The trauma of life and death in Gaza

This is an audio transcript of the Rachman Review podcast episode: ‘The trauma of life and death in Gaza’

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Gideon Rachman
Hello and welcome to the Rachman Review. I’m Gideon Rachman, chief foreign affairs commentator of the Financial Times. This week’s podcast is about the war in Gaza and the situation facing Palestinian civilians and the Israeli hostages still held there. My guest is Sigrid Kaag, the UN’s senior humanitarian and reconstruction co-ordinator for Gaza.

The killing of Yahya Sinwar, the leader of Hamas in Gaza, briefly inspired hopes that the war might be brought to an end. Instead, in recent days, there’s been an upsurge in fighting. So is there any hope for peace and reconstruction in Gaza?

Benjamin Netanyahu voice clip
The singling out of the one and only Jewish state continues to be a moral stain on the United Nations. It has made this once respected institution contemptible in the eyes of decent people everywhere. But for the Palestinians, this UN house of darkness is home court. They know that in this swamp of antisemitic bile, there is an automatic majority willing to demonise the Jewish state on anything.

Gideon Rachman
That was Benjamin Netanyahu, Israel’s prime minister, addressing the United Nations last month. The Israeli government has made its hostility and contempt for the UN very clear, and that makes the position of Sigrid Kaag very tricky, since she has been appointed by the UN to try to improve the humanitarian situation inside Gaza.

Kaag’s a former deputy prime minister and former foreign secretary for the Netherlands. She hasn’t given many press interviews since her appointment last December, preferring to concentrate on her efforts to get aid and assistance into Gaza. But when she passed through London earlier this week, I sat down with Sigrid Kaag, and I began by asking her to describe the current humanitarian situation inside Gaza.

Sigrid Kaag
The situation on the ground? Sometimes I find it actually hard to describe for the simple reason you want to do justice to what I would call dystopian conditions. It’s an inhumane condition that people have been forced to live in. Their houses have been destroyed, nowhere to stay. They’re staying either by the sea in ramshackle structures from plastic-sheeted covers, sometimes a little bit of a tent. If you’re poor, you’ve sold your tent to sort of get some money to buy goods on the market when there was still something available.

It is a Gaza I have never seen before. And last week we visited a number of communities that are what we call near flood zones, ie winter is coming. Their tents will be flushed away, it’s only a matter of weeks. But people and children and adults have skin diseases, scabies, eczema. Anybody that will show you their arm has multiple signs of either poor nutritional status. That’s of course a given. Diseases, because they can’t wash, no clean water, no proper latrines. Anything you could think of in modern society, or rather we can’t even imagine any more, is happening in Gaza. And it is truly depressing. And as all conflicts, it’s man-made.

Gideon Rachman
Yeah, and that’s to be clear, the majority of the population are living like that. Is anybody living in what you might call vaguely normal conditions?

Sigrid Kaag
No, I don’t think so. Even if their housing structures or maybe part of an apartment building is still standing, they are most likely to have lost family, friends. They’re very far away from where they used to live or work. I’m nowadays pleasantly surprised if we drive around Gaza to see that there are a few houses from which people emerge or you can actually see the world they’ve moved back in. Even though half of the buildings blown out, they’ve decided to put a blanket over the open structure and reside basically in stone dwellings. But it’s rare. And if you look at the studies done, both satellite imagery as well as ground studies, I believe between 60 to 80 per cent of all civilian infrastructure has been destroyed or damaged to an extent it’s no longer usable, so it has to be demolished when the moment comes, we can actually do so.

Gideon Rachman
So, as you look at that situation, what are your priorities? What are you trying to do?

Sigrid Kaag
Well, from my mandate, there were two priorities that were very clear. One of them was to make sure that as the language of the resolution says, we facilitate, accelerate and expedite aid getting into Gaza. The second part was to establish a mechanism to make sure this happens in a transparent but also in a proper way. In the meantime, we’re also focusing all political attention on the need to think recovery and reconstruction. Given the state of destruction, given the totality of needs and the fact that you need to give hope to people.

