Prepare for more bloodshed and volatile strategic reset in Middle East

Across Gaza’s 30 or so hospitals the misery is unrelenting with operating theatres working around the clock. Medical staff tell of using regular soap to clean burns and how very soon they will have to make decisions who to treat and who to leave based on their chance of survival.

Doctors at Gaza’s Dar al-Shifa Hospital, the main medical facility in the enclave, described on Friday, how there wasn’t even standing room for one more patient, let alone a bed and they have a waiting list of 150 people for bone surgery.

Ghassan Abu Sittah, a Palestinian-British surgeon told journalists by phone that “we are at breaking point” and only “life-saving surgery” was now performed. He said that al-Shifa Hospital had some 5,000 wounded, with only 2,500 available beds.

“All hospitals are now reliant on diesel and generators, but fuel will eventually run out,” Abu Sittah confirmed.

Gaza is reeling under the punitive bombardment and blockade Israeli forces brought to bear on this tiny, narrow, 25-mile slither of land pressed against the Mediterranean Sea, between Israel and Egypt. And worse is almost certain to come given that by the time this goes to print Israel’s ground invasion may well have begun.

Tanks move in formation near the border with Gaza on October 14, 2023 near Sderot, Israel. Israel has sealed off Gaza and launched sustained retaliatory air strikes, which have killed at least 1,400 people with more than

Thousands injured

Israel’s military response comes after last Saturday’s unprecedented attack by Hamas militants from Gaza using rocket barrages and raids into Israeli territory that killed 1,300 people and wounded thousands more according to authorities in Jerusalem on Friday.

The number of Palestinians who have died since the start of the fighting rose to 2,200, and there have been 8,700 wounded, the Gaza Ministry of Health said yesterday.

Just before midnight local time on Thursday Israel’s military made its intention clear, telling the United Nations (UN) that the whole of Northern Gaza, home to roughly 1.1m people, should be evacuated within 24 hours.

It then issued the same ultimatum directly to Gazans, telling them to flee south of Wadi Gaza, a riverbed that bisects the strip. “You will be able to return to Gaza City only when another announcement permitting it is made,” the army said in a statement.

Yesterday, Israe also announced that it would guarantee the safety of Palestinians fleeing south on two main roads until 4pm local time though Hamas claimed that 70 people, mostly women and children, were killed in air raids on cars leaving Gaza City.

Israel’s intense bombing campaign has already triggered a frantic search for safety in Gaza. Of the more than 338,000 people who have fled their homes, two-thirds have taken shelter in UN run-schools, while others are staying with relatives or in hotels. The bombing has hit 18 UN-run schools since the Israeli offensive began, including two that are being used to shelter displaced people, according to the UN.

The strikes have also hit another 70 schools run by the Palestinian Authority (PA) said the UN Office for the Coordination of Humanitarian Affairs. One of the most densely populated places in the world, Gaza has no bunkers or shelters to protect civilians from bombardment.

On Friday the response from the UN and humanitarian organisations to Israel’s ultimatum was both quick and unequivocal in its condemnation.

“The United Nations considers it impossible for such a movement to take place without devastating humanitarian consequences,” warned Stephane Dujarric, spokesman for UN Secretary-General Antonio Guterres.

His view was echoed almost universally among the humanitarian sector with Medecins Sans Frontieres - Doctors Without Borders - saying, “Unprecedented' doesn’t even cover the medical humanitarian impact of this…We condemn Israel’s demand in the strongest possible terms.”

The UK founded Oxfam meanwhile was equally critical; “The world can see that this evacuation order is both utterly inhumane and impossible; the Israeli government must rescind it immediately,” insisted Amitabh Behar, Oxfam’s International Executive Director.

For its part, Israel has said that there will be no humanitarian break to its siege of Gaza until all its hostages who are among an estimated 150 people - including foreign nationals - who were seized by Hamas during its raids last weekend are freed. These include children, women, and older people who Hamas claim to be detaining in the network of tunnels the group has constructed over years to smuggle both weapons, munitions and other supplies from neighbouring Egypt.

The deputy chief of Lebanon's Shiite militant group Hezbollah, Sheikh Naim Qassem, delivers a speech during a rally in Beirut on October 13, 2023, as thousands of protesters poured onto the streets of several Middle East capitals in support of

Military operation

Boaz Ganor is president of Israel’s Reichman University and a counterterrorism expert who advises governments on extortion and hostage negotiations and says much will depend on “the purpose and goals set by decision-makers for a military operation in Gaza.”

Ganor in an interview with Foreign Policy magazine says that while it is still possible to conduct a full-scale military operation and use intelligence aiming to free hostages, “the possibility of doing that simultaneously and freeing the hostages unharmed is close to zero.”

While the safety of all the hostages will be one significant factor in the days ahead, so too is what will become of the millions of Gazans who have no means of leaving the enclave.

With Israel controlling the Erez Crossing also known as the Beit Hanoun Crossing between Gaza and Israel in the north and Egypt controlling the Rafah crossing to the south, these are Gazans’ only exit to the outside world.

Regional analysts say that the US, Israel and some other Arab countries are pushing Egyptian president, Abdel Fatah al-Sisi, to open the southern border or to open a broader humanitarian corridor.

Antony Blinken, the American secretary of state, plans to visit Egypt this weekend as part of a six-country regional tour and there is a growing sense that he may offer Egypt incentives to cooperate and scenes of desperation in Gaza will only add to the pressure.

