Life in the Gaza Strip six weeks after the armed conflict 27 Dec 2008–17 Jan 2009
Evidence from a household sample
survey – A summary
Fafo Institute for Applied
Borggata 2B, P.O.Box 2947 Tøyen
N-0608 Oslo, Norway
Telephone +47 22 08 86 10
Fax +47 22 08 87 00
This multi-topic household sample survey was implemented to collect data to document the living conditions in the Gaza Strip in the wake of Israel’s assault on 27 December and the ensuing armed conflict. It was thought that a fairly rapid assessment would benefit everyone concerned with post-war reconstruction and aid of various sorts.
Through interviews with more than 2,000 households, the survey covered issues such as displacement during the war and damages caused by it, people’s economic situation, needs and concerns, their health and psycho-social status.
The fieldwork was implemented from 3 to 12 March 2009, and face-to-face interviews were carried out at 132 fieldwork locations spanning the entire Gaza Strip.
The survey was funded by the Norwegian Government with additional contribution from the UNFPA. In addition to this summary of findings, major survey outputs will consist of an extensive list of tables posted at Fafo’s web page, and a report to be published jointly by the UNFPA and Fafo.
Seven in ten households (71 %) stayed behind and remained in their dwellings during the entire Israeli attach, while three in ten households (29 %) left their homes and went to live elsewhere. The vast majority of the displaced, 28 % of all Gaza households, moved temporarily and returned home, while 1 % of all Gaza households had not gone back nearly two months after the cessation of hostilities.
The survey asked all those households that had moved from their homes during the war why they left. Allowing more than one answer, these are the results:
- Felt the living area to be unsafe: 95 %
- Partly damaged dwelling: 17 %
- Completely damaged dwelling: 3 %
- Forced to move by soldiers: 3 %
- Wanted to be closer to relatives: 2 %
- Wanted to be nearer to a health facility: 1 %
The majority of those who moved during the war went to live with close family (59 %) or more distant relatives (26 %). Others stayed with neighbours (2 %) and friends (3 %) or took refuge in private or collective places of residence owned by strangers (10 %). This figure includes those who sought refuge at schools.
7 % of those who abandoned their houses and apartments during the war reported that they were looted.
The conditions of people’s current place of residence, i.e. the dwelling where the interviewed households resided at the time of the interview, were as follows:
- Totally unaffected by the Israeli attack and in the same condition as before: 49 %
- Suffered minor damages: 27 %
- Damages that could be fixed: 23 %
- Part of the dwelling beyond repair: 1 %
Type of damages in affected dwellings:
- Shattered windows: 84 % (i.e. 42.5 % of all households)
- Destroyed roofs: 13 %
- Destroyed walls: 12 %
- Water pipes that were not functioning well: 9 %
- Sewage system out of order: 2 %
- Lacked electricity from the grid: 4 %
- Other damages (minor damages to roof or walls, broken tiles on kitchen and bathroom walls, damages to garages and storage and other rooms in the courtyard or adjacent to the main building, etc.): 25 %
The survey enquired what it would cost to repair the damages incurred and bring the dwelling back to its previous condition. These are the results:
- No repair necessary: 50 %
- Less than 1,000 NIS: 8 %
- 1,000-5,000 NIS: 20 %
- More than 5,000 NIS: 22 %
Out of all households with dwellings in need of repair,
- 10 % had already started to fix them
- 26 % revealed they had concrete plans
- 64 % had no concrete plans
Among the latter, the lack of money (80 %) and building materials (65 %) were by far the most commonly stated reasons why people did not intend to repair their homes, at this time.
Those households that had already started to renovate their homes, or that said they had concrete plans for repair activities, were asked about how they would fund the expenses (more than one funding source allowed). The answers:
- Draw on savings: 21 %
- Support from relatives: 21 %
- Assistance from UNRWA: 24 %
- Support from Islamic charity: 12 %
- Help from international NGO: 7 %
- Help from local NGO: 6 %
- Savings club (jamiyyah): 3 %
- Borrow money: 4 %
- Other funding: 4 %
The survey attempted to collect information about the magnitude of the destructions resulting from the Israeli assault by posing questions not only about the residence of the interviewed household but also by including questions about the physical circumstances of people’s neighbourhoods (hara). Merely two out of five households (38 %) covered by the survey lived in neighbourhoods were residential houses were essentially unharmed. The households interviewed reported that their neighbourhoods contained:
- Residential buildings in ruins: 20%
- Partly damaged residential buildings: 42 %
- Moderately destroyed schools: 16 %
- Partly damaged health facility: 8 %
- Totally damaged health facility: 1 %
- Partly destroyed mosque: 18 %
- Completely destroyed mosque: 9 %
As we have seen above, some households reported damages to water pipes, the sewage system, the electricity network, etc. due to the warfare. The survey also enquired about the status of some of these services at the time of the interview. Below are some results.
