The Aid Workers Who Risk Their Lives to Bring Relief to Gaza

In an unheated warehouse in Rafah, Ahmad Najjar ran a power cable from the battery of a banged-up company car to his laptop and sat down to work. Najjar, a thirty-eight-year-old pharmacist, is a medical-donations officer for American Near East Refugee Aid, a nonprofit based in Washington, D.C. It was a cold day in March, and he wore a jacket and a vest as he inventoried towers of shrink-wrapped cartons of donations. There were blood-pressure cuffs, disinfectant, and medicine, but no crutches or oxygen cylinders. Trucks headed for Gaza that contain any metal are sent back at the border.

Najjar had jerry-rigged a workstation: two stacked boxes for a chair and a larger one for a desk, where he propped his laptop to set up a distribution plan. The supplies were urgently needed. After half a year of war, fewer than a dozen hospitals in Gaza remained functional, and then just barely. Nurses used dishcloths as bandages; surgeons operated by cell-phone light, steadying themselves against the booms of incoming shells.

The organization Najjar worked for, known as Anera, was founded in 1968, to provide aid to Palestinian refugees of the Six-Day War. Today, it has a permanent staff of twelve in Gaza and a hundred in the region, supplemented by volunteers and contractors as needed. Anera disperses about a hundred and fifty million dollars a year in humanitarian and development aid, from donors around the world, and oversees many of the programs that it supplies. Sean Carroll, Anera’s president and C.E.O., describes it as a “last-mile delivery partner in Gaza.”

These days, the last mile is difficult to navigate. Gaza is uniquely isolated—governed for the past seventeen years by Hamas and subject to an unremitting blockade by Israel. After thousands of Hamas soldiers and other militants surged into Israel on October 7th, killing some twelve hundred people and taking more than two hundred hostages, Israel began dropping more than seventy thousand tons of bombs, devastating an already precarious place. As aid agencies mobilized, the Israeli government prepared to obstruct them. “Humanitarian aid to Gaza?” Israel Katz, who was then the energy minister, said on social media. “No electrical switch will be turned on, no water hydrant will be opened, and no fuel truck will enter until the Israeli abductees are returned home.” For two weeks, not a single aid truck entered Gaza.

During the past year, as more than forty-two thousand Palestinians have been killed, the Israel Defense Forces have restricted foreign journalists’ access to Gaza to brief and highly controlled “visits.” But I have been in close contact with Najjar and some of his colleagues since the spring. Throughout the war, they have made unthinkable choices with precious few resources. With most of the Gazan health system in ruins, they established field clinics—makeshift structures of white nylon and wooden struts—and recruited displaced medical personnel to staff them. In one note, Najjar said that he and his team had saved a man’s leg from amputation by treating a suppurating wound, but had to turn away a mother whose child had hemophilia. “This is out of our hands because we don’t have the medication,” he wrote. Najjar was known for a buoyant sense of humor, but he could manage only a resigned equanimity: “We have success days and fail days.”

Before the war, Anera’s work in Gaza was focussed less on saving lives than on improving them. It funded early-childhood education programs, trained adults in software engineering, and supported entrepreneurial ventures by women. Electricity, always erratic in Gaza, was a primary concern. Without power, pumps don’t work, and sanitation fails. In heavy rains, septic tanks overflow, flooding the streets and spreading disease. Anera installed new wastewater facilities, along with wells for drinking water and solar panels to run them. Its employees on the ground, all Palestinian, scouted communities’ needs and suggested new projects to Anera’s office in Washington. When Najjar wasn’t distributing medical goods, he was developing proposals for diabetes treatment and children’s dental care.

The bombardments last October upended priorities. The I.D.F. ordered more than a million Palestinians to evacuate the north, and refugees began pouring into Khan Younis, Najjar’s home town. At first, he recalled, he couldn’t imagine that he would be displaced: “I didn’t expect for a moment that I will experience it myself.” He had a comfortable home, shared with his wife, their five children, and his extended family.

But the bombing was getting closer. Yahya Sinwar, the leader of Hamas in Gaza and a principal planner of the October 7th assault, grew up in a refugee camp in Khan Younis, and Israel believed that he and his lieutenants were hiding in a labyrinthine tunnel network beneath the city. The campaign to dislodge them would clearly be devastating. The Israelis used two-thousand-pound bombs, many of them U.S.-made, which smash every structure and living creature within six hundred feet. Determined not to flee, Najjar moved his relatives from the third floor of their house to the first, then reconsidered and moved back up. He’d decided to “be killed with my family quickly, instead of dying under rubble and suffering.”

