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World Health Organization (WHO)
22 May 2006
FIFTY-NINTH WORLD HEALTH ASSEMBLY
Provisional agenda item 13
22 May 2006
Health conditions in the occupied Palestinian territory,
including east Jerusalem, and in the
occupied Syrian Golan: progress report
At the request of the Permanent Observer of Palestine to the United Nations and Other International Organizations at Geneva, the Director-General has the honour to transmit the attached report to the Fifty-ninth World Health Assembly.
Ministry of Health
HEALTH CONDITIONS IN THE OCCUPIED PALESTINIAN
TERRITORY, INCLUDING EAST JERUSALEM
Report presented to the Fifty-ninth World Health Assembly
1. Health services in the occupied Palestinian territory are on the verge of collapse. However, the Israeli occupation authorities, bound by international humanitarian law to provide Palestinians who have been under occupation since June 1967 with health services, continue to impose a blockade on the Palestinian health sector. The Palestinian Ministry of Health, which provides all Palestinians in the occupied Palestinian territory with medical services, is no longer able to perform its essential duties because of lack of funds and the lack of the necessary medical equipment and medicines; the Israeli military and economic blockade imposed on the occupied Palestinian territory; the refusal of the occupation authorities to pay the Palestinians the tax revenue to which they are entitled, and the denial of assistance to them. Health sector personnel, including emergency workers and ambulance men have also been targeted by Israeli occupation forces and many of them have been killed. In these circumstances, the Palestinian people appeal to the international community to help them put an end to the occupation, lift the Israeli blockade imposed on them and on the Palestinian health sector, protect the latter’s health workers and contribute to the sector’s reconstruction.
THE ECONOMIC SITUATION AND ITS IMPACT ON HEALTH STATUS
2. WFP is expecting a 25% increase in the number of people requiring food aid in the occupied Palestinian territory in the next months. Christiane Berthiaume, the Programme’s spokesperson, ascribed the increase to the irregular flow of foodstuffs through border checkpoints controlled by Israel and the suspension of fund transfers to the Palestinian Government. She said that, since salaries are no longer paid, there will be an increase in the number of people requiring food aid. According to the World Bank, the salaries paid to the 140 000 Palestinian civil servants help to support 23% of the Palestinian population.
3. WFP provides aid to 432 000 people in the occupied Palestinian territory; its aim is to secure food for 480 000 people, and the number of those needing aid could jump to 6 000 000 if the current economic situation deteriorates further.
4. The United Nations Office for the Coordination of Humanitarian Affairs in the occupied Palestinian territory, has warned against the deterioration of the humanitarian situation there, ascribing the present crisis to Israeli restrictions on the movement of Palestinians, recurrent military operations, land expropriation, demolition of houses, the building of the “apartheid wall”, and the withholding of tax revenue owed by Israel to the Palestinian Authority – the value added tax and customs duties collected by Israel on behalf of the Palestinian Authority.
5. The United Nations Office for the coordination of Humanitarian Affairs in the occupied Palestinian territory is requesting the Israeli Government to transfer the tax revenues owed to the Palestinian Authority, to shoulder its responsibility for providing humanitarian assistance to the Palestinian people and to stop hindering the assistance provided.
6. Human rights bodies and organizations are warning against the further deterioration of the economic and humanitarian situation in the occupied Palestinian territory because of the continuation of the Israeli blockade and the suspension of western assistance. The World Bank stresses that the suspension of the transfer of revenue owed to the Palestinians, the imposition of restrictions on their movement, and on access to jobs, and the hampering of the flow of international relief aid will cause tremendous economic damage, thus reducing per capita gross domestic product by 27% this year and per capita revenue by 30%; as a result, the unemployment rate will reach 47% and the poverty rate 74%.
7. The Quartet’s Special Envoy for Gaza Disengagement, Mr James Wolfensohn, stated recently before a Congressional hearing, that 940 000 Palestinians (nearly a quarter of the Palestinianpopulation in the occupied territory) rely directly on salaries paid by the Palestinian Authority.
8. As more than 50 000 Palestinians are employed by the health and education sectors, the continuing suspension of financial support for these vital sectors will lead to a severe shortage of essential and vital services such as education, health care, water supplies and sanitation facilities, and may even lead to their total disruption. The Palestinian Ministry of Health operates nearly 60% of primary health care clinics and is responsible for immunizing, respectively, 85% and 25% of children in the West Bank and Gaza. Donors finance 87% of the operating budget of the Ministry of Health. The collapse of health services and of the educational system that addresses the needs of one million children will have tragic implications for the Palestinian people. The Ministry of Health provides 47% of health services, and UNRWA 25%; private-sector institutions and nongovernmental organizations are responsible for providing 16% and 12% of services, respectively.
