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Source: World Health Organization (WHO)
8 May 1987



WORLD HEALTH ORGANIZATION

FORTIETH WORLD HEALTH ASSEMBLY

Agenda item 29






HEALTH CONDITIONS OF THE ARAB POPULATION IN THE OCCUPIED
ARAB TERRITORIES, INCLUDING PALESTINE


At the request of the Permanent Observer of the Palestine Liberation Organization at the United Nations Office at Geneva, the Director-General has the honour to submit the attached report 1/ to the Fortieth World Health Assembly for its information.


-----
1/ See Annex.




Mission Permanente de l'Organisation
de Liberation de la Palestine aupres de
l'Office des Nations Unies-Geneve

Geneve, le May 5th 1987




Dr. H. HAULER
Director General
WORLD HEALTH ORGANIZATION
1211 GENEVA 27




Dear Sir,

Enclosed, please find the report on the Health Conditions in the Territories occupied by Israel since 1967, established by the Palestine Red Crescent Society.

We, hereby, wish to request you to publish this report as an official document of the 40th World Health Assembly, and to distribute it to the participants as such.

Thanking you,

Yours faithfully,



(Signed)

Nabil RAMLAWI
Director
Permanent Observer of the PLO to the UNO



ANNEX

HEALTH CONDITIONS OF THE ARAB POPULATION IN THE OCCUPIED ARAB TERRITORIES, INCLUDING PALESTINE

INTRODUCTION

1. The purpose of this report is to provide an objective view of the health conditions of the Palestinian Arab people in the occupied Arab territories, on the one hand, and to depict various health policies adopted by the Israeli occupation authorities with regard to Palestinian Arab citizens, on the other.

2. Since it is impossible to separate socioeconomic conditions from health conditions, this report begins by describing the deteriorating socioeconomic conditions in the occupied Arab territories, taking into account that health conditions are indisputably the result of the socio-economic situation that prevails in any given country.

3. As this report will demonstrate, the Israeli occupation authorities have perpetrated all kinds of arbitrary and inhuman acts to weaken the Arab community in the occupied Arab territories and prevent its development and progress. They have forced this community into the vicious circle of backwardness, disregarding all human principles and the tenets of international law. These authorities have executed a carefully planned policy to dominate the occupied Arab territories, usurp them from their rightful owners, and Israeli settlements have been built there with the aim of judaizing all occupied Arab territories before finally annexing them to the Israeli entity.

4. To further the disintegration and deterioration of the educational and cultural infrastructure, the Israeli occupation authorities have also perpetrated practices against the educational sector, such as changing curricula and imposing teaching programs serving their purposes, not to mention the continual closure of schools, universities, and scientific research centers, or the incessant violence against students, teachers and professors, who are often dismissed.

5. Israel has systematically violated all human rights in the occupied Arab territories, by imposing collective sanctions, demolition of houses, desecration of holy places and the clergy, and an infinite number of similar practices.

6. Israel has pursued arbitrary policies vis-a-vis the Arab economic sector, and resorted to various measures aimed at undermining all sectors of the Arab economy, with the purpose of weakening it to the extent of destroying its independence, so that it could be easily incorporated into the Israeli economic structure.

7. Such policies have deeply influenced the socioeconomic situation and perpetuated social, educational and cultural backwardness. Deteriorating economic conditions, decreasing income, and the lack of the necessary financial resources for the development of the health sector are but some of the results achieved by such policies. The majority of Arabs have reached or fallen below the poverty line. This, in turn, has left an indelible stamp on the deteriorating health condition of the Arab population.

8. Although commitment to achieve health for all by the year 2000 is one of the major objectives of the health policies set by WHO, the Israeli authorities pursue policies aimed not only at halting and hampering the development of health services, but also at obstructing the construction of hospitals and health facilities, depriving existing hospitals of new specialists and opposing any attempt to develop and modernize these hospitals.

9. The occupation authorities have been combating the Arab drug industry, setting up various obstacles such as restrictions on imports of industrial equipment and raw materials, hampering the process of manufacture, and prohibiting the export of medicines to Arab markets.

10. All forms of terrorization and intimidation have been applied to Arab hospitals and all members of staff in this sector.

11. Particularly perilous, however, are the continual and systematic endeavors of the Israeli authorities to impose their direct and total control over all health sectors in the occupied Arab territories, be it through restrictions on health expenditure, health policy, planning or the organization of health infrastructure and services, practices evidently aimed at incorporating the health sector in the occupied territories into the Israeli health sector.

12. It should be noted that in compiling this report we have drawn on various health documents concerned with the occupied territories, and issued by international, regional and local institutions, which have been consulted as background material. WHO documents, reports of the Special Committee of Experts presented to various World Health Assemblies, other documents dealing with health conditions in the occupied territories throughout the years of occupation, and material published by a number of Palestinian bodies in newspapers,, magazines, periodicals, etc., have been used, in addition to other sources of information exclusive to the Palestinian Red Crescent Society.



Annex
1. SOCIOECONOMIC SITUATION

Introduction

13. The Israeli authorities pursue, in the occupied Arab territories, various arbitrary policies aimed at imposing their total domination on Arab territories and Arab citizens. In pursuance of this aim, the occupation authorities perpetrate all forms of coercion, terror and all sorts of atrocities. They are bent on seizing Arab lands by force, demolishing houses, changing the map of Arab lands and cities and establishing Israeli settlements on these lands to force Arab citizens out of them and oblige them to emigrate from the land on which they have lived for thousands of years.

14. Socially, the occupation authorities are endeavoring to arrest social progress. They are depriving Arabs of education, especially of higher education, and they are closing down schools and universities for long periods of time.

15. Economically, they pursue policies which lead to a lowering of Arab standards of living. Israelis employ Arab labor at very low wages, depriving these workers of most social entitlements and of their right to training. The aim of the Israeli occupation authorities is to bring the Arab economy under the domination of the Israeli economy.

16. Legally, they apply unjust laws to Arabs only. They choose what suits them best from among old arbitrary laws applied by the Turks during Turkish colonization, as well as laws applied by the British during the Mandate.

17. Such practices are very dangerous in view of the Israeli settlement activities in the occupied Arab territories. Undoubtedly, the Israeli presence in the occupied Arab territories is the most cruel form of racist settler colonization in history. The Israeli occupation authorities resort to every inhuman and racist method to expel the Palestinian population from the land on which they have lived for thousands of years in order to judaize the Palestinian lands and towns.

18. The seizure of land and establishment of settlements thereon is a flagrant violation of international law. According to the Geneva Convention of 1949 (Article 49), the Arab territories seized by the occupation authorities are considered occupied territories which must not be annexed or "denatured". However the policies pursued by the Israeli occupation authorities are contrary to recognized rules of humanity as well as to the recommendations of the United Nations and international organizations.


Annex


19. The Israeli settlement policy is not only a serious obstacle to peace, but it is one of the main reasons behind the continuing violence and the sufferings of the Palestinian people since the establishment of the State of Israel in 1948.

20. It should be noted that in recent years there has been a dangerous recrudescence of organized violence and terrorist practices perpetrated by Jewish armed settlers and the Israeli army against Palestinian citizens in order to terrorize them and force them out of their villages and towns for ever.

21. The Israeli occupation authorities' violation of all international laws became obvious with the Military Governor's decree No. 854 of 6 July 1980 subjecting Palestinian educational institutions to Israeli authority.

