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Source: World Health Organization (WHO)
25 April 1988

Permanent Mission of the Palestine
Liberation Organization to the
United Nations Office at Geneva

Geneva, 25 April 1988



Dr H. MAHLER
Director-General
World Health Organization
1211 Geneva 27




Dear Sir,

Enclosed, please find the report on the Health Conditions in the Occupied Palestinian Territories, established by the Palestine Red Crescent Society.

We, hereby, kindly request you to publish this report as an official document of the 41st Session of the World Health Assembly, and to distribute it to the participants as such.

I avail myself of this opportunity to renew to you, Dear Sir, the assurances of my highest consideration.





Nabil RAMILAWI
Director
Permanent Observer of the PLO to the UNO



Encl.




WORLD HEALTH ORGANIZATION
6 May 1988




FORTY-FIRST WORLD HEALTH ASSEMBLY

Agenda item 33



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 to the United Nations Office at Geneva, the Director-General has the honor to submit the attached report 1/ to the Forty-first World Health Assembly-for its information.




----

1/ See Annex.



Permanent Mission of the Palestine
Liberation Organization to the
United Nations Office at Geneva

Geneva, 25 April 1988



Dr H. MAHLER
Director-General
World Health Organization
1211 Geneva 27




Dear Sir,

Enclosed, please find the report on the Health Conditions in the Occupied Palestinian Territories, established by the Palestine Red Crescent Society.

We, hereby, kindly request you to publish this report as an official document of the 41st Session of the World Health Assembly, and to distribute it to the participants as such.

I avail myself of this opportunity to renew to you, Dear Sir, the assurances of my highest consideration.





Nabil RAMILAWI
Director
Permanent Observer of the PLO to the UNO





Encl.







WORLD HEALTH ORGANIZATION A41/INF.DOC./7
6 May 1988




FORTY-FIRST WORLD HEALTH ASSEMBLY

Agenda item 33



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 to the United Nations Office at Geneva, the Director-General has the honor to submit the attached report 1/ to the Forty-first World Health Assembly-for its information.


----

1/ See Annex.





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


CONTENTS
PAGE
    INTRODUCTION
4
                                                                                                                                                                                                                                                                                                                                                            PART I
    DETERIORATION OF HEALTH CONDITIONS IN THE OCCUPIED ARAB TERRITORIES
6
                                                                                                                                                                                                                                                                                                                                                            1.
    Socioeconomic situation
6
    A. Changing the demographic map
    B. Land seizure
6
6
    (1) Settlement in the West Bank
    (2) Settlement in Gaza
    (3) Settlement in the Golan
    (4) Settlement and the contraction of cities
7
7
8
8
    C. Seizure of Arab water sources
    D. Destruction of economic and social infrastructure
    (1) Economic policy of the occupation authorities
    (2) Social policy of the occupation authorities 16

    2. Health conditions

    A. Deterioration of the health infrastructure in the occupied Arab territories (1) Planning
    (2) Pharmaceutical industry
    (3) Health structures in the West Bank
    (4) Health structures in the Gaza Strip
    (5) Medical supplies and equipment
    (6) Health manpower
    (7) Trends in numbers of hospitals and beds

    B. Primary healthcare

    (1) Infant mortality and preventive measures
    (2) Health insurance
    (3) Water supply and sanitation services
    (4) Environmental conditions and sanitation

    C. Epidemiological situation
10
11
11
18

14

14
15
15
15
16
16
17
17

17

18
18
18
18

24
                                                                                                                                                                                                                                                                                                                                                            PART II
    DETERIORATION OF CITIZENS' HEALTH CONDITIONS, HOSPITALS AND HEALTH CENTERS
    IN THE OCCUPIED TERRITORIES

    A. Practices and tools of Israeli oppression and the deterioration of citizens’ health conditions

    1. Live ammunition
    2. Tear gas, chemical gas-and nerve gas, causing death and abortion
    3. Rubber bullets
    4. Beatings, crushing and breaking bones
    5. Curfew
    6. Closure of access roads and establishment of check-points
    7. Restrictions on provisions and medical supplies
    8. Violations of holy places and aggression against the clergy
    9. Aggression and oppressive practices by settlers
    10. Demolition of houses and other measures
    11. Detention
    12. Deportation
    13. Burial alive

    B. Aggression against medical teams and health Establishments

    1. Storming hospitals and breaking up equipment
    2. Aggression against physicians and health workers
    3. Preventing ambulance vehicles from carrying casualties to hospital
    4. Making the work of hospitals impossible
20


20

20
21
23
23
25
25
26
26
26
28
28
29
29

30

30
32
33
33
    CONCLUSIONS

    REFERENCES AND NOTES
33

35
    APPENDICES

    1. Statistics on abortions, December 1987 - 31 March 1988
    2. Statistics on total number and distribution of injuries,
    10 December 1987 - 31 March 1988
    3. Number of arrests by age group, 10 December 1987 – 31 March 1988
    4. Number of martyrs by causes of death, December 1978 - 31 March 1988
40

41
42
43

INTRODUCTION

The purpose of this report is to provide an objective view of the health conditions of the inhabitants of the occupied territories, including Palestine, proceeding from the World Health Organization's definition of "health" as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

This definition implies that the health conditions of any people cannot be separated from overall social conditions. As far as the Palestinian people are concerned, this inseparability of health and social conditions is becoming increasingly important in theory and practice, because the Palestinian people are suffering under the Israeli occupation authorities, which impose difficult conditions hampering any true improvement of health conditions, as mentioned in the successive reports of the Special Committee of Experts. 1/

The Special Committee of Experts stated that "it is not possible in the light of the prevalent situation to speak of a genuine political commitment to improve health", 2/ as the Israeli occupation authorities carried on practices that are inconsistent with laws, agreements and international custom, in order to destroy the basic infrastructure of Palestinian society in every respect: economic, social, educational and health.

The Israeli authorities have increased the viciousness of their practices as the occupation has continued, with greater severity and on a larger scale last year, so much so that life has become unbearable to the Palestinian people. They had no choice but to rise in protest against the occupation authorities and their practices, which were inconsistent with the simplest code of human rights, and to express their undying hope of putting an end to the Israeli occupation and securing their national, human, legitimate and just rights, first among which are the right to return, the right to self-determination and the right to establish an independent Palestinian State under the leadership of the Palestine Liberation Organization, the sole legitimate representative of the Palestinian people.

The overall situation in the occupied territories is not conducive to the improvement of the health conditions of the Palestinian people because it is not possible, as was stressed by the Committee of Experts to "achieves complete state of physical, mental and social well-being when the population is obliged to live under the authority of the occupying power". 3/

The truth is that the situation is now at its worst, as the Israeli authorities resort increasingly to different forms of repression to confront the uprising of the Palestinian people; i.e. different types of arms, even those forbidden by international law, tear gas, severe beatings, collective punishments, i.e. curfews, food and medical embargoes, detention, deportation, attacks on hospitals, health establishments and hostels, as well as other ways and means of repression which will be discussed later. This report covers the recent deterioration of health conditions, the situation in hospitals, forms of Israeli repression, different collective punishments and their direct and indirect impact on health.

The importance of this report, brief as it is, lies in the fact that it aims at clarifying the extent of the deterioration of health conditions in the occupied Arab territories, especially during the final months of last year and the early months of this year, in circumstances where the Israeli Government refused to permit the Committee of Experts to visit the territories and submit its report to the World Health Organization.

If the Palestinian people had the opportunity to participate in achieving the noble objective of the World Health Organization, i.e. "Health for all by the year 2000", they would have been actively pursuing the efforts to attain health for all instead of acting as a mere recipient.

The Palestinians - individuals, families or as a society - should be those who decide on, initiate, and carry on activities concerning the development of their health services. We still have a long way to go to fulfil the basic truth that is continuously stressed by the decisions and guidelines of the World Health Organization, and underlined by the observations and reports of the Special Committee of Experts, which stated that "health problems can be solved only to the extent that the political problem can be solved." 4/ and that "the questions drafted by WHO so as to find out to what extent the national strategies for health for all could be applied to the territories ... are not applicable within the context prevailing in the occupied territories ... there can be no genuine health promotion without peace, freedom and justice". 5/
PART I

DETERIORATION OF HEALTH CONDITIONS IN THE
OCCUPIED ARAB TERRITORIES


1. SOCIOECONOMIC SITUATION

The socioeconomic situation of a people is closely linked to health conditions. As mentioned in the report of the Special Committee of Experts, document A35/16: "There is an undeniable relationship between health and socioeconomic development. For that reason, the Committee considered that it would be useful to study the socioeconomic situation of the occupied territories before examining the health situation". WHO reports state that it is impossible to attain the objective of Health for all by the year 2000 unless efforts are intensified and harmonization is achieved between the health sector and other socioeconomic development sectors, including education., agriculture, water supply, environmental protection, etc.

In document A34/17 the Special Committee of Experts states that "it considers that the sociopolitical situation existing in the occupied territories is favorable neither to the improvement of the state of health of the population concerned nor to the full development of services adapted to the promotion of human welfare".

The policy of the occupying authorities in the occupied Arab territories does not undertake to solve socioeconomic problems; their aims are instead military, expansionist and zionist, in other words, appropriation of Arab land to set up in it Greater Israel. For that purpose, they practice all kinds of arbitrary and inhuman actions against the, local Arab population, with a view to:

(a) changing the demographic map in the occupied Arab territories;

(b) seizing Arab lands and water sources, and building settlements; and

(c) destroying the socioeconomic infrastructure so as to drown the national independent identity.

A. Changing the demographic map

In 1967 the estimated Palestinian population in the West Bank and Gaza Strip was 1 300 000. In 1982, the population remained the same, despite the fact that the growth rate of the Palestinian population is among the highest in the world (3.9), as indicated in a report by the Special Committee of Experts (A36/14). In other words, the population should be about 2-2.3 million, which leads us to conclude that one million Palestinians have been driven out of their land. In another report (document A35/16, paragraph 2.2) the Special Committee of Experts points out that more than 45% of the population is under 15 years of age, and less than 7.9% is over 55 years of age. If the demographic projection and the mortality statistics are accurate, the other possibility is that there is a very high rate of emigration from the West Bank and Gaza. "From 1976 to 1980 some 10 000 people emigrated each year from Gaza and did not return. In the West Bank, emigration varied from 17 000 to 24 000 per year between 1977 and 1980. This substantial emigration would appear to be essentially attributable either to the deteriorating socioeconomic situation or to political reasons."

B. Land seizure

The Israeli presence in Palestine and the occupied Arab territories is the worst kind of racist colonization, for the occupying authorities resort to all military and terrorist methods to get hold gradually of Arab lands and create settlements. In the West Bank, for instance, the occupying authorities had by 1985 taken possession of more than 52% of the Arab territories which are estimated at 5.5 million dunums:



The Jewish settlement of the Arab territories occupied in 1967 started with the destruction of 160 houses adjacent to the Holy Mosque, the confiscation of 600 houses in the same area and the deportation of some 6500 people to remote areas. To install the settlements, whole cities and villages were destroyed, such as the villages of Balo, Badu and Amnas.

A centralized plan was applied to concentrate Israeli settlement in Jerusalem and the surrounding area. Consequently, the number of Jewish settlers in East Jerusalem and the nearby occupied Arab territories exceeds 110 000, and the aim is to absorb 700 000 under the Greater Jerusalem project, together with 400 000 others in the rest of the West Bank.

It is known that Israel is more capable of occupying and confiscating territories than judaizing them, because of the small size of the Israeli population and the low rate of emigration to Israel compared with the area of the occupied and confiscated lands.


(1) Settlement in the West Bank

In recent years the Israeli settlements have grown dangerously in and around the West Bank cities. After Israel had annexed Jerusalem, it launched an intensified action to create three settlements in Hebron, i.e. Kiriat Arba, Orosh Sortom and Alon Shalon. After completing the chain around the city, it decided to allow Jewish settlements inside the city of Hebron, following repeated aggression against Abraham's sacred tomb in that city in order to transform it into a Jewish temple, and taking possession of the "Doubia" building in the center of the town.

Under such plans many groups of settlements have been created, among them the "Riman" group to the west of Jenin, which is composed of four settlements, and the "Sanuz" group which extends from Nablus to Tulkarem and comprises seven settlements.

Moreover, many other settlements have been created in the West Bank. Altogether, 52-54% of the West Bank territories, i.e. 2 816 000 dunums, 1/ have been confiscated.