Some veteran Middle East commentators though have suggested that beyond the obvious humanitarian concerns, bigger geopolitical strategies might be afoot. Among those commentators is David Hearst, editor-in-chief of the London based website Middle East Eye.

Writing on Friday Hearst reminded readers that almost from the moment Israel responded to Hamas’ raid on Israel, Prime Minister Benjamin Netanyahu made one promise that has almost entirely escaped attention when he told the mayors of southern border towns that Israel’s response would “change the Middle East.”

Netanyahu was not alone in his declaration explained Hearst, noting that the leader of the Israeli opposition, Benny Gantz, also hinted at a bigger project: “We will win and change the security and strategic reality in the region,” said Gantz.

Hearst in his assessment of Netnayahu and Gantz's remarks hinted himself though at what might be in the offing.

“Reoccupying Gaza and finishing off just one Palestinian armed group would not change the strategic reality of the region, and you don’t need an army of 360,000 troops to reoccupy Gaza,” observed Hearst.

“This is the greatest number of reserves called up in the history of the country. Could it be that the Israeli leader and others in the country have a bigger plan in mind and if so what might it entail? asked Hearst.

“The first and most obvious answer is a second Nakba, or mass expulsion of a sizeable proportion of Gaza’s 2.3-million-strong population - a figure big enough to alter the demographic time bomb that is in the back of every Israeli’s mind,” Hearst continued, referring to what in Arabic means “catastrophe” and the mass displacement and dispossession of Palestinians during the 1948 Arab-Israeli war.

Egypt uneasy

The same thought no doubt weighs heavily on the mind of Egyptian president, Abdel Fatah al-Sisi. Egypt who is uneasy about the prospect of hundreds of thousands of Palestinian refugees crossing into its territory.

So far, Cairo has been categorical in its refusal to accept refugees from Gaza. Hours before the Israeli announcement giving Gazans an ultimatum to leave, president al-Sisi said Gazans should “stay steadfast and remain on their land”.

While the Biden administration seems determined to set up a so called “humanitarian corridor” for Palestinian civilians in Gaza to flee to Egypt, Cairo is signalling that it will not accept a solution that forces Palestinians to leave Gaza without any hope of return.

Some Egyptian sources say there is a wariness that Washington’s motives may not quite appear as they seem and perhaps have been formulated in agreement with Israel. It is also unclear they say whether the Biden administration would pressure Israel to allow Palestinians to return to Gaza after the war is over.

Within Egypt’s powerful army, there is a long-held belief that Israel sees Sinai as the solution for its Gaza problem. In other words, Israel’s aim is to force Gaza’s Palestinian population over the border and that what is presented as a temporary refugee solution would in fact become a permanent one. There is of course precedence here in terms of those waves of Palestinians who fled to Lebanon in 1948 and in the following decades, resulting in Palestinian militias that formed and resided in Lebanon in the 1970s and 1980s.

Cairo’s fear is no doubt that history could repeat itself and if Israel after its likely forthcoming invasion stays on to occupy and control Gaza, then Palestinian militants including Hamas and Islamic Jihad, could use Egyptian territory from which to launch attacks with the wider potential to destabilise Egypt itself.

These security concerns are doubly worrying for Cairo since Hamas and other groups in Gaza have links to militants in Sinai. Economically too, Egypt is under the cosh of a worsening economic crisis and struggling with an influx of 280,000 refugees from neighbouring Sudan, where a civil war began in April.

But if concerns to the south in Egypt are growing as to the fallout from the conflict in Gaza then similarly there is much nervousness in Lebanon, Israel’s northern neighbour. Ominous signals there are growing of the potential opening of a second front by the fighters of Hezbollah, the Iran-backed Shia militia based in Lebanon. For days there have been exchanges of fire across the border between Hezbollah and Israeli forces. Palestinian militant groups in Lebanon have been involved too.

A full military engagement by Hezbollah, a powerful well-armed and formidable force would dramatically complicate Israel’s military position and escalate the conflict. During Israel’s war with Hezbollah in 2006, the Israeli military were taken aback by the group’s professionalism and high-quality weaponry. What in the 1990’s had been a guerrilla had morphed into something resembling a conventional army and today Hezbollah if perhaps Israel’s most feared enemy.

 Doctors examine an injured child at Al-Aqsa Martyr Hospital after being found in search and rescue operations launched around buildings that were destroyed or heavily damaged

Border reinforced

It's not surprising then perhaps that of the 300,000 Israeli reserve soldiers being mobilised right now, a large chunk is being sent to reinforce this northern border.

Whether Hezbollah will act remains to be seen and some military analysts believe they could be wating for Israel’s complete commitment to a Gaza invasion before fully moving into action in southern Lebanon. A key factor in that decision will also be the thinking behind Hezbollah’s patron, Iran and any plans it might have to widen the regional conflict.

Speaking at a pro-Palestinian rally in Beirut's southern suburbs on Friday, Hezbollah deputy chief Naim Qassem, said it would be "fully prepared" to join its Palestinian ally Hamas in the war against Israel when the time is right.

“We, as Hezbollah, are contributing to the confrontation and will continue to contribute to it within our vision and plan,” Qassem said, before adding, "we are fully prepared, and when the time comes for action, we will take it.”

As Gazans this weekend flee for their lives and Israeli forces gear up for what could be a protracted and bloody ground invasion, rarely has the possibility of Gaza triggering a regional war been greater. Emotions are running high in all Arab capitals and there is no timeline for the Israeli offensive, only the prospect of even more bloodshed and suffering.