The US must support Gaza before winter

Israel's assaults on Gaza have destroyed every sewage processing plant and 70% of sewage pumps in the territory. In June, Oxfam reported that al-Mawasi contained only 121 latrines, then serving half a million people; on 16 November, it was reported that Khan Younis had no fuel for sewage pumps, wells, or water purification.

Infection control and hygiene have long been severely compromised in Gaza. Before October 7, 2023, waterborne illness was already the top killer of children in Gaza. Oxfam reported in 2017 that "Israel's illegal blockade of Gaza severely limits, or prevents altogether, the entry of materials that would allow the water and sanitation sector in Gaza to recover from years of conflict and de-development."

The widespread destruction of housing, sewage, water, and sanitation infrastructure—as well as prolonged malnutrition and repeated displacement—has severely exacerbated this long-standing problem. During the summer dry season, rates of diarrheal disease in Gaza were 25 times higher than prewar levels. People used makeshift latrines and were forced to dump waste wherever they could. The practice further polluted Gaza's already contaminated shoreline and groundwater supplies.

Furthermore, Israel's blockade of commercial goods has caused such scarcity that a 2.6-ounce bar of soap costs $10, while shampoo and laundry detergent are unavailable. Israel has blocked organisations such as Doctors Without Borders from importing hygiene kits. US healthcare workers who volunteered in Gaza recently reported that since October 2023, basic sanitation items have been unavailable even in hospitals.

Hydration is an acute challenge for Palestinians in Gaza, too. Proper rehydration for those suffering from intestinal diseases is impossible. International humanitarian law requires that civilian infrastructure related to water and civilian access to water be protected. However, since October 2023, people in Gaza have had access to only 6% of the water they had prior to the war. Israel has cut or undersupplied water lines that run into Gaza. It has also banned fuel from entering the strip, blocked the transfer of bottled water, compromised local desalination capacity, and destroyed water warehouses. That means that 95% of people in Gaza currently have no access to clean water.

Oxfam estimated in July that Palestinians in al-Mawasi could access only 2.5 litres of water per person per day when only 1 million people were sheltering there, far below the international standard of 15 litres per person per day in a humanitarian crisis. Repairing water delivery systems is dangerous in Gaza; the Israeli military recently bombed a car carrying Palestinian water engineers attempting to repair infrastructure, killing four people, despite the fact that they had coordinated their movements with Israel.

Malnutrition and starvation weaken a person's immune system and ability to heal from injuries. They also permanently impair children's development. Most people who die of starvation succumb to otherwise trivial infections due to weakened immunity. Widespread malnutrition and starvation have left Gaza's entire population vulnerable to waterborne disease, especially children under 5. Recent reports place 86% of Gaza's population in phases three to five of acute food insecurity, where mortality increases significantly.

Amid flooding, displaced people are also at grave risk for exposure to environmental hazards such as toxic sludge, as rainwater combines with the rubble of bombed-out buildings. Exposure-related hypothermia and pneumonia will become additional problems, particularly for children. Nighttime temperatures of 50 degrees Fahrenheit, which are typical of winters in Gaza, are not harmful to adequately sheltered people—but young, sick, older, and malnourished people whose clothes are continuously wet will slowly die in such conditions.

The Biden administration has recognised that winter rains and flooding portend a humanitarian catastrophe in Gaza—unless Israel significantly eases its stranglehold on the territory. On 13 October, US Secretary of State Antony Blinken and Defence Secretary Lloyd Austin sent the Israeli government a letter with clear and specific criteria related to the humanitarian situation in Gaza to be met within 30 days. "Failure to demonstrate a sustained commitment to implementing and maintaining these measures may have implications for US policy," they wrote.

The letter listed measures on which Israel was obligated to act to avoid potentially triggering legal provisions that would halt US weapons transfers. Blinken and Austin further specified that proposed legislation in the Knesset, Israel's parliament, to ban activities by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) "would devastate the Gaza humanitarian response."

Read more: Israel ramps up its 'war' on the United Nations

Those 30 days elapsed on 12 November, but Israel has facilitated less than 15% of the specified aid delivery goal. Humanitarian aid deliveries are at their lowest levels in 11 months. "Israel's actions failed to meet any of the specific criteria set out in the US letter," a coalition of eight international aid organisations wrote in a detailed "Gaza Scorecard."

Israel not only failed to meet the US criteria but also took action that dramatically worsened the situation on the ground, particularly in northern Gaza. On 28 October, the Knesset banned UNRWA from any activity in Israel, East Jerusalem, the West Bank, or Gaza. Still, a US State Department spokesperson said on 12 November that "we at this time have not made an assessment that the Israelis are in violation of US law."

The Gaza Health Ministry has reported 43,985 Palestinian deaths since October 7, 2023, of which 70% are women and children. Though ongoing hostilities and the decimation of Gaza's medical facilities complicate precise recording, available data indicates that Israeli military action has directly and indirectly killed at least 118,908 people. Drawing on comparisons to other conflicts, one public health scholar estimated that by the end of 2024, a total of 335,500 Palestinians may have died since the beginning of the war.

A growing list of UN institutions and experts, governments, rights groups and scholars have labelled Israel's actions in Gaza as war crimes, crimes against humanity, and genocide.

Read more: Gaza is a manufactured apocalypse

Mitigating the imminent winter catastrophe in Gaza would require at the very least a cease-fire, a surge of aid deliveries, safe access for humanitarian and engineering teams, and the entry of fuel. Israel has staunchly refused to allow such moves in the past, arguing that they would aid Hamas.

Only extreme US pressure on the Israeli government can achieve these ends. Since Israel has not responded to the Biden administration's calls to protect civilians in Gaza, the United States should take decisive action by halting arms transfers and jet fuel deliveries. In line with recommendations from Human Rights Watch and other international organisations, Washington could also apply targeted sanctions on Israeli officials "credibly implicated in ongoing serious violations."

For now, the United States is increasingly out of step with international institutions and its own allies in its support for Israel. This week, the US Senate rejected legislation designed to restrict weapons sales to Israel, and Washington vetoed an otherwise unanimous UN Security Council ceasefire resolution. On Thursday, the International Criminal Court issued arrest warrants for Israeli Prime Minister Benjamin Netanyahu and former Defence Minister Yoav Gallant on charges of war crimes and crimes against humanity, including the crime of starvation.

The impending winter rains will place hundreds of thousands of Palestinians in Gaza in immediate and entirely avoidable lethal jeopardy. There is a very narrow window for action. A massive humanitarian effort now could save hundreds of thousands of lives. This may be the last opportunity for the Biden administration to make a difference in Gaza.