In November, Israeli jets began dropping leaflets, warning the residents of Khan Younis to evacuate. Some contained a verse from the Quran, referring to both the Biblical deluge and the attacks of October 7th, which Hamas called Operation Al-Aqsa Flood: “Then the Flood overtook them, while they persisted in wrongdoing.” Najjar remained at home for another six weeks, but, as battles escalated nearby between the I.D.F. and Hamas’s Khan Younis Brigade, he and his family finally left.

The I.D.F. was sending Khan Younis residents to Rafah, in the far south, and to al-Mawasi, a newly designated safe zone to the west. Najjar and his family were ordered to al-Mawasi. A scrap of sandy Mediterranean coast with virtually no electricity, water, fuel, or food, it had become a congested encampment for hundreds of thousands of refugees. Though no bombs fell there in the early months of the war, there was little protection from the elements, and the sanitary conditions were abysmal. “When you see your children get ill several times because of unclean water, and you know the cause but you don’t have the solution,” Najjar wrote, “to see them shiver from the cold and you have nothing to do, to see the water leaking inside the tent when it rains—this made me die inside a million times.” He described the winter at al-Mawasi as “the black months in my life,” saying, “They killed our humanity.”

In al-Mawasi, as in the rest of Gaza, life revolved around securing the necessities for survival. Even after Israel began allowing some aid to enter, the trucks had to wait for days at the border; witnesses at the Rafah crossing observed lines backed up for miles. Once inside, convoys were sometimes beset by desperate crowds and armed gangs. The transit of aid is overseen by an Israeli agency called COGAT, for Coordination of Government Activities in the Territories. Amid the shortages, COGAT became a target of outrage among Palestinians and aid workers, likened by one security expert to a prison gatekeeper.

One of Najjar’s colleagues, a program manager named Suad Lubbad, served as an unofficial shelter coördinator for Anera workers in al-Mawasi. Lubbad, fifty-five, is an even-keeled woman with a Ph.D. in human development and a warm, brisk manner. Since June, she has been running a series of mother-and-child clinics, which Anera established with support from Unicef. Between shifts, she arranges cleaning details and organizes women to bake bread.

Before the war, Lubbad led an Anera program that worked with farmers and women’s coöperatives to provide breakfast—fruit, milk, cheese, and spinach pies—to schoolchildren. Learning materials were scarce, so she showed students how to use Styrofoam food containers to grow seeds, and how to recycle the foil wrapping inside for drawing paper.

As the first bombs fell, Lubbad—a single mother since her husband died, eight years ago—fled Gaza City with her three grown children. Until I asked, she didn’t mention that she’d left family behind; an air strike had killed fourteen of her relatives, including her sister and her sister’s children. Like some ninety per cent of her fellow-Gazans, she was now an internally displaced person.

In a video tour, Lubbad walks through Anera’s corner of al-Mawasi: sandy alleyways, white tents, a few plastic stools, clotheslines sagging under the day’s wash. A diminutive woman in a beige head scarf, she squints at the camera and says, “The good thing here is that we are having olive trees around us.” At times, she described displacement to me as an educational experience: “We have people who had no idea how to light a fire who now do this every night.” But in candid moments she conceded that life in a tent camp was gruelling. “We sleep on the floor,” she said in June. “I have backaches. We see many kinds of insects. It’s very, very hot, and the sunshine is everywhere. We don’t have gas to cook our food.” The obstacles of the war made her job nearly impossible. “You want to sleep to get rid of the whole exhausting day,” she said. “Then you wake up another day to go to work.”

Lubbad opened mobile clinics where they were needed most, setting up in tents or unoccupied buildings. Her patients seemed almost as if they were being attacked by the camp itself. They suffered from skin ailments caused by contaminated sand, or by scabies, bedbugs, and lice. Rat bites were a hazard, as were infections from bathing in seawater polluted by garbage and human waste. Hepatitis and dysentery afflicted people already stricken with grief. One fourteen-year-old boy told Lubbad, “I’m sad that my father has been martyred and I couldn’t say goodbye to him. And I’m sad because even our house that has so many memories with Dad has exploded.”

