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A Nation Under Occupation Inequity In Care Under Israeli Occupation Mamdouh EL-Adl.

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Presentation on theme: "A Nation Under Occupation Inequity In Care Under Israeli Occupation Mamdouh EL-Adl."— Presentation transcript:

1 A Nation Under Occupation Inequity In Care Under Israeli Occupation Mamdouh EL-Adl

2 Victims of Displacement Victims of displacement, torture & war, as a result, receive insufficient help in coping with the physical & psychological impact of the trauma (World Medical Association)

3 Equity in care Individuals should be treated fairly & should not be inappropriately discriminated against in the provision of healthcare (BMA, 2004) Promotion & protection of health are inextricably linked to promotion & protection of human rights (Mann, 1994)

4 Equity Criteria Horizontal equity: Equal treatment for equal needs. Vertical equity: a. Severity of health conditions: Does the intervention particular benefit those with severe health conditions? b. Poverty: Does the intervention particular benefit the poor? (James et al 2005)

5 What is the problem in Palestine?! Inequity in Care. Displacement & Exile. Injustice & The Political Dislocation. The Military Occupation.

6 Occupation

7 GCIV, Art.42: A territory is considered occupied when it is actually placed under the authority of the hostile army. GCIV, Art.43:The authority of the legitimate power having in fact passed into the hands of the occupant, the later shall take all the measures in his power to restore & ensure, as far as possible, public order & safety, while respecting, unless absolutely prevented, the laws in force in the country

8 Occupation of Palestine In 1948: Israel was established. In 1967: Israel expanded & occupied: 1. West Bank (Palestine) still occupied. 2. Gaza strip (Palestine) still occupied. 3. Golan (Syria) still occupied. 4. Sinai (Egypt) Israel withdrew after a peace deal.

9 Palestine under British Mandate 1923 – 1948 During the course of 1948 war, UN decision to divide Palestine: Jews: 52% of Palestine. Arabs: 48% of Palestine

10 Palestine after 1948 War Palestinians were divided into 4 divisions: 1.Pals. of Israel. 2.Pals. of Gaza. 3.Pals. of W Bank. 4.Pals. in Exile. Until 4 th June 1967: - Jews: 30% - Palestinians: 70%

11 Israel after 1967 War Israel occupied 1.The rest of Palestine. 2.Golan 3.Sinai. Size of Israel: sq.KM. I.e. >4times its original size. 410,000 Palestinians Forced immigration Settlements started: Israel started establishing Settlements in Gaza & West Bank for new Jewish Immigrants.

12 Displacement & Exile

13 Displacement & Exile Nakba = Disaster In the course of 1948 war, some 750,000 Palestinians were uprooted from their homes & lands. Expulsion was an integral part of that war The Zionists wanted to acquire as much territory as possible to establish a homogenous Jewish state. (Uri Avnery, 2001)



16 Injustice within the Political Dislocation

17 Powerful + Powerless - Law = Injustice Ariel Sharon: the present confrontation with Arab violence is a continuation of the 1948 war! UN: paralysed under the American domination & the famous American Vito. US Foreign policy. Arab governments.


19 Sharons Wall When completed: - Extends > 400 miles (4 times longer than Berlin wall). - Extends up to 15 miles into Palestinian territory. Its real purpose: To lock >50 illegal Israeli settlements into Israel proper. (Summerfield, 2004)


21 ICJ ruling Israel should abide by The International Law after the World Court ruled that the West Bank Separation Barrier is illegal. (Annan, 2004)

22 Israel rejects ICJ ruling Israel rejects the ruling of The International Court of Justice in the Hague. (Sharon, 2004)

23 Palestinians Under Occupation & Geneva Convention

24 Civilian Immunity under Geneva Convention IV, Art. 3 They must be treated humanely, without discrimination based on race, colour, religion or faith, sex, birth or wealth, or other similar criteria. Violence to life and person including murder, mutilation, cruel treatment and torture are prohibited. The taking of hostages is prohibited. Outrages upon personal dignity, including humiliating and degrading treatment are prohibited. Sentences and executions without a judgment from a regularly constituted court and without benefit of the standard judicial guarantees are prohibited.






30 Healthcare of Palestinians Under Israeli Occupation 2 main factors: 1. Resources. 2. Access to care.

31 Gaza

32 Mental Health in Gaza Population: 1.4 million. El-Nasr Psychiatric hospital: 32 beds. GCMHP: An active & community oriented. Outpatient clinic in Khan Younis.

33 Resources & Needs Gaza data (1998 – 2004): - Doctors: 36% - Nurses: 13% Causes: - Students blocked off from reaching medical school. - Students not allowed to study abroad. - Emigration. (Abdeen, 2005)

34 Attacks on Healthcare staff (since Al-Aqsa Intifada) Staff: 25 killed & 425 injured. Ambulances: 121 attacked & 36 destroyed. 991 denial of access 85 deaths. 10 attacks on hospitals. (PRCS)





39 Deaths of period: – Palestinians: Gaza: 1854 W.Bank:1951 Israelis: Settlers: 213 Soldiers: 315 (GCMHP website) DeathsPalestiniansIsraelis Total Children Women Men

40 Palestinians injured by Israeli forces & settlers (GCMHP website) Total27998 Live ammunition7417 Rubber/Plastic bullets6272 Tear gas6317 Miscellaneous7992 Permanently disabled3530

41 Educational Statistics: – (GCMHP website) killedinjureddetained School students University students Teachers

42 West Bank

43 Mental Health service Population: 2.4 million. Bethlehem Mental Hospital: 320 beds. Staff: 9 psychiatrists & 12 S.W., 3 psychologists, 71 nurses, 2 EEG technicians + administrative staff. OT unit: a grant from British Council. Community Psychiatric clinics in Jenin, Tulkarm, Nablus, Qalqilia, Ramallah, Hebron & Jericho. (Murad, 2002)