9. Mr Wolfensohn, at the Congressional hearing, said that the Karni crossing, between the Gaza Strip and Israel, which is the only route for cargo traffic to and from Gaza, is often and repeatedly closed for lengthy periods of time. The crossing has been closed for 51% of the time since the beginning of the year. Such closures lead to serious shortages of dairy products, flour, fruit and chemicals, in addition to severe shortages of medicines, medical equipment and laboratory substances.
10. In this respect, Mr Pierre Kraehenbuehl, Director of Operations of the International Committee of the Red Cross, stated that under international humanitarian law, Israel, as an occupying power, is responsible for meeting the basic needs of civilians in the occupied Palestinian territory; and that that also included providing them with food, medical supplies, housing and other essential requirements.
THE IMPACT OF THE ISRAELI OCCUPATION ON THE QUALITY OF LIFE OF
THE PALESTINIAN PEOPLE
11. A survey conducted in December 2005 by WHO in collaboration with local research institutions, into the quality of life of the Palestinian population in the occupied Palestinian territory has revealed the following:
• A total of 25% of the Palestinian population suffer from physical and health problems that are detrimental to their quality of life.
• A total of 38% of the population rarely, if ever, enjoy simple daily activities; the same population suffers from frustration, tension and boredom.
• Some 25% of the population suffer from mental problems on account of the killing or imprisonment of their relatives, and their being obliged to pass through Israeli checkpoints and obstacles on their way to their jobs or to schools, or because they live in the vicinity of Israeli settlements, as is the case of 25% of the population on the occupied West Bank.
• Some 20% of the population live near the apartheid wall, which affects them severely, both emotionally and mentally.
• More than half of the Palestinian population are not satisfied with their lives; 68% of them fear for their future and 73% of them have been subjected to humiliation at the hands of the Israeli occupation forces, and feel shocked by the continuing siege and recurrent closures, and the building of the apartheid wall.
WAVE RADAR DEVICE
12. The Israeli authorities continue to violate the right of the Palestinian population to privacy and by so doing, they jeopardize their right to enjoy health. The Israelis have brought a new device called the Safe View Millimeter Wave Radar from the Rafah crossing to the Beit Hanoun checkpoint, the Al Karama crossing and other crossings – through which thousands of travellers and workers pass daily – to frisk them. This device is a very sophisticated, American-made machine that uses holographic millimetre wave technology to frisk Palestinian travellers and workers. This see-through laser radar constitutes an infringement of the privacy and modesty of the population, especially women, and is a health hazard to them.
13. Each year, 3000 new mental patients are added to the list of the mentally ill in the occupied Palestinian territory; 13% of them suffer from schizophrenic disorders, 15% from neuroses, and 27% from affective disorders. The mental clinics admit more than 100 000 patients each year.
14. The Palestinian Ministry of Health responded to WHO’s recommendation on avian influenza by setting up a comprehensive multisectoral strategy covering both human and veterinary health. Implementation of the strategy was ensured through cooperative efforts with different local and international institutions as soon as a declaration was made concerning the detection of avian influenza virus in parts of the occupied Gaza Strip.
15. The plan was and is still being applied to “complex emergency” situations, as described by WHO. Such situations are characterized by the absence of security in most Palestinian regions, owing to Israeli practices of reoccupation and dismemberment of towns and villages, leading to their isolation from their rural environment and limiting prompt access to health and veterinary services.
16. The apartheid wall, the isolation of the Gaza Strip from the West Bank, the frequent closure of crossing points and the presence of barriers and checkpoints are all factors that impede and obstruct implementation in accordance with the timetable set for the plan. Limited financial capacity plays an important obstructive role, especially in compensating farmers affected by this epidemic.
17. The weak capacity of the Ministry of Health to diagnose this disease among humans and our inability to diagnose it in poultry due to the lack of a specialized public health laboratory caused a considerable delay in taking the necessary preventive measures at the right time. Accordingly, the Palestinian Ministry of Health calls on the international community and organizations concerned with health to work to:
• bring political pressure to bear on Israel to stop its inhuman practices, which flout all international agreements, and to allow health and veterinary teams to carry out their duties during this critical time;
• provide the necessary support to Palestinian health and veterinary institutions and, in particular, help the establish an advanced public health laboratory to carry out diagnostic tests for avian influenza in humans and animals;
• provide direct financial assistance to governmental health and veterinary institutions to enable them to continue the implementation of the national plan for avian influenza control;
• bring pressure to bear on the occupying authorities to allow the head of the national commission on avian influenza and his staff to move freely between the Gaza Strip and the West Bank and between different towns and villages in the West Bank in order to follow up and monitor implementation of the plan.
