5 lessons for the UK Government on COVID-19 and Palestinian communities

MAP’s evidence to the International Development Committee

In April, the UK House of Commons’ International Development Committee (IDC) launched an inquiry into the impact of COVID-19 (coronavirus) on countries with on-going humanitarian crises. Medical Aid for Palestinians (MAP) responded by submitting evidence on how coronavirus is affecting the Palestinian communities we serve in Lebanon and the occupied Palestinian territory (oPt).

The pandemic has exposed long-standing, politically-driven vulnerabilities among Palestinians. While MAP’s teams are responding to this unprecedented crisis on the ground, prioritising infection control and containment, such support will need to be sustained and even increased for many months. Meanwhile, accompanying humanitarian challenges grow, including reduced access to healthcare for non-coronavirus illness, deepening poverty, and increased food insecurity.

We are therefore urging the UK government, and the wider international community, to at least sustain their essential aid funding to Palestinians for the duration of the crisis, while also working towards the long-term sustainability of healthcare for Palestinians. Ultimately, aid must be matched with accountability for the many violations of Palestinians’ human rights which make their communities and institutions uniquely vulnerable to shocks such as this global pandemic.

Below, we outline five key takeaways from MAP’s submission to the IDC, which you can read in full here.

1. COVID-19 exposes long-standing vulnerabilities among Palestinian communities

As one of the most densely populated places in the world, effective self-isolation in Gaza is nearly impossible, and water shortages make hygiene and sanitation measures to prevent the spread of COVID-19 more difficult. Gaza has one of the highest rates of unemployment in the world (45%), and more than two thirds (68%) of households are moderately or severely food insecure. Meanwhile, Gaza’s health system teeters on the brink of collapse with chronic shortages of essential medicines and disposables even before the start of the coronavirus crisis. Gaza has just 78 ICU beds and 63 ventilators – many already in use – for a population of 2 million.

In the West Bank, 50% of Palestinian communities living in Area C (the 60% of the West Bank under full Israeli military and civil control, currently threatened with formal annexation) are more than 30km away from a clinic. In Bedouin communities, rates of malnutrition and micronutrient deficiency are high among pregnant and breastfeeding women, with 23% of children under five suffering stunting.  High rates of poorly-managed non-communicable diseases such as diabetes and hypertension increase the likelihood of complications from coronavirus in older adults.

Overcrowded, unsanitary conditions in Palestinian refugee camps in Lebanon make effective self-isolation and other containment measures extremely difficult. Palestinians rely on a fragmented and under-resourced network of UN (UNRWA), Palestine Red Crescent Society, NGO and private healthcare. UNRWA, the primary healthcare provider, suffers a chronic budgetary shortfall that is likely to challenge its coronavirus response in the event of a widespread outbreak, with officials warning that it is “operating on a month-to-month basis”. Moreover, coronavirus containment measures have exacerbated what the World Bank has described as Lebanon’s “worst economic crisis in recent history,” affecting marginalised communities disproportionately.

2. These vulnerabilities are politically driven: displacement, occupation and closure

The intensified and illegal closure and blockade imposed on Gaza by Israel since 2007 is a primary driver of local vulnerabilities to COVID-19. Even before the current crisis, MAP assessed that the UN’s warning that Gaza would be unliveable by 2020 has come true. This long-term de-development of Gaza’s health sector has left it with inadequate infrastructure, essential equipment, drugs, supplies, and human resourcesto treat a widespread outbreak of coronavirus..

Long-standing patterns of violations also undermine COVID-19 response in the West Bank. The discriminatory planning regime imposed by Israel on Palestinians in East Jerusalem and communities in Area C has stifled the development of Palestinian healthcare. Demolitions of Palestinian homes and property including WASH facilities continue despite the pandemic, and attacks on Palestinians by settlers and armed raids of Palestinian homes by Israeli forces have surged. Since the pandemic began, Israeli security forces have dismantled and confiscated a coronavirus clinic in the north Jordan Valley, and shut down a Palestinian testing clinic in East Jerusalem.

In Lebanon, decades of marginalisation, discrimination, and poor access to basic services and economic opportunities have increased the vulnerability of Palestinian refugees. Palestinians are barred from working in 39 “preferred” professions, including most healthcare jobs. 87% of workers receive no paid sick or annual leave, and nearly half (48%) are paid daily.