But it’s very hard to have a compelling story without clarity on the governance and security arrangements for Gaza and in Gaza. And all our efforts are nowadays compounded, not only by the conduct of war, but also the difficulties to get into Gaza, to distribute, to reach people. You have to imagine the roads are almost unpassable, fighting continues, crime is on the rise, looting is a really serious issue. Over and above all the other daily acts of war, which really present significant dangers to civilians, but also the humanitarian workers. We’ve lost over 300 colleagues — 312 humanitarian workers, to be exact — it’s an extremely high toll in a war zone. And well the civilians, as we know, we’re approximating already almost 42,000 lives lost in Gaza.

Gideon Rachman
42,000 civilians? Because the Israelis say . . . (inaudible) . . . fighters, etc.

Sigrid Kaag
I can’t totally . . . yeah . . . I can’t attest to everyone being a civilian. Not at all. So we go by the same data provided by the Ministry of Health. And in the past, I believe international journalists have also shown that they’ve proven to be fairly accurate. There are many more, however, who are missing, and we know that a lot of children are dead, but they’re still under the rubble.

Gideon Rachman
So you’re saying the figure could be a lot higher?

Sigrid Kaag
We fear the figure is significantly higher. And next to that, you’ve got a high number, over 90,000 of people that are injured as a result of war. And given the very strict conditions on the ground, the great difficulties to get any significant volume of aid in and distribute that to people, we’re also seeing that a lot of people will die from basically secondary causes: food insecurity, acute malnutrition of children under five, untreated diseases that were there before the war but there’s no medicine to deal with the conditions. So you see a corollary effect with risks being quite significant. 

Gideon Rachman
Yeah, and what about the situation right now? Because there seems to have been an intensification of fighting in the north. What’s happening? And is it making your task even harder?

Sigrid Kaag
Yeah, I think when I started, people said it’s mission impossible. I used to say it is mission near impossible. I think it’s still that, given the conditions on the ground, given the absence of a ceasefire, the unconditional release of the hostages, they should most certainly not be forgotten. We fear, of course, that they are surviving under the worst possible conditions. And the civilians in Gaza.

But if you look at the volume of aid in the month of October alone, it’s as bad as little as it was in December last year. We’re not able to distribute and let alone reach people in the north. And we measure that and we monitor that by missions, what we call missions, let’s say, from WHO or WFP, that have to ask permission from the Israel Defense Forces to travel from location A to the north in Gaza. They’re either denied, what we call impeded. WFP has been able to provide for its last food rations for north Gaza, but it will last no longer than two weeks or 12 days. No one else can access or work there. Civilians are trapped either in Jabalia camp. They get so-called evacuation orders to leave, but it’s very dangerous. So a lot of people are choosing also to stay where they are, with great uncertainty or perhaps death looming over them. So the situation in the north has always been even harder than in southern Gaza.

But overall, the picture of Gaza is one of destitution. It is a humanitarian catastrophe of a magnitude that I could never have foreseen. None of us, I think. And at the same time, we can have the goods, we should be able to distribute. It’s the duty of the warring parties to be compliant with international humanitarian law. And there is sufficient will to provide for. But if we still fail to reach people and even alleviate a small part of their immense suffering, we are collectively failing. We’re failing as an international community. And to me, as I’ve said to the Security Council in September as well, it’s a matter of political will. And that ends up being choice.

Gideon Rachman
But it’s also, I guess, you need the co-operation of the Israeli authorities to get anything in.

Sigrid Kaag
Absolutely.

Gideon Rachman
Israel, the prime minister and many ministers have been absolutely scathing in their criticism of the United Nations. I think Netanyahu said when he was there that it was riven with antisemitism. So how do you maintain a dialogue with them? Can you maintain a dialogue with them in your efforts to get stuff into Gaza?

