1. This year marks 13 years since the signature of the Oslo Accords, pursuant to which responsibility for health and medical matters in the West Bank and Gaza was transferred from the Government of Israel to the Palestinian Authority (PA). The Oslo Accords and the subsequent Paris Agreement set forth, inter alia, the relationship between Israel and the PA with regard to health-related matters, and establish bilateral expert committees to discuss matters regarding public health, pharmaceuticals, food and nutrition and environmental health.
The Current Geopolitical Background
2. With the completion of its implementation of the Disengagement Plan in September 2005, Israel ended its military and civilian presence in the Gaza Strip by pulling out all of its forces and redeploying them behind the international frontier, as well as dismantling all of the Israeli settlements that were situated there. Following Disengagement, the militant Hamas terrorist organization won Palestinian elections in early 2006, and then violently took control of the Gaza Strip in June 2007. Since the Hamas takeover of Gaza, Israel faces two different governments in the West Bank and Gaza. The first is the Ramallah-based Palestinian Authority headed by Prime Minister Salem Fayyad and President Mahmoud Abbas, with which Israel continues to hold peace negotiations based on a two-state vision. The second is the Hamas regime headed by Ismail Haniyeh, which does not recognize the right of Israel to exist and rejects outright all agreements in existence between the Palestinian Authority and the State of Israel, including the Oslo Accords and the Paris Agreement. Furthermore, the Hamas regime officially supports terrorist attacks on Israeli soldiers and civilians within Israeli sovereign territory and embraces suicide bombers, daily rocket and missile fire on Israeli towns bordering Gaza, and other forms of violence against Israel and its citizens, which target civilian homes, nurseries, kindergartens, schools and universities, and incur fatalities, serious physical and mental injuries, as well as extensive property damage.
3. It should be noted that oftentimes, ironically, the aforementioned Hamas-supported rocket and other attacks on Israeli civilian targets serve to have a detrimental effect on the Palestinian residents of Gaza. For example, recent rocket attacks launched from Gaza have hit the Israeli electricity plant that supplies electricity to the Gaza Strip; an Israeli hospital that regularly treats Gaza residents and a terrorist attack on the fuel depot at the Nahal Oz crossing, killing two Israeli civilian labourers whose task was to supply gasoline and energy for the sake of the well-being of the Palestinian people residing in the Strip. Furthermore, Hamas continuously shells mortars on the crossing points through which humanitarian assistance is channeled. Thus, despite Israeli efforts to provide vital humanitarian supplies and prevent a crisis in Gaza, such Hamas-backed attacks only exacerbate the plight of Gaza’s residents.
Medical and health matters
4. During the last year, May 2007–May 2008, the Israeli humanitarian approach and attitude towards Palestinian civilians has continued despite the complicated and frustrating political environment of that is present in both the Gaza Strip and West Bank. In fulfillment of its recognized humanitarian commitments, Israel continues to provide ambulatory, outpatient and inpatient services to Palestinian patients who access this care in the PA hospitals, upon the request and permission of the Palestinian Ministry of Health. At times these services are provided in conjunction with Israeli and international nongovernmental organizations (NGOs). Even more patients have been referred to Israel since June 2007 due to the closure of the border between Egypt and the Gaza Strip. Last year over 15 000 permits were granted to Palestinian patients and their companions to receive treatment in Israel.
5. The passage of patients from the West Bank continues on a daily, regular basis. Additionally, in spite of the terror attacks launched from the Gaza Strip and the mortars fired on crossings, the passage of patients continues from the Gaza Strip as well. Israelis who serve to facilitate this important humanitarian work are often themselves targeted. This is an implausible and surreal situation.
6. Additionally, upon Palestinian request, Israel continues to provide public health laboratory services, as well as to provide training programmes to Palestinian physicians, nurses and other health professionals in Israeli hospitals, academy and epidemiology courses. Palestinian trainees are enrolled in training or specialization programmes in Israeli hospitals through Israeli NGOs like the Hadassah Medical Organization, Save a Child’s Heart Foundation, Peres Center for Peace and others. The NGOs finance the training projects with donations, and coordinate between the trainees and the hospitals and facilitate the logistics. Through the Israel Defense Forces Coordination and Liaison Office, Israel enables and facilitates the entrance of medical and pharmaceutical supplies donated by donor countries, WHO, the ICRC and NGOs into both Gaza and the West Bank.