(2) Settlement in Gaza

By 1984, the occupying authorities had installed 22 settlements in the Gaza Strip. For that purpose, 38% of the Gaza territories were confiscated, even though the total area of the Strip does not exceed 500 km2 and it is one of the most densely populated regions in the world.

(3) Settlement in the Golan

In 1967, Israel occupied the Golan and other Arab territories. For expansionist purposes, the Israeli Government issued a law proclaiming the annexation of the Golan to Israel, thus infringing the principles of international law. By the end of 1982 there were 41 Israeli settlements in that region. 2/

(4) Settlement and the contraction of cities

The number of settlements in the West Bank, Gaza and the Golan is 224, and there are also 25 military settlements. 3/

As a result of the settlement policy applied in the Arab territories, Arab cities were deprived of the lands seized for the construction of settlements and could not use them to cope with the growth of the Arab population. Accordingly, the occupying authorities apply all kinds of arbitrary measures to suppress the Arab population and deprive it of its right to remain in its own land. These arbitrary measures include:


- preventing municipal councils from enlarging their municipalities, by issuing the City Organization Act;

- making the procedure for issuing building permits to Arabs very difficult;

- destroying houses in an arbitrary way;

- hampering attempts to set up cooperative associations for the inhabitants so as to prevent Arabs from constructing cooperative housing;

- preventing public services from reaching Arab areas where there are plans for building.

Thus the Israelis not only seize the territories, but often follow this by plundering water sources, destroying the economy of the region, supporting action taken by settlers against the Arab population (as will be shown later on), and changing the demographic features of those regions.

The Israeli settlements, therefore, have dangerous social repercussions. Depriving people of the right to build forces them to live together and delay marriage. This produces dangerous social and health effects and threatens the existence of the Palestinian family in the occupied territories.

It must be pointed out that these Israeli practices totally infringe Article 25(l) of the Universal Declaration of Human Rights, which states that "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services... ". Moreover, these practices violate many international charters, agreements
and laws.

C. Seizure of Arab water sources

Assertion of the Zionist presence in the land of Palestine, taking the form of confiscation of Arab lands to install settlements, has been followed by seizure of Arab water sources. The Israeli occupation authorities have taken over more than 80% of the water sources in the West Bank.

The Israeli occupation authorities consider the waters of the West Bank a mere reservoir for Israel. To maintain this situation, they have resorted to various methods in order to keep Arab waters well under their control:

(1) Since the commencement of the occupation they have exploited the water of rivers and wadis, drawing 6 million m3 from the Jordan, Wadi Al-Ouga and Wadi Al-Kalat.

(2) They have seized certain artesian wells and obstructed others. They have demolished 140 water pumps connected to the Jordan river to irrigate the Ghors. In 1979 they demolished irrigation ducts providing water to government orchards.

(3) They have forbidden the Arab inhabitants to dig new artesian wells unless they obtain a prior authorization, difficult to get, from the occupation authorities. The Arab inhabitants are strictly forbidden to dig wells in regions adjacent to the borders of 1967. When permission is obtained to dig an Arab well, the control is extremely severe as it is not allowed to go deeper than 60 m, though wells dug by the occupation authorities may reach as much as 500 m in depth thus drying up Arab wells. The occupation authorities have drilled 29 deep wells for Israeli settlements, thereby diverting more than half the water volume produced by 314 Arab wells.

(4) They have exerted pressure on Arab farmers by limiting the amount of water they are allowed to draw. An Arab farmer is not allowed to draw more than 25 m3 per year from each wall, whereas the settlers are allowed as much as 537 m3. The Israeli occupation authorities have installed meters to measure the amount of water used by Arab municipalities, villages and farmers. A severe penalty is imposed on a farmer exceeding the permitted amount. It is worth mentioning that there is a daily check to ensure that Arab farmers do not draw more water than permitted, while no such constraints exist for Israeli settlements.

(5) Most of the water used by the Israeli occupation authorities comes from the West Bank, so for them it is out of question to leave the water sources in Arab hands. Consequently they have exerted pressure on town and village community leaders to ensure that Arab water supply systems are connected to the Israeli ones so that the occupation authorities can control them and keep them under their domination. In September 1982 the occupation authorities authorized "Mkordet", the Israeli Government Company responsible for water supplies, to confiscate wells and water sources in the occupied West Bank in order to control an important source of Arab water supplies. The pretext given by the occupation authorities is that the company supervises water distribution to the population and the farmers. The truth is that its work aims at improving the position of settlement projects, enhancing the settlements and serving the Israeli armed forces: troops in the West Bank, whether stationed there or mobile.

D. Destruction of economic and social infrastructure


(1) Economic policy of the occupation authorities

The occupied territories suffer from an economic situation characterized by paralysis and complete stagnation resulting from various policies and endeavors by the occupation authorities to jeopardize the national economy. The economic policy of the occupation may be summarized as follows:

a. Destruction of almost all the basic infrastructure of the occupied territories and weakening of their economy and institutions through:

(i) Arbitrary practices in various areas of social and economic life, as mentioned before, such as requisition of land and water resources, condemning agriculture, industry, tourism, education, housing and all other aspects of economic development to backwardness, and dealing a serious blow to municipal and community institutions.

(ii) Weakening of productive enterprises in the occupied territories, or attempts to undermine their work through inequitable practices such as:

(a) Prohibiting any laws or other assistance to be extended to these enterprises, either within or from outside the occupied territories, by development or agricultural banks. Furthermore, in accordance with military orders Nos. 7 and 194, the authorities have closed all our banks that were in operation before 1967.

(b) Imposing constraints on the marketing of produce, or subjecting this produce to competition from Israeli production, which means that is impossible to market such produce either within the territories or outside.

The report of the US State Department on human rights in the occupied Arab territories mentions that Israeli controls on West Bank exports are hampering their marketing opportunities. Israel has laid down new conditions for the construction of new factories and for financial imports from the Arab world by requiring a special authorization for amounts exceeding one thousand dollars. The Israeli authorities have also forbidden Palestinians as from 1983 to use check books or other financial facilities. There are restrictions on the entry of Arab capital to the occupied territories for use in educational or humanitarian programs.

(c) Taxation policy: the occupation authorities impose high taxes on Palestinian merchants and shops and on production enterprises. Arab citizens are therefore faced with the alternative of paying the imposed tax or closing their shops and having their merchandise confiscated, while facing the possibility of imprisonment. The occupation authorities have changed all the tax rates in the occupied territories and imposed an excise tax of 15% on products produced entirely in the occupied territories, regardless of their value. They have also raised import duties and imposed the payment of a deposit equal to half the value of imports, this deposit being reimbursable only after a long period. The occupation authorities have also brought in additional taxes and have recently introduced a new tax of 3% on amounts withdrawn from commercial accounts, whatever the reasons for withdrawal. They have also established a "security tax" in Galilee at the rate of 4%, which means that Palestinian nationals will have to pay for the cost of the invasion of Lebanon and the invasion of Palestinian and Lebanese camps. There is also a tax on scientific books and more than 38 types of taxes which affect Arab citizens, whereas the occupation authorities do not pay any subsidies to Arab producers, and whereas taxes are being imposed at random, at high rates and with high penalties.

b. Attempts to incorporate the economy of the occupied Arab territories into the Israeli economy to serve the purposes of the occupation authorities, both politically and economically, in the following manner:

(i) Exploitation of cheap production factors in the occupied territories.

(ii) Almost complete monopoly of markets in these territories in order to market their products. To this end the occupation authorities have:

- emptied the occupied territories of products;

- increased customs duties on imports and stepped up customs and administrative procedures so as to hamper imports of goods for which there is an Israeli-produced equivalent.

In this manner imports to Arab territories from Jordan fell to less than 1% and those from the rest of the world to less than 8%, and these territories now take no less than 90% of their imports from the Israeli market. In this manner the occupation authorities have monopolized the occupied territories to serve their economy and have also acquired control over at least 8% of the external trade of these territories. Trade between the occupied territories and Jordan fell to 10% and trade with the rest of the world to 8%.

(iii) As a result of the integration of the economies of the occupied territories and of Israel, the problems of the latter have been shifted to the former. The Israeli economy is suffering from a suffocating crisis because it has been militarized and a great part of it is working for the Ministry of Defense to finance the continuing wars of the occupation authorities against the Arab territories, and to finance the policy of settlement in occupied Arab territories. To face this decline the occupation authorities have taken various measures, all of which have adversely affected the occupied territories:

- imposition of high taxation for various reasons;

- discontinuation of certain projects and redundancy measures against Arab workers without any compensation;

- continuous depreciation and floating of the Israeli currency, which has lost 199% of its value; this has led to higher prices and higher production costs at a time when wages are not increasing in the same proportion. Palestinian workers and employees earn their wages in Israeli currency, which means reduced purchasing power and a lower standard of living.

The Israeli policy has affected all sectors of the Palestinian economy, as described below:

(a) Agricultural sector

The agricultural sector is the mainstay of the Palestinian economy, and Israel has deliberately destroyed this sector since the beginning of the occupation. On various pretexts it has requisitioned more than 160 000 dunums to establish Israeli settlements, another 2 000 000 dunums for 4 military purposes, and more than 75 000 dunums of valley lands for military purposes. Since agriculture production is dependent on the availability of arable land and sufficient water resources, the Israeli authorities have laid their hands on water resources in the West Bank and Gaza Strip, linked these resources to the Israeli water network and diverted more than 20% of these resources to Israeli settlements. 5/ On the other hand, the occupation authorities have established a system to control water resources in occupied territories and have forbidden farmers in the West Bank and Gaza from using water from wells except on authorization.

When such authorization is given, at great cost and inconvenience to the Palestinians, the authorities limit water allocation to farmers on the basis of a water meter, and forbid Palestinian farmers from digging wells while authorizing Israeli settlers to do so.

Israel puts many conditions and constraints on Palestinian farmers who are still farming their land. There is a ceiling on water consumption for agriculture, interest rates on loans are high, and Palestinians have to pay high duties and taxes on their produce, 6/ which means higher production costs and lower competitiveness compared with Israeli agricultural produce, which is being dumped on markets in the West Bank and Gaza at prices much lower than the production cost of Palestinian produce. Palestinian farmers therefore try to market their produce abroad, but are then faced with closed Israeli markets and very high export duties.

All this has led of course to low returns on agriculture, and consequently many people have abandoned this unprofitable activity. Figures indicate that almost half the Palestinian farmers have left agriculture and are working in other jobs, especially within the Israeli economy. 7/

An ILO report issued in 1984 indicates that the percentage of agricultural workers has declined by 26% since 1983. 8/

(b) Industrial sector

The same policy applies to the industrial sector. This is clear from the fact that the industrial sector in the occupied Arab territory has not changed much from what it was before occupation. In this respect Benvenisti states "the industrial sector in the West Bank is small and undeveloped and its contribution to GNP was less than 10% in the last period; it was 6.6% in 1976, and 7.3% in 1980, but dropped to 6.7% in 1982. Two-thirds of industrial enterprises are garages, workshops, training shops and cement factories, while the remaining third is concerned with the manufacture of textiles, plastics, leather goods and food. Not more than 76% of industrial enterprises are working effectively; there are 1487 industrial enterprises employing less than three workers, and only three employing more than a hundred workers. 9/

The reasons for the industrial decline can be found mainly in the Israeli policy of destroying this sector and annexing it to the Israeli industrial sector. To this end Israel has put many obstacles in the way of the industrial sector. For example, it is made very difficult to obtain a license to build a factory and when a license is, approved it is issued only provided that it does not conflict with Israeli interests. ' There are also obstacles to imports of machines and raw materials. Chemicals and sheet metal are refused for security reasons. Facilities to export industrial products are also refused, and of course there are the various high taxes, 38 types of tax in all.

The occupation authorities also refuse to allow industrialists to obtain from abroad the capital they need to establish factories and industrial enterprises, and set up obstacles to any assistance given by Palestinian, Arab or international bodies with the aim of promoting industrial development in the occupied territories.

The result of all this has been low income from the Palestinian industrial sector, leading to a deterioration in national income and a reduction in per capita income.

(c) Trade sector

The decline of both the agricultural and industrial sectors has naturally led to a decline in trade.

As already pointed out, the Israeli authorities are destroying the industrial and agricultural sectors and trying to integrate them into the Israeli economy. Palestinian markets have become profitable for Israeli exports; imports to the West Bank from Israel amounted to 88% in 1980. 10/ Israeli exports to occupied Arab territories accounted for some 25% of total Israeli exports in 1983.

