Inequities in Health Care


A report by Dr. David Blumenthal of The Commonwealth Fund (August 15, 2017) documented the stark contrast between health care systems and access for Israelis (“Israel has universal health care coverage, strong primary care, and widespread use of digital tools”) and Palestinians (“The Palestinian health system is hampered by shortages of funding, personnel, and medications, and by poverty”).

“Israel has one of the world’s highest-performing health systems as judged by national health statistics and health spending levels. It invests modestly in health care, spending about 7.3 percent of GDP in 2016 (compared to an Organization for Economic Cooperation and Development (OECD) median of 9 percent). But it has population health statistics that are as good or better than OECD norms: a 2015 infant mortality rate of 3.1 deaths per 1,000 births, and life expectancy at birth of 80.1 years for men and 84.1 years for women in 2015. (The HMOs offer an extra tier of insurance for those who can pay, which typically costs about $50 a month for a family of four. It’s a premium purchased by all but 20% of the population, these being mostly the poorest.

“We spent the last day and a half of the trip in and around Jerusalem, where we got an introduction to the Palestinian health care system. To say the least, this system does not have the resources or results of its Israeli counterpart. Spending was USD 294 per Palestinian in 2012 (compared to USD 2,046 per Israeli in 2011). Life expectancy at birth in 2015 was 70.7 years for men and 74.7 years for women, and infant mortality in 2014 was 12.6 deaths per 1,000 live births. The system is hampered by shortages of funding, personnel, and medications and by the pervasive poverty in occupied territories. Restrictions on movement in the occupied territories are also a huge problem for patients and providers.

“There was no avoiding the conclusion that Palestinian health care is vastly inferior to the Israelis’, or that politics is a pervasive influence in the Israeli and Palestinian health care systems. Of course, the last six months have shown that politics is a huge influence on the U.S. health care system as well. The ethnic and income divides that animate U.S. health care politics are better concealed than the Israeli and Palestinian versions, but they are just as important.’

Another breaking story by Ali Abunimah on Electronic Intifada 2/6/18 is headlined “Gaza hospitals shut down as deadly siege tightens.” According to physicians at al-Nasr children’s hospital, fuel shortages for generators are putting Gazan children’s lives at risk (emergency generators in at least 19 health facilities have run out of fuel). The UN agency OCHA warned that “emergency fuel for critical facilities in Gaza will become exhausted within the next 10 days” unless donors step in to prevent a “humanitarian catastrophe.”

“At the Muhammad al-Durra hospital in eastern Gaza, named for a Palestinian child killed by Israeli forces in 2000 at the start of the second intifada, doctors said at a press conference Monday that entire departments had already shut down and some patients were being turned away.

Speaking at the press conference, Jamal al-Durra, Muhammad’s father, appealed for urgent international intervention, saying that to allow the crisis to continue would be to “kill my son a second time.”

“The imposed fuel crisis threatens dialysis services for 400 patients with kidney failure in the Gaza Strip,” the Palestinian human rights group Al-Haq also said February 12, 2018.

Due to the chronic power crisis, dialysis in Gaza is already a dangerous business.

Al-Haq added that Gaza hospitals are currently unable to carry out 200 operations per day “due to the corruption and subsequent waste of hundreds of units of blood because of the lack of cooling required – a consequence of the deliberately imposed electricity shortage on Gaza.”

Due to Israel’s ongoing restrictions on Gaza’s electricity supply, the population of two million people, half of them children, currently receive electricity for no more than eight hours each day. At times that supply has plummeted to just three or four hours.

“Hospitals have already begun to close. Without funding, more service providers will be forced to suspend operations over the coming weeks, and the situation will deteriorate dramatically, with potential impacts on the entire population,” the UN’s acting humanitarian coordinator Roberto Valent said. “We cannot allow this to happen.”

“Gaza’s health system is on the verge of collapse as hospitals in the besieged territory are expected to face a total power blackout by the end of February,” Ashraf al-Qidra, the Gaza health ministry spokesperson, warned.

While collapsing the healthcare system inside Gaza, Israel is also making it harder for Palestinians to seek life-saving treatment outside the besieged territory.

The number of Palestinians allowed in and out of Gaza, both through the Erez crossing, controlled by Israel, and the Rafah crossing with Egypt – which has been closed for years except with rare exceptions – fell sharply last year.

The exit of Palestinians from Gaza through Erez fell by 50 percent in 2017, compared with 2016, according to OCHA.

On average there were just 7,000 exits per month in 2017, compared with more than 500,000 per month prior to the year 2000.

Israel’s approval rate for medical exits via Erez fell to 54 percent, down from 62 percent in 2016 – the lowest rate since 2006, according to OCHA.”

Examples abound of Palestinians, including pregnant women, being delayed at checkpoints while seeking medical care – resulting in suffering, trauma, increased severity of diseases and disabilities, and sometimes preventable deaths.  67 Palestinian women have been forced to give birth at Israeli military checkpoints, resulting in death of 36 of the newborns.

Albawaba News (5/13/17) describes the results of chronic trauma among Palestinians.

“Palestine leads the MENA [Middle East and North Africa] region in depression and anxiety disorders, with some estimates suggesting that more than forty percent of Palestinians suffer clinical depression, making it the highest rate in the world.