18. We call on the international community and international health institutions to provide assistance in the above-mentioned areas to enable us to protect the region’s population, given that neither boundaries nor barriers can stop the spread of infectious diseases.
19. A statistical report showed that there were 260 Palestinian martyrs and that 1693 Palestinians were wounded in the occupied Palestinian territory during the period from 8 February 2005 to 17 April 2006.
20. The report also mentioned that during the period following the pacification agreement, there have been 34 507 Israeli violations, including 3422 shooting incidents in which 260 Palestinian citizens were killed, 1693 wounded and 7057 arrested.
21. The report also reaffirmed that during the same period, the total area of land confiscated by the occupying authorities was 36 333 donums, while there were 219 acts of felling and uprooting trees. The report further stated that colonists committed 679 aggressions against citizens in different parts of the occupied Palestinian territory. The number of fixed Israeli barriers in the West Bank increased to 505, in comparison with 376 in August 2005. The report showed that there had been tens of cases of detentions of citizens and of persons being denied passage across international crossing points, as well as shelling of residential areas, house raids and continued construction of the apartheid wall.
22. The report confirmed the respect of the pacification agreement shown by the Palestinian side, in spite of continued exposure to arbitrary measures by the Israeli occupying forces, their perpetration of all types of violations against the rights of the Palestinian people, using their full military capacity and causing great physical, human and moral damage among the Palestinian people.
23. Continued Israeli shelling of the northern and eastern parts of the Gaza Strip, involving bombardment with some 400 sea-to-land missiles and daily shelling, has caused great difficulty for people living in those areas, compelling large numbers of Palestinian families to abandon their homes. This has also further hampered access to health services and delivery of medical material necessary for hospital and medical care in the area.
SHORTAGE OF MEDICINES
24. The Palestinian Minister of Health has warned of a possible humanitarian crisis on account of a continued Israeli ban and hasty decisions by the United States of America and the European Union that have led to the interruption of aid to the Palestinian people. He has indicated that there is a severe shortage of medicine stocks in the Ministry of Health’s stores, because of the continued blockade of the Gaza Strip by Israeli forces and their closure of commercial crossing points.
25. The Ministry of Health has also confirmed the depletion of the strategic medicines reserve, which is kept for emergencies. Hospitals are suffering from acute shortages of medicines necessary for the treatment of cancer, cardiovascular diseases, high blood pressure and diabetes. There is also a severe shortage of medicines for kidney patients, as well as of kidney dialysis solutions and disinfectants for dialysis equipment. There is, in addition, an acute shortage of surgical material such as thread, anaesthetics and medical gauzes. Hospitals are also suffering from frequent shortages of food supplies necessary for their patients.
26. The Ministry of Health requires US$ 4 million monthly to cover its operating costs alone (excluding salaries). Frequent closures cause the interruption of hospital activities and prevent the delivery of much international assistance.
27. The Organization Médecins du Monde has warned against the interruption of direct financial aid to the Palestinian Authority, as the current alarming situation could deteriorate even further given the increase in poverty and the rising level of unemployment among Palestinians.
RESTRICTIONS IMPOSED ON HUMANITARIAN SERVICES AND ATTACKS ON
28. The unremitting repression by the Israeli occupation forces has not spared the health sector. Health-sector institutions, including the Ministry of Health and several other institutions such as the Palestinian Red Crescent Society, the International Committee of the red cross and UNRWA have been exposed to violations of their rights and attacks by the occupying Israeli army in the occupied Palestinian territory. These acts have involved repeated incursions against the unarmed Palestinian population and the health sector, summary executions, military operations against civilian population and obstruction of humanitarian assistance.
29. There were 383 attacks by the Israelis on ambulances; 38 ambulances were completely destroyed and 2051 denied access to where they were needed to provide care. There were 375 attacks on health establishments. A total of 447 health workers and ambulance drivers were wounded while performing their duties; 36 health workers and ambulance drivers were killed while performing their duties. 75% of medical personnel are unable to attend for work on account of the dismemberment of the country; this has resulted in the deterioration of medical services and vaccination levels, and interrupted mother-and-child care programmes.
