16 October 2018
The World Health Organization (WHO) has released its latest annual report on the barriers to the realisation of the ‘right to the highest attainable standard of health’ of Palestinians in the occupied Palestinian territory (oPt).
Covering the whole of 2017, the WHO report underlines the continuing – and in many cases growing – challenges Palestinian face to living healthy lives as a result of the occupation:
“In 2017, Palestinians continued to face substantial barriers to realizing their right to enjoyment of the highest attainable standard of physical and mental health. The situation of chronic occupation presents unique challenges to the Palestinian health sector, where patients, patient companions and health staff must all navigate a complex bureaucratic system that limits free movement and creates additional obstacles for the provision of health services and for access to care … In the West Bank, the fragmentation of territory and limited jurisdiction of the Palestinian Authority impedes access to care and impacts on the underlying determinants of health, especially for particularly vulnerable populations in Area C, the Seam Zone and H2 of Hebron.”
The report reiterates the shocking fact that last year marked the lowest rate of approval for exit permits by the Israeli Authorities for patients seeking to leave Gaza to access medical treatment elsewhere in the oPt – the West Bank, including East Jerusalem – and abroad, “with a mere 54% of patient permit applications approved in time to attend hospital appointments.”
“This 2017 approval rate is the lowest annual rate recorded by WHO for patients seeking health care outside Gaza, following a successive decline each year since 2012, when 93% of patient permit applications were approved”
At the same time, the Israeli Authorities more than doubled the permitted processing time for ‘non-urgent’ permit applications (from 10 to 23 working days). Referrals for cancer treatment comprised the largest proportion of patient cases referred out of Gaza (26%), followed by treatments for diseases of the circulatory system (12%); metabolic, endocrine and nutritional diseases (10%); and musculoskeletal diseases (9%).
The report further highlights barriers to the accessibility of healthcare for Palestinians – particularly Bedouin communities – in Area C of the West Bank, where “planning restrictions prevent the development of permanent or semi-permanent structures, including health facilities”, leaving these communities reliant on the services of mobile clinics like the one supported by Medical Aid for Palestinians (MAP) in the Jordan Valley. Similarly, the report finds that Palestinian communities in the ‘Seam Zone’ – the areas between the ‘Green Line’ and Israel’s Separation Wall continue to be “isolated from access to health services in nearby towns”.
Regarding barriers for health workers, the WHO found 26 cases where health staff were denied permits to reach hospitals in East Jerusalem (14 of these to Al Makassed Hospital). The rate of patients being forced to undergo the ‘back-to-back’ procedure when entering East Jerusalem from the West Bank – whereby a patient must be transferred from a Palestinian-registered ambulance to an Israeli-registered one – remained high at 90%. This procedure can cause unnecessary and harmful delays for the patient, particularly in emergency transfers.
Regarding attacks on healthcare – including actual or threatened physical or psychological violence against health workers or facilities, or obstruction of their work – the WHO reports that their 111 recorded incidents are “very likely” to be “an under-estimation of the situation in reality, with a significant number of health providers not actively reporting data.” The reporting period of 2017 includes the violent raids on Al Makassed Hospital in East Jerusalem by Israeli security forces in July of that year. In line with global initiatives against attacks on healthcare in conflicts, including Security Council Resolution 2286, the WHO has implemented a standardised system for recording and reporting such attacks, called the Surveillance System of Attacks on Healthcare (SSA). The SSA has reported more than twice the number of attacks in 2018 (271), including the killing of three health workers in Gaza, and 411 injuries.
The WHO establishes the legal obligations of Israel, as the occupying power, and other actors to respect and fulfil Palestinians’ right to health:
“The right to the highest attainable standard of health is recognized in International Human Rights Law and International Humanitarian Law and places a number of obligations on States that include ensuring access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalized groups; the provision of essential drugs; and the equitable distribution of health services. The obligations on States also pertain to the underlying determinants of health, such as ensuring access to minimal essential food that is nutritionally adequate and safe, as well as access to shelter, housing and sanitation and an adequate supply of safe drinking water.
As occupying power, Israel has a number of obligations under international law to respect, protect and fulfil the right of Palestinians to the highest attainable standard of health and wellbeing. The Palestinian Authority and de facto authority in Gaza also bear responsibilities for ensuring the right to health for Palestinians, to the extent of their jurisdiction. Finally, the international community has a duty to monitor and promote fulfilment of the responsibilities of the occupying power, including its responsibility for the health and welfare of the Palestinian population.”
The report concludes with the recommendations made by the UN Special Rapporteur on the situation of human rights in the Palestinian territories occupied since 1967, Prof. Michael Lynk, in his report on the right to health earlier this year:
You can read the full report here.