Institutes of higher education

22. The year 1982/1983 witnessed an intensified Zionist campaign mounted by the Israeli occupation authorities to exert pressure on institutes of higher education with the aim of destroying the main infrastructure of these institutes and undermining their academic content, for these institutes are considered the life blood of development in the economic, social and educational fields for the population in the occupied territories. The educational institutes in the occupied territories have developed considerably; they absorb 40-60% of all high-school graduates, thus alleviating the need to join foreign universities and the possibility of brain drain. This does not serve the policy pursued by the occupation, which is based on the expulsion of the population, and especially of educated people, from the occupied territories.

23. Lecturers and professors teaching at Arab universities are imprisoned, incarcerated or banished if they do not accept the policy pursued by the occupation authorities.

24. Closing down the university is a standard method of collective punishment of university staff and students for refusing the intervention of the occupation authorities in the academic and administrative affairs of the universities. For example, Bir Zeit University, the largest university in the West Bank, was closed down ten times between 1967 and 1985, on two occasions for periods of four months during the academic year 1981-1982. The occupation authorities have done the following things:

(1) placed the student council and some lecturers under house arrest;

(2) prevented the implementation of the university expansion project due to be completed over a period of 10 years;


Annex

(3) allowed military patrols to violate the university campus regularly, tearing up posters and items from notice boards, repressing students, and suppressing their activities;

(4) declined to respond to a request by the University for residence permits for 30 visiting professors from other countries;

(5) imposed a ban on 5000 university library books, including textbooks, poetry books, and books on non-political subjects;

(6) not exempted Bir Zeit University from customs duties, although Israeli universities enjoy such exemption: in 1980 the University had to pay about $ 250 000 in customs duties. All educational and laboratory equipment, which were duty free before 1967, have been subjected to exorbitant customs duties and taxes.

Schools

25. Statistics for the year 1980/81 show that there are 35 schools in the Gaza Strip and 775 schools in the West Bank. The shortfall is estimated at 794 classes and some 3000 places. Education departments in the West Bank estimated, in their report of 1973, that two-thirds of the classrooms are unsuitable, and the number of available classrooms represents only 60% of the real needs. To compensate for this shortfall the inhabitants are obliged to build classrooms at their own expense. Statistics for the year 1980/81 show that 1490 classrooms are still rented, and around 355 rooms were built at the expense of the inhabitants in Ramallah. In Nablus most classrooms are built at the expense of the inhabitants and the municipality; the same goes for other areas in the West Bank.

26. The number of pupils per classroom is 50 or more. A statistical survey of the number of pupils per classroom in 1978/79 showed that an average of 60% of classes had more than 50 pupils.

Pupils

27. There are 250 000 pupils in the occupied territories, including 14 000 in the last stage of their secondary school course. They are subjected to all sorts of harassment and arbitrary measures, such as arrest before examinations take place or the payment of heavy fines. In Bethlehem 15 girl students were expelled from Al Khodr secondary school for girls and the school was closed down for three weeks. In Nablus more than 40 students were arrested and in 1983 more than 20 schools were closed down and a great number of students were subjected to all sorts of intimidation.

Teachers

28. There are 7 200 teachers laboring under difficult professional conditions. They lack the necessary material means to discharge their educational duties properly. Moreover, their salaries are extremely low in relation to the cost of living and they are liable at any time to have their services terminated if they happen to be arrested. Promotion to a higher grade is frozen, although the rules and regulations in force do not allow such procedures.

Educational curricula

29. The name of Palestine and all references to the Palestinian presence have been deleted and replaced by the word "Israel". All references to resolutions adopted by the United Nations and other international conferences on the right of the Palestinian people to self-determination have been deleted.

Violations of human rights in the occupied territories

30. The situation with respect to the human rights of Arabs has deteriorated still further as the occupation authorities have changed all the legal rules and regulations which were in force prior to 1967.

ISRAELI POLICIES THAT VIOLATE HUMAN RIGHTS IN THE OCCUPIED TERRITORIES

1. Collective sanctions

31. The occupation authorities impose collective sanctions on Arab citizens, such as arrest, detention, imprisonment (no wonder the number of prisoners reached 200 000), stifling curfews and blockades of refugee camps, villages and towns. In March 1983, the occupation authorities flouted several fundamental rights: they refused Arab inhabitants driving licenses and travel permits, movement was restricted, curfews were imposed, shops were closed, dwellings and wells were destroyed, and populations were displaced. The occupation authorities have tightened their grip on the Arab press, subjecting it to strict censorship. Arbitrary action, which may go as far as arrest and banishment, is taken against journalists. These authorities have also dissolved the elected municipal councils in a number of major cities, replacing them by Israeli army officers.

2. Demolition of houses

32. The occupation authorities resort to the demolition of houses belonging to Palestinian citizens as a punitive measure against their resistance, destroying whole districts and villages. A United Nations report indicated that the occupation authorities had blasted 1 346 houses during 1967-1982.

3. Aggression against holy places and religious leaders

33. Occupation authorities and settlers have repeatedly attacked Moslem and Christian holy places. In 1983, the authorities made 333 attacks on the holy places, sometimes placing explosives in mosques and churches, sometimes attacking the faithful so as to prevent them from prayer. Meanwhile, the occupation authorities continued to carry out excavations beneath the walls of Al-Aksa Mosque in order to destroy it and build the Third Temple on its ruins. These excavations violated Article 32 of the Hague Convention which prohibits archaeological diggings in occupied territories. Moreover, there have been frequent attempts at violating the Prophet Abraham's Mosque at Hebron. Nor did Christian places of worship escape the aggression of the occupation authorities; for instance, there was the attack on the Baptist Church in Jerusalem in October 1982. In May 1983, the German Nunnery in Jerusalem was attacked and two nuns were killed in the Nunnery of the Russian Orthodox Church in the same city.

Actions by the occupation authorities concerning Palestinian refugees

34. The Palestinians who were driven out of Palestine in 1948 and now live in the territories occupied in 1967 - some of them on the West Bank in camps containing 341 000 inhabitants, and some in the Gaza Strip, where 377 000 people live in other camps - make up 69% of the population of the occupied territories and their camps are subjected to continual intimidation campaigns and to iniquitous practices, such as the imposition of curfew, campaigns of arrest and the storming of houses, especially during the night. International statistics confirm that 88% of camp inhabitants have been imprisoned, arrested or subjected to investigation by the occupation authorities. The practices of the occupation authorities reached a peak in the Dahisha and Jabalia camps with initiation of the so-called Ben Borath project in an attempt to get rid of Palestinian camps, i.e. to disperse the Palestinian people and hence destroy the Palestinian cause by wiping out all traces of the Palestinian refugees and breaking off their relations with the United Nations and UNRWA.

The economic situation

35. The Israeli authorities in the occupied Arab territories are implementing a well-defined economic policy in line with their expansionist goals.

(a) With respect to the agricultural sector:

36. The agricultural sector has been the backbone of the Palestinian economy over the years. The occupation authorities, in pursuit of its expansionist and settlement objectives, have annexed large areas of Palestinian land and issued several arbitrary military orders limiting agricultural production. These include the control of operations for marketing agricultural products, control of water resources and severe restrictions on their use by Palestinian farmers as well as restrictions on the exportation of citrus fruits and other products to outside markets. Consequently, the agricultural sector has been deteriorating and its production is diminishing.

