18 August 2017
In June, Palestinians marked 50 years of living under the world’s longest ongoing military occupation. High-quality research is an essential tool for documenting the ways in which the social and political conditions of prolonged occupation affect the health and wellbeing of the Palestinian people who endure it, and for advocating for an end to violations of the right to health.
Scientific research conducted in the occupied Palestinian territory can also be important for attempts to ensure that local healthcare is effective and evidence-based, providing the best possible outcomes for Palestinian patients.
In 2010 The Lancet, one of the world’s oldest and most preeminent medical journals, published a special issue which compiled research on health in the occupied Palestinian territory. After this, the Lancet Palestinian Health Alliance (LPHA) was formed; a network of Palestinian, regional and international researchers who analyse and evaluate the health and health care of Palestinians.
The LPHA aims to develop and advance local evidence-based policy and practice and to encourage advocacy based on their research, and has been supported by Medical Aid for Palestinians from its inception.
“A key function of the LPHA has been to use structured enquiry to describe the health and health care of ordinary Palestinians living in extraordinary circumstance.”
The Alliance is managed by the Institute of Community and Public Health at Birzeit University in the West Bank, and includes multilateral organisations (e.g. the World Health Organization), universities (Birzeit University, American University of Beirut), humanitarian organisations (United Nations Relief and Works Agency), and of course charities like MAP.
This month, the Lancet produced its fifth Special Issue on ‘Research in the Occupied Palestinian Territory’, publishing abstracts from the LPHA’s 2014 conference in Amman, Jordan. Discussing LPHA’s work in this Special Issue, Graham Watt, Rita Giacaman and Huda Zurayk, from the LPHA Steering Group, reflected:
“It is inevitable—given the circumstances of most Palestinians living under Israeli military occupation in the West Bank, during economic and nutritional siege and military bombardment in Gaza, or as refugees in Lebanon or from Syria—that many research studies include the effect of the political context on health.”
Below, we present a digest of a few of the interesting studies in this issue:
Two studies explore how social and political restrictions on Palestinians in Jerusalem negatively affect health and wellbeing.
In one study, Palestinians described their experiences living in Jerusalem, detailing discriminatory demographic and planning laws, exclusionary policies, imposed language and health system, and social and labour integration inequities.
The study’s findings echo wider research, showing structural barriers, cultural subordination, and hostile state values to adversely affect the health of minority populations.
Another study investigates the effect of disrupted family life and insecurity on the health and wellbeing of Palestinians living in Kafr ‘Aqab, which is located within the municipal boundary of Jerusalem but outside the Separation Wall.
The study documented the life stressors to which residents are exposed, including anxiety resulting from legal and administrative battles to maintain residency, increased financial strains, economic exploitation, and the distress of relocating to areas with poor living-conditions to maintain Jerusalem residency.
Most women interviewed as part of the study expressed strong feelings of insecurity for the future of their families' residency. Physical barriers (e.g. the Qalandia-checkpoint and the Separation Wall) were also found to restrict access to families and social support, and pose obstacles to accessing healthcare services in Jerusalem. Most participants also reported harmful environmental conditions, including sewage and water concerns because of increased urban sprawl and inadequate access to municipality services, despite being subject to taxation.
Most research studies conducted in political conflict settings use imported measures of mental health which may not be appropriate for use in local contexts. In one study from this Special Issue researchers produced and tested a mental health measure based on local definition of suffering in the occupied Palestinian territory that they labelled “Feeling Broken or Destroyed”.
Participants referred in Arabic to a type of suffering not included in standard mental health instruments, which was overwhelmingly associated with economic and political hardships. Descriptions from the participants included being or feeling: broken, crushed (muḥaṭṭima), destroyed, (mudammira), exhausted, and tired (ta'bāna).
This local Palestinian definition of suffering informed MAP’s recent briefing on Mental Health and Quality of Life in the occupied Palestinian territory.
Another study included in the Special Edition assessed the long terms effects of political imprisonment on Palestinian men, funding higher levels of trauma-related stress among former prisoners.
Men imprisoned between 2006 and 2011 reported lower functioning than never-imprisoned men in work insecurity, ability to pay for the needs of their children, community belonging, feelings of depression, feeling broken or destroyed and functional limitations.
One study focused on the experience of Palestinian health workers operating in emergency settings.
It highlighted that medics, paramedics, and mental health personnel working in emergency situations are at risk of developing trauma symptoms, and found that an individual’s ‘sense of cohesion’ – defined as “a global tendency to view one's environment as comprehensible, manageable, and meaningful” – appears to at least in part mediate the effects of trauma on anxiety, social dysfunction, and loss of confidence.
You can read The Lancet’s ‘Research in the Occupied Palestinian Territory 5’ Special Issue in full here.
