HEALTH IN THE OCCUPIED PALESTINIAN TERRITORY – Part Two

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Precious water gushes from a water main in Ramallah deliberately smashed by Israeli tank tracks
Precious water gushes from a water main in Ramallah deliberately smashed by Israeli tank tracks

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

News Line is reproducing in Part II the extensive Lancet press release on scientific papers 3 and 4.

3. Chronic Diseases Are Leading Causes of Death in the Occupied Palestinian Territories (OPT) Donors, Society and the Health System Responses are Inadequate and Military Occupation is Impeding Improvements.

As with many developing nations, the shift in the occupied Palestinian territory (OPT) towards urbanisation and Western-style diet, along with decreasing physical activity, has left heart disease, cerebrovascular disease, diabetes and cancer as leading causes of death.

The response of the Palestinian National Authority to the chronic-disease challenge has been limited, as has been interest from international donors on whom the authority has depended for funding such programmes.

Military occupation and its consequences are major impediments to improving the OPT’s fragmented healthcare system.

These issues are discussed in the third paper in The Lancet Series on Health in the Occupied Palestinian Territory, written by Dr Abdullatif Husseini, Birzeit University, OPT and colleagues.

In 2005 (the latest year with data) heart disease caused 21 per cent of all deaths in the OPT, followed by cerebrovascular disease (11 per cent).

Cancers were third with 10.3 per cent of all deaths. Mortality from coronary heart disease was 2·8 times higher in Jerusalem Palestinian men than in Jewish men and 2·7 times higher for Palestinian women than for Jewish women.

Although acute coronary care in the Israeli hospitals in which 84 per cent of Palestinians from Jerusalem received their care was described as generally equally good, interventions were done less frequently on Palestinian patients than on Jewish patients.

Despite the absence of definitive evidence, diabetes mellitus and its complications are major health problems in the OPT according to all estimates.

In 2000, the estimated prevalence rate of diabetes was nine per cent in adults aged 30 years and older.

Reported age-adjusted cancer incidence for the occupied Palestinian territory for 1998–2001 was lower than that in Jordan, Lebanon and in Arabs living in Israel, probably because it was an underestimate since some patients use services outside the territory. In 2005, combined cancer mortality rate in the OPT was 27·8 per 100,000, which is not much different from that in 2000.

Lung cancer, the most commonly diagnosed and most deadly cancer worldwide, is the most common type in Palestinian, Jordanian, Lebanese and Palestinian Arab men living in Israel.

Breast cancer is the most common type in Palestinian women. Smoking rates are high for men aged 10 years and older in the OPT (34.7 per cent), but low for women in the same age group (2.1 per cent). Obesity and being overweight is a big problem in the OPT and is particularly important in the adolescent population.

The authors say that primary prevention of chronic diseases should be urgently addressed by The Palestinian National Authority.

The public health programmes required will need political will at the highest level.

The Palestinian Ministry of Health’s restricted budget encourages emphasis on primary prevention, while segregation and movement restriction encourages decentralisation.

The authors encourage the use of community-based care and easily administered drugs to address the risk factors of chronic diseases.

The OPT health-care system must become more integrated and investment must be provided to train and develop the health-care workforce.

They conclude: ‘One of the major impediments to the improvement of the Palestinian health-care system is the continuing military occupation with all its consequences… Relevant to the challenge of chronic diseases is the effect of a state of perpetual limbo on the national economy, strategic planning, health-care policy formulation and national priority setting.

The geographic and administrative fragmentation of the occupied Palestinian territory, the military checkpoints and barriers to movement and the separation wall and many other fences and barriers, all have detrimental effects on the ability to deliver good health care.

The separation of Gaza Strip and the near impervious blockade of its population can only worsen health status and ability to deliver health care.

4. Palestinians Lack Basic Human Security. Endemic Social Suffering Blocks Health Deelopment and Progress

People living in the occupied Palestinian territory (OPT) lack the basic security that would allow them to be healthy and flourish as a society.