Traumas were compounded by the lack of basic commodities. It was common for women to go a week without bathing because they had no soap. Others, lacking shampoo, cut off their hair. A colleague of Lubbad’s told me, “They’ve lost what it feels like to be a woman. They feel like their identity has been taken away.” Lubbad issued “dignity kits,” containing a hairbrush, a toothbrush, undergarments, sanitary pads, and light head coverings.

The most pressing problem was hunger. When nonprofits were able to get food trucks across the border, they began a fraught process of triage, distributing such staples as beans and lentils, and occasionally meat, to wherever there were passable roads and the need was most urgent. For people without cooking facilities, Anera set up community kitchens, where cooks tended stockpots that produced meals for hundreds of families. It was not remotely enough.

Lubbad spoke about the pressures on pregnant women, hearing the battles at night “and not knowing how to reach the hospital, not having enough food for this baby.” Women were depressed, she told me: “They are facing a lot of troubles to make life easier for their families,” going out each day to search for food and firewood, and cooking whatever they secured. Their husbands apparently weren’t much help. “You know, women can do many things,” she said. “Men, I don’t know, they aren’t able to do so many things at the same time.”

As hunger deepened, the U.N. regularly reported that Israel curtailed truck deliveries into the territory, and the International Criminal Court alleged that Benjamin Netanyahu and the defense minister, Yoav Gallant, were using the “starvation of civilians as a method of warfare.” Brigadier General Elad Goren, who directs COGAT’s efforts in Gaza, brusquely dismissed the charges, insisting that the real problem was the U.N.’s inefficiencies. Though he acknowledged some challenges—“Food insecurity, maybe. Difficulties in access and movement, maybe”—he claimed, “There is no famine in Gaza, period. We check how many calories are entering every day per person. We are not limiting the number of trucks. We are facilitating.”

Stories in the American press have refuted that claim, and more directly implicated the Biden Administration in the crisis. In April, after U.S.A.I.D. and the State Department’s refugees bureau presented clear evidence that Israel had purposefully held back food and medicine from Gaza, President Biden chose to go ahead with weapons shipments. Lubbad evaded the debate, relating only what she saw in her clinics. This summer, she said, “moderate acute malnutrition” was more common than life-threatening “severe acute malnutrition.” For the less dire cases, at least, she had the necessary nutritional supplements—“So far, so good.” But it was worse in the north, which was virtually inaccessible to aid convoys for months. Oxfam reported that people there were subsisting on the equivalent of less than a can of beans per day, and that ninety-five per cent of the territory had no access to clean water.

After Israeli intelligence found continued Hamas activity in Gaza City, the I.D.F. resumed a concerted initiative, effectively blockading the north. Sami Matar, who leads many of Anera’s deliveries, described harrowing journeys there over the summer. On one, I.D.F. soldiers fired a machine gun at his car, damaging the tires and the gas tank. On another, a drone lowered to eye level, and a disembodied voice ordered him to get out and unpack bags of clothes and hygiene products for inspection: “Open the green bag. Open the yellow bag.” In August, he managed to deliver twelve hundred parcels of produce to Gaza City. Upon returning, he reported extreme shortages of milk, vegetables, meat, and medicine. Scarcity led to preposterous prices: tomatoes cost ninety-six dollars a pound. His boss told him that he was being reckless; he had a family to care for. He told her, “If I die, I’m going to die doing my job.”

Under international law, nations at war are obligated to protect humanitarian personnel. In Gaza, aid groups rely on COGAT to facilitate the practice of “deconfliction”—rules meant to reduce the risk that workers are mistaken for militants or inadvertently enter combat zones. Before missions, Anera supplies the names and nationalities of the workers involved, the cars’ makes and contents, and the convoys’ routes. COGAT is expected to convey the information to fighting units, but I.D.F. and intelligence officers can overrule its plans and directives.

Carroll, Anera’s C.E.O., said that the decision of whether to fully coöperate with COGAT was tricky: “Should you be more or less visible?” Humanitarian workers don’t carry weapons, and they worry about attracting attention from the I.D.F. and from militants, who are known to hijack trucks. Some organizations reportedly avoid trouble by paying Hamas, or by handing over a portion of the cargo. (Carroll said emphatically that Anera has no contact with Hamas or any belligerent.)