Except very few (1 %), people in Gaza rely on electricity to be delivered through the public grid. The day preceding the interview, people (those connected to the network) reported receiving 2 hours and 12 minutes of electricity, on average.
The survey examined the sorts of energy people had used for cooking the day preceding the interview. These are the findings (several sources could be mentioned):
- Kerosene: 50 %
- Electricity: 24 %
- Gas: 22 %
- Wood: 15 %
- Diesel: 9 %
- Had not heated food: 2 %
Six in ten households informed the survey team that they were unable to keep the dwelling sufficiently warm at night.
With regard to water, one in four of Gaza’s households rely solely on delivery through the network. Another 62 % are connected to the water network, but combine this with additional sources of water. These other water sources are tanker trucks, reported by 11 % of all households, and private and public wells (5 and 4 % respectively). 2 % said they got water from other households, while 62 % reported that they supplemented water from these various sources with bottled water (small bottles of drinking water or larger quantities of water (typically 20 litres) bought at a nearby store).
72 % of all households reported a sufficient water supply.
We investigated for how long the interviewed households had received piped water the day preceding the interview. The results are as follows:
- Did not have piped water: 13 %
- Received piped water but did not know for how many hours: 19 %
- Continuous supply: 25 %
- More than 12 hours a day: 15 %
- 6 to 11 hours: 10 % 5 hours or less: 18 %
The sewage system was working appropriately in 87 % of the dwellings. In 6 % of the dwellings, there were problems while it was totally defunct in 7 % of all houses.
Domestic waste was collected from 88 % of the households the week preceding the interview.
The survey explored people’s connection to the labour market. Some results:
- 75 % of individuals aged 15 years and above had never held a job
- 22 % had been employed before the June 2007 blockade of the Gaza Strip
- 19 % had been working at the onset of Israel’s war on Gaza
- 19 % was employed the week before the interview
- 40 % of men had been employed before the blockade, 33 % were currently employed
- 5 % of women were employed; stable figure over time
- 94 % of the women had never held a job
- 22 % of men aged 20-24 were currently employed; 28 % had ever been employed
- 4 % of women aged 20-24 were currently employed; 5 % had ever been employed
The employment rate of people with higher education is 2-4 times higher than for people with a different educational background. For example, nearly half of them (47 %) were employed in the week prior to the interview as compared with 11 % of those with basic schooling and 17 % of people with a certificate from secondary education.
Employer status before the 2007 blockade:
- PA: 40 % of all employed
- Private sector: 23 %
- Self-employment: 22 %
- Hamas government: 6 %
- UNRWA: 5 %
- Israel: 4 %
- NGOs and international aid organizations 2 %
Things changed with the onset of the blockade. In relative terms, the significance of private sector jobs and self-employment dropped somewhat and employment with the Hamas government doubled. In December 2008, before the Israeli attack on Gaza, 12 % of the labour force was employed with the local authorities, and 42 % received their salaries from the PA. The Israeli labour market was out of reach.
After the war, the relative significance of the Hamas government as an employer had increased even further as 13 % of the labour force now worked there. PA’s importance as an employer remained stable (41 %), while UNRWA at the time of the survey had 7 % of the labour force on its payroll. The significance of the NGO sector remained the same. A slightly smaller share had jobs in the private sector or were self-employed than before the war (19 and 18 %, respectively).
