A Nation Under Occupation

Inequity In Care Under

Israeli Occupation

Mamdouh EL-Adl

Victims of Displacement

‘Victims of displacement, torture & war, as a result, receive insufficient help in coping with the physical & psychological impact of the trauma’

(World Medical Association)

Equity in care

• ‘Individuals should be treated fairly & should not be inappropriately discriminated against in the provision of healthcare’ (BMA, 2004)

• ‘Promotion & protection of health are inextricably linked to promotion & protection of human rights’

(Mann, 1994)

Equity Criteria• Horizontal equity: Equal treatment for equal needs.• Vertical equity:

a. Severity of health conditions:

Does the intervention particular benefit those with

severe health conditions?

b. Poverty: Does the intervention particular benefit

the poor?

(James et al 2005)

What is the problem in Palestine?!

• Inequity in Care.

• Displacement & Exile.

• Injustice & The Political Dislocation.

• The Military Occupation.

Occupation

Occupation

• GCIV, Art.42: A territory is considered occupied when it is actually placed under the authority of the hostile army.

• GCIV, Art.43:The authority of the legitimate power having in fact passed into the hands of the occupant, the later shall take all the measures in his power to restore & ensure, as far as possible, public order & safety, while respecting, unless absolutely prevented, the laws in force in the country

Occupation of Palestine• In 1948: Israel was established. • In 1967: Israel expanded & occupied:

1. West Bank (Palestine) still occupied.

2. Gaza strip (Palestine) still occupied.

3. Golan (Syria) still occupied.

4. Sinai (Egypt) Israel withdrew after a peace deal.

Palestine under British

Mandate 1923 – 1948

During the course of 1948 war, UN decision to divide Palestine:

Jews: 52% of Palestine.

Arabs: 48% of Palestine

Palestine after 1948 War

Palestinians were divided

into 4 divisions:

1. Pals. of Israel.2. Pals. of Gaza.3. Pals. of W Bank.4. Pals. in Exile.

Until 4th June 1967:- Jews: 30%- Palestinians: 70%

Israel after 1967 War

Israel occupied1.The rest of Palestine.2.Golan 3.Sinai.

Size of Israel: 89359 sq.KM. I.e. >4times its original size.

410,000 Palestinians Forced immigration

Settlements started:Israel started establishing Settlements in Gaza & West Bank for new Jewish Immigrants.

Displacement & Exile

Displacement & Exile Nakba = Disaster

• In the course of 1948 war, some 750,000 Palestinians were uprooted from their homes & lands.

‘Expulsion was an integral part of that war’

• The Zionists wanted to acquire as much territory as possible to establish a homogenous Jewish state.

(Uri Avnery, 2001)

Injustice within the

Political Dislocation

Powerful + Powerless - Law = Injustice

• Ariel Sharon: the present confrontation with Arab violence is a continuation of the 1948 war!

• UN: paralysed under the American domination & the famous American Vito.

• US Foreign policy.

• Arab governments.

Sharon’s Wall

• When completed:

- Extends > 400 miles (4 times longer than Berlin wall).

- Extends up to 15 miles into Palestinian territory.

Its real purpose: To lock >50 illegal Israeli settlements into Israel proper.

(Summerfield, 2004)

ICJ ruling

• Israel should abide by The International Law after the World Court ruled that the West Bank Separation Barrier is illegal.

(Annan, 2004)

                                                      

Israel rejects ICJ ruling

• Israel rejects the ruling of The International Court of Justice in the Hague.

(Sharon, 2004)

                                                      

Palestinians Under Occupation

& Geneva Convention

Civilian Immunity underGeneva Convention IV, Art. 3

• They must be treated humanely, without discrimination based on race, colour, religion or faith, sex, birth or wealth, or other similar criteria.

• Violence to life and person including murder, mutilation, cruel treatment and torture are prohibited.

• The taking of hostages is prohibited.• Outrages upon personal dignity, including humiliating

and degrading treatment are prohibited. • Sentences and executions without a judgment from a

regularly constituted court and without benefit of the standard judicial guarantees are prohibited.

