Palestine: Health Care

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الرعاية الصحيّة في فلسطين

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HEALTHCARE AND MENTAL HEALTH SERVICES IN PALESTINE

The Israeli occupation geographically fragments Palestine, making it harder to organise and administrate a centralised or synthesised healthcare system, and for NGOs to deliver aid. This multiplicity and overlap can lead to inefficiency in healthcare provision. There have been many sociopolitical changes that form the base of the current healthcare system, from colonial restructuring in British Mandate Palestine (1918-1948), the ongoing occupation by Israel, and a shift by Fatah towards diplomatic negotiation and international financial backing that allows global NGOs to provide aid including healthcare. These services exist alongside more marginalised traditional cultural treatments for ill health. Communication between medical services in the oPt are sometimes effected by political disagreements between the two main political parties in the PA, with an increasing gap in the quality of healthcare services between the West Bank (improving) and Gaza (declining). In the Gaza Strip residents are more likely to be classified as refugees, where access to psychiatric services are provided by UNWRA, instead of longer-term systematic psychiatric care. In Gaza there is an even wider gap between the frequency and type of psychiatric conditions (rates of Post Traumatic Stress Disorder [PTSD], Anxiety, Depression) and the lack of infrastructure available.

A rectangular infographic with a bold black and red colour scheme on a white background is titled Israel Denies Cancer Care. The central image is an outline of an egg timer, inside the top of the timer a hand reaches out of black sand. Text to the left reads “28% of applications by Gaza Patients were to see Oncology (cancer) specialists in 2018. Some cancer treatments like radiotherapy are not available in Gaza” In the bottom half of the timer, the black sand turns to big drops of blood pouring down. Red text to the right reads “46 Palestinian cancer patients in Gaza died waiting for an Israeli exit permit in 2017”. Sources are found at bit.ly/vp-righttohealth and the image is attributed to www.VisualizingPalestine.org
Israel Denies Cancer Care to Palestinians: 46 Palestinian cancer patients in Gaza died waiting for an Israeli exit permit in 2017
A rectangular infographic with a bold black and red colour scheme on a white background is titled Child Approved Parent Denied. The central image is the outline of a parent and child holding hands, between them is a pair of scissors and a ‘cut here’ seeking to separate them. The parent is trapped in a darkness, the child on the opposite side holds a red balloon with white text that says “1821 kids approved without parent”. Beneath the parent, black text states “59% of sick kids applying for an Israeli permit to exit Gaza were approved without their parent in 2018.” Sources are found at bit.ly/vp-righttohealth and the image is attributed to www.VisualizingPalestine.org
Israeli approval required for a parent to travel with their child to access healthcare outside of Gaza. 59% of children were approved without their parent in 2018.

There has been a recent decline in donations to international NGOs in Palestine (-30% in 2015, WHO 1)due to a lack of apparent political progression, which leads to ‘donor fatigue’ or ‘occupation fatigue’, combined with post-2008 global economic recession, and shift in emphasis to the refugee ‘crisis’ in Europe. UNRWA is now at a critical juncture where the majority of its funding has been withdrawn by the US government, which historically had been its main source of income. The occupation directly impacts access to healthcare in a number of ways: Palestinians need to obtain a permit to travel between Gaza and the West Bank for healthcare or to access to health services in Israel or neighbouring countries, where Israeli hospitals charge high fees for services. The application process and provision of permits are often delayed or denied without apparent reason, leading to missed healthcare, where 22.6% of travel permits are denied or delayed in the West Bank. Trade restrictions mean that medicines imported into Palestine can be up to 7 times the global market prices2, including those for mental health (SSRIs, e.g. Prozac or Fluoxetine). The PA Ministry of Health often has to borrow money from Israel to cover these, at a high interest rate leading to further debt. In Gaza there is a chronic shortage of medicines, with 30%of essential medicines at zero stock.

