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| - Slumped in a hospital bed, his face obscured by an oxygen mask in an intensive care unit for coronavirus patients in the Gaza Strip, Hussein al-Hajj said he wanted to talk. "Vaccinations are essential, but I'm going to have to survive the virus before getting vaccinated," the 71-year-old retired Palestinian teacher told AFP through strained breaths. In Gaza, a Palestinian territory under strict Israeli blockade since 2007, the pandemic has been defined by contrast. Through its early months roughly a year ago, the enclave's Hamas Islamist rulers largely succeeded in limiting significant viral spread. Access to Gaza was already restricted through Israeli and Egyptian controlled crossings, and Hamas imposed strict quarantines on everyone who sought entry. But in August the first cases were recorded outside quarantine centres, raising fears of catastrophe given Gaza's weak health infrastructure. Now, as Israel broadly re-opens thanks to a world-leading vaccination effort, Gaza's vulnerable health system is overwhelmed. Hajj was admitted to a Turkish funded hospital, built in 2017 on land where polluted stagnant water often pools, which was previously used as a training ground for Hamas's armed wing. The white-haired Hajj was among a group of mostly elderly, male patients curled up on beds and intubated under the care of an overstretched medical team. "My wife and I contracted corona. She stayed in quarantine at home, but I have lung problems, so first I was brought to the hospital, then here," he said in a whisper, referring to the makeshift ICU. "It's a question of life and death. Things can deteriorate at any moment." Health authorities in Gaza say the situation turned more dire following the emergence last month of the more contagious British coronavirus variant, which fuelled a surge in cases among younger Palestinians. "The situation is critical," said Rami al-Abadelah, director of infections diseases at Gaza's health ministry. Last week the enclave of some two million people registered a pandemic record of 23 deaths in a single day. Around 850 Gazans have died from Covid-19, while the territory is expected to cross the 100,000 case threshold within days. The resource-strapped Islamist authorities are conducting about 3,200 tests a day and the 36 percent positive test rate is among the highest in the world, according to the World Health Organization. "Officially we have about 1,000 (new) cases a day, but it's probably 5,000 or more because people don't go to the hospital or call us to say if they have symptoms," Abadelah said. Samer Mansour, head nurse at the ICU, said when the unit opened only one of the nine beds was occupied. Now the beds are "always full," with about 40 percent of patients under 50, he added, explaining that medical staff in Gaza have experience treating combat wounds, but Covid-19 has posed unprecedented challenges. Hamas has tried to contain transmission by imposing a 7:00 pm curfew, an effort to prevent large gatherings for evening meals during the Muslim holy month of Ramadan. But relief from mass vaccination remains a distant prospect. The United Nations and rights groups have said that Israel has a legal obligation to ensure vaccine supply to Gaza, as the military power responsible for the crippling blockade. Israel has baulked at such calls, insisting the Palestinian Authority in occupied West Bank is responsible for all Palestinian vaccinations. For Gazans, that means relying on the PA which has faced a series of procurement challenges and on the Covax programme set up to support Covid vaccinations among poorer nations. "We have received 110,000 doses by we need an additional 2.6 million," Abadelah said. gl-az/bs/hkb
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