Healthcare of Palestinians Under Israeli Occupation

2 main factors:

1. Resources.

2. Access to care.

Gaza

Mental Health in Gaza

• Population: 1.4 million.

• El-Nasr Psychiatric hospital: 32 beds.

• GCMHP: An active & community oriented.

Outpatient clinic in Khan Younis.

Resources & Needs

• Gaza data (1998 – 2004): - Doctors: 36% - Nurses: 13% Causes: - Students blocked off from reaching medical school. - Students not allowed to study abroad. - Emigration. (Abdeen, 2005)

Attacks on Healthcare staff(since Al-Aqsa Intifada)

• Staff: 25 killed & 425 injured.

• Ambulances: 121 attacked & 36 destroyed.

• 991 denial of access 85 deaths.

• 10 attacks on hospitals.

(PRCS)

Deaths of period:28.09.00 –18.10.04 Palestinians: Gaza: 1854 W.Bank:1951 Israelis: Settlers: 213 Soldiers: 315

(GCMHP website)

Deaths Palestinians Israelis

Total 3805 1017

Children 842 112

Women 256 304

Men 2707 601

Palestinians injured by Israeli forces & settlers (GCMHP website)

Total 27998

Live ammunition 7417

Rubber/Plastic bullets 6272

Tear gas 6317

Miscellaneous 7992

Permanently disabled 3530

Educational Statistics: 28.09.00 – 18.10.04 (GCMHP website)

killed injured detained

School students 516 3409 638

University students 198 1245 720

Teachers 28 54 167

West Bank

Mental Health service

• Population: 2.4 million.• Bethlehem Mental Hospital: 320 beds. • Staff: 9 psychiatrists & 12 S.W., 3 psychologists, 71

nurses, 2 EEG technicians + administrative staff.• OT unit: a grant from British Council.• Community Psychiatric clinics in Jenin, Tulkarm,

Nablus, Qalqilia, Ramallah, Hebron & Jericho.

(Murad, 2002)

The Bethlehem Hospital

This is the only inpatient facility in West Bank

‘This hospital was subjected to a missile

attack by the Israeli Army on 01.04.04’

(Giacaman et al, 2005)

The Wall & access to Care

- Qalqilya hospital (Primarily serves refugees)

reported 40% fall in follow up appointments as patients cannot reach the city.

- The Wall when completed will isolate:

97 primary care clinics + 11 hospitals from the populations they serve.

(Summerfield, 2004)

Death at the checkpoint• At least 87 cases (including 30 children) in

which denial of access to medical treatment has led directly to deaths.

This includes babies born while women in labour were held up at checkpoints.

(Summerfield, 2004)

Palestinians in Israel

Access to CareIsraeli National Hospitalisation Records:

Arab patients compared to Jewish significantly underutilise mental health services.

- Possible reasons: 1. Arab healthcare utilisation general pattern. 2. Influence of the cultural over the professional. 3. Lack of Arab mental health practitioners. 4. Availability of mental health service in Arab communities. 5. Arab attitude towards mental health. (Al-kerwani, 2002)However, Swirski et al (1998) highlighted different reasons.

Health of Arab citizens in Israel (1)

• Arabs: 20% of population in Israel.

• 90% of them were born, raised & educated in Israel.

• Despite this large % & long presence in the country Arab localities are underdeveloped.

- Their infrastructure: inferior to Jewish localities.

- National development plans & employment: systematically

discriminated against Arabs.

- Socio-economic status: Arabs at bottom of the ladder.

- Health of Arabs: lagged behind (not surprising).

(Swirski et al, 1998)

Health of Arab citizens in Israel (2)Infant mortality rates/1,000 live births (Swirski et al 1998)

year Arabs Jews

1955 – 59 60.6 32.1

1965 – 69 43.8 20.8

1957 – 79 32.6 15.0

1979 – 80 23.5 12.5

1983 – 84 20.0 10.6

1987 – 88 16.9 8.3

1991 – 92 14.5 7.2

1996 9.3 5.0

A Study by John Hopkins & Al-Quds Universities (3)

• Children under 5 y:

- 20% were anaemic

- 9.3% were acutely malnourished.