A rectangular infographic with a bold black and red colour scheme is titled Treating Trauma Under Israeli Fire. The central image is a thick, curved line with a human hand at either end. On the left, the hand holds a medical kit, beneath it text reads “4348 Palestinians treated for Gunshot wounds at Gaza hospitals”. On the right, the hand is partially severed from the wrist and a large blood drop is emerging from the wound. The blood drop becomes red text, stating that “3 Health workers killed, 570 health workers injured as a result of Israeli attacks on Gaza’s peaceful Great March of Return in 2018. Sources are found at bit.ly/vp-righttohealth and the image is attributed to www.VisualizingPalestine.org
Palestinians and health workers killed and injured by Israel in attacks on Gaza’s peaceful Great March of Return in 2018
A rectangular infographic with a bold black and red colour scheme on a white background is titled 'Israel Denies Medical Training'. The image is dominated by a graphic of a figure in an upright position, drowning in a pool of red assumed to be blood, they are carrying a medic case identifying their profession. The area reaching from the figure’s foot at the bottom of the image to their hand reaching out of the red is demarcated as a stacked bar chart illustrating that there was a 98% rate of denial or delay for permit applications by Palestinians to attend training, workshops or conferences outside of Gaza in 2018, and 68% of application marked as pending are effectively denied due to time constraints. Only 2% of requests for medical training are approved. Sources are found at bit.ly/vp-righttohealth and the image is attributed to www.VisualizingPalestine.org
Israel Denies Palestinians Medical Training: 98% Rate of Denial or Delay

COVID-19

Existing healthcare inequalities have been exacerbated during the pandemic, with the destruction of a COVID-19 test clinic that was under construction in Khirbet Ibziq, the West Bank3in March 2020, to track-and-trace services catering to Israeli or Hebrew speaking citizens, not made available in Arabic for Palestinians4. A COVID-19 vaccine has currently been made and administered to Israeli citizens (January 2021), but not to Palestinians, despite the fact that the state of Israel is responsible for the health of all the populations in the oPt5. The Israeli state has used the pandemic to expand the occupation, still undertaking house demolition and settlement construction, while residents are under lockdown, and Palestinian residents are under more restricted lockdown conditions that settlers in the same areas6.

FOOTNOTES

  1. World Health Organisation (WHO) Report (2017)
  2. 'Trade Facilitation in the Occupied Palestinian Territory: Restrictions and Limitations' United Nations (2014)
  3. Israel Confiscates Clinic Tents During COVID (26th March, 2020 BTSelem)
  4. S C Molavi and Eyal Weizman (2020) The Viral Emergency in Palestine
  5. Gisha, Legal Centre for Freedom of Movement(2021) (Eng) (Ara) (Heb)
  6. The UK-Palestine Mental Health Network invited Palestinian doctors (Prof. Shalhoub-Kevorkian, Dr Abu Jamei) to discuss the impacts of COVID on life in Palestine and mental health: https://ukpalmhn.com/cafe-palestine/cafe-palestine-index/

Infographics by Visualizing Palestine

HEALTHCARE AND MENTAL HEALTH SERVICES IN PALESTINE

The Israeli occupation geographically fragments Palestine, making it harder to organise and administrate a centralised or synthesised healthcare system, and for NGOs to deliver aid. This multiplicity and overlap can lead to inefficiency in healthcare provision. There have been many sociopolitical changes that form the base of the current healthcare system, from colonial restructuring in British Mandate Palestine (1918-1948), the ongoing occupation by Israel, and a shift by Fatah towards diplomatic negotiation and international financial backing that allows global NGOs to provide aid including healthcare. These services exist alongside more marginalised traditional cultural treatments for ill health. Communication between medical services in the oPt are sometimes effected by political disagreements between the two main political parties in the PA, with an increasing gap in the quality of healthcare services between the West Bank (improving) and Gaza (declining). In the Gaza Strip residents are more likely to be classified as refugees, where access to psychiatric services are provided by UNWRA, instead of longer-term systematic psychiatric care. In Gaza there is an even wider gap between the frequency and type of psychiatric conditions (rates of Post Traumatic Stress Disorder [PTSD], Anxiety, Depression) and the lack of infrastructure available.

A rectangular infographic with a bold black and red colour scheme on a white background is titled Israel Denies Cancer Care. The central image is an outline of an egg timer, inside the top of the timer a hand reaches out of black sand. Text to the left reads “28% of applications by Gaza Patients were to see Oncology (cancer) specialists in 2018. Some cancer treatments like radiotherapy are not available in Gaza” In the bottom half of the timer, the black sand turns to big drops of blood pouring down. Red text to the right reads “46 Palestinian cancer patients in Gaza died waiting for an Israeli exit permit in 2017”. Sources are found at bit.ly/vp-righttohealth and the image is attributed to www.VisualizingPalestine.org
Israel Denies Cancer Care to Palestinians: 46 Palestinian cancer patients in Gaza died waiting for an Israeli exit permit in 2017
A rectangular infographic with a bold black and red colour scheme on a white background is titled Child Approved Parent Denied. The central image is the outline of a parent and child holding hands, between them is a pair of scissors and a ‘cut here’ seeking to separate them. The parent is trapped in a darkness, the child on the opposite side holds a red balloon with white text that says “1821 kids approved without parent”. Beneath the parent, black text states “59% of sick kids applying for an Israeli permit to exit Gaza were approved without their parent in 2018.” Sources are found at bit.ly/vp-righttohealth and the image is attributed to www.VisualizingPalestine.org
Israeli approval required for a parent to travel with their child to access healthcare outside of Gaza. 59% of children were approved without their parent in 2018.