(b) With respect to the industrial sector:

37. The Israeli authorities have been impeding the development of the industrial sector in the occupied Arab territories, by refusing to give licenses to Arab citizens to establish industrial enterprises and preventing them from importing the machines and raw materials required by industry. As a result, the industrial sector has suffered a 45.8% reduction in production and a 47.6% reduction in labor. 28% of Arab factories are now working at less than 50% of their productive capacity.

(c) With respect to the tourist sectors:

38. This sector has also suffered from several obstacles to its development. Its productivity has been greatly reduced. The number of hotels in the West Bank dropped from 29 in 1970 to 16 in 1984.


2. ADMINISTRATION OF THE HEALTH SYSTEM
AND HEALTH POLICIES IN THE OCCUPIED ARAB TERRITORIES

Introduction

Health Policies in the Occupied Arab territories

39. The Israeli authorities are following a policy of not only preventing the development of services, whether in primary health care or curative fields, but also of reducing the existing services. Six hospitals in the West Bank and Gaza have been closed, in addition to several centers and preventive medicine clinics, the central laboratory, the tuberculosis control center in Jerusalem, the nursing school and recently the Hospice Hospital, which is in contravention of Article 57 of the Geneva Convention. Some buildings have been seized, such as the Saint Joseph Clinic in Jerusalem, which has been turned into a police station, the Jeneid hospital in Nablus, which has been turned into the Jeneid prison and the Government hospital in Al-Sheikh Jarrah area of Jerusalem which has been turned into the headquarters of the Israeli Police. There are many examples of prohibition of the establishment of new charitable and local institutions. The Israeli authorities rejected a request by the Arab Medical Association of Gaza to establish a hospital, a request by the Women's Association of Beit-Sahour to establish a maternity unit and a request by the Hospice Hospital Friends' Society to renovate the hospital. The permit for construction of a hospital by the Friends of the Sick Society in Hebron was delayed for five years. Existing hospitals are prevented from adding new specialties. The participation of international institutions and organizations in the promotion of health in the occupied territories is minimal. Better knowledge and more rational programming of requirements would encourage international support.

40. Policies relating to health manpower have no plans for training or the development of skills needed by health workers. Research programs have been suspended. Health institutions are not provided with the necessary manpower resources. The reduction of the Government budget allocation for health has led to a reduction of available posts in health institutions and lower wages in spite of the rising cost of living. Many health workers have had to seek employment with other sectors. The Israeli authorities resist any attempt to develop or modernize health institutions and follow the policy of referring patients from the occupied territories to Israeli hospitals and linking Palestinian institutions to Israeli institutions with the aim of dissolving their independent Arab entity.

41. As a result of policies pursued by the occupation authorities, Palestinian health institutions and centers are unable to provide the health services needed. Because of the lack of trained staff, appropriate equipment and sometimes drugs, patients are often referred to Israeli hospitals, which gives them a feeling of frustration and a lack of confidence in the services of their own hospitals. The determination of health policy and the political commitment to achieve health for all are inaccessible to Palestinian authorities and there can be no real commitment under the prevailing conditions in the occupied territories.

Determination of health policy

42. The organization of health services is under the absolute and direct control of the occupation authorities which alone determine health policy in the occupied territories.

Planning

43. This is under the direct supervision of the occupation authorities. No Arab citizen is allowed to participate or express views. Thus, it cannot be said that there is health planning aimed at raising the level of health of the people. There is no medium- and long-term planning. The conduct of health activities is based on a short-term planning concept. The local health staff make efforts to evaluate and analyze the health situation, based on the preparation of an inventory of services and certain estimates of the health needs to be met. Unfortunately, evaluation of the needs of the population is not supported by a fully adequate system of statistical information, or by epidemiological or social surveys concerning the utilization of services, the attitudes of physicians or the population, or an analysis of felt needs in relation to the needs as determined by the doctors, who are not allowed to express their views or participate in planning to determine the priorities and health policies of the occupied territories.

44. The military authorities allocate for the hospitals of the West Bank about one-tenth of the funds allocated for one Israeli hospital of medium size. The entitlements of an Arab physician in the occupied territories amount to only about 50% of those of an Israeli physician. It should be noted that the military administration does not release any figures relating to the health budget in the occupied territories.

Health budget for the West Bank

45. If we consider the health budget for the West Bank during the period from 1978 to 1984 as an indicator of health conditions, it becomes clear that the budget decreased from US$ 35.36 million in 1978 to US$ 3.98 million in 1984, i.e. about 15.7% of the 1978 budget. The budget for 1985 decreased to less than US$ 3 million. In contrast the health budget in Israel increased from US$ 1139 million in 1978 to US$ 1931 million in 1984, i.e. a 170% increase. Although the population of the West Bank is equal to 22.5% of the population of Israel, the expenditure on health per Palestinian does not exceed 2% of health expenditure per Israeli.

Poverty level in the occupied territories

46. There is a decline in the average monthly income in the occupied territories which means that the high costs of medical services is not met by an increase in family income, which further aggravates health conditions.



West Bank
Gaza
1983
1984
1983
1984
Minimum family
income required
($)

Real family income
586.0



441.8
586.0



380.0
586.0



462.4
586.0



380.0
Discrepancy between
minimum required and real income ($)
144.8
206.0
123.6
206.0
Percentage of median poverty indicatory
24.7%
35.2%
21.15%
35.2%
AssumptionsAverage family 6 persons
Average number of
working members 2 persons


Management of health services

47. The Israeli authorities deprive Arab physicians and health officers of the right to participate in the management of public health services. Evidence of this is found in the centralization of all health matters in the hands of the Israeli authorities, and the insufficient, ineffective participation of nationals in such matters. When the Committee wished to find out what financial measures had been decided for the extension of health programs, it was not possible to obtain the necessary information. Reports indicate that community participation in general, and the participation of health officers in particular, in the planning, management and distribution of budget allocations are practically non-existent.

Israeli policies and the Arab pharmaceutical industries

48. The Arab pharmaceutical industries in the occupied territories are experiencing enormous difficulties by virtue of Israeli practices in relation to these national production establishments. These practices are as follows:

- Difficulties over the importation of raw materials. The importation of these materials through the Jordanian port of Aqaba, and their conveyance over bridges on the Jordan river exposes them to great heat and makes them liable to deterioration. Furthermore, meticulous inspection of these substances exposes them to damage and deterioration. After all that, the occupation authorities end by banning the importation of these raw materials because they are strategic chemicals.

- The imposition of taxes and doubled customs duties on the output of drugs, which increases production costs and prices, making the drugs uncompetitive vis-a-vis Israeli products.

- The creation of obstacles and difficulties to obstruct the Arab pharmaceutical industries. Consequently Arab drug companies in the occupied territories are facing enormous financial crises, which prevent them from meeting the needs of Arab citizens in the occupied territories.


Health Infrastructure in the Occupied Arab Territories

Introduction

49. This part of the report deals with the health infrastructure in the occupied Arab territories, through the examination of two main components; first, the governmental health infrastructure, and second, the health infrastructure managed by charitable, private, and international organizations.