30. The Ministry of Health calls on the international health institutions to bring pressure to bear on the occupying Israeli authorities to cease their attacks on Palestinian health establishments, ambulances and medical personnel and to comply with international agreements.
RESTRICTIONS IMPOSED ON PATIENTS
31. Since the beginning of 2005, the Israeli authorities have prevented 1823 patients, i.e. 37% of patients needing special treatment, from receiving such treatment in hospitals in Israel and the occupied West Bank, including east Jerusalem, and 562 patients between January and the end of April 2006. Of those patients, 40% were women and 35% children. The patients were suffering from the following conditions: congenital heart malformations affecting neonates and children; infant blood disorders; tumours; conditions requiring heart catheterization; conditions requiring eye surgery and corneal grafts; conditions requiring diagnosis by magnetic resonance imaging; nosocomial infections; and conditions affecting premature children and requiring intensive care.
32. It has to be mentioned that since 25 January 2006, the Israeli authorities have banned the admission of new patients (with the exception of emergency cases) to Israeli hospitals and hospitals in the occupied West Bank, and allow follow-up treatment only of former patients (women aged over 35 and men aged over 40).
THE APARTHEID WALL
33. The United Nations Office for the Coordination of Humanitarian Affairs in the occupied Palestinian territory, which closely monitors issues raised by the building of the apartheid wall, has reported that by last October approximately 75% of the wall had been built on occupied territory in the West Bank and 25% in the area of the pre-1967 frontier.
34. The wall and the colonies cut off entire communities from the main health services such as the al-Uyan and al-Maqasid hospitals in Jerusalem, thus endangering the more than 70 000 Palestinians who hold residence permits for Jerusalem. The wall also poses a threat to the town of Qalqilia, as it seriously hampers access to the town’s only hospital by its 46 000 inhabitants, transforming a 20-minute trip into a journey of three and a half hours. In addition, 80 000 Palestinians have difficulty attending health services in Ramallah and Jerusalem; 35 000 have inadequate health services and 5000 none at all. The wall has also isolated entire regions from one another, hindering access to health services, as for example at Jenine, Selfite, Kalandia and Bethlehem.
35. The Ministry of Health calls on States and health institutions to bring pressure to bear on the Israeli Government to comply with the decision of the International Court of Justice in the Hague concerning the halting of the building of the apartheid wall, the demolition of the parts already built and the payment of compensation to the Palestinians for the huge moral and physical injury suffered.
DETAINEES: 20 000 CITIZENS, 500 OF WHOM ARE CHILDREN, DETAINED
SINCE THE BEGINNING OF 2000
36. Between 1967 and March this year, the Israeli occupation forces arrested more than 650 000 citizens, 9499 of whom are still held in 30 Israeli prisons and detention centres, and 421 of whom have been imprisoned for more than 10 years. Between the declaration of pacification at the end of February 2005 and March 2006, they arrested more than 4000 Palestinians.
37. Since 1967, a total of 183 detainees have died: 72 were assassinated after their arrest, 69 died under torture in Israeli prisons and detention centres and 42 died from lack of medical care. Since 1967, the Israeli occupation forces have arrested some 10 000 women, 500 of whom have been arrested since 2000; 120 women are still in prison, five of them are not yet 18 years old and 16 are mothers separated from their children (some 60 in all). In addition, more than 4000 children have been arrested since 2000; 330 of them are still imprisoned and 70 are suffering from various illnesses because of lack of proper care and treatment.
38. The treatment meted out recently to Mrs Samar Sbeih, a prisoner in the Israeli prisons, was despicable. Mrs Sbeih was transferred from prison to the maternity hospital with her hands and feet in chains, undressed in the full view of the Israeli soldiers while she was searched, and gave birth to her first child, who will live with her in prison – the world’s youngest prisoner. This incident should stir the international community, humanitarian organizations and human-rights organizations into vigorously defending the rights of Palestinian prisoners in general, and those of women and child prisoners in particular.
39. The Ansar Assajin association has identified 76 cases of torture by Israel of prisoners, of whom more than 98% have been beaten and 60% placed in morgue body chambers, a common practice in Israeli prisons. Some 32% of tortured prisoners carry physical sequelae, 38% suffer from serious mental and obsessive-compulsive disorders and 48% from depression on account of the treatment received in prison. For these reasons, we urgently implore the human rights organizations to investigate the practice of torture in Israeli prisons, to verify that it exists and to monitor unlawful Israeli practices against Palestinian detainees.
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