- 13.2% were chronically malnourished.

(Summerfield, 2004)

Health of Jewish Immigrants

• On the other hand planned national support systems have achieved a comparatively high health standards for large groups of Jewish immigrants. (Swirski et al, 1998)

• Why not do the same for Palestinians?!

Palestinian residents of East Jerusalem(1)

• In 1996: Israeli Interior Minister changed its policy regarding Palestinians living in East Jerusalem (occupied by Israel following 1967 war).

• Purpose of this policy: To rescind the residence rights of as many Palestinians as possible!

• Effect on Healthcare: This policy had an adverse effect on rights to healthcare.

(Swirski et al,1998)

55,000 Jerusalem Arabs to be outside the city (2)

• The security barrier (Wall): - will leave 55,000 of Jerusalem’s Arab residents on the

Palestinian side. (Ehud Olmert, Israeli Deputy PM)

- Arab population in the walled area will be by 25%.

(A senior Israeli government official) (Sciencedaily.com)

Inaccess to care

At the checkpoints

At the Checkpoints

• Checkpoints at entrance to some villages close at 7.0 pm. Not even ambulances can pass after this time!

As an example: near Qalqilya A man + his ill daughter + Israeli solders + the fence.A Palestinian doctor was also refused access to the

child & was forced to do physical examination & to give the girl an injection through the wire!

(Summerfield, 2004)

Enas: 3 y old Cancer patient (1)• Enas: diagnosed few months ago with cancer.• Her Dr decreed that Enas’ home must be air-

conditioned to keep her environment hygienic especially in hot summer. This is to protect Enas from infections that might be fatal with immunity.

• Enas must receive injections which must be refrigerated.

• Israeli authority denied Enas electricity supply.

Enas: 3 y old Cancer patient (2)• Her family keep her injections in a vessel with ice!!!

• Enas has been repeatedly rushed to the hospital with very high temperature.

• Her father is a paediatrician who treats many children daily. The Israeli state turns its back to his seriously ill chid.

• PHR-Israel petitioned Israeli high court on 24.08.05 against Ministers of Health, of infrastructure & of Interior.

• On 26.08.05, I received an e-mail from PHR-I informing that they are still trying!!!! (PHR-I, 2005)

Enas: 3y old cancer patient

F: Not a Story but a Tragedy (1)

• F is a 28y old Gaza resident Palestinian woman suffering cancer. F has been trying to reach Oncology Dept., Sheba Medical Centre for urgent chemotherapy.

What happened to F in an awful 10 days is unbelievable.

In Gaza: no single Oncology Dept.

F was not allowed to go to Egypt for treatment.

F: Not a Story but a Tragedy (2)

• PHR-Israel: tried to help Permit to F.• F had mastectomy but denied family escort.• F was supposed to return to Sheba for

treatment on 14 September..application refused & F had to wait.

• PHR-Israel:Permit to F allowed after delay.• F was so ill, her mother was allowed to escort F

F: Not a Story but a Tragedy (3)

• F & her mother after 4 hours at a roadblock, was ordered by soldiers to strip in front of them & stood wearing an undergarment.

• F’s mother burst out crying at the sight of her sick, humiliated daughter. The Israeli soldiers scolded her to shut up!!!!!

• Finally an officer came, reprimanded the soldiers & allowed F to get dressed. (Levy, 2004)

• I don’t know what happened to F, God knows.

Israeli Army Kills Peace Activists

• Tom Hurndall (British)

• Rachel Corrie (American)

Israeli Army Kills Peace Activists

Tom (Thomas) Hurndall:

1981 – 2004

Was a photographer & member of ISM.

On 11.04.04 Tom was shot in head by an Israeli sniper.

God bless his soul.

The Best Medicine

‘History has shown that reform

(social/ political is the best medicine.

For victims of oppressive violence this means acknowledgement & justice’.

(Summerfield, 2002)

Can we make Peace without Justice?!!!

Conclusion

• Access to healthcare & equity in care are basic human rights.

• Military Occupation undermines these rights.

• Inequity in care should not be tolerated.

Thank you