When asked to identify the household’s most important source of income the past week, these are the results:
- Salary from the PA: 24 %
- Self-employment: 11 %
- Salary from the private sector: 8 %
- Salary from the Hamas government: 6 %
- Salary from UNRWA: 3 %
- Salary from the municipality, local authority: 1 %
- Assistance from UNRWA: 8 %
- Assistance from family and friends: 8 %
- Assistance from the Hamas government: 2 %
- Assistance from the PA: 1 %
- Assistance from Islamic charities: 1 %
- Other income: 1 %
- Neither employment income nor assistance: 24 %
The desperate economic situation in Gaza continued to deteriorate with Israel’s armed attack. When compared with the situation six months earlier, this was, according to the interviewed households, the situation:
- Household economy had worsened: 63 %
- Household economy had remained the same: 35 %
- Household economy had improved: 2 %
32 % of the households said they would be able to secure their basic needs the coming three months.
The survey posed the following hypothetical question: If your household had a sudden need for 1,000 NIS, would you be able to raise the money in a week (and if yes, how)? The answers are:
- Impossible: 60 %
- Doubtful: 7 %]
- Yes, draw on savings: 11 %
- Yes, help from family and friends: 20 %
- Yes, draw on savings clubs and other sources: 2 %
The majority that thought they would not manage to come up with 1,000 NIS if an unexpected need should arise were asked how long their circumstances had been so difficult. The answers:
- Situation not that difficult: 4 %
- A long time or always: 17 %
- Since the eruption of the 2nd intifada: 28 %
- Since the June 2007 blockade: 48 %
- Since the recent Israeli assault: 3 %
The survey attempted to investigate how people’s dire strait in general, and the circumstances of the war specifically had affected their food intake. We asked if the interviewed household had experienced a list of conditions during the war due to the lack of money or food, etc. The results:
- Had reduced the food intake every day or often: 43 %
- Had lacked a hot meal every day or often: 36 %
- Had skipped hot meals daily or often due to the lack of cooking gas: 55 %
- Had fasted involuntarily for a whole day or often due to the lack of food: 9 %
- Had reduced their food intake every day or often to ensure that children got full: 33 %
The survey further inquired from where the households received their most important food staples the week preceding the interview. The results:
- Bought in shops: 75 %
- Mainly used food they had stored up: 11 %
- Food from family or other kin: 9 %
- Food distribution by UNRWA: 4 %
- Food distribution by Hamas: 1 %
- Food distribution by a religious organization: 1 %
The survey examined the extent to which people in Gaza had received some sort of assistance during or after the recent hostilities, and in the near past:
- 72 % of the households had received such assistance during 2008 and before Israel’s assault on Gaza 27 December
- 48 % had received assistance during the war
- 78 % had received support in the weeks since the cessation of hostilities
- 17 % of all households had not received any assistance since January 2008
Those households that received assistance during the war reported the following types of assistance:
- Free health care: 27 %
- Food aid: 24 %
- Free health insurance: 20 %
- Cash support: 2 %
The picture changed dramatically after the cessation of hostilities. As mentioned above, nearly four in five households (78 %) had received some sort of help after the war. The following list specifies the kind of assistance they had received (comparison with before the war in parenthesis):
- Food aid: 67 % (49 %)
- Free health care 41 % (43 %)
- Health insurance 24 % (31 %)
- Cash support 17 % (11 %)
- Employment through job-creation schemes 1 % (3 %)
As shown, food and cash aid had a wider outreach after the war than it had before Israel’s attack.
The interviewed households had received support from the following institutions after the war:
- UNRWA: 63 % (up 5 % as compared with before the war)
- PA: 17 % (down 4 %)
- Hamas government: 10 % (up 5 %)
- Islamic charities: 8 % (up 3 %)
- Other Palestinian NGO: 10 % (unchanged)
- International NGO: 3 % (up 1 %)
- Municipality, local authority: 2 %
- Hamas: 2 %
- Fatah: 1 %
- Other institution or relatives: 3 %
When asked to consider all kinds of help, including from relatives, the household might have received since the Israeli attack ended and to identify the most crucial provider, this becomes the picture:
- UNRWA: 53 %
- PA: 5 %
- Hamas government: 4 %
- Relatives and friends: 3 %
- Islamic charity: 3 %
- Other Palestinian NGO: 2 %
- Hamas: 1 %
- Other support: 2 %
The survey requested the households to identify their two most pressing needs at the time. With regards to the top priority, this is the list:
- Cash: 39 %
- Cooking gas: 20 %
- House repair: 16 %
- Food: 12 %
Other topics such as medical help, rental subsidies, electricity and so forth were mentioned by 1-3 % of the households.