Government health infrastructure

50. This includes the following components:

1. Health infrastructure in the West Bank

2. Health infrastructure in the Gaza Strip

3. Health manpower in the health infrastructures

4. A comparison between health infrastructures in the occupied Arab territories on the one hand, and those in Israel and Jordan, on the other.

Health infrastructure in the West Bank

51. This will be discussed in the context of various areas of the West Bank, i.e. Jerusalem, Ramallah, Nablus, Tulkarem, Jenin and Bethlehem.

Health infrastructure in Jerusalem

52. The military authorities have separated the city of Jerusalem from the rest of the West Bank. This has in turn been divided into six health districts, with the objective of obliterating Arab identity in these areas and undermining all health institutions therein. The Israeli authorities have closed the only Arab hospital in Jerusalem, namely the Hospice. Furthermore, they have undermined the system of Palestinian health institutions by:

1. Separation of the health institutions in Jerusalem from those in the West Bank.

2. Prevention of the people in Jerusalem from joining the health insurance system in the West Bank.

3. Take-over of the new government hospital in the district of Sheikh Garrah in Jerusalem, which has been transformed into the headquarters of the Israeli Ministry of
Police.

4. Closure of Sebaford Children's Hospital and the health department and clinics in Jerusalem.

5. Closure of the anti-tuberculosis center, despite its enormous importance.

6. Closure of the blood bank in Jerusalem, which is the only one in the area.

7. Closure of the Jerusalem central laboratory. The Special Committee of Experts has condemned the closure of this laboratory and the anti-tuberculosis center.

8. Closure of the Hospice Hospital, although it was the only government hospital in Arab Jerusalem, providing service for this city and the surrounding villages with a population of some 150 000 people, mostly poor or with low incomes. The hospital was closed down on 29 July 1985, members of staff were arrested and interrogated after the authorities had forcibly removed patients from their beds. The occupation authorities have presented justifications for this act which are too flimsy to warrant a reply.

Health infrastructure in the district of Ramallah

53. The population of the Ramallah district was 135 000 in 1985. Prior to 1967 there were four hospitals in the district with a total of 209 beds, distributed among the Field Hospital with 93 beds, the old Government Hospital with 58, the new Government Hospital with 58 beds and the Communicable Diseases Hospital. The occupation authorities have closed down the Field Hospital, which contained 20 beds for children, and converted it into administrative offices for the military governor, and later into a prison. They have also closed the Communicable Diseases Hospital, and in 1975 they merged the old Government Hospital with the new one, thus reducing the number of beds for children by more than half. It has been impossible to meet the needs of the population on account of the insufficient number of diagnostic units, which means referral of patients to Israeli hospitals for para-clinical tests, which places a further burden on the hospital budget. A regional laboratory would save time, effort and money, but the Israeli authorities object to tile construction of such a laboratory. The Ramallah hospital also faces numerous technical difficulties, in addition to the shortage of staff caused by low salaries.

Health infrastructure in the Nablus district

54. The Nablus district had an estimated population of 150 000 in 1985, and has the following hospitals:

- The old Government Hospital with a capacity of 153 beds in 1967, which was reduced after the occupation to 87 beds, 30 for internal medicine, 30 for children, 10 for ENT, 4 for kidney diseases, 4 for intensive care, and 9 for physiotherapy and convalescence. Although the hospital suffered from an acute shortage of medical staff, and the lack of proper equipment, it was closed down by the occupation authorities and its equipment was confiscated.

- The new six-story Rafidia Hospital was to open on completion in 1967. The occupation authorities put only two floors into use in 1975. These contain 118 beds: 50-for surgery, 38 for gynecology and obstetrics, 20 for orthopedic patients, and 10 for ENT cases. The hospital needs maintenance if it is not to deteriorate because of the shortage of maintenance staff.

Health infrastructure in Hebron

55. In 1985 Hebron had a population of some 160 000 distributed among five towns and 55 villages. The only hospital in this district was established in 1965, with a capacity of 100 beds. The report of the Palestinian relief committee states that 69% of the Hebron population are utterly destitute, which is the highest percentage in the West Bank. Only 13% of the population benefit from medical insurance schemes. Those who are not covered have to pay about $ 100 per day for treatment and hospitalization. The Hebron hospital is the only hospital in this poor area of the West Bank. In 1967 there were 1.04 beds per 1000 citizens, but in 1985 this figure had declined to 0.63 per 1000.

56. Reports indicate that the entire hospital needs renovation, that it suffers from problems in such areas as nursing staff, laundry service, X-ray equipment, the lift, lack of certain drugs, shortage of manpower, poor electricity and water supplies and sewage facilities. These problems are due above all to insufficient budget allocations.

57. On May Day 1980, the Hebron Friends of the Sick Society applied for permission to build a 300-bed hospital, supported by the Islamic Conference which contributed the sum of $ 6 million, but the Israeli authorities refused permission to build at the time.

Health infrastructure in the districts of Tulkarem and Jenin

58. Tulkarem and Jenin, which are almost the same in terms of infrastructure, reflect the imbalance in the development of the health infrastructure since 1967. They are far from the central area and have fewer health services. The services that they do provide are almost unknown in the villages around them.

59. Tulkarem had a population of 145 000 in 1985; Jenin has 130 000 inhabitants. The number of beds in the Tulkarem hospital, which was 70 in 1967, came down after the occupation to 60 beds equally distributed between surgery, internal medicine, gynecology and pediatrics. The beds reserved for surgical cases were subsequently cancelled. Jenin had 70 beds in 1967. After the occupation the number of beds was reduced to 55, allocated as follows: 16 for surgery, 12 for gynecology, 10 for pediatrics, 17 for internal medicine. The surgical beds were subsequently cancelled. Many in-patients go to Nablus, Ramallah, Jerusalem, Bethlehem and "Israel" for treatment.

60. The facilities of Tulkarem government hospital are very poor, especially so in the X-ray department, for lack of a specialist. The laboratory is able to carry out only very simple tests; it often lacks laboratory reagents and the necessary equipment and supplies. The bed occupancy rate is low, either because some departments are not in use or for lack of the requisite facilities.

61. Conditions at the Jenin hospital are no better than those at hospitals in other areas. It suffers from a shortage of staff - medical specialists, laboratory and X-ray technicians, adequate laboratory preventive services and orthopedic and ENT surgeons. The level of care provided is only 10% of the level in the developed countries of Europe and. in Israel.

Health infrastructure in Bethlehem district

62. This district, which includes Bethlehem, Beit Jallah and Jericho, has a population of about 110 000, according to the 1985 statistics. There are public, private and charity hospitals in Bethlehem district. The public hospitals include:

Beit Jallah hospital

63. In 1967 this hospital had only 64 beds, of which 14 were for internal medicine, 12 for surgery, 5 for gynecology, 18 for orthopedics and 3 for cancer. The beds for neurosurgery have been abolished, and chemotherapy beds reduced from 5 to 3. The report of the Special Committee of Experts states that: "The hospital is quite active but it has its problems like the other hospitals: lack of ambulances; shortage of staff, particularly nursing staff; lack of coordination at the central level in drug distribution."

64. Some governments and institutions provided assistance for this hospital, e.g. the Swedish Government (US$ 635 000), the Jordanian Government (US$ 250 000), the Beit Jallah Municipality (US$ 120 000), the Arab Association for Health Services (US$ 100 000). The military authorities donated only US$ 50 000.