Sigrid Kaag
Yes, I do. And I always attest to the fact that I have a constructive relationship with the Israeli authorities. At the same time, the measure of success of what the international community wants and what you need for international humanitarian law, you can measure it by the aid that gets in or doesn’t get in, what gets distributed or doesn’t get distributed. The metric and the condition of human life, civilian life in Gaza is at the moment appalling. So dialogue remains very important.

We try to find solutions. We’ve built all the different access routes, we’re organising the volume we’re trying to get greater goods in, also the typology of assistance that is actually permitted to enter. But at the end of the day, it falls way short of what is needed and certainly what is needed right now for human beings to survive — not to thrive — just to survive in Gaza. And that’s the metric that counts, that’s the only metric we can use collectively.

Gideon Rachman
Give me a sense of what that dialogue with the Israelis is like. Because obviously their public rhetoric is very condemnatory of the United Nations. In private, can you have a constructive conversation? Do you feel that you’re trying to do the same thing or that you’re being deliberately frustrated? Do they lecture you? What’s it like?

Sigrid Kaag
Well, I have a tendency not to comment on conversations I’m having bilaterally. So let me stick to that, because it actually doesn’t help. At the same time, we’re having different conversations, I would say. Also difficult ones. At the same time, I’m trying to focus on what’s needed and how we can do it. Equally so where, for instance, we have to change the way we work from the humanitarian side, if there are solutions that could be different. And if you look at the polio campaign that was conducted in September, it was an example of what’s possible if everybody wants it to happen when you have a humanitarian pause and when the humanitarian organisations are enabled and protected to do their job. If the parties want to, it can be done. Then it’s upon us to organise it, get the supplies in, get the cold chain in this case in order, and then you can say, OK, operationally you and you didn’t do a good job, but we’re not getting to that point. And these are part of the conversations we continue to have.

Gideon Rachman
But don’t the Israelis have some point when they say the UN has over many years failed in Gaza because they say, well, look, you know, Hamas built this massive network of tunnels, sometimes on the UN-run schools, that some of the people who took part in the October 7th attacks were also employed by the UN. So can you understand why they might distrust the UN?

Sigrid Kaag
I can very much understand the emotion. That’s normal. I mean, I think we should never forget the immense trauma that the 7th of October has inflicted on the country and its citizens. Not only the loss of life, the fact that a number of families are still waiting for their loved ones to be returned safely and securely from Gaza, the hostages. The trauma is immense.

At the same time, the United Nations in Gaza has been working there for decades, particularly UNRWA has provided for health services, education. It has a strong track record also in social services. UNRWA in Gaza in particular, is the lifeline of what is the social fabric. It’s a large employer, 13,000 staff and counting, I would say.

Every incident and every allegation always needs to be taken seriously, and the secretary-general has done so. People have also been fired, investigations have taken place, and former foreign minister Colonna has issued a report with recommendations to the agency, and I would say the UN needs to implement.

Distrust is, of course, also a human emotion. But it’s very important we also look at what the mandate is in this case of UNRWA: it comes from the General Assembly, it’s an international organisation that since the early days of the establishment of the state of Israel has rendered very important services equally so in the West Bank, in Jordan, Lebanon and Syria. So as a UN, we rely very much on UNRWA, in Gaza especially, to continue to provide for humanitarian assistance and beyond. Now, in this regard, of course, you are aware of the Knesset’s draft legislation that lies before Israeli parliament, which, if adopted in present form, would have far-reaching consequences for UNRWA and therefore also the UN to operate effectively in Gaza.

Gideon Rachman
Explain what does that legislation say?

