaten by Israeli troops after a raid at their hospital last month.[2] Doctors Without Borders stated they had closed a primary care facility in al-Mawasi, stating, "This is the second health facility we have been forced to close this week and another step in Israel’s systematic dismantling of Gaza’s health system."[3] In May 2024, more than 30 states condemned Israel's attacks on Gaza's health system.[4] Dr Dorotea Gucciardo from Glia stated, "What we’ve been witnessing since October is a complete systematic destruction of hospitals by the Israeli military, starting in the north and working their way to the south".[5] "Israeli forces are committing “brutal massacres regularly” and “destroying” the health system across the Gaza Strip."[6]

Doctors Without Borders stated, "With the insane escalation of violence in various locations in the Gaza Strip over the last 48 hours, and while the Rafah crossing point has remained closed for a month, the health system has been stretched to the point of collapse. The situation is apocalyptic."[7] "without a significant refill of medical supplies in the coming days" the NGO may have to "stop or drastically reduce some of its medical activities in Gaza".[8] "The World Health Organization (WHO) has registered more than 1,000 attacks on healthcare facilities in the Occupied Palestinian Territory since the October 7 terror attacks"[9] In July 2024, the International Committee of the Red Cross stated all of southern Gaza's health facilities had reached their "breaking point".[10]

Israel used the Turkish-Palestinian Friendship hospital as a military base.[11] International doctors who volunteered in Gaza described the situation there as the worst they had ever seen before.[12] In August 2024, the head of the Palestinian Red Crescent stated that Israel had achieved the destruction of the healthcare system in Gaza.[13]

Attacks on hospitals

[edit]
This section is an excerpt from Attacks on health facilities during the Israel–Hamas war § Attacks in the Gaza Strip.[edit]

On 12 October 2023, the ICRC stated: "Hospitals in Gaza risk turning into morgues". On 15 October 2023, WHO data showed there had been 48 reported attacks on healthcare facilities in the Gaza Strip, resulting in damage to approximately 24 hospitals and healthcare facilities, including six hospitals.[14] According to the World Health Organization, at least 521 people, including 16 medical workers, had been killed in 137 "attacks on health care" in Gaza by 12 November.[15] By 14 November 2023, only one hospital was still operating in the north of Gaza.[15] On 7 February 2024, the UN stated that only 4 of its 22 health facilities in Gaza remained operational.[16]

The IDF accused Hamas of military operations inside hospitals, including alleged attacks on IDF soldiers, weapon storage, fighters taking shelter, providing support for Hamas tunnels, human shielding, and holding hostages[17] Many of these claims, however, have been debunked under scrutiny from journalists.[18][19][20] According to The Guardian: "It's almost impossible to refute every accusation that has been made, but it's clear the intended and actual result of this campaign has been the systematic destruction of the healthcare infrastructure for Palestinians in Gaza".[21] Doctors Without Borders stated Israel had shown "complete disregard for the protection and safety of medical and humanitarian missions and their staff".[22]

al-Shifa Hospital

[edit]
This section is an excerpt from Al-Shifa Hospital siege.[edit]

Al-Shifa Hospital, the largest medical complex in Gaza, was placed under siege by Israel in mid-November 2023 during the Israel–Hamas war, after saying it had contained a Hamas command and control center beneath it. The incident was followed by a second major raid by Israeli forces in March 2024.

On 11 November, the hospital was completely encircled, cutting it off from the rest of Gaza City. According to Gazan health officials, the hospital contained 1,500 patients, 1,500 medical workers and around 15,000 displaced people who were seeking shelter in the hospital.[23][24] Both Israel and the United States have said that Hamas maintained command centers or command "nodes" below the hospital. Both the hospital's administration and Hamas denied that,[25][26][27] with the former asking the international community to send security experts to verify the Israeli allegations.[28] There were over 100 dead bodies placed in the courtyard and later buried by medical staff in a mass grave due to the siege.[29][30][31][32] On 15 November, Israeli forces said they entered the hospital after killing militants outside, and that they had discovered a Hamas command centre, weaponry, and tactical gear.[33]

