Isolating Gaza from the World: Humanitarian Implications of Israel’s Seizure of Rafah

Prior to the fall of 2023, Rafah was a relatively unknown city in the already poorly understood Gaza Strip, especially to much of the world outside of the Middle East. The smallest of the five governorates of the Strip by population, Rafah was most closely associated with its land border between the Gaza Strip and Egypt, and served as the link between the besieged Strip and the rest of the world. The Rafah refugee camp is one of the largest in the occupied territories. For a short while, Rafah was also where the Gaza International Airport once stood for a brief period after the Oslo Accords of the 1990s, before Israel bombed it years later, never to permit its reconstruction.

Today, Rafah is internationally recognized as a site of unfathomable horrors; one where starving children were burned alive and dismembered in their plastic and cloth tents. While the images and videos from the Rafah tent massacre on May 26 that killed dozens disturbed the world, Israel persisted in bombing the area multiple more times in the following days.

Once a place where, just months ago, more than a million people in Gaza came to flee the destruction of their homes and cities in the north, now Rafah has become another target of Israel’s ceaseless bombardment and ground offensive—confirming the assertion by the head of the World Health Organization as far back as November 2023 that “nowhere and no one is safe” in Gaza.

It is not just the bombardment and the ongoing ground offensive, however, that have led to misery across Gaza, but also Israel’s clampdown on movement and imposition of harsh restrictions on aid and personnel entering the territory. Declaring a complete siege, Israel did not allow the first aid convoy to enter Gaza until October 21, and the border crossing Israel permitted to open was the one at Rafah—one not designed to accommodate thousands of trucks’ worth of cargo. Israel also demanded intrusive security measures for all trucks, and frequently rejected aid.

Israel’s clampdown on movement and imposition of harsh restrictions on aid entering Gaza has led to misery across the strip.

But after May 6, 2004, somehow the situation deteriorated even further. Israel seized the Rafah border crossing, which was already allowing a pitiful amount of aid in per day despite the desperate need, as it engaged in an ongoing invasion. Just days after the tent massacre, nineteen aid agencies, including Save the Children, Doctors without Borders, and Oxfam, released a letter warning that due to the escalation in Rafah, “the humanitarian response is in reality on the verge of collapse.”

Impunity as Israel Seizes Control of Rafah

Despite months of justifications for multiple massacres, disturbing footage of detainments and looting of people’s homes, the blockade of aid, and a host of other Israeli violations, US President Joe Biden claimed several times that he did indeed have some red lines in Gaza, such as an invasion of Rafah. The United States maintained that stance even two weeks after Israel forced the occupants of Rafah to flee and invaded the area. This action was “limited,” in Biden’s view, and not the “major military operation” about which he had warned his ally. Days after the tent massacre, National Security Communications Advisor John Kirby maintained the position, saying that while the images were “horrific,” the administration would not change its stance because, “we have not seen them smash into Rafah.” Israeli tanks entered central Rafah the same week.

Aside from debating the semantic difference in the type of operation Israel was waging in Rafah, there was one clear outcome: Israel seized the Rafah crossing, essentially preventing entry of any aid into Gaza. The lack of access to aid was a significant component in both the International Court of Justice genocide case against Israel as well as the International Criminal Court’s applications for warrants for the arrest of Israel’s prime minister and defense minister. The United States claimed many times that the slow trickle of aid into Gaza was a problem. Meanwhile, trucks were waiting on the other side of the Rafah border, filled with food that would rot and medicines that would not withstand the heat.

The United States announced that the seizure of the border crossing would be compensated by additional border crossing openings. Israel opened the Erez crossing in the north on May 1, but closed it on May 9. Since May 8, the Karm Abu Salem (Kerem Shalom) crossing, also in the south, has been deemed not logistically viable since May 8 due to insecurity. While technically trucks can enter, their cargo cannot safely be distributed; in one incident, Israel opened fire on Palestinian border workers approaching the crossing to retrieve aid. Only one land crossing remains functional.

The United States also claimed that its new floating dock, which cost $320 million to build, would ease the humanitarian burden of Rafah’s closure. A few weeks after assembly was completed in May, it broke apart and needed to be dismantled for repairs. Even in the best case scenario, it was estimated to be able to bring in 150 truckloads of aid per day; Gaza needs a minimum of 600 trucks per day just to meet basic demand. From May 7 to May 28, just over 1,200 trucks entered Gaza, and most through a crossing in the north. Passage to the south for these trucks is not only dangerous, but with many roads destroyed, is also logistically difficult. The humanitarian impacts of this massive disruption will undoubtedly cause further harm to the people of Gaza.

Increased Hunger and Famine

Israel has a long history of purposefully controlling food imports into Gaza, including counting the calories needed for the population to determine the number of trucks that would be permitted in shortly after the start of the blockade. While Israel eventually eased some restrictions, the blockade persisted, causing economic collapse and significant shortages of goods throughout Gaza. In January 2023, an estimated 75 percent of people in Gaza were deemed “moderately or severely food insecure.”

