Fighting for health

If one breaks a leg, one goes to the hospital, if one has a heart attack, one can count on prompt medical care, if one is pregnant, one can be sure that once contractions start, there will be people to help deliver the baby in good health. But what if these daily things which have become so normal, cease to exist? What happens if you are seriously bleeding, but no ambulances can reach you? What if you are about to deliver, but you cannot reach the hospitals because there happens to be a wall separating you from the medical care you so desperately need? Even if you tried to apply for a permit months in advance, but it has not been granted to you. And what if you are suffering from a serious disease that can only be treated in a specific hospital, but soldiers do not let you pass the checkpoint? Then one must return home and wait to die, with the knowledge that just beyond the wall, there are people with the skills to save your life, the life of your child or unborn baby. Once the right to health is taken from you, it becomes of omnipotent importance.

International law and political context

This is the case in Palestine, where the Right to Health is violated on a daily basis, and where people suffer from a large variety of hardships as a consequence. The Right to Health of all peoples is adopted under International Human Rights law. It was first formally set out under the 1946 WHO-Constitution and was later enshrined in the Universal Declaration of Human Rights, which states that ’Everyone has the right to a standard of living adequate for himself and his family, including food, clothing, housing and medical care and necessary social services’. Israel is signatory to this declaration, but fails to abide by it. By putting in place increased movement restrictions, by erecting the separation wall, by increasing the number of checkpoints, road blocks, only-bypass roads and by expanding its settlements, Israel seriously hampers Palestinians from reaching essential health facilities, but also obstructs Palestinian health professionals from doing their work, leaving the health sector with tied hands. The full scope and impact of these occupational policies can only be comprehended when listening to the stories of individuals suffering from the direct consequences.

Local implications

"It hurts me a lot when I remember how the baby moved inside me and what happened to him. What did he do wrong? I also gave birth to my daughter in my seventh month, and now she is healthy. This poor baby died because there wasn’t anybody to help me deliver him." This is the account of Naheel ’Awni ’Abd a-Rahim Abu Rideh who lost her baby after she was not allowed to pass the checkpoint on her way to the hospital. She recounts: “The pain got worse. I felt as if I was going to give birth any moment. Now and then, the soldiers came over to the car and looked at me lying in the back seat. I was really worried about the fetus, and couldn’t stop thinking that I’d have to give birth in the car while the soldiers watched. It is not difficult to imagine the feelings of fear and humiliation such a situation would cause every woman to suffer. And then, imagine the heartbreaking scene of this women- following many others- returning home carrying a death child, who could have been saved, had the woman been allowed to go to the hospital. And ask yourself if these measures which are affecting innocent people are truly meant to secure the Israeli state…

The “security” measures of the state of Israel not only disenable people to reach medical help, but also pose serious constraints on the functioning of doctors and hospitals. This is exemplified in the village of Ni’lin, where people have been fighting a nonviolent struggle for months to protest against the illegal confiscation of most of their olive lands, which is responded to by rubber bullets, sound bombs, teargas and live ammunition from the soldiers “protecting” the Israeli settlement, unrighteously established on Palestinian lands. During these protests, ambulances were prevented from entering the area and medics were prevented from reaching those who have been wounded. Ahmad Ayyash, a doctor working for the Palestinian Medical Relief Society was shot at whilst attempting to reach a wounded adolescent. Ahmad commented "I made every effort to show the soldiers that I was a health worker". Nonetheless, ten seconds later, soldiers fired 14 more bullets at the vehicle, damaging the body and smashing the windows. "This was a deliberate and targeted act of violence", said Ahmad. "This is not a one-off incident, but it is part of a wider series of attacks against medical staff. I have been attacked three times before under similar circumstances in Bil’in village", he added. Under the Fourth Geneva Convention, medical staff are afforded special protection and should be given full access to emergency situations in conflict zones. However, Israeli soldiers show no respect for Palestinian doctors and violate International law.