“According to the study, 54 percent of Palestinian boys and 46.5 percent of Palestinian girls aged 6-12 years old are estimated to have emotional and behavioural disorders.

In Gaza, the crisis is particularly acute, with the besieged enclave witnessing three Israeli military offensives within six years. Poverty, mass unemployment, and physical entrapment severely exacerbate the crisis.

A study of adolescents in the besieged territory after the 2008-9 Israeli offensive found that 30 percent reported symptoms meeting the criteria for Post Traumatic Stress Disorder, according to a report by Medical Aid for Palestinians (MAP) investigating the health impact of 50 years of military occupation.

Among areas heavily bombarded during the 2014 war on Gaza, 54 percent of children were recorded as suffering from severe PTSD, whose symptoms include flashbacks, nightmares, avoidance behaviour, difficulty sleeping, and intrusive distressing recollections of traumatic experiences.

Following the 52-day war, which killed more than 2,200 Palestinians, the World Health Organization (WHO) estimated that more than 20 percent of the Gazan population may have developed mental health conditions which required psychosocial care.

“In the first five years of the Israeli blockade, the Gaza Community Mental Health Programme reported an 18 percent rise in depression. Drug addiction and suicides, once unheard of in Gaza, have increased as a result, with coping mechanisms for Gazans all but exhausted.”

“While exposure to direct violence is a major driver of mental health conditions, restrictions on movement, home demolitions, checkpoints, and abuse by Israeli soldiers in the West Bank all contribute to pervasive experiences of humiliation, which exacerbate psychological stress.

Around 78 percent of Palestinians report having experienced military raids on their homes, 62 percent have been verbally abused, and 43 percent physically abused between 1987 and 2011, the MAP report says.

Most adolescents have witnessed a stranger humiliated by Israeli forces in the preceding year, while 29 percent have witnessed a family member humiliated, a 2007 Journal of the Royal Institute of Public health report says.

The arrest of children by Israeli military forces is another common driver of mental health disorders in young people, leading to high rates of anxiety, depression, and attentional and educational difficulties. It can also lead to higher rates of suicide and self harm.

Defence for Children International – Palestine (DCIP) found that 75 percent of children detained between 2012 and 2015 endured some form of violence during their arrest by Israeli soldiers. Over 70 said they experienced verbal abuse, intimidation and humiliation, while 70 percent also underwent strip searches.

“Palestinians’ right to health cannot be realised under perpetual occupation, which poses constant threats not only to physical safety, but also psychological and emotional wellbeing,” MAP says.

The Independent (U.K.) 2/14/18

A total of 54 Palestinians died last year waiting for Israeli visas to allow them to leave Gaza for medical treatment, the World Health Organization (WHO) has said, a figure it says shows the depth of suffering imposed on people in the coastal enclave.

Only 54. Percent of 25,000 applications for travel permits were granted in time for patients to attend scheduled appointments, research from the WHO released on Tuesday [2/13/18] found, down from 62 percent the year before and 92 percent in 2012.

The Rafah crossing from Gaza to Egypt has also remained mostly closed since 2013, restricting access to health.

In the summer of 2017, three critically ill babies died after their medical permits were delayed, according to Gaza’s Health Ministry.

The Rafah crossing from Gaza to Egypt has also remained mostly closed since 2013, restricting access to health care. Before July 2013, more than 4,000 Palestinians travelled monthly via Rafah crossing for health-related reasons, stated Human Rights Watch (HRW).

“It’s unconscionable that Israel prevented so many critically ill people from accessing care that might have saved their lives,” said Sarah Leah Whitson, Middle East director of HRW.

Al Jazeera 2/13/18 by Farah Najjar —

Israel was responsible for at least 54 Palestinian deaths last year as it rejected hundreds of medical permit requests it received from Gaza residents seeking treatment outside the besieged strip, rights groups have said.

In a joint statement on Tuesday, the Gaza-based Al Mezan Center for Human Rights, Amnesty International, Human Rights Watch, Medical Aid for Palestinians (MAP), and Physicians for Human Rights Israel (PHRI), highlighted the immediate need for Israel to end its decade-long siege of the Gaza Strip.

In 2017, Israeli authorities approved fewer than half the medical permit requests it received, which were tied to appointments and treatment sessions in hospitals across the occupied territories and Israel – the lowest level since 2008.

More than 25,000 permit requests were submitted to Israeli authorities. Of those, 719 were refused, often under the pretext of security.

Another 11,281 applications are still pending approval – meaning thousands of people are in a state of jeopardy.

Samir Zaqout, Al Mezan director, told Al Jazeera that there is no “real rational reason” why patients in need of urgent medical assistance are denied hospital access …

Hani, father of seven-year-old cancer patient Ruba, said his daughter was recently denied a medical permit for the first time in seven years.

“She’s not the only one,” said Hani, who chose to conceal his last name for fear of reprisal.

“I had a daughter who died when she was just seven months old,” he told Al Jazeera. “She suffered from the same cancer, and we lost her six years ago.

“I don’t want to lose another daughter.” …

Hani said the family had received permits before on some 300 occasions and was not given a reason for the latest refusal.

“I don’t even understand why, there were no reasons given to me this time, and I utilised every contact I had … nothing is more important to me than my children’s wellbeing.

“Who else do we turn to?”…