19 March 2020
This month, Medical Aid for Palestinians (MAP) hoped to attend the 43rd regular session of the UN Human Rights Council to once again raise our concerns about challenges to the right to health of Palestinians living under occupation in the West Bank and Gaza. We intended to highlight continuing restrictions on freedom of movement of patients caused by Israel’s permit regime; the de-development of healthcare in Gaza accelerated by Israel’s near-13-year illegal closure; and the continuing lack of protection for Palestinian health workers and lack of accountability for attacks on them by Israeli forces.
The session was, however, cancelled due to the Coronavirus (COVID-19) pandemic, and so were planned side events and oral statements to relay these vital messages. Nevertheless, MAP did submit a written statement to the Council and member states which you can read here, outlining the challenges above, and calling for international action to address them.
There are currently 44 recorded cases of coronavirus in the West Bank and none in Gaza. Our written statement outlines prominent health and wellbeing concerns in the occupied Palestinian territory, and how the capacity of the Palestinian healthcare system and the availability and accessibility of vital services to patients has been badly undermined by the policies of the occupying power, Israel. If and when coronavirus spreads, it is likely to exacerbate these existing problems and directly threaten the health and wellbeing of many Palestinians.
Here are some of the issues raised in the statement:
In 2019, Israeli authorities demolished or seized 623 Palestinian homes and other structures in the West Bank, including East Jerusalem, a 35% increase from 2018. This resulted in 914Palestinians displaced (more than half children), almost double the number in 2018. Demolitions constitute a threat to residents’ physical and mental health.
In Area C of the West Bank, Israel inhibits the construction of medical infrastructure and essential services such as water, sanitation and electricity for Palestinians. Consequently, there are no permanent healthcare centres for approximately 300,000 Palestinians living in Area C. For half of the 351 Palestinian communities in Area C the closest clinic is over 30km away.
Movement restrictions, limited access to potable water, poverty, restricted livelihoods, and persistent threats of demolitions and forcible transfer all negatively affect the health and wellbeing of Palestinians in Area C. Malnutrition is a continuing concern: 23% of Bedouin children in the Jordan Valley suffer stunting, with potentially life-long impacts on economic, educational and health outcomes. Half of all children in the Jordan Valley (49%) and 19% of mothers are anaemic.
The intensified and illegal closure imposed by Israel since 2007 is a primary driver of humanitarian needs in Gaza. This has accelerated the de-development of the healthcare system directly, through restrictions on movement of people and goods, and indirectly, through economic damage and compounding Gaza’s political and functional separation from the West Bank.
MAP’s assessment is that the UN’s warning that Gaza would be unliveable by 2020 has indeed come true. Some 96% of aquifer water is undrinkable. Unemployment reached 47% in 2019, with youth unemployment at 64%. Almost half of the population (46%) lives below poverty line and 62% of households are food insecure. One in ten children in Gaza suffers stunting due to chronic malnutrition.
Gaza’s hospitals often lack adequate supplies to treat patients. According to the Ministry of Health and World Health Organisation, 48% of essential medicines and 26% of medical disposables were at ‘zero stock’ in 2019, meaning less than one month’s supply available at Gaza’s Central Drug Store. The health of patients with cancer and kidney disease is particularly threatened, with 58% of chemotherapy drugs and 41% of kidney dialysis medicines at zero stock in December 2019.
Restrictions to the exit of health workers limits professional development opportunities outside Gaza, leading to shortages of specialists in cardiovascular surgery, oncology, ophthalmology and neurosurgery. Only 15% of applications for health workers to exit Gaza were approved by Israel in 2018. Israel’s onerous “dual-use list” of materials it classifies as having a potential military use restricts entry of some medical equipment, including X-ray scanners and medical radioisotopes.
With certain medical specialties only available at hospitals in East Jerusalem, the West Bank, or abroad, and the quality of healthcare diminished in Gaza, many patients require referral outside for treatment. In 2019 Israel denied 9% of exit permit applications (2,164 applications, including 363 for children), and delayed 26% past the appointment date (6,404 applications, including 1,763 for children). Of patients referred outside, 31% required cancer treatments. Cancer patients applying for chemotherapy and/or radiotherapy whose permits are delayed or denied are 1.45 times less likely to survive in subsequent years.
Almost half (49%) of 26,798 permit requests for patient accompaniers were denied or delayed. This is particularly problematic for parents accompanying sick children and for companions of the elderly and those with disabilities, and compounds stress and worry of patients. Restrictions by Egypt at the Rafah border also limit patients’ ability to exit for treatment elsewhere.
The “Great March of Return” demonstrations since 30 March 2018 occur in a context of, and are partly motivated by, Gaza’s humanitarian collapse and the continuing denial of Palestinian refugees’ internationally-recognised right of return.
Israel’s use of force against demonstrators has been characterised by widespread use of live ammunition, teargas and rubber-coated steel bullets. Between 30 March 2018 and 31 October 2019, 35,450 Palestinians were injured and 212 killed (including 46 children) by Israeli forces. Some 7,996 Palestinians suffered gunshot wounds, predominantly to their limbs. An estimated 1,209-1,746 patients require extensive specialised limb reconstruction treatment, with multiple surgeries and prolonged rehabilitation over two years or more. 149 amputations have taken place, including 30 to children.
This influx of trauma patients has compounded pressures on Gaza’s healthcare system, including the postponement of 8,000 elective surgeries. Israel’s “dual-use” list severely restrict entry of carbon fibre components used to stabilise and treat limb injuries, and carbon fibre and epoxy resins used to produce artificial limbs, resulting in patients being fitted with heavier, less comfortable alternatives. Despite diminished local healthcare capacity, only 17% of applications for patients injured during the demonstrations were approved up to 31 December 2019.
What is more, from the beginning of the protests to December 2019, Israeli forces injured 845 Palestinian health workers and damaged 118 ambulances. Three health workers were killed by live ammunition in 2018 (Musa Abu-Hassanin, Razan al-Najjar and Abdallah al-Qutati). Paramedic (Mohammed al-Jedeili) was shot with a rubber-coated steel bullet on 3 May 2019, which fractured his skull, and he died on 10 June while being treated in hospital in Hebron.
In March 2019, the UN Commission of Inquiry “found reasonable grounds to believe that Israeli snipers intentionally shot health workers, despite seeing that they were clearly marked as such.” These killings and injuries of health workers also occur in a context where “the Government of Israel has consistently failed to meaningfully investigate and prosecute commanders and soldiers for crimes and violations committed against Palestinians or to provide reparation to victims.”
This is a snapshot of just some of the challenges that were affecting health and healthcare in the occupied Palestinian territory even before the coronavirus pandemic began. While fighting this unprecedented global health crisis, governments and other duty-bearers, including Israel as an occupying power, must fulfil their human rights obligations to the people under their jurisdiction.
The following recommendations made in the statement are therefore more urgent than ever, and we urge the UK and other countries to enact them:
