Health Under Occupation

On 13^th March, at Birzeit University near Ramallah, five articles from the university’s Department of Public Health were launched. The subject was health in the occupied Palestinian territories. The articles are being published by the medical journal, The Lancet, which is based in London but is widely read throughout the world. The articles have been condemned as propaganda by the Israeli prime minister’s spokesperson, Mark Regev. As an expert propagandist, he will know, if he has read the articles, that the studies they report have been conducted by able Palestinian academics collaborating with respected scientific workers from a number of countries, and reported with a care and objectivity which are the antithesis of propaganda.

Whereas there were health gains in the occupied Palestinian territories (the West Bank, East Jerusalem, and the Gaza Strip) during the 1990s, improvement has not been maintained. Infant mortality remained at about 27 per 1000 live births between 2000 and 2006, compared with 3.9 in Israel. The stillbirth rate has recently increased in Gaza. The proportion of stunted Palestinian children under the age of 5 years increased from 7.2% in 1996 to 10.2% in 2006. Stunting results from chronic malnutrition. It is serious because it is associated with reduced mental development and with increased illness in childhood and in adult life. Malnutrition is a result of the poverty imposed on Palestinians by Israeli occupation policy. In 2007, 52% of families (40% in the West Bank and 74% in the Gaza Strip) were living below the poverty line of US$3·15 per person per day. The average annual income of a Palestinian is $1200, compared with an Israeli average of $26000. Nearly half the Palestinians are now dependent on food aid.  

The psychological toll of the occupation is enormous. The lives of Palestinians have become more insecure since 2000. Not only are Palestinians killed nearly every day by the Israeli military, but others are assaulted, injured, or humiliated. Palestinians are subjected to restriction of movement at armed checkpoints and due to the barriers round Gaza and much of the West Bank. Detention, torture, destruction of trees and crops, demolition of houses and theft of land are daily occurrences. Unlike the Israeli settlers who were moved out of Gaza in 2005, the Palestinians receive no compensation for their losses.  

Though Israeli government and military strategy is the overriding cause of deficient healthcare in the occupied Palestinian territories, international donors pursuing their own agendas, and problems in the administration of health care are contributory factors. The Palestinian Ministry of Health is hamstrung by the occupation because the hostile occupying power not only rigidly controls movement of people (including patients and health workers) and materials (including drugs and medical equipment) between the occupied territories and the outside, but also within the Palestinian areas. The minimum humanitarian requirement is that there should be uninterrupted movement of people requiring medical care through checkpoints, but these agents of oppression need to be removed altogether. Their main purpose is not Israeli security. Controlling movement of Palestinians within the territories has little or no bearing on Israeli security, and checkpoints between Israel and the West Bank can be, and are, circumvented.

The Israeli military has repeatedly damaged ambulances, prevented them from attending injured and dying people, has injured and killed health personnel, and refused women giving birth, and many severely ill people, access to hospitals. It has bombarded hospitals and clinics. These atrocities contravene the Fourth Geneva Convention, which Israel has signed and ratified. It is essential that the truth is told about the effects of the occupation on the health of Palestinians. This is the importance of the Lancet articles. Armed with such information, we have to campaign as hard as we can for our governments to apply pressure on Israel to end the terrible suffering its military is inflicting on Palestinians.