How does the pandemic affect one of the world's most crowded and battle-scarred territories? From merchants to doctors, the 2.2 million Palestinians of the Gaza Strip are forced to make tough choices to survive.
On a single street, a vegetable seller, supermarket worker and secondhand clothes merchant recently showed up at their day jobs — though the clothes merchant said he was convinced all three of them had COVID-19.
"I feel bad about myself. I would quarantine myself for a whole month if I could, but I have to keep the shop open. I have no other source of income," Hossam, 26, told NPR by video chat. He declined to give his full name because he could be arrested for keeping his shop open while sick.
Hossam lost his sense of taste and smell, and became fatigued, but refused to take a COVID-19 test. If it were positive, his whole family would be ordered to quarantine and he and his brother, the family's sole breadwinners, wouldn't be able to work. Gaza's Hamas rulers offer no financial aid to those quarantined at home.
"I have some savings that could last us for a day or two. But when that runs out, no one will knock on our door to help us, to say, here's 50 shekels [$15] to help you manage," Hossam said. "No one cares about anyone here."
So Hossam went to work and tried to be careful. He wore a black mask at his shop and asked customers not to step inside.
He sells clothes Israelis don't want anymore — army sweatshirts, elementary school T-shirts with Hebrew logos — delivered through Israel's fortified border to the Gaza market. If his customers ever found out he had the virus, he worried they'd think he'd imported it along with the Israeli clothes and never buy from him again.
"There are many others like me who don't want to report their illness so they can keep working," he said.
This is common in Gaza, where most live below the poverty line and the economy is in a chokehold due to a nearly 14-year Israeli and Egyptian blockade severely restricting trade and travel to the Islamist-ruled territory.
In the first months of the pandemic, being cut off proved to be an advantage. The few infected travelers who did enter Gaza were quarantined and there was no discernible community spread.
Then, in late August, a Palestinian woman escorting her daughter to a Jerusalem hospital returned to Gaza, bringing the virus back and infecting four relatives. It spread.
Gaza police imposed strict curfews and lockdowns, even erecting sand berms and concrete barriers around refugee camps and crowded neighborhoods with high infection rates. Those who tested positive for COVID-19 were confined to their homes with police standing guard outside. Gazans became reluctant to get tested for that reason alone.
Though police have discontinued the practice, testing rates remain low. More than 52,000 Gazans have tested positive, but with random testing conducted throughout Gaza, health officials estimate the virus has actually infected 200,000 Gazans — close to 9% of the population. More than 500 have died.
Meanwhile, Gaza's health system hangs by a thread after more than a decade of blockades, wars between Gaza's Islamist fighters and Israel's army, and sanctions by the rival Palestinian leadership in the West Bank. Its COVID-19 wards even struggled to provide enough oxygen for ventilators until the United Arab Emirates paid for a fresh supply in January.
Health officials praise nightly curfews and weekend closures for helping reduce infections. Now the curfews are being relaxed. Last month, the Hamas government reopened mosques and schools. This week, Egypt opened its border crossing, allowing Palestinian travelers to return to Gaza. On Thursday, officials canceled the curfews and closures. Not everyone thinks these decisions are wise.
"Now they decide to open some of the schools and the mosques. Because of that, there is high risk to increase the patients of corona. We are afraid that the cases will be more bad in Gaza because [of] this step," says pharmacist Tholfikar Swairjo.
Every day, Swairjo sees about 50 customers with COVID-19 symptoms. Some refuse to get tested and buy vitamins instead. Some claim the pandemic is a global imperialist conspiracy.
"It's something stupid, but they believe that," Swairjo says.
Next door, Israel leads the world on vaccinations per capita. In just a month and a half, more than a third of the country's 9 million citizens have received at least one shot.
The Palestinian territories remain far behind. The West Bank received its first COVID-19 vaccines only this week. Israel delivered 2,000 Moderna vaccines for Palestinian health workers there, following pleas from human rights groups to help, and Russia sent 10,000 Sputnik vaccines. Palestinians are also waiting for larger shipments, including from Russia and the World Health Organization's COVAX program, which is sending vaccines to poor populations.
Gaza has yet to receive any vaccines. Dr. Majdi Duhair, a Gaza health official, said he had expected several hundred to arrive through the Israeli border crossing Thursday, but an Israeli official tells NPR that the government has not yet approved vaccine deliveries to Gaza. It is a politically sensitive issue. An Israeli lawmaker asked leaders not to allow vaccines into Gaza until Hamas releases two Israeli captives and the bodies of two Israeli soldiers killed in battle in 2014.
That kind of tradeoff is unlikely, and Israel is expected to eventually allow vaccines into Gaza. Prime Minister Benjamin Netanyahu said this week that getting vaccines to Palestinians is in Israel's interest, calling it "the right step."
In Gaza's COVID-19 wards, medical staff say they do not expect to receive many vaccines in early shipments, and doubt there will be enough for all staff. They plan to vaccinate only medical workers above 50 years old and medical workers with chronic illnesses.
"This should be a humanitarian issue, but politics play a role. The priority of the companies is to sell the vaccine to wealthy countries more than poor ones," says Dr. Atef al-Hout, who heads Gaza's COVID-19 wards.
The pandemic has taken a heavy toll on Gaza's medical specialists — the few who did not join the exodus in recent years of hundreds of doctors who found better salaries and lives abroad.
Al-Hout says four doctors and three nurses died of COVID-19 in Gaza in the past year, including 51-year-old Dr. Majdi Ayyad, one of Gaza's last heart surgeons. Now there are only three cardiac surgeons left for a population of more than 2 million.
"Mercy be on those we lost," al-Hout says with a sigh.
Baba reported from Gaza City. Estrin reported from Jerusalem.