The list for second priority is dominated by the same concerns but other issues received higher ‘votes’:
- Cash: 22 %
- Food: 21 %
- Cooking gas: 20 %
- House repair: 9 %
- Electricity: 6 %
- Medical help: 5 %
- Furniture: 4 % Etc.
Summing up the four key household needs identified by the survey (by adding together the households’ first and second priorities), this becomes the picture:
- Money: 61 %
- Cooking gas: 40 %
- Food: 33 %
- House repair: 25 %
Illness, injury & the use of health services during the war
As we saw above, in some neighbourhoods health facilities were destroyed during the war, and several households moved because they wanted to be closer to health services. In this section we describe people’s health and help-seeking behaviour during the war.
According to the survey, approximately one in ten (11 %) of Gaza’s population suffer from some sort of chronic health failure. Naturally, the prevalence of longstanding health problems increases with age and is twenty times more common among people aged 60 years and above than among children younger than ten (61 versus 3 %).
Reportedly, two in three chronically ill persons (66 %) were in need of medical care during Israel’s attack. Of those,
- 53 % received adequate care
- 27 % received care that was inadequate
- 20 % did not receive medical care
Reasons for receiving inadequate medical care or no care whatsoever (although such care in their opinion was required):
- Could not afford consultancy or treatment: 46 %
- Too dangerous to go to the hospital or clinic: 30 %
- Health facility closed: 4 %
- Health facility destroyed or so packed with war victims that it lacked capacity: 3 %
- Lack of a nearby facility: 5 %
- Self-treatment: 1%
- Other reason: 17 %
2-3 % of the people in Gaza suffered from acute illness during the war period, they were injured by the warfare, or they experienced severe distress and other psychological symptoms triggered by the war.
Individuals younger than 20, particularly those below 10 years of age, and individuals older than 60 suffered less injuries than other people. The young also were inflicted by acute (somatic) illness less often than other persons. However, according to the survey children and youth were more prone to have health problems caused by distress than others.
66 % of those who became abruptly ill or suffered from war injuries sought medical care. The survey explored the reasons why people did not receive medical examination or treatment following acute illness or injury, and these were the answers:
- Did not require treatment or care: 35 %
- Too dangerous to reach hospital or clinic: 26 %
- Facilities lacked capacity due to (more severe) war injuries: 10 %
- Could not afford care: 10 %
- Lack of a nearby facility: 10 %
- Self-treatment: 4 %
- Other reasons: 5 %
The vast majority of people with acute illness or injury were diagnosed and treated by a medical specialist (52 %) or general practitioner (35 %) while some people went straight to a pharmacist (10 %). A few saw a nurse only (2 %), or consulted a traditional healer (2 %), and a handful just consulted a non-professional relative.
The acutely ill went to a public hospital or clinic (45 and 11 %, respectively), they received care at a privately owned hospital or clinic (6 and 9 %, respectively), or they visited a health facility run by UNRWA (14 %). 6 % received consultation or treatment at home and 10 % saw the pharmacist at a pharmacy.
12 % of all married women aged 15-49 had been pregnant (or gave birth) during the three months before the interview. Broken down by age, these are the figures:
- 15-19 years: 6 % pregnant (or gave birth) in the reference period
- 20-24 years: 23 % pregnant
- 25-29 years: 18 % pregnant
- 30-39 years: 16 % pregnant
- 40-49 years: 2 % pregnant
Place of delivery:
- Public hospital: 77 %
- Private hospital: 8 %
- Private clinic: 7 %
- Public clinic: 5 %
- UNRWA facility: 1 %
- NGO facility: 1 %
- At home: 1 %
The youngest mothers (aged 15-24) more often than others gave birth at private facilities. Doctors supervised nine in ten deliveries (89 %) while midwives and nurses assisted 10 % of all deliveries. Having no professional support occurred rarely.
More than half of the pregnant women and those that had given birth recently (58 %) received pre- or post-natal care during the war. Four in ten of the women that did not receive such care wanted it but were prevented by the conditions of the war:
- Travel too dangerous: 34 %
- Health facility had stopped operating: 5 %
- Health facility filled with war victims: 2 %
- Facility destroyed by shelling: 1 %
UNRWA facilities (37 %), public clinics (27 %), private clinics (15 %) and public hospitals (14 %) provided most of the pregnancy care.