After a media tour, The Guardian and CNN reported that the Israeli army had rearranged or doubled weapons for the tour[25][34] and that an Israeli video showing the discoveries had been edited. NBC News said that Israel released several pieces of inaccurate or disputed information, which weakened Israel's credibility.[35] Al Jazeera said that "many experts" accused Israel of fabricating evidence.[36] On 22 November, Israel published video showing multiple tunnels beneath the hospital;[37] The Wall Street Journal and The Guardian reported that this fell short of the original command center claims.[38][39] Israel published surveillance footage taken by the hospital's cameras, appearing to show two hostages being taken into the hospital.[40] The Guardian reported that Hamas had previously publicized taking hostages to receive medical treatment.[41] On 21 December, The Washington Post published analysis concluding that the hospital buildings in question were not actually connected to the tunnels.[42] On 2 January 2024, the United States released newly declassified documents showing that its spy agencies continued to believe that the hospital had been used as a command and control centre,[43] and the following day Israel announced that it had dismantled a tunnel beneath the hospital.[44] News reports the next day said that that both Israeli and US statements are not considered as conclusive proof of Hamas use of al-Shifa.[45][46]

The raid on the hospital and Israel's limited findings of military infrastructure led to international criticism,[47][48][49][50] including by UN High Commissioner for Human Rights Volker Türk who called for an independent investigation.[51] International law prohibits the targeting of hospitals unless used for a military purpose that is "harmful to the enemy", as well as the use of human shields for combatants; both constitute war crimes.[52] Jeremy Scahil accused Israel of waging a propaganda war to detract from accusations that its actions at al-Shifa constitute violations of international law. Medical staff at al-Shifa have accused Israel of directly causing the deaths of civilians being treated at al-Shifa, including prematurely born babies.[53] The head of the World Health Organization said, "hospitals are not battlegrounds," and that Israel's action was "totally unacceptable."[54] On 18 March 2024, Israeli forces conducted an overnight raid on Al-Shifa hospital following intel that senior Hamas officials had regrouped and were using the hospital "to command attacks".[55][56] After a two week siege that ended on 1 April 2024, the Al-Shifa hospital was mostly destroyed,[57] and hundreds of dead Palestinians were found in and around the hospital, including in mass graves.[58]

Nasser Hospital

[edit]
This section is an excerpt from Nasser Hospital siege.[edit]

During the Israel–Hamas war, the Nasser Hospital faced multiple attacks, including a siege and raid in January and February 2024. The hospital siege by Israeli forces created severe shortages of food, anesthesia, and painkillers. Reports emerged of Israeli snipers targeting individuals outside the hospital. Despite international calls for restraint, the Israel Defense Forces (IDF) ordered the evacuation of displaced people inside the hospital on 13 February 2024. On 15 February, Israeli soldiers raided the hospital. The hospital had completely ceased functioning by March 2024.

Kamal Adwan Hospital

[edit]
This section is an excerpt from Kamal Adwan Hospital siege.[edit]

During the Israel–Hamas war, the Kamal Adwan Hospital, a hospital in the Gaza Strip, Palestine, was besieged by the Israel Defense Forces.

Impacts

[edit]

"The repeated mass casualty events resulting from the unrelenting hostilities have stretched to breaking point the response capacity of our hospital – and all health facilities in southern Gaza – to care for those with life-threatening injuries,” said Gaza head of sub-delegation for the International Committee of the Red Cross (ICRC), William Schomburg."[59] Patients with preexisting conditions, including cancer, diabetes, and other disabilities were unable to receive treatment.[60] "In contexts like Gaza, where the health system has been decimated and has collapsed, late access to care is posing a health risk to pregnant women and their children, with tragic—even lethal"[61]

Evacuations

[edit]

Northern Gaza

[edit]
This section is an excerpt from Gaza Strip evacuations § Hospitals.[edit]

On 14 October 2023, Israel ordered the evacuation of 22 hospitals in northern Gaza. The WHO described the order as a "death sentence" for the sick and wounded.[62] Doctors Without Borders issued a statement calling the order "outrageous," "an attack on medical care and on humanity," and condemned it "in the strongest possible terms."[63] The World Health Organisation released a plea requesting Israel to rescind the orders, noting the extreme difficultly moving patients in critical care, the depletion of medical supplies, and that "the four Ministry of Health hospitals in south Gaza are already beyond capacity".[64] Similar statements were issued by UNICEF and IRC.[65][66] The WHO expressed concern about the evacuation order sent to the al-Quds Hospital in Gaza.[67]

