EPF PIN member Harry Gunkel reflects on health care in Palestine.

The assault and invasion of Gaza this summer, the third in five years, put Gaza into the headlines once again. But more often than not in American media reports, the ‘story’ was not the enduring occupation and siege of the West Bank and Gaza by Israel, but the diversionary message of “terrorist” tunnels, rockets “raining down” and Israel’s need to defend itself. True enough, there was frequent mention of Palestinian casualties, but the numbers of dead and injured people were recited as though they were currency in the political debate between Israel and Hamas.

The high rate of Palestinian casualties and their severity, the damages to numerous Gazan hospitals and clinics, and the destruction of water and sewage facilities should have directed attention to an aspect of the occupation and siege that is frequently overlooked – the health of people living under the occupation.

Health care in the occupied territories gets short shrift among policy and militarization wonks. Perhaps because it’s an area outside their expertise or perhaps because there is a tacit assumption that health care is somehow exempt from the restrictions of the occupation; ie., that people who are ill, who are in need of medical or surgical care, who are pregnant, or disabled receive the care they need because it is humane to provide that care. Sadly, that assumption is wrong.

The multiple mechanisms employed to enforce the occupation apply to everyone: young or old, healthy or ill. Checkpoints that stop movement, the permit system that dictates who may go where, and the intimidation and harassment techniques have no boundaries. So every year in the West Bank and Gaza we see women deliver babies while stopped at a checkpoint, or men die of heart attacks because they cannot pass the checkpoint, or children die of cancer because they do not receive a permit to get to a hospital for treatment. Sporadic reports have occurred of birth defects caused by toxic dumping by Israel in the West Bank or by frequent x-raying of pregnant women at checkpoints.

It is difficult to obtain reliable information about the health of Palestinians. A search of electronic databases reveals virtually no reports in American medical journals during the last five years. But thankfully, the prestigious British medical journal The Lancet has provided two separate series of articles profiling and detailing health care among Palestinians. The first was published in March 2009 shortly after the so-called “Operation Cast Lead” invasion of Gaza, and the second in December 2013. The first was a series of articles from a wide array of institutions and agencies surveying several aspects of the health of Palestinians and the health care system in general, while the second series provided results of several clinical research projects carried out in Palestine. The latter series is significant because it shows the remarkable yearning for normalcy, professionalism and intellectual curiosity that prevails despite the circumstances of occupation and siege.

These series were rather groundbreaking and should be commended. One author in the series wrote,

“Palestinian predicaments share many of the same challenges facing other low-income and middle-income nations. Palestinian concerns should be integrated into… international discussion—an integration that has yet to take place. Too often, Palestinian voices are marginalised from international fora and debates around health. The purpose of this Lancet Series is to outline the contours of these concerns and to provide a framework for greater international understanding of Palestinian health priorities. Health offers an original way into a new dialogue for peace and justice, a point of departure for a new era of cooperation internally, regionally, and internationally. Making health a shared objective for all parties could provide a catalyst for unprecedented collaboration through nascent networks of scientific and medical exchange. In their own way, the alliances that have produced the report we publish this week are examples of how science, medicine, and public health can channel geographically and culturally diverse intellectual resources to constructive human—and political—ends.”

The two series from The Lancet can be obtained from a medical library or from health care professionals. Abstracts (short summaries) are available online for free at www.sciencedirect.com, but the full articles must be purchased by general public.

Detailed review of the findings of these series of scientific articles is beyond this scope, but a few salient points can be called out.

• The health care systems in the West Bank and Gaza are weakened both from without and within
  • From without, the total control of all borders by the Israeli military forces delays, interrupts or prevents delivery of needed supplies, equipment, and medications. The permit system and restrictions of movement prevent health care personnel from seeking advanced training or continuing education outside the Territories. Further, Palestinians pay taxes but Israel controls the revenue and frequently withholds the revenue in punishment (for example, when Palestine sought UN recognition of statehood), leaving governmental health workers and facilities in permanent instability.
  • Within, four sectors provide care to people in the Territories. UNRWA provides care for about 40% of the population who are refugees from the original 1948 conflict; the Palestinian Ministry of Health; NGOs; and a small private sector. These four authorities compete for resources and have been unable to establish significant collaboration or cooperation.
• More than half of Palestinians now live below the poverty line and are food insecure. Unemployment is above 25% and above 50% in much of Gaza.
• Stunting in childhood is on the rise. Stunting in childhood increases the risk of death and disease burden including compromised cognitive development and obesity and chronic disease in adulthood.
• Mental health disorders are increasing with a majority of respondents in surveys reporting sleeplessness, fear, distress, and life dissatisfaction. Children were highly exposed to traumatic events, such as witnessing a relative being killed, seeing mutilated bodies, and having homes damaged. Studies also reported several psychosocial problems, including behavioral problems, fears, speech difficulties, anxiety, anger, sleeping difficulties, lack of concentration at school, and difficulties in completing homework.
• Certain specific communicable diseases such as pulmonary tuberculosis and meningococcal meningitis are on the rise, along with non-communicable diseases especially diabetes and hypertension.

There are many places in the world with worse health and health care systems than Palestine, but what requires our attention about Palestine is that the health crisis is directly attributable to an occupying power and its supporters who are unchecked by the international community. This is the worst malady of all.