Palestinians in 'chronic health crisis'

The 3.8 million people living in the Palestinian territories are 'enduring a chronic health crisis', says a major report.

A Palestinian woman and her child walk in front of a destroyed house in Rafah, in the southern Gaza Strip.

LONDON // The 3.8 million people living in the Palestinian territories are "enduring a chronic health crisis", according to a major report published today. Health systems are inadequate with Israeli military occupation hampering improvements, while the "endemic" social suffering of the Palestinians blocks health development and progress, according to the report in The Lancet, the British medical journal.

The report, a series of papers that took two years to compile, involved health professionals and academics working in the Palestinian territories and researchers from the World Health Organization, UN agencies and academic institutions in the United States, United Kingdom, Norway and France. One of its main conclusions is that the best way to bring an end to the chronic diseases and other health problems rife in the territories would be the establishment of a sovereign Palestinian state - something that Jimmy Carter, a former US president commenting on the report, feels could be more of a reality following the election of Barack Obama. The report, which highlights the fact that women and children often suffer worst under the current regime, examines a range of health issues including maternal and child health, cardiovascular diseases, diabetes, cancer, health and human security and the future of the health care system. It also looks at one constant threat to life, limb and mental stability in the Palestinian territories - the threat of military action.

One of the papers in the report offers what The Lancet says is "the first, carefully corroborated synthesis of the threats to Palestinian life and well-being" whether the source be disease, poor health care or a bomb. It records that between 2000 and 2009 more than 4,700 Palestinians, mostly civilians and including 900 children, were killed by military action. The total excludes the 1,300-plus who died during the Gaza Strip invasion that began in December. Another 35,000 Palestinians have been injured in the conflict since 2000. Rajaie Batniji, the lead author of the paper, from the department of politics and international relations at Oxford University, says today's threats to both physical and mental health come from bombing and shelling, demolition, occupation and regulations that do not permit building on most of the land. Insecurity is heightened by land confiscation and the destruction of crops, coupled with problems of limited access to fuel, electricity, water and sanitation. There are also the problems caused by "humiliation and degrading treatment" meted out to Palestinians at more than 600 Israeli-controlled checkpoints and road barriers in the West Bank.

Movement restrictions directly and destructively affect the social determinants of health, says the report, while the construction of the "separation wall" creates a feeling of permanent distress and loss of hope among Palestinians while also posing a physical obstruction to healthcare facilities. "Political solutions that improve Palestinian security will simultaneously reduce threats to physical, mental and social health ? most threats require social and political solutions that are beyond the capacity of the health sector ? By identifying and communicating the link between human-security threats and health conditions, Palestinian health can become an integral part of the political solution to this conflict," says the report. In another of the report's papers, Rita Giacaman, a doctor from Birzeit University in Ramallah, looks at how the demographic characteristics, health status and health services of the population have been affected by 60 years of continuing war conditions, including 40 years of Israeli military occupation of the West Bank and Gaza.

She finds that, although health, literacy and education standards are above those in several Arab countries, all are substantially lower than in Israel. About 40 per cent of families in the West Bank and 74 per cent in Gaza were living below the poverty line of US$3 to $15 (Dh11 to Dh55) per person per day in 2007. Since 2000, life for Palestinians has become much harder, more dangerous and less secure, with unemployment and reliance on food aid at record levels in the Gaza Strip even before the latest Israeli invasion. As with other nations, the Palestinian territories are "undergoing an epidemiological transition in which cardiovascular diseases, hypertension, diabetes and cancer have overtaken infectious diseases as the main causes of illness and death", the report says. But they are "faltering where other modern, western nations are progressing. Infant mortality in the region stalled at 27 per 1,000 live births during 2000-06 - the same level reported in the 1990s. The rate in Israel is 3.9 per 1,000 live births." The rate of tuberculosis in the territories has risen by 58 per cent in recent years and meningococcal meningitis by 53 per cent. Mental disorders have risen by around one third to 43 per 100,000 in 2003 from 32 per 100,000 in 2000.

Various factors, including lack of development under Israeli military rule and mismanagement by the Palestinian Authority, mean that Palestinian health services are inadequate and many patients must be referred elsewhere, primarily to Israel, Egypt and Jordan, the report says. "We have shown that, after a period of improvement in Palestinian health in the occupied Palestinian territory, socio-economic conditions have deteriorated since the mid-1990s, with a humanitarian crisis emerging in the Gaza Strip and intensifying as a result of the Israeli army invasion in December 2008 and January 2009," the report says. On maternal and child health, the report says that Palestinians suffer in common with many other families in low-income countries. But it says that problems such as poverty, poor nutrition and an overburdened health system are complicated by the problems of military occupation and continued warlike conditions. Just getting an ambulance to take someone to hospital can be a complicated, time-consuming problem because of the extensive system of Israeli roadblocks. Between 2000 and 2006, there were 69 cases of Palestinian women actually giving birth at Israeli checkpoints while 10 per cent of all pregnant women were held up on their journeys to hospital by between two and four hours. The average journey time without roadblocks was between 15 to 30 minutes, according to the report. In his paper on maternal health, Hanan Abdul Rahim, a member of both Birzeit University and Qatar University, said fertility rates among Palestinian women are among the highest in the world.

He says that about 28 per cent of these women are married to a first cousin, which can have adverse health implications for children. Dr Rahim finds that human resources are scarce in some specialisations, such as neonatology and paediatric surgery, and that there is also a problem with the ineffective use of available specialists. He concluded: "Lives cannot be saved without access to 24-hour curative services to deal with unpreventable complications. Such an achievement requires a political solution of unrestricted mobility, ensuring access to services." On chronic diseases, the report says that, in common with other nations, Palestinians are suffering because of a shift towards urbanisation and western-style diets. Coupled with decreasing physical activity, this has led to heart disease, cerebrovascular disease, diabetes and cancer becoming leading causes of death. The response of the Palestinian Authority to the challenges posed by chronic disease has been limited, says the report, partially as a result of limited funding from the international donors on whom the authority depends. Richard Horton, the editor of The Lancet, said yesterday: "The goal of this series is to change the way health professionals, politicians, policymakers, media and the public view, think about and discuss the predicament facing this region of the Middle East." [e-mail]