On 29 October 2023, Tedros Adhanom Ghebreyesus, the head of the World Health Organization, described reports from the Palestinian Red Crescent that the al-Quds hospital had received an urgent evacuation warning and notice that it was "going to be bombarded" as "deeply concerning." He reiterated that it was "impossible to evacuate hospitals full of patients without endangering their lives."[68]

Doctors across northern Gaza stated they were unable to follow Israel's evacuation order, since their patients, including newborns in the ICU, would die.[69] On Monday 16 October, Israel ordered the al-Ahli Arab Hospital, and the rest of northern Gaza, to evacuate.[70] Because of insufficient beds in the southern Gaza Strip and no means of transporting patients, such as newborns in incubators or patients on ventilators, the evacuation orders were widely regarded as impossible to comply with.[70] On 17 October, a widely condemned explosion in the al-Ahli courtyard resulted in significant fatalities.[71]

On 10 November 2023, Muhammad Abu Salmiya, the director of Al Shifa hospital, noted that despite Israeli bombings, medical staff would stay with patients until the "last moment."[72] Abu Salmiya stated, "There is a war against hospitals... this has never happened in any war."[72] On 12 November, the IDF announced that it was enabling a safe passage from Al-Shifa, Rantisi, and Nasser hospitals, and opened and secured an additional one to help people to evacuate to the south.[73] On 13 November, however, the Gaza Health Ministry stated thousands of patients were unable to evacuate, after Israel's military encircled health facilities.[74]

On 14 November 2O23, Human Rights Watch noted the impossibility of evacuation from al-Shifa Hospital, stating , "There is no reliably safe route to evacuate. Satellite imagery confirms fires, military operations, and roadblocks on every conceivable route. And many sick and injured people in the hospital wouldn't be able to evacuate even if the roads were clear."[75] At least 40 patients died during the Al-Shifa Hospital siege and its subsequent evacuation.[76]

Southern Gaza

[edit]

"The Gaza European Hospital in Khan Younis, one of the territory’s last standing hospitals, is within the evacuation zone. It has transferred patients, including those in intensive care and babies in incubators, and medical equipment to other facilities “in fear of bloodshed,” according to the hospital’s deputy director and doctors."[77] WHO chief Tedros Adhanom Ghebreyesus stated the Gaza European Hospital was "completely empty", after the hospital cancelled all scheduled surgeries and evacuated its staff and 400 patients.[78] During the July 2024 evacuation of Gaza City, the al-Ahli Arab Hospital was evacuated. A witness stated quadcopters flew as patients evacuated, stating, "Such a painful scene of mass exodus … there were patients evacuated on their hospital beds with their drips on."[79] "Teams from MSF working across the Gaza Strip, endeavouring to provide essential and lifesaving care to those who have been injured by relentless Israeli attacks, have also been forced to flee for their lives."[80]

"On July 2, the European General Hospital evacuated its staff and patients, fearing it would be attacked. That left Al-Aqsa Martyrs Hospital in Deir al-Balah and a field hospital in Rafah as the only facilities able to offer reconstructive surgery, said Dr. Ahmed al-Mokhallalati, Gaza’s last reconstructive plastic surgery specialist. Al-Mokhallalati said he has been rushing between hospitals, at one point overseeing treatment for 400 patients in one and 500 in another. At the Rafah field hospital, he was doing up to 10 surgeries a day."[81] "U.N. spokesman Stephane Dujarric said U.N. humanitarian officials report that the frequent evacuation orders and relentless hostilities are further devastating Gaza’s health system – making it increasingly difficult for people who have been repeatedly displaced to access essential services."[82]

Killing of medical staff

[edit]
This section is an excerpt from Killing of health workers in the Israel–Hamas war § Attacks on health workers in Palestine.[edit]