Without human security, development aid will not result in development.

These issues are discussed in the fourth paper in The Lancet Series on Health in the Occupied Palestinian Territory, written by Rajaie Batniji, Department of Politics and International Relations, University of Oxford, UK, and colleagues.

This paper offers the first carefully corroborated synthesis of the threats to Palestinian life and well-being.

By pulling together data from Israeli and Palestinian Non-Government Organisations (NGOs), international agencies, academic studies and news sources, the paper provides an authoritative and comprehensive view of the threats to health and human security that have intensified since 2000.

The authors look at health through the World Health Organisation (WHO)’s broad definition of ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. 

A human security framework is used to describe the threats to survival, development and well-being in the OPT. 

Between 2000 and 2009, more than 4700 Palestinians—mostly civilians, including 900 children, were killed by Israeli military action.

In addition, more than 1,300 Palestinians were killed in the recent Israeli attacks on the Gaza strip, December 2008-January 2009.

As well as these deaths, some 35,000 Palestinians have been injured in the Israeli-Palestinian conflict since 2000.

Deaths have risen as a proportion of total deaths and injuries since the first uprising—which began in 1988, with possible reasons for this cited as reduced Palestinian participation in the uprisings, under-reporting of injuries during major attacks, or use of increasingly lethal tactics by the Israeli military, also indicated by the high ratio of head and upper-body injuries in the second uprising.

Today, threats to homes and properties come from aerial bombing and shelling, direct demolition, occupation and regulations that do not permit building on most of the land in the OPT.

Land confiscation and destruction of crops, such as the uprooting of olive groves and fruit orchards, heighten insecurities.

Access to fuel, electricity, water and sanitation in the occupied Palestinian territory is disrupted by Israeli restrictions and military incursions.

Severe restrictions and destructions, particularly in the Gaza Strip, threaten basic survival because medical, sanitation and sewage facilities cannot function.

Pollution of beaches with sewage has created a potential public-health hazard.

The UN office for the Coordination of Humanitarian Affairs has reported that since 2007, 50–60 million litres of untreated and partly treated sewage have been disposed of every day into the Mediterranean sea surrounding the Gaza Strip.

Water restrictions have left Palestinians with some of the world’s most acute water shortages at 320 cubic metres per person per year (threshold is 1,700 cubic metres and absolute minimum is 500 cubic metres).

Humiliation and degrading treatment occur for Palestinians at more than 600 Israeli-controlled checkpoints and road barriers in the West Bank.

Movement restrictions affect every aspect of Palestinian life, such as the ability to travel, work, marry, study, worship and be with family. These restrictions directly and destructively impact the social determinants of health.

The separation wall, under construction since 2002, the continuous increase of Israeli settlements and settlers in the West Bank and the loss of freedom of movement, creates a feeling of permanent distress and loss of hope for the future of Palestinians—while also obstructing access to healthcare facilities.

Social resilience, seen as a positive adaptation amid adversity, is holding together Palestinian society and its economy, including the health system.

However, as conditions deteriorate, the social fabric of Palestinian society is eroding.

Since 2007, community ties have been weakened by clashes between Fatah and Hamas forces, tearing families apart.

The Israeli policy of exerting physical and mental pressure on those who need medical permits and Palestinian prisoners has strained Palestinian social cohesion.

The authors conclude: “Political solutions that improve Palestinian security will simultaneously reduce threats to physical, mental and social health … most threats require social and political solutions that are beyond the capacity of the health sector.

Social solutions should aim at strengthening social networks and the capacity of the health sector to provide support.

Political solutions should address and reduce the threats posed by weapons, destruction of homes, torture, humiliation and restrictions on movement and on the economy to a minimum.

By identifying and communicating the link between human-security threats and health conditions, Palestinian health can become an integral part of the political solution to this conflict.