Sigrid Kaag
I don’t know it by heart, so I do want to cite it wrongly. But it basically calls UNRWA a terror organisation. It will render its operations de facto near-impossible, if not impossible, both in Gaza but also in the West Bank, including where its offices in East Jerusalem. And it would have a damning effect and impact on the ability of the UN, but also the broader humanitarian community in Gaza in particular to operate. It risks also having a tremendous destabilising effect on the wider region. You can just imagine how Jordan, for instance, would feel about this or Egypt and other countries.

Now, the letter that — I believe it’s a leaked letter — but the letter that secretary of state Blinken and secretary of defence Austin have sent to their Israeli counterparts, which provides for a 30-day window, is also asking for a different consideration of the draft legislation before UNRWA. It demonstrates the importance of the work by UNRWA. And at the same time, one has to be very clear, if there are allegations that can be underpinned by evidence, the UN always needs to act. And the secretary-general’s always been clear about that.

Gideon Rachman
Right. You work with the Israelis or you try to. Who can you work with on the Palestinian side that isn’t Hamas?

Sigrid Kaag
We work with the Palestinian Authority. All of the UN does. Same as the member states. And we work closely with Prime Minister Mustafa in support of his vision and that of minister of planning Wael Zakout. But we also work with Palestinian NGOs. They’ve been there for a long time. They survived Hamas. They are eager to contribute and I think support Palestinian NGOs, alongside the leadership of the Palestinian Authority, reform, to rejuvenate it, whichever adjective you want to add on to it.

But the support for Palestinian NGOs, to my mind, is extremely important also for a vibrant civic society. To have diversity of views, to be part of the democratisation of the process, and to really have the voices from Gaza be in the lead as to their priorities, the direction of travel for Palestinians from the Gaza Strip, but very much connected to the West Bank because a future Palestinian state is the Gaza Strip, West Bank and of course East Jerusalem as its capital.

Gideon Rachman
I mean, your mandate is getting aid in and helping the immediate problem, but it’s also reconstruction. Is that possible with an ongoing war?

Sigrid Kaag
Yes, a tough one. I’ve been saying from the outset that we need to provide for both political horizon and prospects. Because if you are in Gaza today — even if you’re a fellow traveller, if you’re there in and out as a UN official like I am — you get overwhelmed by the sheer scale and scope of the horror of the destruction. And it’s very easy to think this is just impossible, it will never be done again. And if you look at the statistics, some officials say it might take seven or eight decades before Gaza is rebuilt. That’s future generations. We can’t have that.

So for me, it’s very important we not only get the technical studies done per sector — education, infrastructure, health, you name it, employment — that we know what needs to be done. And we start to prepare early on because you cannot condemn people to a life of only humanitarian assistance. Palestinians are proud. They used to be well-educated, they still are. They are determined and they need to overcome this immense trauma. We need to do so by investing. And in the absence even of clarity around the governance and security arrangements, we can do more. I mean, we will not be able to provide even for the basic of health services if we don’t have recovery of some of the health infrastructure. That’s already a pathway to reconstruction. Yes, the war needs to stop. At the same time, in order to tackle diseases, in order to deal with all the issues and needs that the Palestinians have, we need to focus on reconstruction, and it’s going to cost billions and billions and billions.

Gideon Rachman
Who would provide that money given that Gaza keeps being invaded, keeps being attacked? I mean, it would be knocked down again in 10 years’ time.

Sigrid Kaag
Yeah, well, that’s always the big question. We know, of course, that the Gulf states have made it very clear: without a political horizon, the return of the Palestinian Authority, without proper governance and security in place, we will not invest. In the meantime, I know that the political discussions might take some more time, but we need to provide for people, and that requires funding. I’m convinced that that funding may be coming forth from both the European Union and Gulf countries. But the big ticket, the real story of reconstruction, is tied intrinsically to the establishment of the two-state solution and a safe and secure Israel. And you need to invest against that.