Israeli exports to the West Bank and Gaza totaled 598 million dollars in 1982, whereas Israeli imports from the West Bank and Gaza totaled only 177.8 million dollars in the same year. 11/

The serious decline in the economic situation has forced a great number of Palestinian workers to work in the Israeli economy, where they lack the minimum rights normally granted to all workers anywhere in the world.

It should be mentioned that the number of Palestinian university graduates is increasing regularly, including doctors who work for Israeli employers.

An ILO report indicates that Palestinians working in Israel totalled 85 000 in 1982 and increased to about 92 000 in 1984. 12/ Other statistical sources indicate that the number may have been closer to 100 000 workers in 1984. 13/ Most of these workers are employed in tiring and dirty jobs that Israeli workers will not accept, and are subject to the deductions from salaries made by the Israeli authorities in respect of the 38 types of tax, including airport tax and travel ticket tax, departure tax at bridges and taxes on car transportation, not to mention the heavy burden borne by the Palestinian people on account of the value-added tax introduced by Israel in 1976 at an initial rate of 8% and subsequently increased to 12% and then to the present level of 15%.

It can be seen from the foregoing that Israeli policies have led to a decline in the economic situation of the occupied Arab territories: smaller markets, lower per capita income, and a decline in living, social and health conditions.

(2) Social policy of the occupation authorities

Israeli policies aim at hindering social progress in the occupied Arab territories by preventing the setting-up of social development plans and programs. Furthermore, the Israeli authorities do not allocate the necessary funds to achieve social progress and to provide social services for Palestinian citizens. A review of the education and services sectors in the occupied territories bears out the above statements.

(a) Education

The Israeli authorities pursue policies that block any progress in the education sector. This is borne out by the following:

(i) Hardly any budgetary funds are allocated to the education sector and its development or to the improvement of education programs.

(ii) No jobs are offered to Palestinian graduates and many Palestinian students have to stop their education for lack of qualified teachers.

(iii) The Israeli authorities do not provide the necessary funds to appoint more teachers to meet the rapid increase in the number of students.

In 1982, for example, there were 7575 Arab teachers responsible for 165 557 students. According to official Israeli statistics, the teacher/student ratio in Israel is around 60% higher than in the occupied territories.

(iv) There is a serious shortage of classrooms in Arab schools, more than 2000 rooms are needed.

(v) Students, schools, institutes and universities are subject to Israeli oppression. Students are imprisoned, their parents are harassed, and institutes and universities are shut down for prolonged periods. The education sector is neglected and the national Palestinian culture is constantly and systematically suppressed.

(b) Public utilities and services

The Israeli authorities totally neglect the public services sector. Local utilities, transport facilities and family services and care, for example, are seriously lacking. This is despite the fact that a great number of Palestinian families are badly in need of such care, especially after the expulsion, imprisonment or death of the heads or other members of families and the destruction of many of their houses by the Israeli authorities.

In this respect it must be pointed out that 1346 houses owned by Palestinian citizens were destroyed by the occupation authorities between 1967 and 1982, according to a United Nations report.

(c) The occupation authorities' practices against trade union activities and trade unionists

The occupation authorities have on many occasions amended the laws governing trade union activity in their own interests, giving them the right to interfere directly in Arab trade union affairs. A case in point is Decree No. 825 issued by the occupation authorities, which stipulates that a list of candidates for the elections of trade union governing bodies must be presented. The Decree entitles the Israeli labor officer to delete any name from the list, so that any undesired person is excluded from key positions.

Furthermore, workers are denied their trade union rights and freedoms, the trade unionists are constantly harassed, detained, expelled and attacked. Very few trade unionists are spared the ordeal of detention and threats; others are confined to house arrest in order to curtail their normal activities in general and to disrupt their trade union activities in particular.

Moreover, the occupation authorities raid trade union premises, attack their members, destroy and confiscate their possessions. The Construction Workers' Trade Unions in Tulkarem and Bethlehem, for example, were raided in April 1983.

The authorities also restrict the development of trade union activity. They reject any demand for the opening of new trade union centers. In the Arab sector of Jerusalem, they closed down 17 trade union branches, and prohibited trade unions from joining the General Federation of Trade Unions in the West Bank, disregarding the fact that these trade unions had been members of the Federation before the occupation (in 1967).

By preventing the creation of any new trade unions, and by preventing unions from joining the General Federation, the occupation authorities aim to paralyze trade union activity in the occupied territories and thus render the trade unions unable to protect the interests of Arab workers or provide them with social and economic assistance.

2. HEALTH CONDITIONS

A. Deterioration of the health infrastructure in the occupied Arab territories

Health conditions, like all other conditions, economic, social and educational, are continuously declining. The impact of socioeconomic deterioration on health conditions is compounded by the health policy of the occupation authorities, which is based on the following:


(i) Maintenance of health services and institutions as they were before occupation in 1967, with no plans or programs to develop those services; on the contrary the occupation authorities have closed a great number of hospitals, clinics, preventive medicine centers and nursing schools, as well as reducing health manpower.

(ii) In view of the inability of government health institutions to provide medical care for people in the occupied territories, health institutions of a social or private nature try to provide some health care but are prevented from doing so by the occupation authorities, which oppose the establishment or development of private or charitable health institutions.

(iii) The occupation authorities have endeavored, in this as in other areas, to incorporate the Palestinian health institutions and Arab citizens in Israeli institutions, with the aim of completely absorbing the Arab independent entity and annexing it to the occupying state. In order to implement the health policy of the occupation authorities, certain administrative or financial policies are practiced which put the services under the direct control of the occupation authorities and their central administration, so that Arab citizens are not permitted to participate or give their views.

The health policy of the Israelis affects the following areas:

(1) Planning

Israelis do not permit Palestinians to participate or to give their views. It can be said that there is no health planning for the short, medium or long-term, and that there are no possibilities for such planning. For instance, the allocations made by the military authorities to West Bank and Gaza hospitals hardly amount to one tenth of the credits allocated to one Israeli hospital. The salary of an Arab doctor hardly reaches 50% of that of an Israeli doctor. The health budget in the West Bank for the previous years 14/ reveals that average expenditure on the health of a Palestinian citizen does not exceed 20% of that on the health of an individual in Israel, and this shows how the household income per month is declining in the Arab territories.

(2) Pharmaceutical industry

We are facing great hardships in importing raw materials, which are either forbidden as strategic chemicals, or subjected to procedures that make them perish, or subjected to high and multiple taxation that raises the cost of production and the price of products; this makes them unable to compete with Israeli drugs.

(3) Health structures in the West Bank

The occupation authorities have declared Jerusalem part of Israel and have completely destroyed its health institutions by separating them from others in the West Bank and by preventing Palestinians from Jerusalem from joining the health scheme in the West Bank. They have also closed the pediatric hospital, the central laboratory and blood bank and the center for tuberculosis control. These measures were crowned by the closure of the Hossein Hospital which is the only Arab hospital in Jerusalem providing services to some 150 000 citizens, most of whom are from the limited income groups. The Government Hospital in Sheikh Jarrah was transferred to police authority.

In the area of Ramallah the occupation authorities closed the field hospital which became the office of the military command and then a prison. They also closed the hospital for contagious diseases and integrated both the new and old government hospitals, halving the number of beds allocated to children and making it impossible to provide services for the population


The number of beds has thus declined from 209 serving some 115 000 people in 1967 to about 160 beds serving some 140 000 people in 1987.

In the region of Nablus the occupation authorities closed the old Government Hospital which had a capacity of 153 beds. They closed four stories of the new Rafidyiah Hospital and the number of its beds declined to only 118. The field hospital in Rafidyiah was also closed and its equipment and supplies were requisitioned. In fact, as was pointed out in the report of the Special Committee of Experts, the Rafidyiah Hospital is in need of assistance to stop its decline through inadequate maintenance. 15/ In the region of Hebron the Hebron Hospital was the only one in a region containing some 250 000 inhabitants. According to censuses, this hospital provided half a bed per 1000 citizens in 1967 and the rate has now declined to one quarter of a bed per 1000 citizens in 1987. In this region there are only 135 doctors, i.e. one for every 1852 citizens, and only 16 of these are specialists. 16/ In the areas of Tulkarem and Jenin the total population is 82 000, and the occupation authorities reduced the number of beds in the hospitals of Tulkarem and Jenin from 140 to 115, among the departments of gynecology, surgery, pediatrics and internal medicine; the surgery beds were subsequently removed from the Jenin hospital.

In the region of Bethlehem the total population is about 21 000 distributed between the areas of Beit Jala and Jericho, where there are government hospitals, private and charitable hospitals. The number of beds in the hospital at Beit Jala was reduced and several departments were closed, including the neurosurgery department. The number of beds for chemotherapy declined from five to three. The report of the Special Committee of Experts mentioned that the hospital was suffering from the same problems as other hospitals - lack of ambulances, and inadequate staff and nurses.

In the area of the valleys where the Jericho hospital is situated, the number of beds in the hospital declined from 72 to 48. In 1986 the number of beds was reduced to 26 by the authorities, as they closed the department of bone surgery which was to lead to the total closure of the hospital.

(4) Health structures in the Gaza Strip

The number of inhabitants in the Gaza Strip at the beginning of 1987 was 664 378, including 427 893 refugees from 1948.

In that sector there are two major bodies in the field of medical services, the first run by the military authorities and the second by TWA. The Israeli military authorities spend 30 dollars per head per year on health. 17/ The number of beds in the Gaza Strip dropped from 1004 in 1974 to 855 in 1982. 18/

The occupation authorities have closed two hospitals, the Tel Al Zahour hospital and the fever hospital, and are using them as administrative and military offices. They also reduced the number of beds in the hospital for chest diseases, the only one in the region, to 70 beds in 1980.

The military occupation authorities run four hospitals in the Gaza Strip and also participate in the administration of the El-Shifa hospital in the city of Gaza, which is the biggest in the Strip, with 336 beds. It is not in good condition, however, because supplies have been inadequate over the years and its level of equipment bears no comparison with that of Israeli hospitals. Patients in the El-Shifa hospital suffer from cold in winter, especially in the old buildings, since heating is insufficient in the wards containing 140 beds.

The Nasser hospital at Khan Younes used to have a department for bone surgery with about 20 beds, but in December 1984 it was closed by the Israeli authorities.

As for the national hospital (Al Ahli), it was the only private hospital in Gaza, with 65 beds, and was run by the Evangelical Mission, but it was very expensive at around 100 dollars per night. The occupation authorities run 25 clinics in different parts of the Gaza Strip which are associated with various hospital departments. One researcher has described those clinics as follows: "Most of these clinics have few or no medicines, and are lacking in necessary laboratory equipment. Many of them do not have any equipment for emergencies. The quality of their services is very limited, and they are frequently used for referral to hospitals". 19/

(5) Medical supplies and equipment

All hospitals suffer from old and inoperative supplies and equipment, besides problems resulting from inadequate medical and professional teams, inadequate supply of electricity and water, and poor sewage; all of this clearly stems from the health policy followed by the Israelis in the occupied territories, a policy which does not allocate sufficient funds to satisfy the minimum requirements.

(6) Health manpower

The Israeli authorities do not replace any employee who resigns or retires, which means deterioration of health services. In spite of the need in many, health sectors and centers many Palestinian doctors remain jobless, especially in posts financed by government budget for services. Furthermore, salaries are still low.

The occupation authorities close certain centers and hospitals or amalgamate them, leading to redundancies. Medical staff have no opportunity for training or specialization and lack job security and stability because of arrest, imprisonment or expulsion; associations are prohibited and there is interference in the practice of the profession.

(7) Trends in numbers of hospitals and beds

After 21 years of occupation, hospitals are declining in number, and beds are fewer, as has been shown. Instead of 12 operational government hospitals and three others which were about to open in 1967, there are only nine government hospitals today, and many obstacles face the opening of private ones.

The number of beds in government hospitals in the West Bank declined from 1045 in 1979 to 951 in 1984. In the Gaza Strip it declined from 1004 in 1974 to 855 in 1982. 20/

Reliable information indicates that there are only 1.8 beds per 1000 in the occupied territories whereas there are more than 6.9 in Israel.

In the West Bank there are only 26 hospitals, working with almost non-existent resources, and only some 2100 beds to serve some million Palestinians living in the occupied Bank. In Israel there are more than 148 government hospitals with 27 000 beds. Israeli sources state that plans provide for an increase of 30 beds only in West Bank government hospitals by 1990. 21/

Specialized clinics are rare, five in the West Bank and two in Gaza, i.e. one clinic for 250 000 persons.

