Access to health services for Palestinian people - Case studies of five patients in critical conditions who died while waiting to exit the Gaza Strip
The Jewish German philosopher Hannah Arendt wrote that 'the very substance of violent action is ruled by the question of means and ends, whose chief characteristic, if applied to human affairs, has always been that the end is in danger of being overwhelmed by the means, which it both justifies and needs.(1)'
Concerning the Gaza strip situation, there are a lot of means which overwhelms ends. One of these is the quasi total closure of Gaza, since June 2007 by the Israeli authorities for security reasons. The closure is causing physical, psychological and economic isolation of Gaza citizens. 'An affront to the dignity of the people' as it was recently defined by the UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator.(2)
In this publication we would like to focus public attention on the deterioration of access for health patients who need to be referred outside of the Gaza Strip to receive the appropriate medical treatment.
The publication contains the description of five stories of people who recently died while waiting for a permit to allow them to have access to a hospital outside of Gaza. These are only five of many more cases of common people that during the last months have had the misfortune of becoming severely ill in the Gaza strip.
The denial and delay of permits released by the Israeli authorities for patients who have to leave Gaza for health reasons increased during 2007(3) causing further problems, in addition to the usual access difficulties that have been affecting the Palestinian population, particularly during the last eight years.
In fact the right to health - availability, accessibility and quality of health facilities, services and goods - appears to be optional for the Palestinian population:
1) Tertiary health care is practically unavailable in the West Bank and Gaza, so patients must be referred and treated outside for specialized medical treatment.
2) The closure system (more than 580 checkpoints, road blocks, earth mounds, etc. in the West Bank - a territory of 6,000 sqm - and the current quasi total closure of the Rafah, Erez and Karni borders in Gaza), the separation wall in the West Bank and a strict permit regime are limiting patients' physical access to health care facilities, services and goods.
3) The deterioration of economic conditions, which is increasing poverty and unemployment rates, has significantly impacted the economic accessibility of medical treatment and drugs.
4) Strikes by health professionals in the West Bank since August 2006(4) have placed a further strain on the health sector.
5) The internal strife in the Gaza strip since the beginning of 2007 has been complicating the management and access to health services.
6) The cumulative effect of all these factors as well as others reasons - e.g. the lack of proper medical education in the West Bank and Gaza - is determining the deterioration in the quality of the available and accessible health services.
From a general health perspective, WHO is highly worried both for the deterioration of the quality of life of people in the occupied Palestinian territory, in particular in the Gaza strip, and for their access to health.
The five stories described in this publication show nonsense, inhumanity and, at the end, tragedies. Tragedies that could and should have been avoided.
Head of Office WHO for West Bank and Gaza
(1) Hannah Arendt. Reflection on violence. New York Review of Books, 27 February, 1969
(2) J. Holmes, United Nations Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator. Press statement, 18 February 2008
(3) See page 37
(4) The longest medical strike was related to the lack of regular salary payment due to the financial crisis of the Palestinian Authority (PA). This was the consequence of the Israeli government withholding tax revenues and the lack of direct support to the PA from the major donors after the Hamas government came to power in March 2006. Other strikes are recently taking place in Gaza against the removal of health managers and hospital directors by Hamas