The latest health report from the Lancet considers Israel guilty of ‘crimes against humanity’ for the deaths of pregnant women and their babies at Gaza checkpoints.
The findings of the report, Research in the Occupied Palestinian Territory 2, reveal the terrible hardships Palestinians bravely endure in the Occupied Palestinian Territories (OPT), especially following the Israeli bombing raids on Gaza in December 2008 and early 2009.
This latest Lancet group publication, released on Tuesday, is further analysis of surveys by Palestinian health professionals and researchers, first made by the Lancet in March 2009 after Israeli forces slaughtered well over 1,400 Palestinians and injured over 5,400 in Operation Cast Lead.
The Lancet report comprises the results from several writers’ workshops held this year, that span a variety of health concerns related to the effects of coping with economic difficulties and shortages, restrictions on movement, political tensions and fear of outside attack.
In an abstract titled: Childbirth at checkpoints in the occupied Palestinian territory, Halla Shoaibi of Ann Arbor University in the USA studied ‘the context of childbirth in the occupied Palestinian territory and the effects of checkpoint activity on the access of pregnant women to hospital during labour’.
She says: ‘10% of pregnant Palestinian women were delayed at checkpoints every year from 2000 to 2007, while travelling to give birth in hospital.
‘These delays resulted in 69 births, and 35 infant and five maternal deaths at the checkpoints.
‘Generally, the type and severity of the delay-related morbidity are not recorded.
‘National and international laws are not clear about the consequences and penalties of arbitrary delays in allowing pregnant women access to hospital during labour.
‘Since April, 2005, the UN Commission on Human Rights has issued several resolutions. However, no legal recourse has been taken to address the issue of pregnant Palestinian women giving birth at Israeli checkpoints.’
In her findings, Shoaibi states: ‘Palestinian women’s choice of place for giving birth is determined not only by the availability and affordability of services, like in most countries, but also by their ability to reach hospital maternity services during labour, and military closure and siege.
‘Restriction of movement has resulted in an increase in births at home rather than in a hospital; data indicate that only 8% of all births took place at home in 1999 compared with 33% in 2002.
‘Women have to deal with uncertainty and delays when prevented from getting to a hospital because of checkpoints.
‘Their coping mechanisms in reaction to the fear of being unable to reach hospital on time include acceptance of non-hospital settings for childbirth, with reduced standards of care and increased risks to them and their babies.’
Shoaibi’s study was undertaken through desk research and legal-case analysis, with data from criminal cases filed during the International Criminal Tribunal for the former Yugoslavia and the International Criminal Tribunal for Rwanda.
Shoaibi’s interpretation of her findings leads her to conclude: ‘The denial of passage to Palestinian women in labour, resulting in increased numbers of childbirths at checkpoints and en route to the hospital, is consistent with the criteria for crimes against humanity.’
She adds that this is in accordance with article 7(1)(k) of the Rome Statute of the International Criminal Court — ‘ie, “other inhuman acts of a similar character intentionally causing great suffering, or serious injury to body or to mental or physical health”, and meets with the presence of “widespread or systematic attack directed against any civilian population”.
‘Further research is needed to assess whether and how such a case could be made to the Rome Statute of the International Criminal Court.’
The Gaza Strip has one of the highest total fertility rates in the world, at 5·4 births per woman in 2006.
Thus, restrictions on movement, apart from being tedious and humiliating, can be a matter of life or death for Palestinian women with substantial need and demand for antenatal, perinatal, and postnatal health-care services.
The use of these maternal health services was studied by Majdi Ashour from the UN Relief and Works Agency (UNRWA) and Graham Watt from Glasgow University.
Although the results of their survey of 832 Gaza Strip households indicated ‘the relative stability’ of the choice of providers of antenatal-care services by pregnant women, they state that accessing these health services is ‘complicated by the protracted political conflict and the continued economic hardship, which have worsened since 2006’.
The results ‘suggest that the economic adversity of the Palestinian population, as a result of the Israeli siege, has led to increased use of childbirth services that are provided free of charge.
‘The childbirth services provided by government hospitals and used by most mothers can be thought of as a safety net for families that are poor and uninsured, but the lower maternal satisfaction in these services is cause for concern.’
Impaired access to health services and drugs was also part of a study by Majdi Ashour, Nedal Ghuneim and Aed Yaghi.
Using data from reports by Birzeit University’s Institute of Community and Public Health, in Ramallah, West Bank, after the Israeli invasion of five West Bank towns in 2002, they investigated the effects of Operation Cast Lead on different dimensions of health and the lives of civilians in the Gaza Strip.
These included damage to homes, displacement, manifestations of anxiety and psychological distress, as well as disruptions of essential public services, food shortages and loss of income.
346 (48%) of 718 interviewed households had non-household people living with them, 45% were hosted by other people for at least 24 hours during Operation Cast Lead, and 48% had damage to their houses.
49% had impaired access to health services and 49% to drugs.
The psychological effects of Operation Cast Lead have been horrendous: 87% had at least one screaming household member, 86% cried, 65% loss of appetite, and 588 (82%) nightmares.
Disruption of electricity for all or most of the time was experienced by 96% of households, 35% had disrupted potable water supplies entirely and 36% for most of the time.
26% had disruption of their landline phone for all or most of the time, and 56% disruption of waste collection.
A loss of income was reported by 233 (32%) households, and 611 (85%) had food shortages.
‘The effects of the Operation Cast Lead on the life of civilians living in the interviewed households were, according to their reported perceptions, devastating, and geographically linked to the intensity of activities of the operation,’ say the authors.
Another study, funded by Medical Aid for Palestinians, looked at the feelings of insecurity which remained, even six months after the end of the attacks.
Women felt more nervous and insecure than men, with over-65s who were better educated and had a better standard of living, having lower levels of insecurity.
The authors say: ‘Although intervention through support of Gazans with food and other aid is important, interventions need to address the cause of human insecurity — namely, the violence of war and the sieges.’
The Lancet’s editor, Richard Horton, said: ‘The conclusion I drew from this third year of collaboration is that, although conditions for research remain difficult, there are growing possibilities for scientists wishing to place their skills in the service of strengthening Palestinian academic institutions specifically, and rebuilding Palestinian society more generally. . .
‘The Lancet will certainly continue to develop our links with Palestinian health scientists.
‘And we will return again in 2012 to report on what we hope will be continuing progress in deepening the roots of health research as an essential foundation for Palestinian self-determination and development.’