On 15 October 2023, a total of 28 health workers had been killed and 30 recorded incidents of violence against health facilities, ambulances, and health workers since the bombing began.[83][84][85] By 16 November 2023 it was reported that more than 200 health care workers had been killed, per the Palestinian Ministry of Health, with some killed at hospitals, in ambulances, or at the sight of bombings, while others killed at home.[86] On 18 January 2024, Israel struck a building which was housing Medical Aid for Palestinians staff and their family members, causing several injuries.[87]

The Gaza Health Ministry stated on 9 February 2024 that 340 health workers had been killed since 7 October.[88] Meinie Nicolai, a director of Doctors Without Borders, stated that Israel had killed two humanitarian aid workers, and that neither the U.S. nor Israel had provided an explanation.[89] Reem Abu Lebdeh, a trustee on the UK board of directors of Doctors Without Borders, was killed by an Israeli airstrike in Khan Younis.[90] On 26 March 2024, the Palestine Red Crescent Society stated that 15 of its staff members had been killed since 7 October.[91] By 1 June 2024, the number had risen to 33.[92] In June 2024, Doctors Without Borders stated six of its workers had been killed in Gaza since 7 October.[93]

According to Al Jazeera, 160 medical facilities within the enclave have come under fire from the Israel Defense Forces, and 60 ambulances were disabled. Only four medical facilities remained operational in Gaza, but their survival is uncertain unless they receive the necessary aid. A total of 200 medical workers had reportedly lost their lives in the Strip.[94] In July 2024, a Palestinian doctor and his family were killed by an Israeli airstrike after complying with an Israeli evacuation order.[95]

"More than 500 health care workers have been killed since October, either during assaults on hospitals or in strikes on homes, according to the U.N."[96] Medical Aid for Palestinians stated, “That equates to an average of two health care workers killed every day, with one in every 40 health care workers, or 2.5 percent of Gaza’s health care work force”.[97]

Medical supplies

[edit]

a surgeon at Al-Ahli hospital stated, "anaesthesia is not available, but in order to save the lives of citizens, we resort to amputation, and this causes severe pain for the wounded".[98] In July 2024, Israeli evacuation orders in northern Gaza strained the existing medical facilities, as they struggled to access fuel and medical supplies.[99] Doctors Without Borders warned of the lack of available anesthesia, stating, "If we have to continue going like this... we won't be able to operate. We won't operate without anaesthesia".[100] after poliovirus was detected, WHO chief Tedros stated, "The decimation of the health system, lack of security, access obstruction, constant population displacement, shortages of medical supplies, poor quality of water and weakened sanitation are increasing the risk of vaccine-preventable diseases, including polio".[101] On 31 July 2024, Tedros stated the WHO would be sending one million polio vaccines to the Gaza Strip in the coming weeks.[102] Amy Kit-Mei Low a Canadian doctor working with Doctors Without Borders, stated, "We have to ration off the soap and the hand sanitizer because supplies haven't come in and we can't disinfect properly".[103]

UNOCHA reported that the Nasser Hospital was experiencing "a dire lack of blood units, medical supplies and hospital beds" even as it was forced to handle mass casualty influxes from attacks.[104] In August 2024, an American doctor returning from a medical mission to Gaza stated that hospitals were lacking gauze, soap, and syringes.[105] The spokesperson for the Al-Aqsa hospital stated they were lacking "the most basic medical necessities", which was "a clear signal that the entire health sector has collapsed in Gaza".[106][107]

Medical equipment

[edit]

By June 2024, hospitals in Gaza could not operate at full capacity due to their damaged equipment.[108]

Epidemics

[edit]
See also: 2024 Gaza Strip polio epidemic and 2023 Israeli airstrikes on municipal services in the Gaza Strip