Now, there are interesting studies carried out together with the European Union, the UN, but also Palestinian initiatives or initiatives from the private sector, also Palestinian diaspora, that make both a compelling business case and at the same time underpin what you can call realisation of Palestinian statehood in a modern fashion, in a transparent way, based also on the return of Palestinian institutions, in this case, the Palestinian Authority. They have their own plans and I think it’s our duty to make sure we can reinforce that and support that.

But you need clarity on the financing. You want transparency. You need to combat corruption. In any postwar era, it’s very easy for funds to go astray, let’s put it that way. So we need to have proper structures in place and all that thinking is happening now. So I wouldn’t call it so we can plug and play, but we’re ready to accelerate and move very quickly. You can’t tell people, well, we’ll start thinking about it now once there is a ceasefire. Too late.

Gideon Rachman
Reconstruction, obviously, it’s a physical job, but also I guess it’s a psychological problem. And one hates to think of, you know, if you’ve lived in those conditions, you mentioned the trauma of Israelis, the October 7th and you know, I just read that survivors of the Nova Music Festival, one of them just killed themselves. But there must be huge numbers of Palestinians who, as you say, have lost family members, have been maimed. They’ve lived in terrible conditions. I don’t know what you do about psychological trauma like that.

Sigrid Kaag
No. And the entire population is traumatised. And I always, frankly speaking, I always feel very humble, but also sometimes almost ashamed at what we are allowing to happen. And our words are very little and our actions even less. There are a number of programs that are being kick-started. Basically, mental health and psychosocial trauma counselling for young children, for adults. But again, here also the scale is so overwhelming and enormous. The traditional caregivers are traumatised themselves and they need to somehow find remedy and support and care for all the younger ones that have been affected. It needs a whole new approach. WHO is looking at this.

A number of Palestinian NGOs are really active in the field and with children, they start very light touch. And one important step is to get children back into locations of learning, I would say. Because a lot of the schools have been destroyed or used as temporary shelters for the displaced. And initial UNRWA studies have shown that some of the children that have somehow been back in a learning environment, they’re more calm. They can talk about their trauma, loss of brothers or sisters or their entire family in a way with other survivors as they all are, and it helps them. So is picking up somehow the thread of what used to be their daily lives, but in a very different setting. That is also a first step of starting that conversation.

But my push with my colleagues is to organise this truly at scale in a sustained manner over many years. And it needs expertise, it needs Arabic speakers, it needs people that are very much from the culture or familiar with the culture. And it needs, of course, different elements of support in the home. I can’t even call it home any more. Within the tented areas, in places of learning, in places where healthcare is provided. But nothing, nothing like you and I would imagine if you’ve been traumatised and the type of support you’d be getting, you go to your counselling session, you will go and speak to a professional. None of that is currently available.

Gideon Rachman
So to conclude, I mean, obviously you are very much engaged in the same daily struggle to alleviate the situation in Gaza. And you said that people had said to you, one, it’s a hopeless task. But as you look ahead, how possible is it for you to maintain faith that Gaza can return, in some form or other, to being a kind of normal living environment?

Sigrid Kaag
I think it’s a duty. As you may recall, we last met when I was still in the Dutch government and I only took this role as I consider it a moral imperative to try to both be part of an effort to alleviate suffering, to do what’s right, and to establish or help plant some of the seeds for a better and different future. That it was going to be easy, I never thought. That it’s very much an uphill struggle, absolutely.

But at the same time, you see pockets of hope from within Gaza. Children, Palestinian civil society is strident, strong, ready to pick up where they had left off a long time ago. So what we need to do from the privilege and the luxury of our position is to make sure that they have everything they need to succeed against the odds. Am I hopeful? Maybe that’s too optimistic. But I think it’s our duty to create hope. And we can only do so by continuing to work. And when my time is up, so to speak, I hope many other people will come and take over the battle. That’s all we can do.

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Gideon Rachman
That was Sigrid Kaag, the UN’s co-ordinator for humanitarian relief in Gaza, ending this edition of the Rachman Review. Thanks for listening. Please join me again next week.

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