Diagnosis facilities are very primitive and poor. There are no dentistry clinics in the West Bank and Hebron, and the occupation authorities have closed the two clinics at Ramallah. As for laboratories there are 12 in the West Bank and two in Gaza, while the Central Laboratory in Jerusalem has been closed. These laboratories are helpless and can perform only rudimentary tests. 22/

Departments of radiology provide poor services and cannot perform radiological tests since their equipment is pre-1967, and in many cases they conduct only bone and chest examinations. 23/

For blood banks, we have already mentioned that there used to bet a Central Blood Bank in Jerusalem which had six branches in the West Bank, but it has: now been closed. In Gaza, people have donated blood in order to improve the situation in the blood bank.

B. Primary health care

Maternal and child health centers, already less than the minimum, do not have the necessary equipment and staff to meet the minimum requirements or carry out follow-up programs for antenatal care and child health, as regards immunization, growth, nutrition, hereditary diseases, congenital anomalies and control of the causes of infant mortality. This precarious situation is complicated by the fact that: children constitute 48.7% of the total population in the occupied Arab territories, that only 12.37% of the total number of hospital beds are allocated to children, that they are treated by general practitioners rather than pediatricians, that outpatient primary health care is given to them by health auxiliaries and that deliveries, particularly in rural areas, are carried out by traditional birth attendants. It is not surprising that there are 266 villages in the West Bank without maternal and child health centers, a situation imposed by occupation.

(1) Infant mortality and preventive measures

The infant mortality rate is an important indicator that reflects the health condition of any population group. It is well known that the infant mortality rate in the occupied Arab territories is very high. The statistics of the Israeli occupation authorities originally indicated that, for the period 1976-1984, the infant mortality rate in the West Bank was 30-38 per 1000 and in Gaza 34 per 1000, but they were widely criticized for this false information and changed these figures in a later report in 1986, to give an infant mortality rate of 70 per 1000 in Gaza. 25/ However, it is difficult to obtain accurate figures for the infant mortality rate in the occupied Arab territories, without a survey covering a wide sector of the population in various areas. We can therefore only use an approximate estimation of 80-140 per 1000 for the infant mortality rate in the West Bank and Gaza. 26/

Preventive measures and medical check-ups for schoolchildren and workers are rare and often non-existent.

(2) Health insurance

According to the data available this year, the number of participants in the government health insurance scheme fell in 1987 to 30% in the West Bank and to 56% in Gaza, compared with 83% in 1981 and 60% in 1984. The reasons for this drop are: (i) the health services provided in clinics are not consistent with the amounts paid by the citizens to the occupation authorities; (ii) the high cost of living and the low per capita income have rendered the citizens unable to afford the enormously high insurance premiums, which have more than doubled in recent years.

(3) Water supply and sanitation services

These services are below standard, deliberate negligence preventing their development. Services in the central part of the Gaza strip, for example, lack adequate water facilities, with the result that drinking water sometimes mixes with waste water overflowing from open drainage channels. The same thing is happening in Jibalia camp. During the summer, mosquitoes and other vectors infest brackish water pools, spreading diseases and epidemics. This applies to most camps and villages in the occupied territories.

(4) Environmental conditions and sanitation

Most of the houses in villages and towns in the occupied Arab territories are still without latrines or waste disposal networks. Shops in most villages sell Israeli-made foodstuffs and canned products that are below the required level of safety. Sale of unpasteurized milk has led to the transmission of brucellosis and other food-borne diseases.

Apart from the limited efforts of local societies, proper health education is desperately needed to prevent the spread of adverse health habits.

C. Epidemiological situation

Several field studies, reports received by the Palestinian Red Crescent and reports of medical relief committees have confirmed the spread of epidemics, particularly respiratory diseases which affect 43% of the population, gastrointestinal diseases which affect 17% and diarrhoeal diseases which affect 37% and are the main cause of infant mortality. Other diseases of the skin, bones, eyes, nose, ears, throat, blood, heart, endocrine glands, and the nervous system, in addition to venereal diseases, allergies and brucellosis affect some 463 970 people, i.e. nearly one third of the population. These figures were taken from government hospitals and clinics during one year - 1986 -,and exclude private clinics, UNRWA clinics and other health institutions. 29/

Reports and studies of the epidemiological situation indicate that, despite immunization efforts, outbreaks of communicable diseases such as diphtheria, poliomyelitis and measles still give serious cause for concern. This shows that the claims of the occupation authorities of a 90% immunization coverage are false.

Previous reports of the Special Committee of Experts confirmed that intestinal parasitic diseases are a major public health problem. 30/ Neonatal tetanus is still spreading.

Pulmonary tuberculosis is also a health problem complicated by the closure of the TB control center in Jerusalem and the reduction of beds in the chest disease hospital in Gaza to 30 beds. Leishmaniasis is a current problem in the West Bank, and so are hyperthyroidism and malaria in the Jordan valley.

The major chronic diseases are cardiovascular, renal and hematological diseases and cancer. There are no facilities in the hospitals of the occupied territories to deal with these diseases. In recent years there has been extensive spread of viral hepatitis and the number of cases is still high in the West Bank and Gaza. The disease is closely related to environmental sanitation and behavior patterns. Malnutrition due to protein deficiency, ignorance or infections is a serious problem, complicated by the fact that families cannot afford to buy meat except on rare occasions.

Eye diseases have been widely and rapidly spreading. In the entire West Bank, there is only one hospital, St John's, that deals with eye patients. Its total number of beds has been 82 since 1983 and it is staffed by 10 physicians and 56 nurses serving a population of 440 484 persons. 1.7% of the population in the occupied territories suffer from acute visual failure. For mental disease, there is only one hospital in the West Bank, in Bethlehem. It treats only chronic cases, which in the occupied territories are three times as numerous as in Israel. Statistics indicate that the mortality rate is steadily rising among mental patients. Arteriosclerosis, hypertension and heart disease account for 43.6% of deaths. 31/ This shows the cumulative effect of factors that are detrimental to the health of the Palestinians under occupation, factors that are promoted by the occupation authorities through hostile policies and suppressive practices against the Palestinians.

In brief, the health infrastructure in all the occupied Arab territories has been destroyed over the years of occupation, to such an extent that it now falls below the minimum requirements for primary health care. Numerous diseases are spreading and mortality rates are rising, particularly among children.

The American delegation of Doctors for Human Rights, visiting the occupied Arab territories in February 1988, gave a typical description of the health conditions after a visit to hospitals and clinics. They said, "The condition of the hospitals which we visited was much worse than what we watch in the MASH series. After all, the facilities in these hospitals were originally below the minimum level. When compared with the lowest level of health services in some of the third world countries, the level of the services in Al-Shifa hospital, for example, was even lower. In Queen Alya government hospital, which was not clean, one of the two sphygmomanometers was not working and ambulance services were completely lacking. 32/

Health workers in the occupied Arab territories have had to shoulder the basic responsibilities of saving the lives of thousands of injured victims of Israeli suppression, under the deteriorating health conditions and lack of simple equipment. The escalation, by the occupation armed forces, of the use of brutal suppressive measures has led to thousands of injuries among unarmed citizens who were only asking for their legitimate human rights.

In the next part of the report we shall describe and analyze the means of suppression used by the Israelis and their direct and indirect effects on the health of Palestinians. We shall also describe the condition of hospitals and health institutions in the occupied Arab territories since December, when they have had to cope with increasing burdens while at the same time facing acts of aggression against their staff.

PART II

DETERIORATION OF CITIZENS' HEALTH CONDITIONS,
HOSPITALS AND HEALTH CENTERS IN THE OCCUPIED TERRITORIES

A. PRACTICES AND TOOLS OF ISRAELI OPPRESSION AND THE DETERIORATION OF CITIZEN'S HEALTH CONDITIONS

In confronting the defenseless Palestinian people who are demanding their just and legitimate human rights, the Israeli occupation authorities are resorting to various types and methods of oppression that are detrimental to man's health and his physical and mental safety. These methods vary from outright murder, serious injury often leading to permanent disability, to damage that leads to psychological disorders difficult to overcome.

In fact the Israeli forces, acting on formal orders from their leadership, do not replace one method of oppression and murder by another but accumulate such methods and add new ones every day.

The following is a brief outline of such oppressive practices, with some realistic examples, figures and testimonies demonstrating the extent of brutality on the part of the Israeli occupation forces.

1. Live ammunition

Statistics attached to this report show that 160 persons have been killed through the use of live ammunition 1/ that the number of injuries reached 6294 by the end of March 1988, and that 2000 of these injured persons are threatened with permanent disability.

Information sources inside occupied Palestine have reported that the Israeli occupation forces are using, in addition to conventional live ammunition, two new types of bullets.

First: bullets of very high frequency that cause burns to the body and explode inside the body before exiting on the other side. These sources have described this type of bullet as infinitely more dangerous and deadly than ordinary ammunition.

Second: bullets that change direction, causing injury and severe ruptures in various parts of the body before leaving it, in addition to the use of explosive bullets and dum-dum bullets that are internationally prohibited. 2/

A group of American physicians (Doctors for Human Rights) on a fact-finding mission to Palestine recently estimated that 50% of injuries caused by the use of live bullets are to the legs and will cause disability. 3/ They are caused by ultra-speed bullets that cause severe ruptures when they explode. Such ruptures are also caused by what Dr Jennifer Lenning has called lead snow on account of the nature of the ammunition and the manner of explosion. Dr Lenning also referred to the possibility of paralysis in the legs caused by directing bullets to the lower part of the body; shooting at the eyes may have been a mere accident. Asked whether a bullet directed at the feet could deflect and hit the upper part of the thigh or the pelvis, as some Israeli military officials claim, Dr Lenning answered that this was most unlikely, if not impossible, that there were several records of injury to the upper thighs, that doctors had recognized wounds on the surface of the body caused by bullets or rubber bullets or by beating, 4/ and that the Israeli occupation authorities had supplied soldiers with ammunition far more dangerous than the internationally prohibited dum-dum bullets, which traveled at a speed of 2 kilometers per second. A large number of Palestinian citizens have been hit by such bullets, 11 of whom have asked the Israeli lawyer Felicia Langer to file a lawsuit on their behalf with the Chief Military Attorney-General's office and the Israeli Government's legal adviser. Dr Roustom El Nimti, Director of El Makassed Hospital, 5/ has emphasized that surgical operations performed on casualties have proved that the occupation authorities are using this type of ammunition, which is far more dangerous than dum-dum bullets. He explained that this type of bullet explodes inside the body, leaving behind vacuoles that lead to several types of inflammation and infection, and in the lawsuit it is stated that the use of such bullets is illegal, not to mention in contravention of international law. Solicitor Langer commented that the use of such bullets is internationally prohibited and wondered if the Israeli authorities were not the only authorities in the world using such ammunition and thereby creating an entire generation of disabled persons.

2. Tear gas, chemical gas and nerve gas, causing death and abortion

The use of tear gas, chemical gas, incendiary bombs and nerve gas is a daily event to be seen in all parts of the occupied territories, where the Israeli occupation authorities resort to every brutal method of oppression conceivable in attacking defenseless Palestinian demonstrators. The detrimental effect of such methods is not confined to injuries and temporary suffocation; they also lead to death and permanent disability. Doctors have certified that the use of such gases could cause death in one of two ways: 6/ by depriving the body of oxygen; through their effect on the blood circulation, where gas is transformed into toxic chemicals such as cyanide. And in effect the empty tear gas canisters carry a warning that reads as follows: Warning - could cause fires - must not be directed at persons because it causes death or injury. Made in the United States of America: MFG 1988.