According to the survey, just about 1 % of the population suffered severe acute psychological distress caused by the war. The survey was not, however, designed to capture people’s psychological health or ill-health in detail. Nevertheless, it included a few questions to capture how the population in Gaza had been affected by the war. A considerable proportion reported symptoms of war-related distress several weeks after the withdrawal of Israeli troops and the bombardment came to a close.
For example, 13 % of the population suffered from sleeping problems the week preceding the interview and for the bulk of them (10 % of all individuals) the onset of the problem was during or after the war. Children aged 5-9 (especially girls) seems to have been somewhat more affected by this problem while youth aged 15-24 (particularly boys) are bothered slightly less than other age groups.
23 % of children aged 5-14 had a bed-wetting problem the past week:
- 7 % reported bed-wetting that had lasted for a long time
- 15 % of the children had acquired the problem with the Israeli assault
Bed-wetting, particularly such problems that had started with the war, occurred more frequently in younger than older children, but bed-wetting caused by the war was even reported for 9 % of children in the 10-14 age group. These are the results by age for bed-wetting that started before versus during or after the armed conflict, respectively:
- 5 year-olds: 11% and 28 %
- 6 year-olds: 9 % and 23 %
- 7 year-olds: 7 % and 26 %
- 8 year-olds: 8 % and 17 %
- 9 year-olds: 8 % and 15 %
- 10 year-olds: 5 % and 13 %
- 11 year-olds: 9 % and 10 %
- 12 year-olds: 5 % and 7 %
- 13 year-olds: 6 % and 9 %
- 14 year-olds: 4 % and 5 %
26 % of children had problems with their concentration during the seven days before the interview. For four in five children with concentration difficulties (i.e. 21 % of all children), the problem had arrived with the warfare. Concentration problems, which had arrived with the war, were most widespread with children aged 6 and 7 with a prevalence of 26 and 28 %, respectively). While concentration problems were found to be slightly more common in boys, there was no systematic gender difference concerning the spread of bed wetting.
The information presented in this section to his point is basically collected from proxy respondents (typically a mother or father about his or her children, and one adult about him or herself and other adults in the household). However, the survey also included a battery of questions meant to tap into people’s psychological wellbeing and that were posed directly to one randomly selected adult aged 18 and over in each household. The reference period was the past two weeks. The results are presented below:
- 36 % had lost the appetite often or sometimes (17 and 19 %, respectively)
- 39 % reported concentration difficulties often or sometimes (18 and 21 %, respectively)
- 55 % said they had the feeling of war actions as if they were still going on often or sometimes (32 and 23 %, respectively)
- 31 % had disturbing dreams and nightmares often or sometimes (16 and 15 %, respectively; more of a problem for women than men)
- 40 % said they felt so nervous that nothing could calm them down often or sometimes (19 and 21 %, respectively)
- 39 % felt so angry that they felt out of control often or sometimes (18 and 21 %, respectively; men more often report such anger than women)
- 41 % felt so depressed that nothing could cheer them up often or sometimes (23 and 18 %, respectively; more frequently reported by men than women)
- 42 % felt so restless that they could not sit still often or sometimes (21 and 21 %, respectively)
- 41 % felt so deeply hopeless that they thought things would never get better (24 and 17 %, respectively; more prevalent among men than women)
These symptoms of psychological distress are as prevalent among youth aged 18-24 as in the rest of the population: 34 % reported frequent loss of appetite lately and as many had concentration difficulties. Further, 27 % of the youth reported nightmares, 35 % reported anger, signs of depression, and a deep sense of hopelessness.
9 % of the adults said that they were totally unable to carry out normal activities such as getting dressed, washing, carrying out household chores, go to work, etc. in at least seven out of the past 14 days. 47 % confirmed that they were fit to carry out ordinary, mundane activities every single day of the reference period (two weeks).
The survey asked the adults to identify their major worries and the intensity of their concerns. These are the results:
- 86 % were very of quite worried about the economic situation (70 and 16 %, respectively)
- 81 % were very of quite worried about the political situation (60 and 21 %, respectively)
- 68 % were very of quite worried about the security situation (48 and 20 %, respectively)
- 64 % were very of quite worried about the employment situation (48 and 16 %, respectively)
- 52 % were very of quite worried about the health situation (34 and 18 %, respectively)
- 49 % were very of quite worried about the family situation (34 and 15 %, respectively)
To sum up, it seems people in the Gaza Strip are most worried about the political and economic situation followed by security and employment, while health and family issues are of somewhat less, but still considerable, concern.