Palestinian refugees have been denied their right to return to their homes by Israel for more than 72 years.

3. The COVID-19 crisis has knock-on effects on Palestinians’ access to healthcare and other humanitarian needs

As the Palestinian health sector has pivoted to COVID-19 response, access to other health services has reduced. In Gaza, breast cancer screening has stopped and is now limited to diagnostic services only. Routine management of non-communicable diseases is also postponed, as well as early child growth and development services, and physiotherapy. According to UN OCHA, over 9,000 patients in Gaza face postponements to their elective surgeries, 3,000 of which are urgent.  In the West Bank, over 4,000 elective surgeries are also expected to be postponed each month.

Across all areas, significant restrictions on livelihoods resulting from COVID-19 social distancing measures, are likely to exacerbate poverty and chronic food insecurity, resulting in more families going hungry during the course of the pandemic. Compounded economic impacts are felt especially by women and people with disabilities who face long-standing barriers to livelihoods and the full enjoyment of their rights.

4. International aid is necessary and must be sustained long-term, but should be focused on Palestinian self-determination

In the oPt, the UK has contributed $1 million to support the World Health Organization (WHO) and UNICEF to “purchase and co-ordinate the delivery of medical equipment, treat critical care patients, train frontline public health personnel and scale up laboratory testing capacity.” The UK also continues to be one of the largest international donors to UNRWA. There are, however, fears that underlying resource shortages and international donor fatigue will reduce the capacity to maintain hygiene, quarantine and testing capacity. This aid is essential and must be at least sustained for the duration of the pandemic and to ensure the disease remains contained and the catastrophic scenario of a widespread outbreak in the oPt and Palestinian refugee camps in Lebanon is averted.

Donors should work to mitigate the knock-on effects of COVID-19, in particular to livelihoods, food security, and access to healthcare for non-coronavirus needs, to avoid a secondary humanitarian crisis caused by worsening poverty.

In the longer term, international aid should support the sustainable development of the Palestinian healthcare system and other institutions, helping ensure that Palestinians have the necessary resources and infrastructure to respond independently to future crises. DFID should ensure it meaningfully consults with Palestinian communities in determining its aid strategies in the oPt. Alongside humanitarian funding through UN agencies, where possible DFID should support Palestinian civil society to implement programmes, particularly in Gaza. UK aid should be guided by upholding the right to self-determination of the Palestinian people.

5. Aid must be matched with accountability for violations of international law that are the root causes of Palestinian vulnerabilities

The unpreparedness of the Palestinian healthcare sector to deal with the COVID-19 pandemic underlines the international community’s failure to address long-standing root causes of this fragility amid Israel’s 53-year occupation: continuing impunity for violations of international law that undermine health and healthcare, including repeated attacks on Palestinian healthcare.

As the occupying power in the West Bank, including East Jerusalem, and Gaza, Israel has a duty under the Fourth Geneva Convention to adopt and apply “measures necessary to combat the spread of contagious diseases and epidemics” to the fullest extent of the means available to it. Ongoing violations by Israel, including the continuing collective punishment of Gaza’s population, the demolition of Palestinian homes and other essential infrastructure, and barriers to healthcare access, are additionally egregious in the context of a global health crisis.

The UK government should therefore ensure its international aid to the Palestinians is matched by an international law-based foreign policy, and diplomatic pressure to address actions by Israel that perpetuate aid dependency and undermine the effectiveness of humanitarian programmes. Specifically, the UK should:

  • Ensure that Israel respects its duties as an Occupying Power to deploy all means to combat the spread of contagious diseases in the oPt;
  • Demand an immediate and permanent cessation of demolitions and seizures of Palestinian homes, WASH facilities and clinics, and ensure Palestinian health workers can continue their work unimpeded and without fear of attack or obstruction;
  • Support genuine investigations into, and legal accountability for, violations of international law in the oPt, including military attacks on medical personnel and infrastructure as a way to prevent future violations and to provide justice;
  • Demand Israel end the illegal closure and blockade of Gaza; and
  • Urge Israel and other local duty bearers to ensure that any restrictions on human rights implemented to combat COVID-19 are strictly necessary, proportionate, non-discriminatory, and time-bound.

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