Palestinians plagued by medical inequality under Israeli occupation

Medical deprivation is plaguing Palestinians living under Israeli occupation in the West Bank, struggling under siege in Gaza, and residing as refugees in Lebanon.

Speaking virtually on Tuesday from the West Bank Bedouin community of Tabaneh, near the expulsion-threatened Palestinian village of Khan Al-Ahmar and the illegal Israeli settlement of Kfar Adumim, local leaders detailed the healthcare inequalities existing between them and settlers.

It comes just weeks after Israel greenlit 1,800 new West Bank settlement housing units and made an early move towards backing more than 1,300 others, threatening to deepen Palestinian healthcare woes.

Mohammad Ali, a community leader known in Tabaneh as Abu Qasem, said: "We live a very difficult reality… since about 50 years [ago], and there are people who have been facing these difficulties since even [longer ago] than that."

The West Bank came under Israeli occupation in 1967.

Ali continued: "They suffered a lot from so many things: life, health, social matters – everything. We thank God [that] things are a little better, but the suffering is still going [on]."

Addressing journalists attending a digital delegation organised by UK-based charity Medical Aid for Palestinians (MAP), Ali explained it can take as long as two or three hours to get urgent medical attention at night. Tabaneh is in Area C – the region of the West Bank where Israel is in total control.

A key healthcare lifeline is a mobile clinic run by MAP's partner organisation, the Palestinian Medical Relief Association, which visits Tabaneh and other communities regularly.

There are also nearby settlement medical facilities. However, local Palestinian Bedouins cannot use them, Abu Raed Sulieman Ararra, a leader from Khan Al-Ahmar, noted.

"If we are three or four kilometres [away] from the… settlements, how can we access their clinics?

"Which roads [are we] to take? We can't do this. We are prohibited," he said.

"The settlers are the worst neighbours. We've never seen worse than that."

Israeli settlers across the West Bank often use violence against local Palestinians.

"The increase of settlements just means more difficulty for Palestinians to travel along the West Bank… more attacks by settlers on West Bank communities, more threats on West Bank communities living in various villages"

MAP West Bank director Aisha Mansour revealed the mental health toll this has, recounting a discussion she had with a mother in a different community in the Jordan Valley where residents rely on outdoor bathroom facilities.

"Her children are scared to go to the bathroom. They hold it and wait until their mother can go with them because of their experiences with settlers coming into their communities and threatening them and attacking them."

Mansour explained the likely consequences of building the more than 3,000 settlement units that were either greenlit or given early backing by Israel.

"The increase of settlements just means more difficulty for Palestinians to travel along the West Bank… more attacks by settlers on West Bank communities, more threats on West Bank communities living in various villages," she said.

"And, of course, this has an impact on not just the mental health, but the physical wellbeing of Palestinians."

The impact on Palestinians' ability to travel also means it'll become harder to get medical attention quickly, Mansour added.

For women, these universal problems are aggravated by another layer of challenges.

Maha Jalayta, from the Jordan Valley's Abu Hussein community, said: "As a woman, I can't leave the community without a man accompanying me."

The reality of being pregnant and needing monthly health check-ups also poses its unique issues.

If a woman misses the doctor on one of the two occasions they come to the community each month, problems can arise.

"If I… need[ed] to go to Jericho it might take me the whole day to… arrive," Jalayta said.

"I would have to leave my kids alone, of course. [It] takes so many hours. And I would be still worried and concerned about my kids because of the surrounding environment."

She added: "There are women, to let you know, who don’t go at all. They… spend the nine months of pregnancy without any check-up[s] because they can't leave their homes."

Another inequality experienced by Palestinians is in access to Covid-19 vaccinations.

Israel has been widely condemned for failing to vaccinate Palestinians living under occupation, with many, including MAP's Mansour, arguing international law requires it to do so as an occupying state.

"So, literally, within the West Bank, you would have a settler, who probably was not even an elderly person or suffering from a chronic disease… who was able to access the vaccine early on," she said.

Despite this, "a Palestinian living in a nearby village, maybe an elderly person, maybe a person with non-communicable diseases… was… not able to access the vaccine," Mansour explained.

"That Covid-19 situation really reflected the discriminatory policies against Palestinians by the Israeli occupation regime."

In Gaza, the fight against coronavirus was most notably harmed by Israel's 11-day bombardment of the Strip in May.

"She died waiting for the approval [to seek cancer care in East Jerusalem] from the Israeli authorit[ies], and she had five children. Her youngest was months old only"

Besides killing 260 Palestinians, Tel Aviv's military efforts struck medical facilities.

MAP senior Gaza programme manager Mahmoud Shalabi said there was a "near total destruction of the health clinic in my neighbourhood" – the sole coronavirus vaccination centre serving northern Gaza's hundreds of thousands of residents.

Beyond coronavirus, when Gaza's seriously limited health services cannot provide treatment for diseases like cancer, residents must get agreement from Israel to receive attention outside the enclave.

Only 64 percent of such requests were given the go-ahead in August this year – a figure close to the overall rate for 2021 up to that point.

Shalabi discussed his cousin's battle with liver cancer and attempt to seek specialist care in East Jerusalem.

"She died waiting for the approval from the Israeli authorit[ies], and she had five children. Her youngest was months old only."

He said Gaza's lack of drugs and other provisions, and limited training opportunities has led to "the spiralling and unequal development of three different health services" across the blockaded Strip, East Jerusalem and the West Bank.

Shalabi also noted Gaza's mental health crisis, where 95 percent of children show signs of "deep psychological stress", according to 2018 research from global charity Save the Children.

The MAP worker urged a language rethink.

"The medical terminology of PTSD refers to post-traumatic stress disorder.

"However, I want everyone to revise that terminology because nothing is 'post' in Gaza. It's actually a continuous traumatic stress disorder… It's ongoing, and it's daily, the traumatic… disorders that the people are facing."

When the Israeli state was founded in 1948, hundreds of thousands of Palestinians fled or were expelled, and they and their descendants became refugees. This period is known as the "Nakba" or catastrophe in Arabic.

Many ended up in Lebanon, where about 250,000 Palestinian refugees live to this day.

The economic and political meltdown of their host country, which has seen medical provision threatened even for Lebanese nationals, has had a profound impact on Palestinian refugees.

"Sixty-five percent of them were living below the poverty line even before Lebanon's economic crisis compared to only 28 percent of the Lebanese community," MAP's Lebanon programme manager, Wafa Dakwar, said.

"The economic and political meltdown of their host country, which has seen medical provision threatened even for Lebanese nationals, has had a profound impact on Palestinian refugees"

"During the economic crisis, the conditions desperately deteriorated."

Dakwar added that Lebanon's government "systematically discriminates" against Palestinians in areas like health and housing and prevents them from working in certain types of job.

"At the root causes [sic] of the problem is Israel's denial of Palestinian refugees[']… right to return to Palestine for more than 70 years.

"Even though we're not living in Palestine, we're still victims of discrimination and fragmentation while the Israeli law… permits the immigration and citizenship of Jewish people around the world," she said.

"Permanent exile is not only a barrier to health and dignity but also it restricts our ability to contribute to a sustainable health system that serves all Palestinian refugees."

Featured image credit: Aseel Baidoun/Medical Aid for Palestinians

Nick McAlpin is a journalist at The New Arab.

Follow him on Twitter: @NickGMcAlpin