Jericho hospital

65. The Government Hospital in Jericho provides services for the Ghors region. The number of beds has been reduced from 72 to 48 (5 internal medicine, 5 pediatrics, 7 general surgery, 26 orthopedic surgery). The radiological service has old apparatus and a small laboratory permits basic tests to be done, but there is no blood bank.

66. It is worth mentioning that in 1986 the military authorities abolished 26 out of the 48 beds originally designated for orthopedics, as a step towards the closure of the hospital. The closure of Jericho Hospital is the next target of the occupation authorities. Having closed the Hospice Hospital they are taking the same steps in connection with Jericho Hospital as led to the closure of the Hospice Hospital, i.e. reductions in beds, services and budgets. This has resulted in the deterioration of health conditions in the area.

Health infrastructure in the Gaza Strip

67. In 1969, the total population Of the Gaza Strip was 364 000, and reached
560 000 in 1985, an increase of 54%.

68. Health services in the Strip are experiencing difficult times: instead of expanding in line with the population growth, services suffer more than in the West Bank. The Israeli occupation authorities have closed the Tal-Al-Zouhour and Fever hospitals and transformed them into military departments and offices. The bed total was reduced from 977 to 755 in 1982. The only chest diseases hospital in the area has not been spared. The number of chest beds was reduced from 210 in 1967 to 70 in 1980.

69. The military occupation authorities operate four hospitals in the Strip and contribute to a fifth, the Bureij Chest Hospital. The 336-bed Al-Shifaa hospital is one of the largest in the Strip but it is in bad shape due to lack of funds over the years and lack of equipment in comparison with the Israeli hospitals.

70. Patients in the Al-Shifaa hospital, especially in the old blocks, must endure cold winters as the only source of heating in the 14-bed wards is inadequate. In 1983, the mortuary in Al-Shifaa hospital remained out of order for more than 41 year until a Gaza resident donated the money for repairs. In 1984, financial difficulties forced the department of surgery to suspend elective surgery for six months.

71. In December 1984, the Israeli authorities closed down the approximately 20-bed orthopedic department of Nasser hospital, Khan Yunis, claiming that: it was contaminated, and transferred its activities to Al-Shifaa hospital in Gaza.

72. In 1984, there were constant delays in operating schedules as a result of breakdowns in the anaesthetic equipment, the operating table or the X-ray machine. The people of Khan Yunis complained of the long queues, in addition to widespread dissatisfaction with the hospital medical services. The 65-bed Evangelical Mission hospital, the only private hospital in Gaza, costs more than US$ 100 per night, including surgery and medicines. Nevertheless, it has been financially handicapped for some time. The Arab Medical Society's application to establish a 300-bed voluntary hospital has not yet been approved.

Health manpower

73. Health manpower is a perpetual problem in the occupied Arab territories because of the Israeli occupation authorities' practices and policies designed to continuously freeze and reduce the number of personnel. The Israeli authorities do not appoint replacements for those who resign or retire. Consequently the health service has deteriorated. The report of the Special Committee of Experts indicated problems of recruitment and training at all levels. Despite the needs of many health centers and sectors, many Palestinian physicians are unable to find budgeted posts in the State services in order to work. Moreover, salaries continue to be low. The health manpower sector lacks a health manpower development plan.

74. Among the practices and procedures of the Israeli occupation authorities aimed at forcing health personnel to abandon their posts and migrate are the following:

- closing or merging some health centers and institutions so as to make posts redundant;

- low salaries despite the rising cost of living, tax levies and a soaring rate of inflation;

- lack of training or specialization opportunities as well as of facilities and equipment required for work;

- lack of job security and stability because of imprisonment, incarceration, expulsions, etc.;

- persons who were outside the occupied territories at the time of the occupation are not allowed to join their families;

- attempted interference with the laws governing professional practice, as for example Order No. 745/1978, issued by the Israeli occupation army.

Health manpower statistics

75. The table below shows the average numbers of some categories of health workers and the average number of hospital beds per 1000 population.


AVERAGE NUMBERS OF HEALTH WORKERS, 1984


Doctors
Dental Surgeons
Pharmacists
Nurses
Hospital beds
Average per 1000 population
West Bank

Gaza

Israel

Jordan
0.27

0.05

2.9

1.2
0.015

0.10

0.70

0.02
0.14

0.10

0.62

0.33
0.33

0.52

3.6

0.66
1.15

1.4

6.4

1.8

Trends in number of hospitals and beds

76. The Israeli health sector is discussing means for increasing wages, attracting manpower, reducing working hours and organizing annual training courses for workers in intensive care for premature babies and in intermediate level care.

77. Special efforts are being made to increase the average number of doctors and nurses per patient in various fields of specialization, including the care of premature babies, while such requests are considered an intolerable and an exaggerated expense for the primitive health sector in the West Bank.

78. Public hospitals are an essential part of the hospital services available to the population of the occupied territories. In 1967, Palestinians had access to twelve public hospitals as well as three other newly opened hospitals, which reflected the progress that had been made in the development of the health sector.

79. Now, however, after twenty years of occupation, there are nine public hospitals and eight private hospitals in the West Bank, i.e. almost a tenth of the number of Israeli hospitals in 1984. After twenty years of occupation, the Arab medical sector has become disorganized: some departments have no administrators, while others are administered by one specialist.

80. The military authorities have taken control of clinics, maternal and child care centers nursing schools and other health institutions, most of which are grouped in urban areas, far from 75% of village populations. The table below shows trends in the total number of schools and of beds.



Number of private and public hospitals
1979
1980
1981
1982
1983
1984
% of growth
West Bank

Gaza

"Israel"

Jordan
17

7

140

22
17

7

144

35
17

7

146

35
17

7

148

32
17

7

150

48
17

7

152

53
nil

nil

+8.6%

+65.61%
Total number of beds
West Bank

Israel
1,045

25,011
1,021

26,267
1,021

26,579
991

27,247
991

26,430(sic)
951

27,039
-9%

+4%


Specialized clinics

81. In addition to hospitals, clinics provide treatment services. Nonetheless, the state of the latter does not seem to be much better than that of the hospitals. Few specialized clinics exist: five in the West Bank and two in the Gaza Strip, i.e. there is roughly one clinic for every 250 000 people. These numbers show the extent to which treatment facilities are lacking in the occupied territories. Moreover, such facilities are extremely primitive, and there are no dental surgery clinics in the West Bank and Hebron. Furthermore, the occupation authorities have closed two clinics in Ramallah.

Laboratories

82. There are 12 laboratories in the West Bank and two in Gaza; the central laboratory in Jerusalem has been closed. These laboratories are to all intents and purposes useless, as they can only perform primitive tests. Materials for other tests are sent once a day or once a week, depending on the hospital, to Israeli hospitals. The equipment of these laboratories remains old and outdated. No facilities are available to buy modern equipment suitable for more highly developed diagnostic methods.

Radiology

83. Such services are deteriorating. X-ray examinations are not available, since the equipment used today is the same as before 1969. It cannot be used for anything other than taking bone and chest X-rays. There is only one specialist radiographer in the West Bank, yet X-ray technicians work 24 hours a day in the hospitals and some X-ray units have been in use since 1963. It must also be pointed out that the costs of the X-ray and laboratory examinations performed in Israeli hospitals are deducted from the budgetary allocations for health services in the occupied territories.

