The right to health is a fundamental aspect of human rights and dignity. The access health, conceived as physical, mental and social well-being, not just absence of disease, is protected by the United Nations, asserting that everyone has the right to basic healthcare.
However, the Palestinian health system is systematically under obstruction and threat by Israeli illegal occupation policies hindering access to such a fundamental right. Moreover, recent funding cuts, spearheaded by the US, has deeply hindered institutions that support the provision of health care in Palestine.
These two drivers are making full access to health for all Palestinians virtually impossible.
Research conducted by Palestinian human rights advocacy group al-Shabaka in June 2019 shed light on the lack of access to health in Palestine and the inequalities it raises when compared to provisions of the Israeli health care system. Some of the conclusions of the study portray how alarming the current situation is.
On average, Palestinians have ten years less life expectancy when compared to Israelis, including settlers living in occupied territory. Maternal and infant mortality rates in Palestine are between four and five times higher than in Israel. The blockade imposed on Gaza has made the health situation in the Strip particularly challenging. In 2018, over 19 facilities providing health care in the besieged enclave had to close due to a lack of electricity.
Breast cancer: the first cause of death for Palestinian women
Among diseases in Palestine, cancer and its treatment are among the most alarming threats to the Palestinian population. The al-Shabaka report concluded that only six oncologists provide care to the West Bank, seven work in East Jerusalem and the number of cancer specialists in Gaza amounts to only three.
When considering a gender perspective, women in Palestine are particularly affected by the lack of access humane health care. In conversation with Palestine Monitor, Administrative and Medical Director of the Ramallah based Dunya Women’s Cancer Clinic, Dr. Nufuz Maslamani, explained that breast cancer is the first cause of death for women in Palestine.
Providing both diagnoses of breast cancer and treatment in Palestine is a difficult task that faces a great number of challenges, especially related to the Israeli illegal occupation. Dr. Maslamani explained that one of the main problems is that women come too late for diagnosis.
Access to breast cancer detection in the West Bank is not widely available. “[The] Dunya Clinic was, until early this year, the only centre for diagnosis of this disease in the West Bank,” Maslamani explained. Only in 2019, did the Palestinian Ministry of Health develop a similar facility in the town of Beit Jala near Bethlehem.
Even when detection facilities are available at the Dunya clinic, regular procedures are often impossible to implement. Performing biopsies with radioactive substances on patients are not possible, as Israel does not allow the material necessary for the procedure into the West Bank, although the radioactive potential is small.
Israel deems such items as threatening for some can potentially be used to build weapons. Shin Bet (Israeli Security Agency) has argued that Hamas attempts to smuggle explosive material under the guise of medical supplies.
Consequently, other diagnostic techniques have to be used which usually “entails women to suffer edemas, immobilisation of arms and other painful effects,” Maslamani said.
When it comes to cancer treatment, facilities in the West Bank are often insufficient due to the lack of radioactive material – forcing many women to seek treatment in East Jerusalem.
Palestinians in need of radiation therapy must go to East Jerusalem, requiring an Israeli issued travel permit to enter Jerusalem. Maslamani stated that permissions are often refused without any reason, “I know many cases, mostly in Gaza, where patients passed away while waiting to get an authorisation for cancer treatment”.
The World Health Organization (WHO) reported in 2017 that only 54 per cent of patient applications to exit Gaza via Erez, the only pedestrian crossing from Gaza into Israel, was successful. A drastically lower rate when compared to 2012 in which 92 per cent of permissions were approved.
In 2017, 54 patients died waiting for permits – over 85 per cent of which were being referred for cancer treatment. The WHO concluded that in 2016, out of the authorisations for Palestinians living in the West Bank to access health facilities in East Jerusalem, 20 per cent were denied.
Health workers under fire: Israel´s new target
Health workers performing medical tasks are protected by International Humanitarian Law. However, in the context of more assertive and aggressive policies of Israel towards Palestine, violence against medical personnel has increased.
Talking with Palestine Monitor, Legal Researcher at legal rights organisation Al-Haq, Rania Muhareb, said they have seen a trend in “excessive use of force against health workers”.
“What we are seeing is indeed intentional targeting of them,” Muhareb said.
Muhareb explained that since March 30, 2018, four health workers have been killed by Israeli forces while attending injuries and performing their duties. Three of them were killed in Gaza during the Great March of Return and one of them in the West Bank.
“The orders that were given to Israeli soldiers and snippers in the Great March of Return was to use live ammunition against unarmed civilians,” Muhareb explained. “There is a systematic plan to target Palestinian civilians and that has included health workers as well.”
The latest case of a Palestinian medic being killed was that of 17-year-old volunteer paramedic Sajed Abd Al-Hakim Hilmi Mizher, which has been extensively covered by an investigation conducted by Al-Haq.
Sajed was shot to death by Israeli occupying forces on March 27 this year while attending injured during clashes between Palestinians and Israeli soldiers in the Bethlehem Dheisheh Refugee Camp in the occupied West Bank. Sajed was wearing a high visibility medic vest, clearly marked as a health care worker.
When asked whether Israel’s targeting of health workers amounts to War Crimes, Muhareb strongly agreed. Moreover, she asserted that, “so far no-one from the Israeli forces has ever been held accountable” and that international jurisdiction is the only avenue possible for an investigation and punishment of Israeli illegal exercise of violence as “the Israeli judiciary is unwilling to genuinely do so”.
According to Muhareb, when it comes to the killing of Palestinian medic personnel, “widespread impunity prevails”.