The survey asked the randomly selected adult individuals who they would see if they wanted to talk to someone about their worries. Multiple answers were allowed. These are the results:
- Prefer not to talk to anyone: 18 %
- Do not need to talk to anyone: 6 %'
- Family member: 59 %
- Friend: 22 %
- Professional: 1 %
Men were prone to go to friends more often than women (28 versus 16 %), while women more frequently than men said they would raise their worries with a family member (65 versus 52 %).
The survey also listed seven professionals/groups of people that could be of assistance to people with various concerns. Did the respondent believe the mentioned professional could be of any help to him or her with his/ her current worries? 24 % answered ‘no’ to all (groups of) professionals listed. Below we have ranked the (groups of) professionals according to the percentage of ‘yes’ answers they received:
- Religious group: 58 %
- Social worker: 41 %
- Psychiatrist: 39 %
- Health worker: 37 %
- Women’s group: 16 %
- Police: 9 %
- Lawyer: 6 %
One question examined whether there were certain activities that people would have liked to do ‘these days’ but for various reasons were unable to do. 21 % reported that there were no such activities. The following answers were given:
- Social visits to friends and family: 49 % (women 56 % and men 53 %; 18-24 yrs: 43 %)
- Leisure activities: 37 % (falling percentage by increased age)
- Sports: 32 % (40 % men and 24 % women; falling percentage by increased age; increased percentage by enhanced educational level)
- Going to the market: 19 % (24 % women and 13 % men)'
- Domestic activities: 17 % (falling percentage by increased age; no gender difference)
- Going to restaurants and cafes: 17 % (21 % men and 14 % women)
- Going to work: 15 % (22 % men and 8 % women)
- Agricultural activities: 4 %
- Going to school: 3 % (falling percentage with age)
Finally, the survey presented a list of 10 topics and asked the respondent to rank them according to his or her degree of concern. If we add together the percentage of respondents that mentioned a topic as one of four concerns, the following becomes the list:
- Economic security: 86 %
- Employment: 60 % (66 % men and 54 % women)
- Security situation: 59 %
- Family: 45 % (49 % women and 41 % men)
- Politics: 43 %
- Education: 39 % (43 % women and 36 % men)
- Health: 35 % (60 % in the 55+ age group)
- Marriage: 10 % (13 % men and 7 % women)
- Migration: 10% (14 % men and 6 % women)
- Recreation: 5 %
The survey and its sample
Fafo carried out the household sample survey in the Gaza Strip from 3 to 12 March 2009, some six to eight weeks after Israel’s assault on Gaza, which ended 17 January.
The interviews were implemented at 132 fieldwork points (clusters) selected for us by the Palestinian Central Bureau of Statistics (PCBS) from 15 strata, covering the entire Gaza Strip. The sample frame used by the PCBS is derived from the 1997 Census. Before drawing the random selection of households from the 132 clusters, we re-listed all households. This was necessary because of the considerable time lapse since the Census and the likely demographic changes since then due to population movement, new houses, and destroyed houses caused by Israeli bombings, particularly during the recent assault.
A total of 2112 households were randomly sampled. In each household one household member aged 18 years or older was randomly selected. The latter step of the sampling process relied on a so-called Kish table.1 Due to a variety of reasons such as non-existent and vacant dwellings, non-contact after two re-visits, mentally unstable respondents or respondents who were too old and weak or too sick to manage the interviews, or refusals (a total of 85) etc., the number of households and randomly selected adult individuals actually interviewed was considerably reduced. In one of the 132 fieldwork sites (clusters), all houses had been ruined by the war. Altogether 2020 households (95.5 % of the original sample) were visited. 1832 adult persons (equaling 90.5 % of the participating households) were interviewed face to face.
The survey interviewed approximately as many women as men, and the random selection process ensures that also other characteristics of those interviewed mirror the overall adult population in the Gaza Strip.
1 Leslie Kish 1965, Survey sampling. New York: Wiley, page 399.