Blood banks

84. There is one central blood bank in Jerusalem which has six branches in the West Bank. As already mentioned, this bank has been closed. In Gaza, the population donated blood to improve the situation of the blood bank.

Primary health care

85. It is impossible to consider the primary health care system without reference to development plans in general and health development in particular. The following elements will be dealt with as inherent to the primary health care system.

Maternal and child care

86. Primary health care is concerned, in the first place, with the mother and child, as will be shown later. Maternal and child care centers are not available in the occupied territories as they should be. They lack the equipment and human resources which they need to function successfully, and do not have programs of antenatal care for mothers during pregnancy or programs of prenatal care to monitor the growth and nutrition of infants and the main causes of prenatal death. Children represent 48.7% of the population in the occupied Arab territories, but we nevertheless find that the services offered to children there are not sufficient at all. In 1983, the number of beds available for children was only 27.12% of the total number of beds, although children make up almost half the population.

87. Furthermore, we find that children are often examined by generalist pediatricians. In all the West Bank public hospitals, there are only twelve graduate specialized pediatricians. In the West Bank, there are 84 maternal and child care centers and in the Gaza Strip, there are 18 centers. Primary health care is provided in clinics by medical assistants (assistants, nurses and midwives). Midwives continue to play a major role in care at delivery in many rural places. 366 villages in the West Bank have no maternal and child care centers.

Clinics

88. There are 145 government clinics in the West Bank under the military administration. In Gaza there are 21 government clinics. Many of these lack even the equipment needed for primary health care delivery and many essential drugs. The stock of most drugs is exhausted by the tenth day of each month. There are some 305 out of 450 villages without clinics, (whereas each Zionist settlement established in the West Bank or Gaza has a well-equipped clinic). It should be noted that these clinics are not open all week and that they do not receive any emergencies at night. Most of them are visited no more than twice a week by the physician concerned, and even then he does not stay long, because he has to travel back home. Physicians always complain that they have to examine some 20 to 50 patients an hour, which means less than three minutes per patient. In contrast, every Israeli settlement in the West Bank and Gaza has at least one resident physician and one nurse who are on duty throughout the week.

89. Most clinics in the West Bank and Gaza have one male or female nurse, but a number of them do not even have a nurse. Working conditions at these clinics are unsatisfactory, their locations unsuitable to meet the concrete needs of towns and some villages with a population exceeding 10 000 people. The clinics are visited twice a week by a newly graduated general practitioner for two hours each time; for the rest of the week they are manned by an often unqualified nurse.

Trends in infant mortality

90. Infant mortality is an important indicator of the level of primary health care. Therefore rates produced by the Israeli occupation authorities will be discussed here to reveal the extent of the fallacies contained therein; this will be followed by an attempt to present new and more realistic rates.

Biased official infant mortality rates

91. For many years the military occupation authorities have published and disseminated statistics on infant mortality, which the Central Statistics Bureau in Israel has had to revise before recognizing them officially. These statistics show that still births constituted 30 to 38 per 1000 live births in the West Bank during the period 1976-1984. However, the Central Statistics Bureau in Israel has adjusted these figures to read 70 per 1000.

92. With regard to populations of the refugee camps on the West Bank, UNRWA has published statistics on the subject showing that infant mortality among refugee-camp populations ranged between 37 and 84 per 1000 between 1977 and 1984. But it can still be said that there has not so far been a realistic, reliable statistical study in this regard, because most researchers in the field have adopted statistics disseminated by the occupation authorities that are far from being precise. A study conducted in the West Bank indicates that infant mortality rates in the Nablus District have ranged between 100 per 1000 in Hawara and 286 per 1000 in Majdal Bani Fadel.

Health of schoolchildren

93. Preventive activities and health checks for school children and workers remain, according to a report by the Special Committee of Experts, "weak and in many cases are non-existent".

Social welfare

94. Social welfare to supplement health care in the areas of mental health, maternal and child care, and prisoners' health, for example, is non-existent. Moreover, inflation makes it difficult for people to obtain basic food (animal protein) and there is no program of education for health and nutrition.

Health insurance

95. In 1978 the Israeli occupation authorities introduced a health insurance system which was made compulsory for government, village and municipal council employees, including those retired, and optional for the remaining categories. However, the system imposed by the occupation authorities fails to solve the problem of deteriorating health services provided to Arab citizens, because such services are delivered through the governmental health institutions located in the occupied territories which, as we have already mentioned, suffer from a severe shortage of equipment, financial resources and manpower. Upon the introduction of this system, the existing health establishments should have been developed so as to cope with the additional burdens, but this has not happened. Hospital clinics, for instance, were considered as specialized clinics, which does not introduce any new element nor require a new budget, since the specialist is there in the clinic before and after the system is instituted. Clinics staffed by general practitioners should have been opened in the evenings, but this has been done only in 4 clinics in Gaza.

96. Medicaments are not available, in most cases, and the insured have to buy them at their own expense. Furthermore, patients who need laboratory tests or X-rays must resort to private laboratories where the costs are very high, because the state laboratories are not well equipped.

Medical fees

97. The occupation authorities claim that the number of insured persons amounts to 40% of the population of the West Bank and 80% of the population of the Gaza Strip, in order to make the health insurance system appear successful and useful. The statistics available to us show, however, that the number of persons insured does not exceed 20% in the West Bank and 60% in the Gaza Strip, which implies that more than two-thirds of the population in the former and two-fifths of that in the latter are not insured.

98. The table shows medical fees paid by those without insurance in governmental health facilities in the occupied territories. An overnight stay in hospital rose from 220 shekels (about $20) in 1981 to 48 000 shekels ($160) by the end of 1984.


MEDICAL FEES PAID BY THE NON-INSURED
IN THE OCCUPIED TERRITORIES (IN ISRAELI SHEKELS)

Date
One-night
hospital stay
Outpatient
visits
X-ray
Laboratory
January 1981

May 1981

October 1981

May 1982

January 1983

December 1984
220

600

900

1500

4300

4800
10

30

50

100

130

-
30

60

90

200

-

-
30

100

100

300

-

-

99. Israel considers that digging new and deep wells in the occupied territories is against its interests. Zionist policy on supplying water to Arab citizens under the occupation can be summarized as follows:

1. Imposing further limitations on water consumption which have a negative effect on the health conditions of the population.

2. Establishing only a minimum water infrastructure in towns and totally depriving villages of those facilities. The report of the World Health Organization, document A36/13, says that "the salinity of the water and the inadequacy of supplies is a matter of great concern to municipalities, which would like to use their own budgets to dig wells, but face the Israeli government's refusal to authorize them to do so".

100. Israeli claims concerning the development of water resources and the improvement of drinking water supplies in the occupied territories are pure lies. A few villages have chlorinated water supplies. Some 265 villages lack any such facilities or any water supplies at all. They rely totally on nearby springs, wells and river basins.

101. Out of a total of 350 000 villagers, 285 000 do not have access to sources of acceptable drinking water. In other words, nearly 50% of villagers, whose number does not exceed 1000 per village, do not have access to drinking water, either because there is no piped water supply system, or because of lack of chlorination. We can say that 35% of the population of the occupied territories are subject to all kinds of diseases and illnesses as a result of the drinking and use of polluted water. Most of the population of the West Bank get their water supplies from catchments, as is well known. The occupation authorities decreed that the bulk of the water supplies should remain unused and that there should be no real development of those resources lest it had a negative impact on Israel's water supplies. Thus the use of water has continued to be regulated in many areas as it has been for decades, without any development.