7. One area in which there has been encouraging cooperation is the preparedness training for outbreaks of infectious diseases like pandemic influenza, including the endemic Avian influenza, which has provided the opportunity for Palestinian and Israeli experts to meet together under the umbrella of the Middle East Consortium of Infectious Disease Surveillance, backed by the WHO and international NGOs. Israeli and Palestinian health experts meet in order to exchange information, to evaluate the situation and to coordinate policy and action. The implementation of the International Health Regulations (2005) regarding Pandemic Influenza preparedness has become a mutual need and it was addressed through a workshop of Jordanian, Palestinian and Israeli public health professionals. This workshop was part of a larger trend of increased cooperation between public health professionals in the region, and collaboration on other pressing matters continues through a variety of channels.
THE ISRAELI-PALESTINIAN COOPERATION IN THE FIELDS OF HEALTH AND MEDICINE BETWEEN MAY 2007 AND MAY 2008
Re-establishment of the bilateral expert committees
8. At the end of 2007 the Israeli and Palestinian Ministers of Health met and decided to re-establish the bilateral expert committees, as outlined in the Paris Agreement, to discuss various bilateral matters on public health, pharmaceuticals, food and nutrition and environmental health. The committees have already met once during the early months of 2008.
Provision of medical care to Palestinian patients in Israeli hospitals
9. 66 671 patients from the West Bank have been treated in Israel hospitals over the past year, among them 10 290 children; approximately 40% of them were hospitalized and 60% received ambulatory services of various sorts.
10. 7 226 patients from the Gaza Strip were granted permits to be treated in Israeli hospitals over the past year of 2007. This is an increase of over 50% from 2006, when 4 754 were permitted to enter; 3 802 were hospitalized and 3 973 received ambulatory services of various sorts. Nearly 90% of the requests were approved to visit Israeli hospitals. The 10% denied permits, due to perceived security threats, were given the opportunity to take an Israeli ambulance shuttle to cross into Jordan. Prior to the closure of the Egypt-Gaza border, Palestinian patients were also given the choice of crossing into Egypt for treatment.
11. The Gaza Coordination and Liaison Administration of Israel receives and processes the requests for transfer and coordinates travel arrangements with the PA Ministry of Health in Ramallah.
Provision of public health laboratory services to the Palestinian Health Authority at any request of the Palestinian Ministry of Health
12. Public health laboratories at the Israeli Ministry of Health continue to provide assistance upon request to the Palestinian Ministry of Health for laboratory tests for poliomyelitis, measles, mumps, influenza and other viral diseases. During 2007, three Palestinian specialists were trained at Israel’s central virological laboratory to provide laboratory diagnosis for influenza and Avian influenza.
Enabling transports of medical equipment and medicines to enter into the Gaza and West Bank areas
13. Israel facilitates the transfer of medical equipment and medicines donated to the Palestinians by donor countries, the WHO, the ICRC and various NGOs.
Provision of training programmes for Palestinian physicians, nurses and other professionals in Israeli medical institutions
14. Various Israeli NGOs organize training programmes and capacity-building exercises for individual Palestinian health professionals and finance them by contributions from donor countries. An example of a foreign organization that organizes and finances training programmes for Palestinians is the Middle East Cancer Consortium, unique partnership between the United States and the Ministries of Health of Cyprus, Egypt, Israel, Jordan, the Palestinian Authority, and Turkey, which aims to reduce the incidence and impact of cancer in the Middle East through the solicitation and support of collaborative research.
15. During the past year of 2007, 72 physicians (two from the Gaza Strip), six nurses and two plasmapheresis technicians have participated in a variety of medical and surgical training programmes. More than 20 health professionals underwent full residency programmes and 53 underwent either short training programmes or medium-term programmes of a few months duration in the fields of anesthesiology, intensive care (adults and children), traumatology, orthopedic surgery, cardiac and thoracic surgery, vascular surgery, neurosurgery, urology, ENT surgery, ophthalmology, oncology, haematology, gastroenterology, dermatology, medical imaging, paediatric cardiology, or paediatric rehabilitation. Four have undergone post-doctorate fellowship in pharmacology and haematology. In addition, 618 trainees from the health field in the West Bank underwent short term training programmes in Israel or abroad (facilitated by Israeli parties) which lasted 3–4 days.