Thus, it did not take long for humanitarian agencies to start warning of malnutrition and hunger after the closure was announced on October 7. By December 18, Human Rights Watch had already compiled evidence to argue that Israel was using starvation as a weapon of war. By January 16, the United Nations said that hundreds of thousands were starving, and in March, the Integrated Food Security Phase Classification Famine Review Committee estimated that more than 1 million people in Gaza would be in Phase 5—the highest classification, indicating catastrophe conditions—by July.

Israel has a long history of purposefully controlling food imports into Gaza.

This classification came long before the closure of Rafah. According to a UNICEF spokesperson, “If the crossing is not urgently reopened, the entire civilian population in Rafah and in the Gaza Strip will be at greater risk of famine, disease and death.” For now, with the American pier non-functional and most border crossings closed, and with no significant effort to pressure Israel to find ways to increase distribution of aid, the famine conditions that had started in northern Gaza will quickly spread to the south. Some aid agencies had prepared for a potential invasion, stocking water, food, and some medicines, but they warn they are quickly being depleted.

And it is not just about the quantity of food, but also its quality. Approximately 1 in 3 children under the age of 2 across Gaza suffer from acute malnutrition due to lack of access to a consistent, varied, and nutritious diet. Many who have been able to eat have not had fresh meat, fruit, or vegetables in months, subsisting on bread and canned foods. After food distribution was suspended in Rafah shortly following the invasion, agencies warned that treatment of acute malnutrition in more than 3,000 children will be paused. On May 30, Israel indicated it would resume permitting the import of fresh foods from Israel and the West Bank into Gaza for the first time since October, yet it is unclear how to overcome the logistic hurdles of distributing the food throughout Gaza.

A Multidimensional Health Disaster

With a health system that essentially collapsed months ago and hundreds of humanitarian workers killed, limited access to medical supplies, and an environment of overcrowding, poor sanitation, and minimal food and water, the population of Gaza is poised for an escalation in the ongoing health crisis.

While the number of battle-related deaths is difficult enough to verify due to the number of bodies buried under rubble, the number of deaths from indirect causes, including medical ailments, is in some ways just as difficult to approximate. Some people, knowing there is little medical care available and with the insecurity of traveling even short distances, will not seek treatment. Others with chronic health conditions like diabetes, cancer, or heart disease depend on medications or procedures that are almost impossible to get anywhere in Gaza. While dedicated workers have been able to rebuild infrastructure enough to offer some services, like dialysis, the scale is nowhere near what is needed.

The number of deaths from indirect causes is just as difficult to approximate as the number of Gazans missing.

Of course, to an extent, this was the case before October 7 due to the blockade. Every month, thousands of Palestinians from the Gaza Strip would apply for medical permits to receive care in Israel or the West Bank. This was a process almost entirely controlled by Israel, and required all medical patients, from babies to the elderly, to go through a time-consuming permit process, even for urgently needed care. Israel denied permits or delayed them regularly, and some patients have died while waiting. Today, there are many young patients who require urgent care and need evacuation, and that is in addition to people with health needs unrelated to conflict-related injuries.

After October 7, although this process significantly slowed, Israel was still approving some medical permits for patients (only 46 percent of applications were approved), all of whom left through the Rafah crossing. But with Rafah closed, the process has halted. The United Nations Office for the Coordination of Humanitarian Affairs estimated that, as of May 18, more than 700 young patients who should have already been evacuated for medical care are stuck in Gaza. For some, the delay could significantly impact their prognosis, and yet there is no clarity on when this process will resume.

Tightening the Siege

By late May 2024, reports indicated that Israel had seized the entire border area between Egypt and Gaza in Rafah, giving itself effective control of the southern border of the territory. There is no doubt that Israel was only able to so quickly gain control of all the territory’s land borders, as well as its access to the sea, because it already had the mechanisms in place to do so. However, even within the dystopian parameters of the pre-existing blockade, there was some understanding that Rafah had to serve as a main artery for the entry of aid into Gaza, as well as for the medical evacuation of those who need it.

With Israel seizing control of Rafah for a yet unknown period, and ensuring that movement in or out is stifled, Gaza is in relatively uncharted territory. Fuel needed to run generators, water treatment systems, and other vital services is scarce. Signs of starvation and the spread of disease have already been reported. According to Medicine Sans Frontières, there is no longer a functional hospital in Rafah. While there were already rumors that the United States was urging Israel to reopen Rafah by the end of May, Egypt demanded a Palestinian entity to run the crossing, and it is unclear what Palestinians Israel may approve to do so. Israel has also said that an international entity should manage the border eventually but has not yet found a suitable choice.

Whether Rafah opens or remains closed in the coming days, significant damage has already been felt by the Palestinians living in Gaza who depended on the already meager trucks of aid that entered through the crossing. The governorate of Rafah itself, which previously had experienced significantly less bombing damage than areas in the north, now has more unlivable pockets as well as an increasingly desperate population with nowhere to go. In line with the consistent, clarion calls from every major humanitarian agency in the world, to even begin to address these multiple crises, an immediate ceasefire and unimpeded access to aid, from all crossings, is long overdue.

The views expressed in this publication are the author’s own and do not necessarily reflect the position of Arab Center Washington DC, its staff, or its Board of Directors. 

Featured image: Shutterstock/Anas Mohammed