102. The annual domestic water consumption rate in the West Bank is about 20m3 per person. The corresponding figure in Israel is 60m3 per person. This rate differs from one area to another in the West Bank. In some villages in the Jenin district where water is drawn from wells, the villager's average annual water consumption is about 7 m3 per person, which is about one-tenth of that of the Israeli citizen.

103. The conclusions of a study published by the Bir-Zeit University in the West Bank on bacteria in the drinking water supplies of eight villages in the Jordan Ghor area state that: "drinking water quality in all the study villages was not acceptable according to the WHO guidelines (10 E. coli/lOO ml of unchlorinated water)." Half the water supplies stored in tanks was not of acceptable quality for use, according to American public health standards (200 E. coli/lOO ml).

104. Jericho is one of the most disadvantaged areas in respect of health and water pollution, since drinking water sources are not only used by humans and animals, but also for washing and cleaning purposes. In winter, water flowing from streams mixes with waste water and refuse before entering the drinking water canal.

Water supplies and sanitation in Gaza

105. Water installations in Gaza are inferior to those on the West Bank. An attitude of deliberate negligence is preventing their development and improvement. In the first place, the refugee camps at Rafah are without any acceptable water supply; in some parts drinking water pipes and the pipes carrying the residual water overflowing from open sewers pass over one another.

106. Inhabitants of Gaza who live at a distance from the main population centers have no central water-supply installation. Furthermore, the salinity of the Gaza water is very high, from 0.7 to 1 thousandth, yet no serious attempt has been made by the military administration to reduce the salinity, which is daily increasing.

107. The towns in the Gaza Strip, Khan Yunis and Rafah, lack the requisite means for purifying waste water. People discharge most of their waste water into open drains.

108. Sewage in the camps is disposed of in cesspits, but there are no arrangements for emptying the pits, so they overflow and stinking pools are formed. During the summer months mosquitoes and other insect vectors of micro-organisms breed around these pools, spreading diseases and skin infections. It is not surprising then that diseases like cholera, typhoid, dysentery and hepatitis occur in these places. Notwithstanding some services performed by UNRWA in the field of environmental sanitation, such as water purification and supply, sewage disposal, drainage, and rodent and insect control, not more than 39.7% of dwellings had drinking water supplies in 1981, for example, which reduced the likelihood of sanitary conditions in the refugee camps being improved.

Environment and sanitation

a. The sewage network and latrines

109. A high proportion of the rural houses in the occupied territories are still not equipped with latrines or a sewage disposal system. On the other hand, four towns in the West Bank have waste water purification facilities.

110. The study on the installation of latrines has shown that this operation led to the appearance of microbes and vectors. It should also be noted that there are no flushing toilets, because they are so expensive. It would appear that the only way of providing these facilities is by paying grants to house owners, who would then be responsible for installing the water closets themselves. This is in fact the method used in developed countries. However, the occupying power intends neither to facilitate this approach nor to relieve the suffering of the Palestinian people subjected to occupation.

b. Food safety

111. Some 90% of the goods (including all types of foodstuffs) imported by the occupied territories come from Israel. These territories are thus an important market for Israeli industry. For the Israeli authorities, of course, marketing Israeli products takes precedence over the health of the inhabitants of the occupied territories. For example, of the 5000 offences related to food safety committed last year, only 580 were penalized, a rate of under 12%.

112. In addition, most of the food shops in the occupied Arab villages sell Israeli goods which do not conform to food safety requirements. Furthermore, the treatment of unpasteurized milk is at the origin of infections caused by micro-organisms such as Brucella, etc. Thus foodborne diseases are constantly encountered.

Health education

113. One of the most important means of improving preventive health services is to develop health education programs. In the occupied territories, however, there are no allocations in the health budget for expanding the health education infrastructure.

114. A large number of inhabitants suffer from poor health or even die owing to lack of any health education program in the Gaza Strip, where numerous diseases persist as a result of lack of knowledge on health matters, bad eating and drinking habits or poor hygiene and sanitation conditions, which could have been effectively dealt with through proper health education.

115. However, none of this has been provided because of insufficient, or nonexistent, budget allocations for such a purpose.

THE EPIDEMIOLOGICAL SITUATION IN THE OCCUPIED ARAB TERRITORIES

Introduction

116. Any independent study to collect information on the spread of disease in the occupied Arab territories faces considerable difficulties. Such difficulties are summed up below:

- the Israeli authorities prevent any unauthorized visits to the occupied Arab territories by specialists from foreign institutes. When authorizations are issued they are often not honored;

- local Palestinian researchers and specialists are not allowed to collect or transmit any information. If they try to do that they will be dismissed from their posts and will be jailed or banned from the occupied territories. One of the main reasons for not mentioning the sources of independent studies is fear of subsequent retaliation;

- the reports of the Israeli government are biased and manipulated to give the unreal impression that the health situation in the occupied territories is ideal.

Spread of disease in the occupied Arab territories

117. Statistics indicate that diseases of the respiratory, digestive (especially among children) and circulatory systems, and mental disorders are the most widespread complaints in the occupied territories, and that 34.5% of all hospital admissions are for respiratory diseases in children.

118. It has become evident from an epidemiological analysis that, despite immunization efforts, outbreaks of a number of communicable diseases still give serious cause for concern. For example, there was an outbreak of diphtheria in the West Bank in 1979 and 1980 and an outbreak of poliomyelitis in children in both the West Bank and Gaza from 1974 to 1980. Measles has also broken out of late in both regions. Such epidemic outbreaks can hardly be viewed in isolation from the immunization program in the occupied territories. The Special Committee of Experts points out that in the Golan Heights vaccines were transported to maternal and child health centers in an unsuitable manner and that there was no refrigerator in one of the clinics it visited. Another report points out that in 1984 the incidence of measles was 14 times as high as in 1983 and the incidence of whooping cough was four times as high, probably for lack of immunization.

119. Despite the allegations of the Israeli authorities that they had immunized 90% of the population of the occupied territories, many cases of epidemic measles occurred during 1981-1982. A study carried out in the Gaza Strip revealed that 1859 cases of measles occurred, that 38.7% of the sufferers had been immunized against the disease and 61.3% had not.

120. Efforts to control diarrhoeal diseases, which rank among the most serious causes of disease and death in Gaza and the West Bank, are being assisted by WHO. However, as pointed out by the Special Committee of Experts, although this strategy for controlling diarrhoeal diseases is helping to mitigate the grave consequences of acute diarrhea, it fails to deal with its extremely complex causes in this region. No change has been reported in the situation regarding intestinal parasitic diseases, and it has been pointed out in a related study that 60% of schoolchildren suffer from intestinal parasites as a consequence of poor sanitation. Enteritis

is a public health problem, as shown by the fact that 84 cases of typhoid fever and 266 cases of dysentery were reported in the West Bank in 1983, and 173 deaths were caused by enteritis. In Gaza, 50 cases of typhoid fever and 25 cases of cholera were reported, and these diseases are related to sanitation, drinking-water and communal behavior patterns. The high incidence of tetanus persists among both infants and old people in the occupied territories.