But Israeli occupation authorities do not comply with instructions for use or take any note of the warning as they throw these bombs directly at demonstrators at close range. They also throw these bombs inside houses, mosques, churches, schools, and crowded market places as they storm these locations. Innumerable cases of such use have been recorded. 8/ They are repeated daily, and result in further injuries, deaths, abortions and disability. Occupation authorities are intensifying the use of helicopters to direct tear gas bombs and other chemical weapons, as well as nerve gas and incendiary bombs, at Palestinian citizens. Chemical analysis undertaken at Hebron University 9/ shows that two types of gas known as CM and CS are being used. The effect of the former lasts only a few hours and it is not lethal; whereas the second type of gas, a chemical known as ortho-chlorobenzylidenemalononitrile, has a totally different kind of effect and is used in the form of black powder. It can be released from helicopters, special rifles, or be thrown directly at people. Chemical analysis has proved that CS gas is lethal when used in concentrated form, particularly in confined spaces. The report indicates that children, the elderly, and those who suffer from heart and respiratory conditions, are exposed to the risk of death. It must be noted that there is nothing in the world at present which can be used against this CS powder, which penetrates the respiratory tract and infiltrates into blood cells and fine tissues and mucus, and that this fine powder can adhere to the body, causing several types of burns and injuries, and can remain on clothing, walls and carpets for several days. Dozens of victims have died, hundreds have been disabled, and there have been over 100 cases of spontaneous abortion as a result of the use of these gases. Israeli occupation authorities have developed other and even more dangerous types of gas and chemical bombs; Israeli television reported on 17 January 1998 that the Israeli police intend to use new methods to confront demonstrations throughout the occupied territories, adding that among these methods is a new type of tear gas which has rapid and powerful effects. And that special nets lowered from helicopters to trap demonstrators would soon be in use. Israeli television also reported on 13 February 1988 that a new type of equipment for launching gas bombs over longer distances and wider areas was being used, and the new equipment was shown.

The use of gas bombs containing dangerous chemicals has also been intensified. These bombs burst into flames, releasing red smoke, when thrown, and an example was given by medical sources at El Makassed Hospital in Jerusalem. On Friday, 26 February 1988, the hospital admitted two young men and a woman in a semi-coma which lasted for some 24 hours, noting that these casualties had been exposed on that day to a bomb of this type used by the occupation authorities, and that the conditions from which they were suffering were different from those caused by tear gas which was widely used at the time, as they were suffering from convulsions and stiffness of limbs. Momentary blockage of the respiratory tract, involuntary movements and fits and convulsions in all parts of the body, and urinary dysfunction were reported. Medical sources also reported that some of the casualties were unconscious and explained that they needed a double dose of anaesthetic to control their convulsions and that they had to be placed in intensive care for three days, after which they recovered consciousness. These sources added that the Israeli occupation authorities used such bombs when they attacked defenseless Palestinian citizens in the town of Halhoul, near Hebron, and that red flames and smoke and fumes were seen when they were thrown at the demonstrators.

Physicians at the El Makassed Hospital in Jerusalem said that the chemicals in these bombs had also caused disorders and agitation of the nervous system and brain in these three casualties. There was temporary malfunction of the respiratory tract center in the brain, and contractions of the larynx and of bronchi led to a state of suffocation.

Physicians noted for the first time that the effects of exposure to these chemicals included change in the color of the blood to a light red color and said that this was unusual color and was a new phenomenon they had not met before; this emphasizes the direct effects of such chemicals on the blood. One question to which these physicians would like an answer is whether these chemicals will have long-lasting effects on the large numbers of casualties, and in particular whether these effects and symptoms may lead to epilepsy. The occupation authorities throw bombs inside houses and confined spaces indiscriminately, as they did on 23 January 1988 when they stormed the house of the Reverend Ibrahim El-Khouri of the Orthodox church in the town of Beth Sahour, injuring four members of his family, among them his wife and his 90-year old mother, who were both taken to El-Hassan hospital in Beth Gala in a critical condition.

In addition to all this, the Israeli occupation authorities use rear gas in the form of powder, which is sprayed directly at citizens with special hoses. 11/

3. Rubber bullets

Rubber bullets contain a piece of sharp metal inside them which can cause serious injury, particularly when fired at close range. This is as dangerous as the use of live ammunition because of the serious wounds and fractures it can cause, in addition to bringing on internal hemorrhage of the stomach and rupture of the tissues.

Several cases of blindness have been recorded, as in the eye hospital in Jerusalem, where 30 such cases were reported in a period of 2 months. 12/ Rubber bullets have been further developed to cause greater injury, as testified by a leading military officer in the command headquarters of the central area, who stated that these bullets have been developed because the Arab inhabitants had become familiar with the procedures and instructions for opening fire and had become bolder and no longer feared to attack the soldiers. This meant that the means available to them had lost a great deal of their effectiveness, and the military authorities therefore had no choice but to develop their combat equipment and weapons against Arab inhabitants. 13/

4. Beatings, crushing and breaking bones

Israeli occupation authority practices, exemplified by cruel beating of defenseless citizens, breaking their bones and their limbs, have become common throughout the occupied Palestinian territories; and the order issued by the Israeli defense minister on 19 January 1988, endorses such atrocious activities. He made a statement on that date in which he declared that "this approach - beating and breaking bones - is more effective than arrest, because detainees in the El Fareaa prison for instance, cannot remain there in excess of 18 days - according to the Minister Rabin - after which they return to demonstrating and throwing stones in the streets but if soldiers break their hands or their arms, that will prevent that from resuming their demonstrations for another one-and-a-half months at least". 14/

On the day following the issue of this order, Israeli soldiers began to use clubs and truncheons with metal edges and rifle butts, and to kick with their hard boots to break the bones of demonstrators, as well as using hard rocks and iron rods; several cases of such practices were witnessed in the refugee camp of Jabalia, where on 20 January 1988, 50 such cases were reported as sustaining severe wounds and serious fractures; in the two days following the issue of this order, hospitals in the Gaza strip received 200 patients with fractures resulting from brutal beatings, and on 27 January there were more than 1000 cases in Gaza alone, where soldiers stormed houses and started beating up families, including children. One such case was that of an 8-month old girl who received four stitches in the scalp after sustaining an injury. Soldiers also round up men in certain locations and beat them collectively, sometimes they choose persons at random from passers-by on the street, and start beating them in front of others. Many of them were reported to be women, who sustained injuries and some of whom died as a result of such practices. 15/ Dr Jack Baker who was an eye-witness to such practices, has commented that "this is a flagrant and unmitigated violation of people's rights committed by both the army and police". 16/

As from 19 January 1988, the occupation authorities embarked on a new method of beating up citizens and breaking their limbs, placing their hands on the ground and hitting them with clubs to break the bones of the hands. An example of this occurred on
20 January 1988, when 6 citizens from the town of Kabattia, to the south of Jenin, were brought to Rafidia surgical hospital after being assaulted in this way. 17/ What is to be noted is that casualties suffer multiple fractures and wounds, and Dr Lenning has stated in describing this situation that "it is as though the patients had been placed inside an electric washing machine while the top was rotating after binding their hands and feet, and then thrown to the ground motionless, while soldiers continued to beat them all the time". 18/

Physicians attending to the wounded who sustained injuries in this manner, say that beating them includes hitting hard on the muscles, which causes internal bleeding, leading in turn to painful swelling that cannot be treated and that may be a cause of permanent injury or disability. 19/ Soldiers hit all parts of the body including genitals, and as one doctor at the Beit Fajar hospital told the French press agency (AFP), "Israeli soldiers break at least the right hand of every person they get hold of who is accused of throwing stones". 20/

On 9 February 1988, the Beit Yuala Hospital received Kamal Suati (aged sixteen) from the village of Beit Fajar, near Bethlehem, who was brought in on a stretcher with his body full of wounds, blood gushing from his lips and his teeth broken, and as he was being treated by the doctors it was found that he had lost one of his kidneys as a result of being beaten, and that his right hand and leg were also broken. 16/

Casualty records show the outcome of different types of serious injuries, proving that occupation authorities stop at nothing in inflicting as much damage as possible on demonstrators, even if this means permanent disability. There is no doubt that revelation of even approximate figures, because exact figures are difficult to obtain under the circumstances, will alert WHO to the seriousness of the oppression practiced by occupation authorities and the gravity of its effects on the health of Palestinians, showing that it will leave an entire generation of Palestinian inhabitants with permanent disability. The American medical group put the number of casualties in the West Bank and the Gaza Strip between 9 December 1987 and 10 February 1988 at 38 000, an estimate based on statistics covering only 10% of the towns and the population covered by hospital records over a period of four days, and that if these statistics were extended to cover a period of sixty days, they would yield the following table:


Percentage No. of casualties
Percentage No. of casualties
West Bank
10
3,300
100
33,000
Gaza Strip
10
500
100
5,000
3,800
38,000


Be that as it may, approximate calculations based on the number of serious injuries suggest that there would be at least 200 casualties a day. This does not, of course, include those injured through exposure to various other means of oppression. It is limited to those who have been hospitalized or admitted to clinics for treatment, or treated by local medical teams and traditional healers. Hence, estimates made by the Palestine Red Crescent Society anticipate some 76-80 000 serious injuries per year. If this rate were to persist, and it is based on the number of casualties recorded during the past five months (from December 1987 to the end of April 1988), it is quite clear that there would be a serious danger of creating an entire generation of disabled persons among the Palestinian people in the West Bank and the Gaza Strip.

A proper reading of these findings based on the above statistics, which cover both the West Bank and the Gaza Strip, particularly during the visit of the American group, would show that it would be more realistic to assume that there have been tens of thousands of casualties, and not merely a few hundred, as claimed by Israeli officials. 23/


There are serious problems hampering the recording of casualties in hospitals, as doctors and medical teams are fully preoccupied with the treatment of casualties and the figures may therefore be some 50 times in excess of the estimates. It must also be noted that many casualties receive immediate treatment and leave hospital without being recorded, for security reasons, and that, for various reasons, many casualties are not even brought to hospital. Further numbers of casualties are treated locally in villages by their families and relatives and by local medical teams or by traditional healers, for fear of being arrested if there were to go to hospital. 23/

Beating does not merely mean beating

Dr Lenning has stated that most casualties have multiple fractures and serious injuries to the hands, arms, legs and neck. It is clear that limbs have been deliberately maimed and broken by placing hands on the ground and breaking them, or by tying demonstrators to electricity pylons or to tree trunks with rope and running them down with military vehicles, etc. Dr Lenning said that this cannot be compared with the methods of self-defense used by the victims, 24/ and added that "the word beating does not really mean what it says in this context, nor does it conform to the medical definition of injury, because beating up in this manner does not cause the normal fractures we are familiar with; in this case, the muscles will heal in the form of muscular fibers and not as whole muscles, and will not regain their proper shape and contractility. This type of fracture sends large quantities of protein into the bloodstream, causing kidney failure, as in fact happened in some cases, while beating demonstrators on the skull has often caused brain hemorrhage".

5. Curfew

Since the middle of December 1987, the occupied Palestinian territories have been subjected to curfews at times lasting over 20 hours a day, for several days in succession. The average number of citizens under curfew was 250 000 people per day, as reported by the Israeli daily "Maariv" on 18 January 1988, which states that "over 150 000 people in the refugee camps of the Gaza Strip are under total curfew".

On 18 January 1988 the Israeli army lifted the curfew on the refugee camps and villages in the West Bank after more than three weeks but maintained the curfew on the town of Salfit. 25/ On the same day the curfew on 200 000 people in the Gaza Strip and the camps was renewed and extended to cover other areas in the West Bank and the Gaza Strip. These included the old and new camps of Balatah, Sair, Ba-abd, and Al-dahisha, and the Al-shajaa neighborhood of Gaza. 26/

6. Closure of access roads and establishment of check-points

The occupation authorities have closed the access roads to towns, villages and camps, and set up military check-points on these roads. They are prohibiting citizens from leaving these areas and citizens from outside the areas from entering them. They prohibit the entry of journalists, provisions, relief supplies and ambulances, and confiscate all water brought in by women from wells and water sources nearby. They also impound provisions brought in by citizens during the brief periods when the curfew is lifted. The authorities have also closed borders, bridges and points of entry by day, and during the uprising they prohibited all citizens and others from entering or leaving the occupied territories, and extended this prohibition to include reporters in these areas, with view to imposing a complete and total blackout on crimes committed and perpetrated against citizens of the occupied territories.

7. Restrictions on provisions and medical supplies

The siege involving prohibition of the entry of provisions and medical supplies imposed by the occupation authorities was part of the policy of collective punishment practiced by the Israeli authorities. In addition to this, water and electricity were cut off and emergency food supplies were impounded. Fuel was also withheld from the population in the occupied territories and although there are few official reports and little information concerning food and provision shortages and the hunger suffered by the citizens, there is clear evidence-that there were these problems, as a result of the long duration of the siege and curfew and the embargo on provisions and relief supplies to these areas throughout this period.

On 19 January 1988, for example, Israel Radio reported that the Israeli authorities would not permit five lorries carrying food, medicines and clothing to enter the occupied territories to deliver their consignments to UNRWA. These were donations made by Arab towns and villages within Israel; the five lorries in question had reached the outskirts of Gaza at 11 a.m. on 19 January 1988 and were promptly turned back by the authorities.

