The scenes in Gaza's Shifa Hospital today are not much different from during the recent Israeli offensive – bloodied bandages and linen overflowing onto floors, bathrooms becoming filthier by the minute, medical disposables littering the treatment rooms. About the only difference is the operating theatres, which are mostly empty – all elective surgery has been cancelled due to the cleaners strike.
"Patients die if we can't operate – we will be forced to operate using wet linen, beds bloodied by the previous patient," said Dr Hani Hamada, Director of Operating Theatres. "Infection is a real risk, but we have no choice – we have to operate on critical cases."
Hospital cleaners go seven months without pay
The extreme action taken by the cleaners is the culmination of seven months of work without pay, according to Abu Hazem Al Daya, head of the cleaning company Silver Day, which has the contract with the Ministry of Health to clean Shifa Hospital.
"We have 170 workers who have not been paid. The Unity Government took over the contract so they have to pay, but they keep arguing while our workers starve. They tell us to be patient, to wait a week, to wait a month," he said. "And we are not the only ones – there are nine other cleaning companies in the Gaza Strip in the same position."
With a salary of 700 shekels a month, less than USD $200, the cleaners are among the lowest paid workers in Gaza, and can hardly be considered to be an enormous drain on the budget of the Unity Government – but their work is as essential to the functioning of the health services as that of the surgeons and patients who rely on them.
As the head of WHO in Gaza Dr Mahmoud Daher said after touring the maternity unit, "Cleaning is fundamental to the delivery of health services. It should happen, or health is compromised." But he tossed the hot potato of the failure to pay cleaners back to the Ministry of Health, saying, "How the problem should be solved is up to the authorities."
"The authorities" are presumably those of the Ramallah-based Ministry of Health of the Unity Government, which took control in May. Gaza's Undersecretary for Health Dr Yousef Abu Al-Rish is clearly frustrated by the failure of Ramallah to act.
"We have communicated with the Ministry of Health for the last six months – fuel, medicines, cleaning – but they keep saying we have to wait. Now we face a real disaster that threatens medical services, and patients' lives," he said.
Is this Gaza's reward? More dead babies?
"Is this Gaza's reward after the many Israeli violations of their rights, the long summer offensive ? To be deprived of medical services and exposed to even more suffering and death?" Abu Al-Rish asked.
Member of the Palestinian legislative Council Dr Khamis Al Najjar is similarly frustrated by Ramallah's failure to act.
"I don't know exactly where health fits into this Unity Government's priorities. It is more than a catastrophe – it is a medical disaster waiting to happen," he lamented.
With 25% of all deliveries in the Gaza Strip occurring at Shifa Hospital, and 10-15 of the 30-40 deliveries a day being caesarean sections, the cleaners' strike will quickly have a dangerous impact.
"What I saw today in the maternity hospital horrifies me. There are three options – either newborns will die, or mothers will die, or both will die," Al Najjar warned.
New mother Afaf Shlash agrees. She was delivered of triplets by caesarean section two days ago, and is horrified at what she called 'sewage' in the bathrooms she must use.
"I fear for my health, I fear for my babies. These are not acceptable conditions," she said. "Give the cleaners their salaries so they can do their work."
Emergency and Intensive Care Units in critical condition
Head of the Emergency Department Dr Ayman al-Sahbani is visibly upset at the state of his department.
"If this is what it's like after only four hours, imagine what is going to happen at night? This is an emergency department, we received a patient with a gunshot wound to the head from an Israeli navy attack an hour ago – how are we meant to treat emergencies like this in these conditions?" he despaired, pointing at bins overflowing with bloodied gauze and beds with soiled linen. "This problem needs to be resolved immediately."
As we navigated the slippery floors between the emergency department and the Intensive Care Unit (ICU), we passed the head of nursing trying to wipe the floor, lamenting that that they are doing their best to keep the unit clean but they don't even have the proper cleaning equipment.
"Any infection in the ICU and we can lose the patient," said its head Dr Jihad Al Jeidy. "Floors and bathrooms are becoming very dirty, rubbish is gathering. A patient was discharged this morning but we can't use his bed even though it is needed, because there is no-one to clean the bay. I don't even want to imagine what it will be like by tomorrow."
Dialysis patients at risk
Dr Rami Abadla, Director of Medical Services echoed his concern, saying "What we are dealing with here is indescribable," he said. "The services were already over-stretched, and this is the last straw. There is enormous potential for infection, for death, especially for dialysis patients – each one creates huge cleaning needs."
Dialysis patient Elham Hamash demands action.
"You can see how 'clean' this place is," she said disparagingly. ""We are in an unclean environment, this is blood, we can be infected. This has never happened before. We want the cleaners paid so they can do their work."
Cleaners are humans too
This was a common refrain – and not only from the patients. Dr Abadla spoke for all the doctors and nurses when he said," Everyone feels for the cleaners, they are poor people. They need to feed their families. For over six months they have not been paid. They have no salary to survive, no money for food or even for transport to get to work. They just cannot work for nothing, it is completely unreasonable."
Several of the doctors said it was unconscionable to introduce politics into medicine.
Chief Paediatric surgeon Dr Ismail Nasr said, "It is not just the cleaners, it is all health workers, about 60% of them haven't been paid either. Also the caterers. These problems will lead to a crisis in the health sector. It is a political problem, caused by politicians. Medicine should not be a football in politics."
As Gaza Undersecretary Health Dr Yousef Abu Al-Rish and cardiac surgeon and Director General of Shifa Hospital Dr Nasser al-Tatar gowned up for a different operation, that of mopping the floors in a dialysis ward, the cleaners appear set to continue, adamant that they will not give in.
"I am ashamed of myself as a Muslim for this situation," confessed Abu Hazem Al Daya, "But there is no alternative. We can only keep striking until diseases take over and people start dying – maybe THEN someone will do something."
International community must act
Not everyone blames only the Ramallah government.
"It is a cold war," said Dr Abadla. "The suffering goes to the roots. We are stuck. There is no way out. The United Nations and the international community have to take action rather than saying it is an internal problem."
The elephant in the room is the not-so-hidden role of international donors in this catastrophe. When the Unity Government took power, many international donors insisted that salaries of workers in the Gaza public service not be paid on the grounds that they were Hamas employees. Despite the almost universal practice of an incoming government continuing to pay the salaries of public servants, many donors threatened to with-hold financial assistance to the Palestinian Authority if existing contracts were honoured.
Today's situation is the end result of that policy of collective punishment – and like all collective punishment, the most vulnerable are suffering the most.
"When Palestinians first arrived in Gaza the UN was prepared, with refugee camps ready and waiting," said Dr Abadla.
"Now they see what is going on, they know what is going on, but they are not taking any action. This is a crime. Staying silent now is a crime. It is no longer just an internal problem, it is not a Unity Government problem, or the PA or Hamas – it is an international problem, and it needs immediate international action."
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.