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Israeli Occupation Devastates Medical Units in Palestine

Rima Merriman

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The lack of access to medical services resulting from the Israeli occupation of the Palestinian territories is having devastating effects on the population, a conference held at the University of Illinois in Chicago on March 7 concluded. Heightened maternity deaths, increasing numbers of traumatized patients suffering from lack of treatment, emergency services unable to come to the rescue of the injured, acute malnutrition, anaemia and stunting among Palestinian children are but a few of the dramatic consequences of the occupation since the outbreak of the second Intifada.

The conference, Health Consequences of Military Occupation and its Impact on Palestinian and Israeli Populations, gathered professionals from the fields of medicine, clinical psychology, environmental engineering, mental health, conflict analysis and resolution and nutritional science, from Palestine, Israel and the USA.

Rachel Rubin, professor of public health at the University of Illinois and one of the organizers of the conference, explained that the ad hoc group of people on the organizing committee realized that there were long- and short-term health consequences for both populations, but “we are against the occupation, so that already has set a certain underlying premise for the conference.”

The major issue that panellists kept coming back to was the lack of access created by numerous checkpoints and, more recently, by the wall, restricting movement and transport, and thus affects the economy, access to natural resources and access to physical and mental health services. The chief executive officer at the Augusta Victoria Hospital in Jerusalem, Tawfiq A. Nasser, described the effects of the access restrictions on patients, staff and medical supplies in Palestine. “We have now started going back to the times of the Greeks. We have something called city states. Each city in the Palestinian territory is trying to develop itself into a state. We are losing the concept of specialization and referral. If you have an excellent cardiac unit in Jerusalem, but the people in Nablus cannot use it because they can?t get to it, then they have to develop their own.”

National planning, in a donor-based economy, is impossible, he said. “To get to Maqased Hospital, it takes an act of God,” Nasser said, going on to explain that sometimes, after six hours of an ambulance going out for an emergency and not returning, “we find out it is because the ambulance has been confiscated or the personnel removed.” Nasser said, as a result, makeshift mobile medical units are now back in operation, as they had been during the first Intifada, derailing Palestinians away from their goal of developing a long-term healthcare system. NGOs are delivering health services using crews of mostly enthusiastic, but minimally trained, young people.

“As much as I like their spirit,” Nasser said, “you should see how the patient arrives at the hospital.”

Because the Palestinian economy is fragmented or nonexistent (with Gaza unemployment rates up to 80 percent), healthcare is under funded. Medical insurance is provided by the Palestinian Authority (PA) as well as the UN Relief and Works Agency. However, the PA doesn?t get the $20 million-$25 million in tax returns from the Israelis, and so sustainability is shaky at best. Speakers on other panels cited corroborating statistics that demonstrated the severity of the access problem. Alan Meyers of the Jewish American medical Project in Boston mentioned the UN?s Population Fund documentation of 56 births at check points, 19 maternal deaths and 26 neonatal deaths since late 2000 through last summer.

Almost every speaker framed the information being presented from the perspective of human rights. Marjatta Tolvanen, a UN?s Children?s Fund project officer, cited the UN resolution on the right of every human to enjoy the highest available standard of physical and mental health. Access to potential resources is under constant attack in Palestine, Reem Musleh, a doctorate in philosophy candidate in Environmental engineering at Michigan State University, said. She talked about destruction of the environment and its adverse effects on health: sewage pipes deliberately destroyed, haphazard garbage disposal because landfill permits are hard to get, scarcity and high cost of water due to water tankers not being permitted to reach villages, the cutting down of olive trees (over 1 million since 2000) and soil erosion. As a result, children pass out at school because the water they have access to is too saline, and renal dysfunction is very high.

Jumana Hassan Odeh-Issawi, director of Jerusalem?s Palestinian Happy Child Center, cited figures that showed the prevalence of traumatic experiences in Palestinian children (between 6-16 years of age) as well as acute malnutrition, anaemia and stunting. Food, not unemployment, is now the number one priority in Palestine, where 80 percent of children live on under $2 a day.

The sheer compilation of misery mounted as World Bank statistics were quoted and details of daily life in tents pitched over the rubble of demolished houses were described. But Jess Ghannam, a licensed clinical psychologist in California who spends part of each year in Gaza working in community mental health centers, was still able to talk about the resilience of the population. He described how, to get to his class in Rafah, students who lived a few kilometers away in Gaza City had to start walking to school at 3am to get there on time and then leave at 4pm to be home by midnight.

“Palestinian children and adults have the highest number of post-stress trauma of any people in the world, including Bosnia, East Timor and West Africa, but the number of Palestinians who have the disorder is well under 10 percent.” He attributed this resilience to enduring family structures and shared knowledge of political and historical context.

The audience, made up of students, activists and health professionals from Illinois and several other states, were largely in agreement with the underlying premise of the conference, which proceeded without the controversy and heated debate attendant on discussions of Palestinian/Israeli issues on university campuses in the USA.

The one point of sharp disagreement occurred between two Israeli speakers at the conference. Zeev Wiener, head of the Community Programs in the Hosen Center for Trauma and Disaster in Tel Aviv, cited the statistics of Israeli dead at the hands of Palestinians under occupation since the beginning of the second Intifada, through Feb. 22. He went on to define traumatic stress syndrome and pointed to its prevalence among Israeli citizens exposed to terrorism: 5.3 percent need professional help, 58.6 percent feel depressed, 76.6 percent show at least one stress symptom. He connected these findings with ongoing polls that showed a decline in patriotism and militancy among Israelis, increased domestic violence and increased aggression against Palestinians.

Members of the audience, including one of the speakers on the panel, Simona Sharoni, executive director of the Peace and Justice Studies Association, who has also served in the Israeli military and holds dual USA and Israeli citizenship, criticized Wiener?s presentation for its lack of context. “Suicide bombings ? must be seen as symptoms that stem from a political reality that is the occupation. My research shows that violence by Israelis, both domestic and in terms of the occupation, is a learned behavior, the result of how Israeli men are socialized.”

In her presentation, Sharoni said there was very little by way of numbers and statistics regarding how the occupation affects the mental health of Israelis, who are not allowed to travel to Gaza or the West Bank: “This is not a coincidence. The government and the media are determined not to let Israelis know how they themselves are affected by this.”

Sara Roy, senior research scholar at the Center for Middle Eastern Studies at Harvard University, described the “approaching ruination ? of Palestinian economy and society. The occupation has always been about the denial of normal life. The intent is not only to separate Palestinians from Israelis, but also to isolate Palestinians from one another. Nothing sustainable can happen until the occupation ends.”

Published Friday, March 19th, 2004 - 12:43pm GMT

Article courtesy of the Daily Star

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