By Maya Gebeily

BEIRUT, May 28 (Thomson Reuters Foundation) — With a first COVID-19 jab under his belt and the second a few weeks away, Imad Agha was overwhelmed with relief. But his hopes of immunity were dashed when violence erupted in Gaza.

The 11-day conflict between Israel and Hamas-controlled Gaza killed nearly 250 Palestinians and more than a dozen in Israel before a ceasefire took hold on May 21.

During that time, primary health care facilities turned to treating war-wounded instead of vaccinating, and the main COVID-19 testing lab was put out of service by bombing.

"Of course I never got that second dose," said Agha, a 39-year-old doctoral student who has been unable to leave Gaza to complete his studies in Malaysia since the coronavirus pandemic began more than a year ago.

"All we were thinking about was surviving," he told the Thomson Reuters Foundation by phone from his hometown of Khan Younis.

Working on the COVID-19 frontline as a member of Khan Younis's municipal coronavirus committee, Agha fears that the conflict has set Gaza's coronavirus response — already struggling over the last year — even further back.

More than 107,000 people have been infected and 1,010 have died of COVID-19 in Gaza since the first case was recorded in March 2020.

Only 8,000 out of Khan Younis's 350,000 residents have received at least one vaccine dose, Agha said.

"There were another 1,500 people who were supposed to get their second doses the week the war started, but whose appointments were canceled," he added.

"Now that the war is over, the coronavirus challenges will start," he said.

Rare Commodity

Gaza is one of the most densely-populated places on earth, with 2 million people packed into a 365 square km strip of land, including 600,000 in eight refugee camps, according to the United Nations agency for Palestinians, UNRWA.

At least 95% of the population of Gaza, mostly cut off from the world by an Israeli-led blockade, does not have access to clean water — a nightmare scenario during a global pandemic.

Agha said Gaza had already struggled to access PCR tests since the first coronavirus spike in the summer of 2020.

"When the cases started to increase, we had to restrict PCRs to anyone with very strong symptoms," said Agha, who has barely seen his 80-year-old mother for fear that he could infect her.

"Even then, there weren't enough kits. Soon enough, around 50% of all the tests we were doing were coming back positive — so for every 1,000 tests, we'd get 500 positives."

Vaccines finally started being offered in Gaza in March, with donated doses of Pfizer, Sputnik, and AstraZeneca.

Authorities prioritized health staff and encouraged Palestinians over the age of 60 to register online for an appointment.

"People would come to me and say they didn't have internet, so I'd sign them up directly on my phone," said Agha.

Despite his role checking on self-isolating COVID-19 cases, Agha didn't immediately qualify as he was not officially a health worker and was too young.

Within weeks, vaccines had become a rare commodity.

"A vaccine is a right for everyone but when it's rare, what do you do? Who do you give?" said Agha.

After his wife Mariam and two young sons were infected, Agha qualified for a priority first dose on April 10.

Funerals

When the conflict began exactly a month later, worries about coronavirus were overtaken by fears of injury and death.

"People, including myself, forgot the virus. What's harder to survive? War or corona?" asked Agha, who dropped his COVID-related responsibilities to check on families in bombed-out neighborhoods or keep his kids distracted from shelling.

"They stopped wearing masks, they slept 10 to 20 people in a single room. What can you say to someone in that situation?"

Hospitals already struggling to cope with the COVID-19 pandemic were stretched even further. The coronavirus isolation ward at the main Al-Shifa hospital was transformed into an intensive care unit for thousands wounded in the conflict.

The bombardment knocked Gaza's main PCR testing laboratory out of service, and a delivery of urgent health care equipment — including vaccines — remained stuck at the border for two weeks.

About 48,000 Palestinians were displaced and sought shelter in schools, the UN agency for Palestinians UNRWA said, with social distancing nearly impossible.

Only 2% of people in Gaza received at least one dose of a COVID-19 vaccine, the World Health Organization (WHO) said this month, compared to 10% in the West Bank.

Since the ceasefire, the WHO has received 10,000 Sinopharm and 46,800 Pfizer doses for Gaza.

Agha doesn't know when he will get his second Sputnik dose — but fears a new coronavirus spike is around the corner.

"No one is wearing masks today," he said anxiously.

"There are funerals in every street and everyone is shaking hands as they give their condolences. You think we can say 'Oh, no, let me disinfect my hands' in a situation like that? You think you can elbow-bump?"

(Reporting by Maya Gebeily @gebeily; editing by Katy Migiro. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers the lives of people around the world who struggle to live freely or fairly. Visit http://news.trust.org)