A False Dawn. Palestinian Health and Human Rights under Siege in the Peace Process
Report of a fact-finding mission by Johannes Wier Foundation, the Netherlands and Physicians for Human Rights - UK
November 1998
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EXECUTIVE SUMMARY & CONTENTS INTERNATIONAL FEDERATION OF HEALTH AND HUMAN RIGHTS ORGANISATIONS (IFHHRO) EXECUTIVE SUMMARY
This report is the outcome of a visit to the West Bank and Gaza Strip in October 1997 by the Johannes Wier Foundation and Physicians for Human Rights-UK, affiliates of the International Federation of Health and Human Rights Organisations (IFHHRO). The visit was conducted by an Anglo-Dutch team of health professionals and a human rights lawyer. Local organisations concerned with health and human rights invited the Federation to witness their problems at first hand and to draw international attention to them.
The objectives of the visit were to investigate: access to health care of the Palestinian population, following the transfer of responsibility for health from Israeli to Palestinian hands in the wake of the Oslo Accords; and the role of health workers and professional bodies in relation to violations of human rights and ethical codes. The aim was to review the findings against relevant international standards, and to present them to relevant professional, political and human rights organisations worldwide. Such a record would also be an expression of solidarity with fellow health professionals practicing in an area of conflict.
Findings were measured against international standards including codes of conduct for medical professionals such as the Declarations of Geneva and Tokyo, as well as international human rights and humanitarian law.
The legacy of occupation since 1967 had left the Palestinian health system under-developed and under-resourced after twenty seven years of military occupation which fostered neglect and dependency on the Israeli health system.
Following the peace process, Palestinians in those areas now live under a complicated mix of Israeli occupation and varying levels of autonomy. This small geographical area has become a mosaic with Israeli security and the slow progress of the peace process dominating the lives of the Palestinians who live there. Inevitably, such a situation has a severe impact on health care provision. The peace process saw the creation in May 1994 of a Palestinian Ministry of Health with responsibility for primary, secondary and tertiary care to Palestinians in all areas except East Jerusalem, still under Israeli control.
The Palestinian National Authority is striving to build an integrated and coordinated health care system under a multitude of constraints. Freedom of movement for Palestinians has become a pressing problem. At the heart of the problem is the geographical fragmentation of the Palestinian areas: the almost total separation of Gaza from the West Bank, cutting off many Palestinians from East Jerusalem, and the division of the West Bank itself into areas. The Israeli security forces exercise control over the Palestinian population through a system of permits and closures or sieges which constitute a collective punishment.
There has been significant hardship as a consequence of this fragmentation, the policy of closures and security measures. Access to health care, the organisation and training of health professionals, the movement of patients and the provision of services were all adversely affected. The main tertiary care services are located in East Jerusalem, which is extremely difficult or impossible to reach. The resultant morbidity and mortality were the most striking findings of this mission.
Morbidity and mortality were also affected by a range of other factors. There are limited resources for provision of health care, due inter alia to Israeli restrictions on the Palestinian economy and to poor management and corruption. Israel is implementing a number of policies aimed at a de facto deportation of Palestinians from Jerusalem, depriving thousands of people of their right to health care. Environmental factors are an important issue, particularly insufficient quantity and quality of water, with Israel taking an unequal share of the available resources. All of the above, together with poverty, oppression and hardship, have an impact on the mental health of the population. There was a prevailing sense that high expectations raised by the Oslo process have not been met and the initial optimism has given way to frustration and a sense of loss.
The severe retrictions on access to health care for Palestinians violate Israel's obligations under international humanitarian law to ensure the welfare of the occupied population. They also contravene the prohibition on use of collective penalties and on interference with provision of medical services. Human rights standards are also violated including freedom of movement and the right to enjoyment of the highest attainable standard of physical and mental health.
In this climate, health professionals face some difficult choices. The role of health professionals and their awareness, response and participation in human rights abuses is crucial. While certain non-governmental organisations are active in promoting international standards, there is relatively little awareness of these standards among local health professionals. The Israeli Medical Association has failed to speak out against the health implications of Israeli policies in the Palestinian areas and has failed to take proactive steps to address allegations that Israeli doctors actively participate in torture.
This report ends with specific recommendations directed at the Israeli and Palestinian authorities, organisations of health professionals and the international community. These include calling on all parties to observe and implement international standards and to work to guarantee full unhindered access to health care for all Palestinians. This would be a suitable way to mark the fiftieth anniversary of the Universal Declaration of Human Rights coming in the same year as the fiftieth anniversary of the establishment of Israel. Action must be taken now to ensure the right to health of the Palestinian people and to end their suffering.
TABLE OF CONTENTS
Acknowledgements
Glossary
Executive summary (English)
Presentation of this report and response
I Introduction
II Objectives and Method of Work
1. The mission objectives
2. Method of work
III International Standards
1. Medical ethics
2. International humanitarian law
3. International human rights law
IV The Legacy: Health care after 27 years of occupation
1. Palestinian health care provision prior to autonomy
2. Interim arrangements under the Oslo Accords
V Current Reality: Health care under autonomy
1. Setting the context
2. Providers of health care
3. Restrictions on movement
4. The case of Palestinian Jerusalemites
5. Obstacles in the development of a Palestinian health infrastructure
6. Environmental health
7. Mental health impact
VI Violations of human rights and ethical codes: the role of health workers and professional bodies
1. Awareness
2. Participation
3. Response
VII Conclusions
VIII Recommendations
Appendices
Appendix 1 - List of Informants
Appendix 2 - International Standards
Appendix 3 - Oslo Accords, Article 17
Appendix 4 - Resolution of the WHO
Executive summary (Arabic)
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