Although the situation in the West Bank is challenging for doctors, medical staff in Gaza faces an additional layer of hardships due to the Israeli siege which has been imposed since June 2007, following Hamas’ electoral victory in January 2006. The result of the siege is that essential goods, including medicines and fuel –necessary for feeding the powerplants that provide for the electricity in the Strip- are prevented from entering. Time and again, Gaza is put in the dark when the powerplants stop working due to fuel shortages. Regularly, sewage water streams through the streets as an effect of the inability of the generators to regulate the water pumping station, or due to the lack of essential spare parts to fix the station. Since sewage water is highly toxic, many people have become ill, others even have died. This all could have been prevented, had Israel allowed for one checkpoint to open and let spare parts and fuel enter the area. These are constant threats people in Gaza face on a daily basis. Bringing relief is extremely hard, since doctors often lack the essential medicines to cure diseases, as these medicines are simply not let through. Only imagine the impact electricity cuts have on the functioning of hospitals. Imagine executing surgeries without essential electrical tools -or even light- and without medicines, such as anaesthetics. Imagine a situation in which doctors are prevented from going to work at times as they do not have fuel for their cars, and a situation in which busses have stopped working due to lack of fuel -as have all other means of transportation. The mobility of doctors is what determines life or death in emergency situations. This is the true face of the Israeli occupation.

Responding to the local needs- the Palestinian Medical Relief Society

Faced with a situation in which there is a lack of everything needed to make a society function, Palestinians -resilient as history has made them- continuously attempt to find ways to fight injustices and circumvent the imposed restrictions. The Palestinian Medical Relief Society is one of those local NGO’s that brings medical relief to the most vulnerable communities. It is a grassroots, community- based Palestinian health organization that exists almost 30 years. Throughout the years it has adopted its policies according to the changing needs of the population which result from changing conflict dynamics. As such, following the building of the Separation wall and other movement restrictions, it established mobile clinics. These mobile clinics bring medical services to those people who are unable to reach medical care themselves. Moreover, it aptly responded to the situation in Gaza. As of January 2008, PMRS declared a status of emergency and has stepped up its emergency program to support the needs of the people in Gaza. Because emergency response alone is not enough, PMRS has developed a broad scale of permanent programs, working in different areas thereby addressing a large variety of beneficiaries with different health needs. Moreover, through the establishment of National Health Programs, PMRS attempts to address the roots of the problems by emphasizing prevention, providing education, stimulating community participation, and focusing on the empowerment of people. In a situation where people’s diseases cannot be cured because of the occupational constraints or where people in the first place become ill -physically and mentally-, because of the occupation, it is not only health professionals, but policy makers and the population as a whole who are confronted with a large dilemma. Health problems cannot be solved by doctors alone. Instead, health improvement needs to come from situational change. Peace is crucial for health services- not least for mental health. Dr. Abu Tawahina said pointedly: "Our staff feels inadequate in helping our patients. When the source of someone’s mental symptoms comes from physical needs not being met, then there is very little that therapeutic techniques can do."

Therefore, PMRS equally works on a policy level. Internally, it contributes to a viable Palestinian civil society whose national goal is based on the achievement of equity, democracy, respect for Human Rights, and on freedom from discrimination and aggression of any form. Externally, it works on raising global awareness by addressing to Israeli policy makers and the international community as a whole, thereby attempting to modify existing policies. A broad approach to deal with the implications of prolonged occupation on the health status of the Palestinian population is necessary. Although of high importance, merely providing medical services is comparable to bringing water to the sea. A real solution to the health problems in the West Bank and Gaza Strip can only come through serious commitment to actions that deal with the core issues of the conflict, that address unequal power structures and the lack of adherence to Human Rights.

In order to uphold the Palestinian Right to Health, concerted action is needed. As with any other human right, states -including the state of Israel- are under the obligation to respect, protect and fulfil this right. The world should live up to its laws and take action and return to the people of Palestine the human rights they are entitled to, by making serious efforts to achieve justice and peace.