8. Violations of holy places and aggression against the clergy

Occupation soldiers daily violate the sanctity of Islamic and Christian holy places and attack members of the clergy and have done so since the beginning of the uprising. Approximate statistics show that more than 350 to 500 assaults are made every year against religious places and clergy, and information received from occupied Palestine indicates that most mosques in the West Bank and the Gaza Strip have been exposed to attack and that members of the clergy have been assaulted inside these mosques. Such violations take different forms:

1. Storming of mosques and beating up of worshippers with clubs and cudgels and rifle butts.

2. Intensifying Israeli military presence around mosques and molesting citizens on their way to prayers by subjecting them to close inspection, humiliating them, cursing them and provoking them through attack, assault, and bodily harm as well as preventing some of them from reaching the mosques.

3. Cutting off electricity supplies during prayers in the mosques, particularly the Friday prayer which is considered the most essential part of the ritual of prayer.

4. Throwing gas bombs into mosques during prayers.

5. Shooting at worshippers inside mosques or as they are leaving them.

6. Throwing bottles of liquor, prohibited by Islam,
through the windows of mosques and churches.

7. Storming mosques and churches and using loudspeakers to level insults and racist expressions intended to cause religious or general provocation. 27/

9. Aggression and oppressive practices by settlers

Aggression against Palestinians by settlers is part of official Israeli policy aimed at creating an atmosphere of fear and terror to force citizens to leave their lands. 28/

This has taken the form of numerous acts of terrorism, such as abducting and killing citizens (as well as women and children), setting fire to fields, shops, cars, petrol stations and entire markets. Beating up citizens, shooting at them and looting from houses and stores, attacking mosques, churches, schools, institutes, universities and institutions, and breaking up any furniture and equipment to be found there. Also uprooting fruit trees with bulldozers and electric saws, and other acts of aggression perpetrated with no scruple or fear of punishment by the Israeli authorities, which emphasizes the fact that these acts of violence by settlers against Palestinians are another manifestation of the official policy of the Israeli occupation authorities. Such acts of aggression were intensified beyond all description at the beginning of the uprising and in a manner that contravenes the most basic human rights.

The following are examples of the settlers' aggression and oppressive practices towards Palestinians:

Storming houses and beating up families

On 12 December 1987, for example, Rabbi Moshe Levinger was walking with a group of his disciples in the streets of Hebron and hitting citizens with clubs and rifle butts at random in the presence of Israeli soldiers who were guarding them. On 23 December 1987, followers of Rabbi Meir Kahana stormed the town of Shafa-Amr with the aim of terrorizing citizens who were on strike in solidarity with Palestinian citizens in the West Bank and the Gaza Strip. On 19 January 1988, a certain Arieh, one of the Jewish settlers in the West Bank,' said that if they used live ammunition against Palestinians, it was because they had no other choice, 29/ referring implicitly to the accident which occurred on 11 January 1988 where a 17-year-old Palestinian was shot dead by Pinhas Wallerstin, the Chairman of the Council of the settlement called Ben-Yamina.

On 19 January a number of settlers stormed El-Aroub refugee camp at night, entered several houses by force, smashed the furniture and other household possessions, and beat up Palestinian families, particularly the families of Helmy Khanis Al Jawabra, Ahmad Abdel Motei and Ahmad Abou Kheirat.

On 20 January.1988, a joint force consisting of soldiers of the occupation authorities and settlers stormed the village of Kafr Al Deek (4000 people), 4 km west of Nablus, at midnight, entered five houses by force after smashing their front doors and windows with clubs and iron rods, and started beating up the families living there, causing injuries to 15 citizens, two of whom were taken to the Women's Union Hospital in Nablus.

They also stormed the village mosque that night and shattered its windows. Such acts of aggression by settlers against Palestinian citizens and their property have been intensified and extended to smashing cars and setting fire to bus stations and public facilities in all parts of the occupied territories.

Cutting down trees and confiscating land

On 21 January 1988 a group of settlers confiscated a piece of land owned by a Palestinian citizen, Hassan Abdul Fatah El Faraheen, which is located in Whadi, in the El Hamam area to the west of the village of Aula; they cut down 200 olive trees and vines with electric saws. The citizen in question asked the Hebron police the following day to investigate this act of aggression but to no avail. His land, which covered about one hundred dinams, had been confiscated in the same way as several other pieces of land since 6982, including large areas in this particular town and throughout the West Bank. 30/

Abductions

On 3 February 1988 settlers abducted four young men from the village of West Silawad, near Nablus, and drove them in a Peugeot 505 car to an unknown destination. The names of the young men were Meher Sherif, 14, Yussef Drees, 17, Kazam Mehemed Suleiman, 16, and Mahamar Ahmed Ali Hanna, 16. On the same day settlers also abducted 30 children from El-Dahisha Camp and a few hours later released the se under 12 years of age. They handed over the others to the occupation authorities. 31/

There are reports of children being abducted by settlers, of their being maltreated and of abducted children being left on roads and in the desert. The eldest son, aged 14, of trade union official Yasan Ayoub of Beit Hanina, Jerusalem, was abducted and driven away in a car, brutally beaten and left on the roadside. Ten-year-old Ahmed Sobhi Hammad from Gaza was also abducted by settlers on 29 February 1988 and is still missing.

The intentions of Israeli settlers become crystal-clear, when it is realized that many of them, not content with this kind of oppression and terrorism, want to do much more, as can be concluded from the statements made by the Secretary of the "Eril" settlement that he looks forward to the day when if an Israeli child is injured more than 2 000 Palestinians would be injured in retaliation. He made these statements at a meeting between Deco, the Israeli Deputy Minister of Defense, and members of the Council of West Bank settlements, where the Chairman of the Council emphasized that the activities of Israeli forces are extremely satisfactory but that he wished to strengthen cooperation between the army and settlers, meaning of course to try and strengthen and reinforce methods of oppression and terrorism against Palestinian citizens.

10. Demolition of houses and other measures

Occupation authorities demolish houses systematically or seal them with red wax on the grounds that a member of the household is accused of activities against the security of the State. This means that any building occupied by several families unrelated to one another could be demolished if one of the people living in it happened to be the subject of such charges. This procedure is derived from British Emergency Law 119 issued in 1945; the military governor is empowered to take such a decision and implement it forthwith. This punishment affects indiscriminately all the people living in a building and the decision to demolish or seal off a whole building can be taken without a specific charge being leveled against its inhabitants.

The number of houses demolished by the end of 1987 was 2766; 70 of them were demolished in 1987 alone in different parts of the West Bank and the Gaza Strip. The situation has become worse in recent months, when any Israeli officer or soldier can take the decision to demolish a house without giving sufficient notice to those who live in it.

11. Detention

The occupation authorities have issued a number of military orders in addition to the British Emergency Law of 1945 governing the procedures for arrest, detention and trial. The main features of Israeli policy in this field are as follows:

(1) Arrest in accordance with British Emergency Law No. 119 of 1945, when detention is carried out on the strength of an order from the military governor and the accused is tried before a military court.

(2) Detention under Article 587 of Military Ordinance No. 378, issued on 4 August 1985; this is called administrative detention, and the military governor of any administrative area can order the arrest of any citizen without a specific charge. Administrative detention can last for as long as six months and may last even longer under the terms of Article 587. The seriousness of this procedure is reflected by the fact that the Israeli Supreme Court does not interfere, its role in this field being confined to making sure that a detention order is based on a charge related to public or State security.

(3) Collective detention is one of the means employed by Israelis when they lay siege to entire areas by night or day, order houses to be evacuated, take away male members of the families concerned and detain them without filing charges.

(4) Indirect detention, whereby young men are summoned daily and may be kept by secret police officials for prolonged periods, as a means of bringing pressure on them and making them appear to be collaborators with secret police agencies.

Detainees are subjected to interrogation and all types of brutal torture. Women and children under 15 years of age are not spared, and the number of children detained up to 28 March 1988 had risen to 1650. A report compiled by the Committee of Spanish Jurists which visited the occupied Territories between 3 and 9 January 1988, states that in El Zaharia prison alone there were 450 detainees whose ages ranged from 12 to 14 years and who were living in tents under the pouring rain.

Approximate statistics indicate that more than 15 000 citizens have been detained during the first three months of 1988.

Three hundred have been detained under administrative detention orders, 134 of them being kept in Genate prison alone. Israeli forces have set up a number of detention camps (Ansar 2, 3, 4 and 5) side by side with military camps in all areas; detainees are housed in hastily erected tents next to the camps.

Israeli practices in this field flagrantly contravene the rules and principles of international law and the Geneva Conventions (particularly Articles 22, 29, 31, 65, 67, 68, 147 and 301 of the Geneva Convention signed on 12 August 1949).

12. Deportation

Israeli occupation authorities resort to deporting Palestinian citizens by decision of the military governor. The deportees have no legal redress except to petition the Israeli Supreme Court, which always declares such orders to be illegal. Statistics show that over 2500 citizens have been deported from the occupied territories since 1967. Recently Israel has deported four citizens and is taking measures to deport another nine. In fact, this practice is contrary to the Geneva Convention, which stipulates that the laws applicable to occupied territories are those that were in force before the occupation. If the practice is based on the British Act of 1945, it must be recalled that the British themselves rescinded that Act in May 1948. The Fourth Geneva Convention prohibits the forcible collective removal of citizens and the deportation of persons from occupied territories by occupation forces, no matter what the reasons may be. The British had applied the deportation law against the former Israeli Justice Minister, Don Joseph, who described the British action at that time as being worse than Nazi laws. When a number of Palestinian deportees decided to return home on a ship chartered for the purpose and in accordance with international law and the Geneva Conventions and Security Council resolutions, Israel blew up the ship in the port of Limassol in Cyprus.

13. Burial alive

Palestinian citizen, Hamadosni Mohammed Iyad (33 years) from the village of Salem states that he saw Israeli soldiers and a number of settlers leading away four young men from the village, whose names are Masim Mohamed aid Humdan, Abdul Lotif Mohamed Shetaya, Esam Shafak Hawad Shetaya and Mustafa Abdul Majid Hamdan, who were being brutally beaten all over their bodies with stones and clubs, and continued, "I saw four Israeli soldiers forcing the four young men to kneel down on the ground as though they were praying; they then tied the knees and feet of these young men and started beating them two at a time. Meanwhile a military bulldozer was closing access roads into the village with stones and earth, and one of the soldiers asked the bulldozer driver to pile earth over the boys. There was an exchange between the soldier and the driver, but I could not make out the words. I realized, however, from the soldier's gestures that he was asking the bulldozer driver to bury the boys but the driver refused to do so. Eventually, however, he did scrape up piles of earth and drop them on top of the boys; he continued to do so until the mud and muck completely covered two of them. Part of the head of the third was still above the earth that was being piled on them and so was Abdul Lotif's head, because he was the tallest of the four and did not get completely buried. Having done the job the soldiers were congratulating each other saying Col Hekafod, which means that they were happy with the job they had just done". 33/

Citizens rushed to help the four boys and got them out from under the heaps of mud and carried them to Jericho Hospital and nearby Nablus Hospital, which was under siege, where they received treatment and were discharged, except for Hisan Shefi, who had sustained fractures in both arms, both legs and the neck.

In fact, these Israeli practices are part of the policy of collective punishment, which is reflected in the living conditions in the occupied territories. It is quite obvious that it will have long-lasting direct effects on the health of Palestinians, and that the indirect effects are even worse and more serious.

As these practices are carried out in towns, villages and camps, in streets and in houses, and everywhere that can be reached by Israeli oppression, it makes it impossible for hospitals, health centers, physicians or medical teams to carry out their humane duty of alleviating pain in their fellow citizens and treating the wounds and injuries resulting from Israeli oppression. This is a question that will be discussed in the next part of this report.

B. AGGRESSION AGAINST MEDICAL TEAMS AND HEALTH ESTABLISHMENTS

Since the first day of the uprising in the occupied territories, the Israeli authorities adopted the policy of causing as many injuries as possible, prolonging the period of recovery from these injuries for as long as possible and causing permanent disability among the greatest number of citizens.

The Israeli occupation forces set siege to hospitals and storm emergency departments in these hospitals, preventing the delivery of basic medical provisions to them. In addition to intercepting ambulance vehicles and preventing medical teams from carrying the wounded and the injured to hospitals, they have also hampered and limited the freedom of movement of physicians and beaten up several doctors, casualties and hospital workers, as well as visitors.

