HEALTH IN THE OCCUPIED PALESTINIAN TERRITORY – Part Three

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Youth on a march in London in January against the Israeli attack on Gaza
Youth on a march in London in January against the Israeli attack on Gaza

TOP British medical journal The Lancet has published a series of detailed research reports on the health status of 3.8 million people living in the Occupied Palestinian Territory (OPT).

In Part Three News Line is reproducing the extensive Lancet press release on the final scientific papers.

5. ‘The Best Solution for Health in the Occupied Palestinian Territory (OPT) is a Sovereign Palestinian State.

‘Developing the ailing health system in the occupied Palestinian territory (OPT) will be near-impossible under military occupation.

‘The best-case scenario to improve the health system would include the creation of a sovereign Palestinian state.

‘These issues are discussed in the fifth and final paper in The Lancet Series on Health in the Occupied Palestinian Territory, written by Dr Awad Mataria, Birzeit University, OPT, and colleagues.

Four main providers are responsible for primary, secondary, and tertiary health care: the Palestinian Ministry of Health (PMoH), Palestinian non-governmental organisations, the UN Relief and Works Agency, and the private sector.

‘Health services are financed through a mixture of taxes, health insurance premiums and co-payments, out-of-pocket payments, local community financial and in-kind donations, and loans and grants from the international community.

‘Reviews of the health sector estimated that total health expenditure in 2002 was 8·6 per cent of gross domestic product (GDP) and per-person expenditure was $135 in 2005.

‘While some indicators for the OPT are good (most women receiving some form of antenatal care and 95 per cent immunisation coverage), inequalities persist and mental-health problems are rising.

‘The authors say: “In view of the turbulent situation, the chances of the occupied Palestinian territory achieving most Millennium Development Goals by 2015 are low.

‘ “Movement restrictions cause serious problems for the health sector.

‘ “In July, 2007, alone, there were 40 recorded cases of ambulances being denied access to patients in the West Bank. A survey at the end of 2003 found that the number of people needing one hour or more to reach an appropriate health facility had increased by ten times in three years.

‘ “Financial accessibility to health services, especially for the most deprived sections of the population, has been compromised since 2000.”

‘Results of recent surveys show that a third of a representative sample of the population could not access health services because of high costs and that people living with financial hardship or in poverty are twice as likely as rich people to be unsuccessful in accessing hospital care.

‘Health services in the Gaza strip have deteriorated rapidly since the political impasse between Fatah and Hamas, and the Israeli and international boycott of Hamas.

‘In June, 2007, Israel refused to allow travel outside the Gaza Strip for all patients referred to health-care services abroad through Israel (282 cases), a policy indicative of Israel’s decision to impose collective restrictive measures against civilians in the Gaza Strip.

‘A recent WHO report documents patients who died between October, 2007, and March, 2008, after being denied access to specialised treatment from outside the Gaza Strip.

‘Whereas Israel has 6·3 nurses for every 1,000 people, the OPT has only 1·7. Health-care services remain highly physician-oriented, with doctors running many activities that could be done by nurses and community health workers at much lower costs.

‘Insufficient monitoring and lack of supervision have allowed cronyism and corruption, a lack of commitment and interest, and erosion of public trust and satisfaction.’

The authors say: ‘The factors that hinder health system development are not unique to the occupied Palestinian territory, but they are exaggerated and perpetuated under the oppressive conditions of the Israeli military occupation.

‘ “Furthermore, occupation creates some of the difficulties. Occupation policies of separation, isolation, and segregation have created uncertainty, raised transaction costs, and shrunk markets, resulting in critical constraints on the survival of the Palestinian economy as a whole.”

‘The report goes on to say: “Under the best-case scenario, the Palestinian Ministry of Health can choose to limit its role to being the steward of the system, while providing a basket of core services — including public-health activities — and the funding needed to cater for the needs of specific categories of the population, for example vulnerable groups.

‘ “Under the worst-case scenario, the focus has to remain on emergency relief, with attempts made to pursue human capacity development.

‘ “Finally, the scenario of the continuing status quo means consideration should be given to coordinating and harmonising the efforts of donors and providers to avoid wastage of scarce resources.’ ”

Dr Awad Mataria, Birzeit University, OPT. T) +972 2298 8654/5 E) awad@birzeit.edu

For full article see: http://press.thelancet.com/opt5.pdf 

Health is a Critical Political Objective Towards Peace and Justice.

