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Divide and Conquer: Inequality in Health

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Under the Same Regime: Shorter Lives, Poorer health

For the first time, a Physicians for Human Rights–Israel report analyses the health metrics gaps between the Israeli citizens and residents of the Occupied Territories. Palestinians live 10 years less than Israelis, infant mortality is five times higher than in Israel, and the mortality of women at childbirth is four times as high. “As long as the occupation continues, it is Israel’s responsibility to equalize the health conditions of the populations”.

“Divide and Conquer”, a new report by Physicians for Human Rights–Israel published today, is the first to make a comparison of health conditions in the Occupied Territories and in Israel by using health indicators and socio-economic determinants of health that influence the residents’ ability to exercise their right to health.

The report shows findings that indicate significant gaps between indicators for the two populations*: Thus it was found, for example, that the average life expectancy for Palestinians is about 10 years lower than for Israelis, that infant mortality is five times higher in the Occupied Territories than in Israel (18.8 per 1,000 births as compared to 3.7), and that maternal mortality is four times higher in the Occupied Territories than in Israel (28 per 100,000 births as compared to 7).

Gaps were also found in the financing of, the services provided by, and the manpower available to the Palestinian healthcare system. Thus it was found, for example, that the national expenditure on health per person in the Occupied Territories is about one eighth of the Israeli health expenditure. The rate of physicians per capita in Israel (3.33) is higher than in the Palestinian territories (2.08 physicians per 1,000 residents), the rate of specialists is eight times higher in Israel than in the Occupied Territories (1.76 as compared to 0.22), and the rate of nurses in Israel is 4.8 per 1,000 residents, whereas there are only 1.9 nurses per 1,000 residents in the Occupied Territories. It was also found that there are inoculations given in Israel that are not given in the Occupied Territories. Examples are the inoculations against hepatitis A, chicken pox, pneumonia, rota virus, and human papillomavirus. This is despite the fact that infectious diseases are much more common in the Occupied Territories than in Israel.

The report also reviews the Israeli mechanisms of control, which prevent the Palestinian Ministry of Health – which has its own faults – from providing full health services to the residents of the Occupied Territories, with detrimental impacts on their health. Israel's imposed limitations on the freedom of movement of patients, medical staff and medications is one such mechanism of control. Another is Israel's control of the Palestinian budget, including the health budget, for instance through Israel’s control of the customs and Value Added Tax revenue for goods entering the Occupied Territories. Israel often makes use of this control level, and denies the transfer of these funds to the Palestinian Authority as a punitive measure. By doing so, Israel interferes with the financing of the Palestinian healthcare system and condemns it to exist in a state of uncertainty.

The Palestinian health system is in chronic crisis, which does not allow it to provide an appropriate response to the needs of the population. At the foundation of the report is the argument that the crisis situation engulfing this system did not happen overnight, and that it is closely related to the Israeli control of the Occupied Territories. Despite the hopes that came with the Oslo Accords, in practice there has been a situation for two decades now in which two populations live in one territory and under one government, but with different rights.

Mor Efrat, A Coordinator at the Occupied Territories Department of Physicians for Human Rights–Israel: “It is the duty of the Palestinian Ministry of Health to provide health services to the population to the best of its ability, but it is Israel’s obligation to provide all the services that exceed the ability of the Ministry of Health, so that a Palestinian child and an Israeli child, who may live only a few hundred yards apart, receive equitable medical care.”

*Residents of the Jewish settlements are included among residents of Israel, as they are allowed to benefit from the Israeli healthcare system