1. Storming hospitals and breaking up equipment

On 9 December 1987, the first day of the uprising, Israeli occupation authorities set siege to El-Shifa Hospital in the Gaza

Strip. 34/ They warned that they would close down the emergency department in the hospital, and that if physicians refused to do so because of the dire need for that department, particularly in the light of the increasing number of wounded and injured, the Israeli authorities would storm the entire hospital and break up all its equipment. This was in fact done when tear gas bombs were dropped from helicopters, after which Israeli soldiers stormed the hospital, throwing more gas bombs into various wings, beat up patients, physicians and nurses, and then arrested a number of wounded persons.

These acts of aggression were repeated even more brutally on the following days and on 12 December 1987 two citizens were shot dead. One of them was an eight-year-old child who was there with his mother, and patients, physicians and health workers in the hospital were beaten up again on the same day. 35/

This was repeated on 18 December 1987 when more than 300 Israeli soldiers and officers stormed the hospital again and occupied all the wings and departments and even the roof, and started to break up medical equipment in the radiology and cardiology departments, and even stormed maternity wings in the hospital. They killed two citizens and wounded 11 at the hospital gate, while more than 50 citizens inside were also injured with clubs, cudgels and rifle butts. Forty other citizens were arrested, some of them already wounded, including a number of children. Such acts of aggression are still being performed continually both inside and outside the hospitals in the occupied territories.

On 11 December 1987 Israeli forces set siege and stormed the Women's Union Hospital in Nablus in the same way and a number of citizens were wounded in the process. Patients inside the hospital were beaten up and this aggression was repeated on 13 February 1988, when patients, physicians and health workers in this hospital were again beaten up. A foreign journalist who happened to be on the scene was not spared either. His cameras and the cameras of other journalists were confiscated while a number of doors and windows in the hospital and the adjacent nursing school were broken and smashed.

The same hospital was again subjected to acts of aggression on 25 February 1988 when Israeli soldiers brutally beat up nurses in their dormitories, stormed the operating theatre in the hospital, and arrested one hospital worker called Mahmoud El-Malwani, who was 19 years of age.

Further acts of aggression were performed in the same way at Nasser Hospital at Khan Younes, when on 15 January 1988 it was stormed and live bullets and tear gas bombs were used in all parts of the hospital while Israeli forces detained 30 citizens and imposed a curfew on the area where the hospital is located and declared it a closed area for journalists.

The Ramallah Hospital again was stormed on 12 February 1988, and Abdullah Aba, who had sustained serious wounds, had arrived only minutes before the storming of the hospital and was not treated as a result of this because soldiers were throwing gas bombs and shooting all over the hospital. He died. Soldiers also beat up patients and physicians and evacuated a number of patients, which endangered their lives.

The El Ahli Arab Hospital in the Gaza Strip was stormed several times; and on 24 February 1988, for example, Israeli occupation forces stormed the hospital, interrogated a number of patients and when the hospital director objected to this behavior he was beaten up along with a number of physicians and health workers in the hospital.

This practice continued in all parts of the territories, and military checkpoints were set up at hospital gates and observation points on the roofs of these hospitals. This means that all the hospitals in the occupied territories are under military siege.

Examples of this include a military observation point on the roof of the El-Shifa Hospital in the Gaza Strip, which was set up on 10 December 1987.

On 5 January 1988 Israeli forces set siege to the Nasser Hospital in Khan Younes and declared it a closed military area.

On 16 January 1988 Israeli forces prevented medical teams and medical supplies from crossing the Iriz military barrier.

On 19 January 1988 Israeli forces set siege to Beit Jala Government Hospital, stormed the hospital and arrested a number of patients, among them Ziad Al-Lahham, who had a fractured foot and who wig beaten up with clubs and rifle butts, which resulted in another fracture to the spine. 39/

On 2 February 1988 Israeli soldiers used live bullets, rubber bullets and gas bombs inside the Columbia refugee camp clinic run by UNRWA, wounding Dr Monzer Tharwat in his right hand, and Rasheed Ali Nasser, a member of the nursing staff, also in the right hand, and Latifa Issa Hammad, 70 years of age, in the back and the shoulder.

Soldiers also threw a number of gas bombs inside Hebron Hospital and inside the hospital laboratory, which caught fire and as a result of which much of the equipment was destroyed.

2. Aggression against physicians and health workers

As mentioned above, the storming of hospitals and health centers was a daily practice; the interception of ambulance vehicles, preventing the wounded from reaching hospital, aggression against physicians and health workers inside refugee camps and in villages and towns were also a daily scene. Particularly ugly was the habit of storming such places, beating up people and preventing them from doing their duty of treating the wounded and the injured, as in the following examples:

On 20 January 1988 Dr Ibrahim El Hur was beaten up by occupation soldiers as he was trying to save one of the wounded in the El-Berig camp, where he lives; soldiers put him in a military jeep and drove all round the camp, beating him up in front of all the onlookers.

Occupation soldiers destroyed the car of a doctor working at El-Shifa Hospital, beat up their driver and prevented him from entering El-Shifa refugee camp, where he lives, and this was done even after Israeli forces had lifted the curfew imposed on the camp in question.

Israeli soldiers beat up doctors and nurses in the Jabalia refugee camp and prevented them from performing their duties in rendering services to casualties in the camp. Israeli soldiers beat up Dr Rabah Mehana and Dr Ahmed El-Yazgi when they stormed the headquarters of the Arab Medical Society in the Gaza Strip; they destroyed the contents of the building and confiscated documents from the center and beat up the Society's Secretary, Mr. Ibrahim Asfour.

Israeli soldiers habitually intercept ambulance vehicles and beat up the medical teams in them. For example, an ambulance vehicle was intercepted near the Women's Union Hospital and the medical team inside was badly beaten up on 13 January 1988, and again on 2 February 1988. Another ambulance vehicle owned by the Red Crescent Society in Nablus was intercepted. A doctor and members of the medical team were badly beaten up, and another ambulance car was intercepted on the same day at the entrance of the El-Ein refugee camp in Nablus, when the doctor refused to surrender the vehicle to Israeli soldiers who wanted to use it to enter the camp and detain citizens living there.

On 4 February 1988 Israeli soldiers tried to force doctors working at El Shifa Hospital to clean up streets around the hospital and pick up stones and cigarette butts; when the doctors refused to do so they were beaten up with clubs and rifle butts. Among them were Dr Shawki Harb, head of the Cardiology Department, Dr Mohamed Khalil, a heart surgeon, and Mr. Noaman Mostafa and Mr. Mohamed Nagi, two members of the nursing staff.

On 11 February 1988 three members of the nursing staff at the Women's Union Hospital were beaten up as they approached the Balata refugee camp. These were Jameel El-Rabahi, Moured Nemr Sobh and Ayad Mohamed Shetary.

3. Preventing ambulance vehicles from carrying casualties to hospital

The occupation authorities are continually preventing vehicles and ambulances from carrying the injured and the wounded to hospitals, as a result of which the emergency departments in these hospitals now suffer from a very serious shortage of ambulance vehicles. The following are some examples of such practices:

Occupation authorities intercepted ambulance cars and prevented them from entering the Nablus area to evacuate the wounded on 12 December 1987. For months after this period in the uprising, ambulance cars were also intercepted and prevented from entering refugee camps and other areas, as, for instance, on 1O.January 1988, when ambulances were trying to enter the central refugee camps in the Gaza Strip, the Jabalia refugee camp and other parts of the West Bank. On 27 January 1988 ambulance vehicles were prevented from entering the village of Saeer, 37/ in the Hebron area, and a representative of the International Red Gross was turned back.

On 3 February 1988 ambulance vehicles were prevented from entering Hebla village, to the south of Kalkailia, where four women were being taken after having been shot at by Israeli soldiers. The same thing happened at Ben Naeem and Kabatia villages on 6 February 1988, when Red Crescent ambulance cars were prevented from entering these areas.

Occupation forces also confiscated other ambulance, cars and used them to enter certain areas and detain citizens therein. They habitually shoot at ambulance cars and this has happened several times on 13 December 1987 and 15 January 1988 in Gaza and in the El-Berig area, and on 23 January 1988 at the Bani Naeem village where the ambulance was confiscated and used by soldiers to enter the village.

4. Making the work of hospitals impossible

On 20 December 1987 the military governor issued an order warning all health centers and hospitals in the West Bank and the Gaza Strip not to receive casualties injured during the uprising and prohibiting all physicians and health workers in hospitals from giving any information or making any statements to the local or international press.

It is to be noted that these atrocities practiced by the Israeli authorities against medical teams, hospitals and health centers are in direct contravention of the rules of international law, the Geneva Conventions and all humanitarian customs and traditions. Such practices have forced physicians in the Gaza Strip and the West Bank to go on strike and to issue a number of calls and statements urging international action and demanding that international organizations attempt to put an end to such inhuman practices.

CONCLUSIONS

This report attempts to show the extent to which health conditions in the occupied Arab territories have deteriorated, and the extent to which the health of citizens under Israeli occupation has suffered.

International organizations and institutions have expressed concern for the health of citizens in the occupied territories and extreme concern at the flagrant violations of basic human rights on the part of Israeli military authorities.

The International Committee of the Red Cross and other international organizations have intensified their efforts to alleviate the pain and suffering of Palestinians in the occupied territories and the International Red Cross has been an observer and an eye witness of such practices throughout the uprising. It was also present when help was needed, and rendered assistance readily to all those who were in need, to hospitals and to health centers, and the same was done by UNRWA and the World Health Organization.

Yet despite these efforts the reality of the situation has not changed because our people still suffer wounds, pain and setbacks from Israeli oppression and from the measures taken by occupation authorities aimed at destroying national institutions and the health of citizens in the areas.

Our Palestinian people want to participate in the attainment of the noble goal of the World Health Organization in providing health for all by the year 2000, but cannot do so because of Israeli occupation and daily violations of their rights in their own land.

The Palestinian people, like other peoples under foreign occupation, look forward to the day when the occupation will end so that they can take an active part in the endeavor to attain the goal of health for all by the year 2000. We wonder whether you are going to enable our people to realize this dream.

The management of health problems entails political action and efforts on the part of other sectors and this necessarily means finding solutions for social and economic problems as well. It entails giving political momentum to health activities and this in turn requires an atmosphere of peace and justice, equity in the distribution of health care, the enjoyment of freedom and liberty, and respect for human dignity. Conditions in the occupied territories today show that these requirements are not met and promotion of the health of the local population is therefore impossible in the circumstances. 39/

Our people are fully confident that the peoples of the world, the international organizations of the United Nations system and other international organizations in all parts of the world which believe in freedom, justice and peace, share the aspirations of our people and their hope of attaining their just and legitimate national rights and goals.


REFERENCES AND NOTES

INTRODUCTION

1/ Documents A33/21, A34/17 and others.

2/ Document A36/14.

3/ Document A31/27.

4/ Document A31/27.

5/ Document A37/13.

PART 1: DETERIORATION OF HEALTH CONDITIONS IN THE OCCUPIED ARAB
TERRITORIES, INCLUDING PALESTINE

1. Socioeconomic situation

1/ Palestine Liberation Organization, Division of Occupied Territories Affairs: Israeli practices against the Palestinian population in the occupied territories in 1987, page 183.

2/ Ibid., pp. 207-209.

3/ Ibid., pp. 196-209.

4/ Benvenesti, Miroun: Economic, social and administrative conditions in the West Bank (1982). The figures are approximate and are taken from 1982 statistics. See Balsam, journal of the Palestine Red Crescent Society, Nos 103-104, February 1984, for the translated version.

5/ Ibid.

6/ When the farmer can not pay these taxes, as often happens, the authorities uproot his crops.

7/ Benvenesti, Miroun: op. cit.

8/ Al-Stark Al Awsat, 17 May 1984. Report prepared by the Tripartite Fact-finding Commission and presented by Francis Blanchard, Director-General of the International Labor Organization (ILO).

9/ Ibid.

10/ Benvenesti, Kiroun: op. cit.

11/ Report of the Economic Division of the Palestine Liberation Organization, 13 February 1988, p. 3.

12/ Antoine, Zablan, Wmeiri, Roux: Palestine Studies, vol. 4, Summer 1977, p. 105.

13/ ILO report, op. cit. Some estimates put the number of workers at 130 000 in 1987.