121. Another health problem in the occupied territories is tuberculosis. Nevertheless, the occupation authorities have closed down the tuberculosis control center in Jerusalem and have also announced their intention of closing down the Birkeh tuberculosis control center in Hebron during 1986. This leaves the area with only one such center, at Nablus. Furthermore, there is not a single chest disease hospital in the West Bank and the capacity of the chest disease hospital in Gaza has been reduced by the occupation authorities from 120 to 70 beds. Leishmaniasis poses another problem in the West Bank, as does goiter, which appears to be endemic in the area. Malaria is endemic in the Jordan valley.

122. Chronic diseases, principally cardiovascular, renal and hematological disorders and cancer, can hardly be dealt with by hospitals in the occupied territories, in view of their very limited facilities.

123. There has also been a very marked spread of viral hepatitis type A in recent years. The number of persistent cases is still large, 1138 cases have been reported in the West Bank and Gaza, and this is another disease related to sanitation and behavior patterns. Calorie-related malnutrition is the most serious problem for paediatric medicine in the West Bank and Gaza.

124. St John's hospital in Jerusalem is the only place in the entire West Bank to provide care for eye patients. It has 82 beds only, the same number as in 1983, and a staff of 10 physicians and 56 nurses who have to serve 44 084 inhabitants, a ratio of 0.5 personnel per 10 000 population. It has been found that 1.7% of the population suffer from acute sight disorders and that the prevalence of blindness there is 133% to 667% higher than the rates recorded by WHO for the world as a whole.

PREVALENCE OF DISEASE IN THE WEST BANK

Ramallah

125. According to studies undertaken by the Palestinian Medical Relief Committee in 1984, some 12% of children in this area suffer from malnutrition and the following diseases: tonsillitis, otitis, mumps, diarrhoeal diseases, measles, bronchitis, rheumatism, hepatitis, typhoid fever, brucellosis and chronic diseases such as hypertension, diabetes and dental and periodontal diseases.

126. Statistics for the Ramallah area illustrate that infant mortality is extremely high, i.e. 160.8 per 1000 children covered by the sample; in individual villages the rates vary from 321/1000 to 143/1000, which yields an overall average of 161/1000. Infant mortality among the Jewish population of Israel, on the other hand, stands at 14/1000.

Hebron

127. According to studies conducted by the Palestinian Medical Relief Committee, there is a high prevalence of infectious diseases such as tonsillitis, otitis media, contagious skin diseases, various diarrhoeal diseases, parasitic diseases, mumps, chickenpox, measles and brucellosis, because of the lack of preventive health measures and awareness. There is also an increase in malnutrition and slum-related diseases such as rheumatic fever and other complaints.

Tulkarem and Jenin

128. Infant mortality is higher here than in any other part of the West Bank. The mortality rate is 136 per 1000 infants in the Tulkarem area and 66 per 1000 among older infants, which is extremely high.

Bethlehem

129. As a result of primitive health services and the outdated hospital in this area, the number of patients referred abroad and to Israeli hospitals for treatment: is higher than in any other district. In the Jericho district 13% of the population have health insurance. It is worth noting too that 31% of children suffer from malnutrition. The Bethlehem district ranks second after Hebron in the West Bank for lack of health services and in the prevalence of skin and gastric diseases, leishmaniasis, and parasitic diseases, in addition to childhood malnutrition. The overall incidence of infectious diseases decreased under Jordanian power between 1957 and 1963 by about 60-70%, an annual decrease of 12-38%. In Jerusalem alone, the decrease for typhoid, measles and meningitis was about 70%. By contrast, during the period of occupation, between 1968 and 1984, the overall number of cases increased by 2.5%. It appears that many diseases were not notified, and were not treated for various reasons. The annual increase was 7%. It also appears that during the occupation period the typhoid fever mortality rate increased by 29%, the incidence of chickenpox by 836% and the incidence of mumps by 925%.

The spread of disease in the Gaza Strip

130. In 1981-1982 the main diseases in the Gaza Strip were in the following order: children's diseases, bronchitis, diseases of the aged, and vaguely defined diseases like heart disease, cerebrovascular diseases and intestinal infections. In 1983 the cancer and respiratory disease rates markedly increased, but the main diseases in children under five were in the following order: neo-natal diseases, respiratory diseases, microbial and parasitic intestinal diseases, and congenital deformities. Public health is also faced with a number of problems, the most important of which is the proliferation of harmful insects and rodents, e.g. mosquitoes and rats. A number of reports indicate a definite increase of mosquitoes and rats during the 1983-1984 period.

Causes of mortality at Gaza

131. In 1967 infectious diseases were the principal cause of death in the population of Gaza. But in 1981 diseases such as coronary heart disease, malignant diseases, diabetes and arterial hypertension, and road accidents, were responsible for over 40% of deaths, the figures increasing in 1983.

132. From 1981 to 1982 the principal causes of death in the Gaza Strip were: prenatal diseases, pneumonia, diseases of old age, coronary heart disease, digestive ailments and cerebrovascular diseases. From 1983 on, malignant diseases and respiratory diseases took the place of the latter two causes of death. The death rate from diseases of the respiratory systems, apart from pneumonia, increased 269% from 1981 to 1983.

Health conditions in Zionist occupation prisons

133. Some 30 to 40 per cent of the population of the occupied Arab territories have been imprisoned at least once since occupation in 1967. In the Fariah prison camp opened in 1982 there were 2161 detainees by 1987, whose average ages ranged between 12 and 25. Children have constituted an astonishingly increasing proportion of the prisoners in recent years. During the first 3 months of 1987, more than 15 students aged 11 to 23 were shot dead by the Israelis, while hundreds were injured during demonstrations demanding an end to the siege imposed on Palestinian refugee camps in Lebanon. Weekly reviews of sentences passed by Israeli courts on Arab citizens show an average of 30 sentences a week, ranging from 6 months to life imprisonment.

134. Health conditions in Zionist occupation prisons have reached such a level that they are a constant violation of all international laws from the moment of arrest onwards. Numerous captives and the reports of the International Red Cross fact-finding missions have testified to the physical and psychological damage resulting from these conditions. The poor and inadequate quantity and quality of food, the lack of drinking water day and night, and water for washing and bathing, sleeping on old mattresses used for many years without being aired, worn blankets, appalling overcrowding in prison cells previously often used as stables by the army prior to occupation, the few narrow windows blocked up by asbestos slabs or iron, the so-called prison clinic operated by Zionist secret service officers and used for intimidating ailing prisoners, empty but for an aspirin tablet or general sedatives, not to mention spraying prisoners with gas, psychological harassment and the penalty of solitary confinement, are but some of the many examples to be quoted. The life of captives in these prisons and the deterioration of their health following captivity are a formidable Zionist scheme designed to annihilate Palestinian captives physically and psychologically despite their steadfastness and their life of continual hardship.

Conclusion

135. This report has attempted to discuss health aspects and related problems in the circumstances occupied Arab territories. Most of these problems can be resolved under normal by local medical and administrative staff working in the public health sector. But in such extraordinary circumstances, and under Zionist occupation of these territories, the solution of such problems is well beyond the capabilities of local workers and health departments.

136. Consequently, the systematic destruction of the health sector under occupation can only be halted by removing the basic cause of such destruction through a political solution based on the aspirations of the population under occupation. The services in the West Bank and Gaza are not adequate to meet the primary health needs of Palestinians living in these areas.

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