"On top of hunger that U.N. agencies says has gripped Gaza since the war erupted on Oct. 7, doctors say scabies, chicken pox, skin rashes and lice are spreading fast. U.N. agencies have repeatedly warned of the risk of cholera and other more serious diseases becoming epidemics."[109] In July 2024, poliovirus was detected in Gaza.[110] The spread of disease was worsened by the destruction of Gaza's municipal services, lack of water, and buildup of waste.[111][112] WHO's head of health emergencies in the occupied Palestinian territories, Ayadil Saparbekov, stated, "With the crippled health system, lack of water and sanitation, as well as lack of access of the population to health services... this is going to be a very bad situation".[113] By August 2024, more than 100,000 Hepatitis B cases had been recorded in Gaza.[114] 40,000 cases of Hepatitis A had been recorded by August 2024, with UNRWA chief Philippe Lazzarini calling it a "frightening increase".[115] According to the UN, the Hep. A outbreak was caused by "massive displacement of people, overcrowded shelters, lack of clean water, soap, and other hygiene supplies."[116]

In July 2024: "Doctors are wrestling with more than 103,000 cases of lice and scabies and 65,000 cases of skin rashes, according to the World Health Organization. In Gaza’s population of some 2.3 million, more than 1 million cases of acute respiratory infections have been recorded since the war began, along with more than half a million of acute diarrhea and more than 100,000 cases of jaundice, according to the United Nations Development Program."[117] In August 2024, a polio epidemic was declared in Gaza.[118] The United Nations called for a temporary humanitarian ceasefire for a polio vaccination campaign.[119] The UN to warned that the collapse of Gaza's solid waste collection system was exacerbating the spread of diseases.[120] Aid workers reported a "a surge in infections of skin ulcers and scabies" in August 2024.[121]

One mother stated that her children were suffering from skin irritation due to sun exposure, as well as a lack of water and hygiene productions.[122]

War crimes

[edit]
This section is an excerpt from Israeli war crimes in the Israel–Hamas war § Violations of medical neutrality.[edit]
Palestine Red Crescent ambulance destroyed by an Israeli airstrike

Israel is alleged to have broken medical neutrality, a war crime under the Geneva Conventions as hospitals are given special protection under international humanitarian law.[123][124] These attacks have been carried out in a manner that aid groups and international bodies are increasingly referring to as systematic.[125] According to Gaza officials, the IDF deliberately targeted ambulances and health facilities with airstrikes.[126][127] In a statement, the Palestine Red Crescent demanded "accountability for this war crime".[128] The International Federation of Red Cross and Red Crescent Societies, UNRWA, and Medecins Sans Frontieres reported the deaths of their medical personnel.[129][130] On 14 October, the World Health Organization said the killing of health care workers and the destruction of health facilities "denies civilians the basic human right of life-saving health" and is prohibited by International Humanitarian Law.[131][132] On 17 October, WHO stated 51 health facilities had been attacked by Israel.[133][134] On 4 November, the Gaza Health Ministry stated 105 medical facilities had been deliberately targeted.[135]

On 21 October, the Ministry of Health noted Israel had attacked 69 health facilities, 24 ambulances, put 7 hospitals out of commission, and killed 37 medical staff.[136] Health workers and aid groups said several hospitals in Gaza were hit by airstrikes and shelling. The Palestine Red Crescent Society accused Israel of "deliberately" carrying out airstrikes "directly around" Gaza's second-largest hospital, al-Quds Hospital, in north Gaza, to force them to evacuate the facility. The World Health Organization (WHO) found it impossible to evacuate the hospital. According to CNN, even those who evacuated south have not been safe.[137] On 30 October 2023, a Turkish-Palestinian Friendship Hospital, located in the south of Gaza, was struck by a "direct hit", causing damage and injuries.[138]

On 3 November, an Israeli airstrike hit an ambulance convoy departing from al-Shifa Hospital carrying, according to a Palestinian Health Ministry spokesman, 15-20 critically injured patients.[139] The Israeli military confirmed the strike, saying one of the ambulances was being used by a "Hamas terrorist cell", and was close to their position.[140] In response, Yanis Varoufakis noted, "Even if the ambulance was carrying a Hamas overlord, bombing it violates the Geneva Convention."[141] UN chief António Guterres stated he was "horrified" by the attack.[142] In prior weeks, Israel had released an animated video stating Al-Shifa hospital contained a hidden, top-secret underground military center.[143] This was flatly denied, with Hamas stating Israel was using "prefabricated" evidence to pre-empt a military strike on a hospital.[144] Laws of war provide limited protections to medical facilities used in such capacities.[145] HRW stated the strikes were apparently unlawful and should be investigated as a possible war crime.[146]

