During 2002, half of the Palestinian population was unable to consult their usual health services, due to border closures and curfews, a World Health Organization (WHO) survey published today reveals. Detours and long waiting hours at Israeli checkpoints led to considerable delays and often forced the population to divert to a different health facility.
According to the Palestinian Ministry of Health, more than 90 patients have died during the last three years while waiting in an ambulance to cross a checkpoint.
Yet, in spite of severe restrictions on the free movement of Palestinians living in the occupied Palestinian territory (oPt) and with great difficulty, up to 95% of Palestinians were still able to reach a health facility in 2002, preliminary findings of the survey found.
The study was carried out in collaboration with the Ministry of Health of the Palestinian National Authority and Al Quds University, in order to assess the impact of Israeli closure policy on access to health services in the occupied Palestinian territory oPt. Data were collected in five districts in the oPt, including Nablus, Ramallah, Hebron, Rafah and Gaza. The survey indicates that the closure policy contributed to the worsening of the economic situation in the oPt, to a high percentage of unemployment and to an overall impoverished population. However, immunization coverage in the five districts included in the survey, has only slightly deteriorated since 2000. Similarly, attendance rates at antenatal clinics can still be considered reasonable, although 22% of pregnant women could not access antenatal services.
In general, the survey found, it was possible to avoid major disease outbreaks and the public health system could be maintained. However, the Ministry of Health has reported single cases or limited outbreaks of some vaccine-preventable and other communicable diseases. According to the Ministry of Health, there would be a risk of a polio outbreak, if immunization coverage declined further, as wild polio virus was detected in the sewage system.
The escalation of the Israeli-Palestinian conflict in 2000 resulted in strict travel limitations for the Palestinian population. Until recently, Israeli closure policy included internal closures within the West Bank and Gaza and closure of travel between Israel and the oPt. Since the beginning of July 2003, Israeli forces have removed some military checkpoints within Gaza and Bethlehem, in the West Bank. However, many Palestinians can still not go from their home to the nearest health facility.
“The outcome of the survey shows a remarkable capacity of the Palestinian health service providers to cope with this difficult situation and to adjust its services to it. It is also the fruit of effective cooperation among donor governments, UN organizations and NGOs to deliver humanitarian assistance,” said Dr Ricardo Solé Arqués, Health-Coordinator at the Jerusalem- based WHO office for the oPt.
Thanks to extensive humanitarian aid and as an emergency solution, in place since March 2000, the Palestinian Ministry of Health has guaranteed free health insurance to those Palestinians unable to pay - now large part of the population. Since 2000, due to mobility restrictions, many people - including health workers - could not reach their workplace anymore and unemployment rates have doubled.
In addition to that, the Ministry has also decentralized many services, increased the number of clinics and relocated health workers to areas with previously difficult access to health care.
However, in the long term, it will be difficult for the Palestinian Ministry of Health and the international community to sustain these emergency measures which are currently minimizing the impact of limited access to health services on the population’s health. Moreover, the United Nations Relief and Works Agency (UNRWA) and the Palestinian Ministry of Health have noted an increase in outpatients consultation and hospital admissions since 2000. To maintain health facilities operational, UNRWA has had to allocate a substantial amount of additional resources to hospitals and clinics.
Meanwhile, health insurance revenues for the Ministry of Health have dropped by 50%. In the case of a further deterioration of the economic situation and with the increasing poverty in the oPt, the functioning of the entire health sector will be put at risk.