44 The Bethlehem Hospital This is the only inpatient facility in West Bank This hospital was subjected to a missile attack by the Israeli Army on (Giacaman et al, 2005)

45 The Wall & access to Care -Qalqilya hospital (Primarily serves refugees) reported 40% fall in follow up appointments as patients cannot reach the city. -The Wall when completed will isolate: 97 primary care clinics + 11 hospitals from the populations they serve. (Summerfield, 2004)

46 Death at the checkpoint At least 87 cases (including 30 children) in which denial of access to medical treatment has led directly to deaths. This includes babies born while women in labour were held up at checkpoints. (Summerfield, 2004)

47 Palestinians in Israel

48 Access to Care Israeli National Hospitalisation Records: Arab patients compared to Jewish significantly underutilise mental health services. - Possible reasons: 1. Arab healthcare utilisation general pattern. 2. Influence of the cultural over the professional. 3. Lack of Arab mental health practitioners. 4. Availability of mental health service in Arab communities. 5. Arab attitude towards mental health. (Al-kerwani, 2002) However, Swirski et al (1998) highlighted different reasons.

49 Health of Arab citizens in Israel (1) Arabs: 20% of population in Israel. 90% of them were born, raised & educated in Israel. Despite this large % & long presence in the country Arab localities are underdeveloped. - Their infrastructure: inferior to Jewish localities. - National development plans & employment: systematically discriminated against Arabs. - Socio-economic status: Arabs at bottom of the ladder. - Health of Arabs: lagged behind (not surprising). (Swirski et al, 1998)

50 Health of Arab citizens in Israel (2) Infant mortality rates/1,000 live births (Swirski et al 1998) yearArabsJews 1955 – – – – – – –

51 A Study by John Hopkins & Al-Quds Universities (3) Children under 5 y: - 20% were anaemic - 9.3% were acutely malnourished % were chronically malnourished. (Summerfield, 2004)

52 Health of Jewish Immigrants On the other hand planned national support systems have achieved a comparatively high health standards for large groups of Jewish immigrants. (Swirski et al, 1998) Why not do the same for Palestinians?!

53 Palestinian residents of East Jerusalem(1) In 1996: Israeli Interior Minister changed its policy regarding Palestinians living in East Jerusalem (occupied by Israel following 1967 war). Purpose of this policy: To rescind the residence rights of as many Palestinians as possible! Effect on Healthcare: This policy had an adverse effect on rights to healthcare. (Swirski et al,1998)

54 55,000 Jerusalem Arabs to be outside the city (2) The security barrier (Wall): - will leave 55,000 of Jerusalems Arab residents on the Palestinian side. (Ehud Olmert, Israeli Deputy PM) - Arab population in the walled area will be by 25%. (A senior Israeli government official) (

55 Inaccess to care At the checkpoints

56 At the Checkpoints Checkpoints at entrance to some villages close at 7.0 pm. Not even ambulances can pass after this time! As an example: near Qalqilya A man + his ill daughter + Israeli solders + the fence. A Palestinian doctor was also refused access to the child & was forced to do physical examination & to give the girl an injection through the wire! (Summerfield, 2004)


58 Enas: 3 y old Cancer patient (1) Enas: diagnosed few months ago with cancer. Her Dr decreed that Enas home must be air- conditioned to keep her environment hygienic especially in hot summer. This is to protect Enas from infections that might be fatal with immunity. Enas must receive injections which must be refrigerated. Israeli authority denied Enas electricity supply.

59 Enas: 3 y old Cancer patient (2) Her family keep her injections in a vessel with ice!!! Enas has been repeatedly rushed to the hospital with very high temperature. Her father is a paediatrician who treats many children daily. The Israeli state turns its back to his seriously ill chid. PHR-Israel petitioned Israeli high court on against Ministers of Health, of infrastructure & of Interior. On , I received an from PHR-I informing that they are still trying!!!! (PHR-I, 2005)

60 Enas: 3y old cancer patient


62 F: Not a Story but a Tragedy (1) F is a 28y old Gaza resident Palestinian woman suffering cancer. F has been trying to reach Oncology Dept., Sheba Medical Centre for urgent chemotherapy. What happened to F in an awful 10 days is unbelievable. In Gaza: no single Oncology Dept. F was not allowed to go to Egypt for treatment.

63 F: Not a Story but a Tragedy (2) PHR-Israel: tried to help Permit to F. F had mastectomy but denied family escort. F was supposed to return to Sheba for treatment on 14 September..application refused & F had to wait. PHR-Israel: Permit to F allowed after delay. F was so ill, her mother was allowed to escort F

64 F: Not a Story but a Tragedy (3) F & her mother after 4 hours at a roadblock, was ordered by soldiers to strip in front of them & stood wearing an undergarment. Fs mother burst out crying at the sight of her sick, humiliated daughter. The Israeli soldiers scolded her to shut up!!!!! Finally an officer came, reprimanded the soldiers & allowed F to get dressed. (Levy, 2004) I dont know what happened to F, God knows.

65 Israeli Army Kills Peace Activists Tom Hurndall (British) Rachel Corrie (American)

66 Israeli Army Kills Peace Activists Tom (Thomas) Hurndall: 1981 – 2004 Was a photographer & member of ISM. On Tom was shot in head by an Israeli sniper. God bless his soul.


68 The Best Medicine History has shown that reform (social/ political is the best medicine. For victims of oppressive violence this means acknowledgement & justice. (Summerfield, 2002)

69 Can we make Peace without Justice?!!!

70 Conclusion Access to healthcare & equity in care are basic human rights. Military Occupation undermines these rights. Inequity in care should not be tolerated.

71 Thank you


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