Originally published 2021-05-19.
On Monday 17 May 2021, an Israeli airstrike in Gaza City badly damaged the al-Rimal clinic, the building that housed the Gaza Strip's only major laboratory for processing COVID-19 tests. The Palestinian health ministry in Gaza said the lab could no longer carry out tests. It happened in the middle of the 11-day war between Israel and Hamas, at a time when Gaza had one of the highest rates of positive coronavirus tests in the world and almost no vaccines.
The lab was not reported to be the target. Israel said its strikes in the area were aimed at sites linked to Hamas, and the clinic was hit by the blast and debris. For the two million people living in the territory, the result was the same: for a time, there was no reliable way to know how far the virus was spreading.
What was hit and what the lab did
The al-Rimal clinic sits in the Rimal neighbourhood, one of the busiest parts of Gaza City. It housed the central laboratory where swabs from across the Strip were processed. Before the fighting began on 10 May, Gaza was testing about 1,600 people a day there.
The same laboratory did more than COVID-19 work. It also handled routine tests for other infections, including HIV and hepatitis, so the damage affected regular health care as well as the pandemic response.
Strikes on the same day also hit near the main Gaza health ministry building and the office of the Qatar Red Crescent. Deputy health minister Yousef Abu al-Rish said medical staff were among the wounded. Ministry spokesman Ashraf al-Qidra said the strikes had stopped screening tests at the central laboratory and threatened the ministry's efforts against the pandemic.
Gaza's COVID-19 situation in May 2021
The damage came at a dangerous moment. In the weeks before the war, around 28% of COVID-19 tests in Gaza were coming back positive, one of the highest rates anywhere. By then, according to the World Health Organization, about 103,000 people in Gaza had tested positive and more than 930 had died.
Vaccines were scarce. WHO said the territory had received roughly 122,000 doses in total, and more than half had not yet been given. That meant only a few percent of Gaza's population had been vaccinated. Neighbouring Israel, by contrast, had run one of the fastest campaigns in the world and had given at least one dose to more than half its population by spring 2021.
The vaccine gap was the subject of a heated debate during the pandemic. Israel argued that under the Oslo Accords health care for Palestinians was the responsibility of Palestinian authorities. Human rights groups and UN experts said that, as the occupying power, Israel had obligations to help vaccinate people in the occupied territories.
Why crowding made things worse
Gaza is about 365 square kilometres, roughly the size of a mid-sized city, with around two million residents. During the war, tens of thousands of people fled their homes. The UN said more than 70,000 were displaced at the peak, most of them sheltering in about 50 schools run by UNRWA, the UN agency for Palestinian refugees.
Matthias Schmale, then UNRWA's director of operations in Gaza, warned that crowded shelters could become places where the virus spread rapidly. Families were packed into classrooms with limited water and sanitation, and hospitals were filling with people injured in the strikes. With testing interrupted and vaccinations paused, health workers had few tools to track or slow an outbreak.
How the war started
Tensions had been building in Jerusalem for weeks. Palestinian protests grew over the threatened eviction of families from the Sheikh Jarrah neighbourhood of East Jerusalem. On 7 and 10 May, Israeli police raided the al-Aqsa Mosque compound during clashes with worshippers in the last days of Ramadan.
On 10 May, after an ultimatum to Israel expired, Hamas and other armed groups in Gaza began firing rockets towards Jerusalem and Israeli cities. Israel responded with an air and artillery campaign across the Gaza Strip. Over 11 days, militants fired around 4,300 rockets and mortar shells at Israel, most of which were intercepted by the Iron Dome system or fell in open areas; some fell short inside Gaza.
The human cost
By the time of the lab strike, Gaza's health ministry said more than 200 Palestinians had been killed, including dozens of children. Israel said many of the dead were militants. When the fighting ended, the UN counted at least 256 Palestinians killed, among them 66 children, and more than 1,900 injured. Israel said its strikes had killed around 200 militants, while Hamas put that number far lower. In Israel, 13 people were killed, including two children, and hundreds were injured by rocket fire.
The al-Rimal clinic was one of many health facilities affected. UN agencies reported that at least 19 medical facilities in Gaza were damaged or destroyed, including hospitals run by the health ministry. The director of the ministry's preventive medicine department, Dr. Majdi Dhair, told The New York Times the strike was barbaric
and could not be justified.
A general strike across the territories
On 18 May, the day after the clinic was hit, Palestinians in Israel, the occupied West Bank, East Jerusalem and Gaza held a general strike in protest at the bombing and at Israeli policy towards Palestinians more broadly. Shops and businesses closed across the territories.
The strike was notable because it crossed long-standing political divides. It was backed by Fatah, the party that leads the Palestinian Authority in the West Bank and is a bitter rival of Hamas, which has ruled Gaza since 2007. Some Arab citizens of Israel who joined it reportedly faced threats of dismissal from their employers.
The ceasefire and the aftermath
An Egyptian-brokered ceasefire between Israel and Hamas took effect on 21 May 2021, after 11 days of fighting. Both sides claimed victory. Most displaced families left the UNRWA schools within days, though thousands of homes had been destroyed or damaged.
Testing and vaccination in Gaza gradually resumed with support from WHO and other agencies, but the episode showed how fragile health services in the Strip were. A single damaged building was enough to halt COVID-19 testing for the whole territory.
The wider conflict did not end in 2021. Gaza saw further rounds of fighting, and from October 2023 a far deadlier war that devastated its hospitals and health system. Looking back, the strike on the al-Rimal lab was an early warning of how vulnerable that system is when war and disease arrive at the same time.
Why health facilities are protected
Under international humanitarian law, hospitals, clinics and medical staff have special protection. Attacks must distinguish between military targets and civilians, and any expected harm to civilians and civilian objects must not be excessive compared with the military advantage. Whether a particular strike met those rules is often disputed, and in 2021 rights groups called for independent investigations into a number of Israeli strikes as well as Hamas rocket fire on Israeli towns.
For ordinary people in Gaza, the lesson was simpler: when a lab, a clinic or a hospital is damaged, the cost is counted not only in the strike itself but in the tests, treatments and vaccines that do not happen afterwards.
Sources: Asharq Al-Awsat (AFP), 18 May 2021: Health ministry says Israeli strike puts sole Gaza COVID lab out of action; Wikipedia: 2021 Israel–Palestine crisis; The New York Times, 18 May 2021 (original report); Al Jazeera, 20 May 2021: Israel and Hamas agree Gaza ceasefire.
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