2. Health conditions

14/ Cf. Palestine Red Crescent Society reports for previous years.

15/ Document A33/21.

16/ Report of the Palestine Medical Relief Commission, 1987, Jerusalem.

17/ Rui, Sarah: Survey on the Gaza Strip and a data collection project on the West Bank, Jerusalem, 1986, p. 102.

18. Israeli Central Statistics Office: Brief Israeli Statistical Handbook, p. 751.

19/ Rui, Sarah: op. cit., p. 109.

20/ For further details, see reports of previous years.

21/ Report issued by the Patient's Friends' Society, Tulkarem, 1987.

22/ Cf. reports of previous years.

23/ Cf. reports of previous years.

24/ Conditions in the clinics are mentioned earlier in this report, on p. 00 (Arabic p. 16).

25/ Israeli Health Ministry: A brief on health services in the West Bank (Judea and Samaria) and Gaza, 1986, p. 11.

26/ According to UNRWA Statistics, the child mortality rate in the West Bank camps fluctuated between 37 and 84 per thousand during the period 1977-1984.

27/ The OPEC Fund approved a grant of US$ 250 000 in 1987, which was to be used by UNRWA to provide a network of concrete roads and a mains sewage network, and to upgrade some of the medical facilities and equipment in the camps, but Israel did not approve the project. Many similar projects met with the same fate.

28/ Report by the representatives of the European Committee for the Defense of Palestinian Refugees and Emigrants.

29/ Balsam, journal of the Palestine Red Crescent Society, No. 147, p. 89.

30/ Document A27/13.

31/ Report of the Medical Relief Commission on the field study in question.

32/ PHRIC: Jerusalem, update 17 February 1988.

PART II: DETERIORATION OF CITIZENS' HEALTH CONDITIONS, HOSPITALS
AND HEALTH CENTERS IN THE OCCUPIED TERRITORIES

A. Practices and tools of Israeli oppression and the deterioration of citizens' health conditions

1/ In their press conference at Kennedy Airport on 1 February 1988 on their return from a fact-finding visit to the occupied Arab territories, members of the American delegation of lawyers stated that Israeli soldiers shoot at demonstrators from as little as 10 meters' distance and that they themselves were shot at with bullets and tear gas bombs.

A pamphlet published in French (24 pages), and including a detailed report on an investigation carried out by three senior officials from the following international organizations: the International Center for Information on Palestinian Detainees in the Occupied Territories, whose headquarters is in Paris, the International Association for Peoples' Rights, whose headquarters is in Rome, and the International Association of Democratic Lawyers, whose headquarters is in Brussels, contained the following statement:

"There is nothing that justifies the Israeli soldiers' opening fire, on demonstrators, sometimes from a distance of only 10 meters ... There is absolutely no justification for what the soldiers claim as shooting demonstrators in self-defense. The truth is that Palestinian youth does not take up arms to express its opposition to the occupation, whereas Israeli soldiers open fire when confronted by demonstrators."

2/ Senator Marsenlio Coria stated at a press conference given by the Brazilian Parliamentary Delegation at the Al Kaser Al-Watani Hotel in Jerusalem on 21 January 1988 that Israeli troops are using dum-dum bullets, which have been internationally banned, and that he had seen some casualties wounded by these bullets in the Al Shifa hospital in the Gaza Strip. He also confirmed that the military district commander, General Imram Mitznal, had endorsed the use of .22

rifles to fire dum-dum bullets on 18 January 1988 (Al-Ehemshemar, 19 January 1988).

3/ Visit from 3 to 7 February 1988 by Professors of Medicine, Jack Baker, Jennifer Lenning, Leon Shapiro and Bennett Simon, of Harvard and New York Universities.

4/ PHRIC: Jerusalem, update 17 February 1988.

5/ That made sure that similar cases were registered at the Shifa Hospital in the
Gaza Strip.

6/ PHRIC, Jerusalem, update 17 February 1988.

7/ This anaesthetic substance was extracted from bomb No. 123456789, which was presented by Rev. Don Wagner to a professor of chemical analysis at Hebron University for analysis of the gas used in it.

8/ Will be discussed throughout the report and when referring to raids.

9/ These gases were analyzed by Bir Zeit University and the results were consistent with those of Hebron University.

10/ See statistics in appendix.

11/ As a restrictive example, there were 50 cases of suffocation and fainting, mostly in children, from the use of this powder in the town of Rafah, in the Gaza Strip, on January 1988. This information was taken from a special report presented to the Palestine Red Crescent Society.

12/ Declaration by a doctor at the Evangelical Hospital. See statistics concerning the number of people wounded with rubber bullets.

13/ Yede'ot Ahranot, 17 December 1987.

14/ Jerusalem Post, 20 January 1988. An Israeli journalist commented in the same newspaper: "Can the soldiers distinguish between reasonable violence and excessive violence?"

15/ See statistics and records on dead and injured persons. The information in this paragraph is taken from the press conference given by the American doctors (Doctors for Human Rights). See also the report of the Palestinian Human Rights Information Center, 17 February 1988, which contains the testimony of Rev. Don Wagner about the savage methods used by Israeli soldiers to beat and kill the young man Khadr Torazi

(19) in Gaza, the report of the chief, surgeon of Shifa Hospital, and the issue of the monthly Balsam for March 1988 ("Testimonies that complete the evidence of the crime').

16/ PHRIC, Jerusalem, update 17 February 1988.

17/ The pictures of the beating of two young Palestinians and the breaking of their arms with stones broadcast by CBS television are an example of the savage methods used daily against Palestinians.

18/ The way the young man Anwar El-Mimi (23) was beaten to death once again illustrates the savagery of the soldiers. See records of dead and injured persons. See also records of the press conference given by the American doctors.

19/ Al-Qabas/Times, 29 and 30 January 1988.

20/ Al-Qabas, France Presse, 9 February 1988.

22/ The delegation of American doctors stated that the head of the Israeli health services had informed them that the number of victims from 21 December 1987 to 3 February 1988 was 250 in the West Bank, while the news agencies told them they had
recorded between 350 and 500 victims in the West Bank for this period.

23/ Confirmed by Dr Lenning (American) at the press conference on 11 February 1988. See publications of the Palestinian Human Rights Information Center (PHRIC), Jerusalem, 17 February 1988.

24/ Ibid.

25/ Hadashot, 18 January 1988.

26/ On the subject of curfew, the Center stated: "information about curfew and closed military zones is inadequate. It is clear, however, that many areas are still subject to curfews and considered as closed military zones. On 26 January, many villages in Hebron were besieged and declared closed military zones; Jabalia and Rafah were subjected to a partial curfew; on 27 January, Salur, Beitur, Rafah and Jabalia were subjected to a full curfew, while the Jelzun camp was besieged and curfew was enforced in it; the village of Al-Ram was declared a closed zone for journalists and a curfew was imposed; on 31 January, a curfew was also imposed on Nablus and the camps of Askar, Beletah and Beit Alura in the West Bank, together with Der El Balah, Shater Camp and the Shujalyah in the Gaza Strip, and all were declared closed zones. PHRIC update, 24 January 1988.

27/ Usually armed settlers participate in such actions, or even commit them alone. On 1 April 1988 Israeli soldiers attacked the Mufti of Jerusalem, Mr Saed Al-Din Al-Alami, immediately after Friday prayers. They hit him on the head with rifle butts until he blacked out; he was then taken to Makassed Hospital.

28/ See reports submitted by the Palestine Red Crescent Society to WHO in 1984, 1985, 1986.

29/ Al-Shark Al-Awsat newspaper, Palestine Press Office in Jerusalem, 19 January 1988.
30/ This information was included in reports of various press agencies, and in a report by the Palestine Press Office in Jerusalem on 22 January 1988.

31/ These are just two examples of events that occur daily in most areas. They are taken from the reports of various press agencies, the Palestine Press Office in Jerusalem, and Al-Safir, a Lebanese daily newspaper.

32/ Al-Qabas, 13 February 1988, and the report by the Spanish Committee of Jurists.

33/ Hamad Husni Muhammet Ayyad's testimony; Washington Post, 26 February 1988.

34/ Press agency reports, memoranda and statements of private associations in the Gaza Strip, doctors' reports, and findings of fact-finding missions.

35/ Two members of the Israeli Knesset, Yousi Sreed and Dray Tsoker of the Human Rights movement "Raats", stated, on 21 January 1988 after visiting the Gaza Strip: "If
Government ministers saw with their own eyes the state of the wounded in Al-Shifa hospital, they would take away the club from the Minister of Defense, Itzhak Rabin ... Israeli soldiers who are confronting the citizens in the Gaza Strip are the victims of high political officials who have completely lost their heads ... We saw the blatant marks of violence in refugee camps in the Gaza Strip."

36/ According to eye witnesses and various press agency reports. on 22 February 1988 Israeli soldiers invaded Nasser Hospital in Gaza town and assaulted doctors, nurses, workers and the wounded, six of whom had to be transferred to, Al Shifa Hospital suffering from serious wounds.

37/ The occupation forces had brought in a great number of soldiers to the village by helicopter, while opening fire and throwing tear-gas bombs.

38/ This "sit-in" spread to most of the hospitals in the West Bank and Gaza Strip. Examples of hospitals which declared "sit-ins" are Ramallah Hospital on 4 February 1988, all hospitals in the West Bank and Jerusalem for half an hour on 10 February 1988, Al-Shifa Hospital in Gaza on 19 January 1988, and Al-Shifa Hospital and Nasser Hospital on January 1988. The doctors' demands were as follows:

(1) To respect this humanitarian profession, not to attack doctors, nurses and emergency squads, to provide them with protection and allow them freedom of movement.

(2) Not to detain doctors and nurses at check-points on their way from their homes to the hospitals and vice versa.

(3) To grant freedom of movement to ambulances so that they can transport the wounded, and not to harm the wounded while in ambulances either by beating or by detaining them.

(4) To set up medical teams covering all specialist fields to provide medical services inside the camps.

(5) To provide the needed medicine for citizens and food for children. See statements and appeals of the Palestine Red Crescent Society, of the Red Crescent societies in Gaza and the West Bank, and of the Arab Medical Association in Gaza; memorandum presented by nurses at Al-Shifa Hospital to
the Head of the Nursing Department in the hospital; and the memorandum presented by doctors at Al-Shifa and Nasser Hospitals to the Health Administrator in Gaza when he summoned them on 20 January 1988.

39/ Report of the Special Committee of Experts, document A35/16.



APPENDIX 1


STATISTICS ON ABORTIONS, DECEMBER 1987 - 31 MARCH 1988


Cause of
abortion
Gas
Severe
beating
Rubber
bullets
Total
Age
0-14
15-30
31-45
46-65
66 and above
-
83
14
-
-
-
22
4
-
-
-
1
-
-
-
-
106
18
-
-
Total
97
26
1
124



APPENDIX 2
STATISTICS FROM ACTUAL RECORDS AND AVAILABLE DATA ON THE TOTAL NUMBER AND DISTRIBUTION OF INJURIES, 10 DECEMBER 1987 - 31 MARCH 1988


Cause of injury
Firearm bullets
Rubber bullets
Tear gas
Severe beating, truncheons
Knocked down cars
Total
Type of injury
Head, eye, ear, nose, face
858
585
46
1,477
35
3,001
Chest, suffocation, fainting
509
116
2,107
162
2,804
Abdomen, waist, internal hemorrhage, pelvis
499
132
192
823
Upper limbs
863
225
1,457
2,545
Lower limbs
2,838
303
683
5
3,829
Back, spinal column, paralysis
339
175
136
650
Wounds, contusion, fractures
388
458
72
8,186
102
9,206
TOTAL
6,294
1,994
2,135
12,293
142
22,858



APPENDIX 3

NUMBER OF ARRESTS BY AGE GROUP,
10 DECEMBER 1987 31 MARCH 1988

Age
Number
0-14

15-30

31-45

46 and above

Unknown
108

3,962

438

61

264
Total
4,833




APPENDIX 4
NUMBER OF MARTYRS BY CAUSES OF DEATH,
DECEMBER 1978 - 31 MARCH 1988


Cause of death

Age
Live bullets
Gas
Severe beating
Crushing
Hanging
Throwing from heights
Total
0-14

15-30

41-45

46-65

66+
18

126

9

6

1
18

6

5

10

9
1

2

-

2

-
-

6

3

1

-
1

-

-

-

-
-

-

-

1

-
38

140

17

20

10
Total
160
48
5
10
1
1
225



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