There has been a recent decline in donations to international NGOs in Palestine (-30% in 2015, WHO 1)due to a lack of apparent political progression, which leads to ‘donor fatigue’ or ‘occupation fatigue’, combined with post-2008 global economic recession, and shift in emphasis to the refugee ‘crisis’ in Europe. UNRWA is now at a critical juncture where the majority of its funding has been withdrawn by the US government, which historically had been its main source of income. The occupation directly impacts access to healthcare in a number of ways: Palestinians need to obtain a permit to travel between Gaza and the West Bank for healthcare or to access to health services in Israel or neighbouring countries, where Israeli hospitals charge high fees for services. The application process and provision of permits are often delayed or denied without apparent reason, leading to missed healthcare, where 22.6% of travel permits are denied or delayed in the West Bank. Trade restrictions mean that medicines imported into Palestine can be up to 7 times the global market prices2, including those for mental health (SSRIs, e.g. Prozac or Fluoxetine). The PA Ministry of Health often has to borrow money from Israel to cover these, at a high interest rate leading to further debt. In Gaza there is a chronic shortage of medicines, with 30%of essential medicines at zero stock.

A rectangular infographic with a bold black and red colour scheme is titled Treating Trauma Under Israeli Fire. The central image is a thick, curved line with a human hand at either end. On the left, the hand holds a medical kit, beneath it text reads “4348 Palestinians treated for Gunshot wounds at Gaza hospitals”. On the right, the hand is partially severed from the wrist and a large blood drop is emerging from the wound. The blood drop becomes red text, stating that “3 Health workers killed, 570 health workers injured as a result of Israeli attacks on Gaza’s peaceful Great March of Return in 2018. Sources are found at bit.ly/vp-righttohealth and the image is attributed to www.VisualizingPalestine.org
Palestinians and health workers killed and injured by Israel in attacks on Gaza’s peaceful Great March of Return in 2018
A rectangular infographic with a bold black and red colour scheme on a white background is titled 'Israel Denies Medical Training'. The image is dominated by a graphic of a figure in an upright position, drowning in a pool of red assumed to be blood, they are carrying a medic case identifying their profession. The area reaching from the figure’s foot at the bottom of the image to their hand reaching out of the red is demarcated as a stacked bar chart illustrating that there was a 98% rate of denial or delay for permit applications by Palestinians to attend training, workshops or conferences outside of Gaza in 2018, and 68% of application marked as pending are effectively denied due to time constraints. Only 2% of requests for medical training are approved. Sources are found at bit.ly/vp-righttohealth and the image is attributed to www.VisualizingPalestine.org
Israel Denies Palestinians Medical Training: 98% Rate of Denial or Delay

COVID-19

Existing healthcare inequalities have been exacerbated during the pandemic, with the destruction of a COVID-19 test clinic that was under construction in Khirbet Ibziq, the West Bank3in March 2020, to track-and-trace services catering to Israeli or Hebrew speaking citizens, not made available in Arabic for Palestinians4. A COVID-19 vaccine has currently been made and administered to Israeli citizens (January 2021), but not to Palestinians, despite the fact that the state of Israel is responsible for the health of all the populations in the oPt5. The Israeli state has used the pandemic to expand the occupation, still undertaking house demolition and settlement construction, while residents are under lockdown, and Palestinian residents are under more restricted lockdown conditions that settlers in the same areas6.

FOOTNOTES

  1. World Health Organisation (WHO) Report (2017)
  2. 'Trade Facilitation in the Occupied Palestinian Territory: Restrictions and Limitations' United Nations (2014)
  3. Israel Confiscates Clinic Tents During COVID (26th March, 2020 BTSelem)
  4. S C Molavi and Eyal Weizman (2020) The Viral Emergency in Palestine
  5. Gisha, Legal Centre for Freedom of Movement(2021) (Eng) (Ara) (Heb)
  6. The UK-Palestine Mental Health Network invited Palestinian doctors (Prof. Shalhoub-Kevorkian, Dr Abu Jamei) to discuss the impacts of COVID on life in Palestine and mental health: https://ukpalmhn.com/cafe-palestine/cafe-palestine-index/

Infographics by Visualizing Palestine

Additional Resources

1.

Reading List: Health and Disability Palestine

healthcare-palestine, disability-palestine

reading-list_health_disability.pdf