During the Siege of Gaza City, Israeli snipers reportedly fired on the intensive care unit in Al-Quds Hospital, killing one person and wounding 28.[147] Doctors in Al-Shifa Hospital reported snipers at the outskirts of the complex were firing at "any moving person".[148] Fabrizio Carbone, the Middle East regional head of the International Committee of the Red Cross, stated Israel's attacks on al-Shifa Hospital could not continue, stressing patients and hospital staff should be "protected in line with the laws of war".[149] In response to the Al-Shifa Hospital siege, Human Rights Watch stated Israel's actions against hospitals need to be investigated as war crimes.[150] Jennifer Cassidy, a legal expert at University of Oxford, stated Israel's siege on al-Shifa was a war crime "plain and simple".[151] Following an Israeli attack on Indonesia Hospital, the Indonesian Foreign Minister called it a clear violation of international humanitarian law.[152]

Photos of Palestinian healthcare workers killed during fighting in Gaza, 25 November 2023

On 18 November 2023, two people were killed while traveling in a clearly identified Doctors Without Borders evacuation convoy in Gaza City.[153] Doctors Without Borders termed it a "deliberate attack."[154] On 16 December, the Euro-Mediterranean Human Rights Monitor called for an international investigation into Israeli war crimes at the Kamal Adwan Hospital.[155] On 17 January 2024, Israeli fire damaged the Jordanian field hospital, leading the Jordanian army to call it a "flagrant breach of international law".[156] On 19 January, Jordan stated Israel had "deliberately" targeted the hospital.[157] The World Health Organization stated on 24 January it had recorded 660 Israel attacks on healthcare facilities, calling them "a flagrant violation of international humanitarian law".[158] On 31 January, Doctors Without Borders stated Israel had conducted "systematic attacks on health facilities" which they stated was unprecedented for their organization.[159]

On 8 February 2024, the Palestinian Red Crescent accused the IDF of deliberately killing one of their paramedics.[160] On 11 February, the Red Crescent accused the IDF of deliberately targeting and killing two of their paramedics sent to rescue Hind Rajab, calling the killing a war crime.[161][162] In response to an Israeli attack at the Al-Aqsa Hospital on 31 March 2024, WHO chief Tedros Adhanom Ghebreyesus stated, "The ongoing attacks and militarisation of hospitals must stop. International humanitarian law must be respected."[163] In May 2024, the Palestinian Red Crescent stated an Israeli attack on their ambulances near Rafah was a war crime.[164] Following the attack, WHO stated, "Health workers are protected under international humanitarian law".[165] In June 2024, the UN Human Rights Office discussed the killing of health workers in Gaza, stating, "These killings have occurred against the backdrop of systematic attacks on hospitals and other medical facilities in violation of the laws of war".[166] In July 2024, the government of Turkey stated that images showing Israel using the Turkish-Palestinian Friendship Hospital as a military base indicated violations of international humanitarian law and threatened to take Israel to court.[167]

Reactions

[edit]

"Most of the doctors and nurses on the mission are experienced conflict zone volunteers. But Ghanem says they have never seen anything like this."[168] In June 2024, the UN Human Rights Office discussed the killing of health workers in Gaza, stating, "These killings have occurred against the backdrop of systematic attacks on hospitals and other medical facilities in violation of the laws of war".[169] In July 2024, Justin Welby, the Archbishop of Canterbury condemned the forced closure and evacuation of the Al Ahli Hospital, stating, "In the face of intense Israeli bombardment, this closure puts injured and sick people in even greater danger".[170] Save the Children criticized Israel's July 2024 attacks on schools and hospitals, calling them "horrific" and stating the "healthcare and education systems are being decimated before our eyes".[171] Dr. Javid Abdelmoneim, a physician with Médecins Sans Frontières, discussed Gaza's healthcare system in August 2024 after returning from two weeks in the Strip, stating, "The system is on its knees. Nowhere is safe... The aid workers are also becoming sick, crippling the aid response".[172]

References

[edit]
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