‘In his Comment which introduces The Lancet Series on Health in The Occupied Palestinian Territory (OPT), Lancet Editor Dr Richard Horton says that: “The goal of this Series is to change the way health professionals, politicians, policy makers, media, and the public view, think about, and discuss the predicament facing this region of the Middle East.”

‘He concludes: “Our ultimate hope is that this Series could contribute to a mass international social movement for peace and justice through health in, and with the people of, the occupied Palestinian land.

‘ “Justice in this context is about fashioning a fair and sustainable future for the people of Palestine. Health can be a magnetic nucleus to draw together the necessary critical mass of agreement to make this idea more than simply an aspiration.” ‘

The Lancet Press Office T) +44 (0) 20 7424 4949 E) pressoffice@lancet.com

For full Comment see: http://press.thelancet.com/opt6.pdf 

Teaching Child Health in the Occupied Palestinian Territory.

‘Since 1999, the UK’s Royal College of Paediatrics and Child Health (RCPCH) has been working to establish a sustainable teaching programme in child health in the occupied Palestinian territory.

‘The aim was and is to upgrade the knowledge and skills of doctors and nurses who work with children.

‘The issues are discussed in a Comment which accompanies The Lancet Series on Health in The Occupied Palestinian Territory, written by RCPCH President Dr Patricia Hamilton, and Dr Anthony Waterston, RCPCH and Newcastle University, UK, and colleagues.

‘They conclude: “The current situation in the occupied Palestinian territory is damaging to child health because it impedes access and disrupts the social network which is necessary for child wellbeing, especially in the rural community.

‘ “In Gaza, the situation is particularly perilous and we have no programme there at present, even though it was the initial focus for our work. We hope to start teaching in Gaza as soon as it is possible to enter and travel safely.

‘ “As an organisation which sees children’s rights as fundamental to child health, the RCPCH will advocate for measures that will allow children everywhere to attend school without fear, live in economic security, have access to a high standard of health care, and be free from the effects of violence.” ‘

Dr Anthony Waterston, RCPCH and Newcastle University, UK. T) +44 (0) 20 70926005/6 E) A.J.R.Waterston@newcastle.ac.uk

For full Comment see: http://press.thelancet.com/opt8.pdf 

Palestinian Refugees Outside Occupied Palestinian Territory (OPT) Must Not be Forgotten

‘In the final Comment which accompanies The Lancet Series on Health in the Occupied Palestinian Territory (OPT), The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNWRA) says that the Palestinian refugees outside the OPT must not be forgotten.

‘They say: “The data depict a complex situation, with emerging diseases and chronic and endemic unsolved health problems.

‘ “Although UNRWA has effectively assisted refugees so far, their increasing economic vulnerability makes them increasingly dependent.

‘ “The future of Palestinian refugees will be conditioned by how children are followed up in their development and growth, how women are protected from negative outcomes of pregnancy, and how the adult population is treated and counselled for leading diseases.

‘By providing the best possible primary-health-care services, UNRWA is enabling these refugees to hold their destiny in their own hands.

‘ “These refugees do need remembering as well, in addition to those populations described in The Lancet Series on health in the occupied Palestinian territory.” ‘

Dr Guido Sabatinelli, Director of the Health Programme of the United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan. T) +962 77 6760097 E)

g.sabatinelli@unrwa.org  or flaviariccardo@hotmail.com

Medical Aid for Palestinians (MAP) Solution Lies in Justice, Sovereignty and Self Determination.

‘The solution to improve health and welfare lies in justice, sovereignty, and self-determination for Palestinians.

‘This is the conclusion of a Comment which accompanies The Lancet Series on Health in The Occupied Palestinian Territory, written by Andrea Becker, Katharine Al Ju’beh, and Graham Watt, of Medical Aid for Palestinians, London, UK.

‘As a UK charity, formed in response to the massacre of Palestinians at the Sabra and Shatila refugee camps in Lebanon, MAP has 25 years of experience working for the health and dignity of Palestinians living under occupation in the West Bank and Gaza Strip, and in Lebanon, where over 200.000 Palestinians live in refugee camps, generations after the 1948 war.

‘The authors conclude: “For too long, the health and welfare of Palestinians within the occupied territory have been secondary to powerful outside interests.

‘ “As Virchow might have put it, the solution lies in justice, sovereignty, and self-determination for the people of the West Bank and Gaza Strip.” ’

Andrea Becker, Medical Aid for Palestinians, London, UK. T) +44 (0) 7795 165 052 E) andrea.becker@map-uk.org

To listen to an interview about the Series with Richard Horton, Editor of The Lancet, see: http://press.thelancet.com/rhaudio.mp3

• Concluded