An already fragile health system
For over 6 decades, the state of Israel has implemented policies and practices that have forcibly displaced and dispossessed the Palestinian population and has increasingly kept the remaining Palestinian population under control in isolated urban enclaves; stateless and living under military occupation. As a result the health sector in Palestine finds itself at the crossroads of a context shaped by the ongoing Israeli occupation, by the increasing territorial, demographic, socio-economic and political fragmentation of the Palestinian state, and a persisting humanitarian crisis. For those working on the right to health in Palestine, we are all too aware of the already fragile healthcare system, even before the COVID-19 pandemic. Now with 526 cases confirmed in the West Bank (WB) with 2 death, and 20 in Gaza1, it has highlighted the already existing failings of a healthcare system on the brink of collapse.
Continued violence and demolitions
The occupied Palestinian territory have not been exempted from the global shutdown which has been initiated to slow the spread of COVID-19. Restrictions have been put in place across the entire West Bank, limiting movement between cities, closing all non-essential businesses and people have been ordered to stay home. For a population with already high poverty levels, and which relies predominantly on daily labor and casual work, these necessary measures will be devastating for the livelihoods and wellbeing of Palestinians. Even before the COVID-19 pandemic, the World Bank expected the Palestinian economy to slip into negative growth in 2020 and 2021.2
We have continued to see Palestinians injured, trees destroyed, and vehicles vandalized by illegal Israeli settlers.
In the West Bank, destruction of property has continued unabated in the first quarter of 2020. Many of which were residence, infrastructure, water, and sanitation facilities (such as water tanks and cisterns, faucets, and latrines), which are also vital to hygiene promotion and preventing the spread of diseases. Settler violence has also continued, despite the lockdown and restrictions of movement for Israeli citizens, due to COVID-19 and we have continued to see Palestinians injured, trees destroyed, and vehicles vandalized by illegal Israeli settlers.3
Further access to important mental health services following these incidents is limited due to the COVID-19 lockdown, despite continued need still existing. Médecins du Monde is still working in the field to ensure that those communities we serve are still receiving access to vital protection, mental health and psychosocial services when needed during this crisis.
Gaza – on the brink of collapse
Access to health within Gaza has witnessed almost a reversal over the last decade. The availability of quality public services in Gaza is questionable and while new departments open in hospitals, but the essential components required to make them run tends to be missing, namely medicines, equipment, and human resources. During the second quarter of 2019, on average, 50% of medicines were available with only one month’s supply remaining, while over 40% were completely depleted.
There are only 65 ventilators in Gaza and 75 ICU beds, for a population of nearly 2 million people.
Lack of medicines has not only a direct impact on the quality of treatment, but it can also represent a growing public health risk when dealing with communicable diseases such as COVID-19 and it can mean the difference between life and death for many patients. Right now, there are only 65 ventilators in Gaza and 75 ICU beds, for a population of nearly 2 million people. Furthermore, there is a huge lack of testing kits and PPE equipment which will hamper efforts to curb the spread of the virus in the Gaza Strip.4
Now with the outbreak of COVID-19 in Gaza, there will be a massive knock on effect on the already overstretched existing healthcare services, with vital health care for many being hampered or stopped at this time.5 Médecins du Monde is working to continue supporting primary health care providers in sexual and reproductive health and mental health services, as well as maintaining access to family planning services and providing remote access to mental health care through use of a hotline. We are also supporting hospitals and the Ministry of Health, through triage training, awareness raising, and the provision of necessary PPE equipment and essential medicines.
Rights of the Child
The detention of Palestinian children has continued even after the introduction of coronavirus containment measures by the Palestinian Authority and the Government of Israel with over 20 children reportedly detained after the introduction of the measures in March.6
Israel must comply with its obligations under the Convention on the Rights of the Child. By not releasing child detainees, Israel is putting the health of these children at risk and the state has an obligation to protect the health, and right to health, of all children under its jurisdiction. Releasing child prisoners due to the COVID-19 emergency will further put Israel in compliance with WHO and UN guidance on the prevention and response to the coronavirus epidemic.
Any response to COVID-19 must be grounded in the right to enjoyment of the highest attainable standard of physical and mental health, without proscribed discrimination. All actors to the conflict should be reminded that health should not be politicized or used as a lever to achieve non-health related objectives. The emergency measures being enacted to deal with this public health crisis must be continuously monitored during and after the pandemic, to ensure that they are not being used as a cover to further disenfranchise the inalienable rights of Palestinians or to further entrench the occupation.
- As the occupying power, Israel must acknowledge full responsibility for the health of Palestinians in the occupied Palestinian territory and genuinely cooperate with Palestinian authorities in the West Bank and Gaza to ensure their health needs are met
- Israel must immediately lift restrictions on humanitarian and medical relief entering the Gaza Strip and facilitate the delivery of essential humanitarian action.
- Israel must immediately halt all demolitions of properties in the occupied Palestinian territory and ensure that Palestinians are protected from increased settler violence during this period.
- Israel must urgently place a moratorium on new admissions of children to prisons and detention centres, and seek alternatives to custodial sentences for children, and Palestinian children who are currently in detention should be released.
- The relevant ministries in the West Bank and Gaza must ensure coordination to allow the entry of medical supplies and humanitarian relief necessary for COVID-19 screening.
- All actors must ensure that humanitarian personnel essential to the response have the ability to enter and leave the Gaza Strip, subject to appropriate public health and safety provisions.
- All actors must facilitate the work of humanitarian agencies continuing to provide for essential humanitarian services, including health, shelter, water and sanitation, food, education, and protection.
- The Palestinian Authority should ensure that proper healthcare funding is channelled impartially to all Palestinians, including those in Gaza.
- The international community must ensure that Israel abides by International Humanitarian and Human Rights Law, guaranteeing that all Palestinians have unrestricted access to healthcare (including all measures available to prevent the spread of contagious diseases) and that access obstacles are eliminated.
- The international community must support the delivery of assistance to Gaza, in cooperation with local authorities, ensuring that counter-terrorism measures do not interfere with the provision of critical goods and services in the Gaza Strip to respond to COVID-19.