SEATTLE, Washington — Palestinians in Gaza and the West Bank often have difficulties accessing health services. The occupation, continuing conflict and poor socio-economic conditions all contribute to the dismal state of healthcare for Palestinians. Recent efforts by the World Health Organization and IntraHealth International have been aimed at increasing the quality of health services available in Gaza and the West Bank.
Conditions in Gaza the West Bank
Poverty, hunger, water scarcity and the poor conditions created by conflict and violence all contribute to health problems for Palestinians. Approximately 29 percent of Palestinians live in poverty. At least 2.5 million are in need of humanitarian assistance. Only around 50 percent of the population receives water from piped water services, and the World Food Programme estimates that 22.5 million are food insecure.
Cardiovascular diseases, cancer and diabetes are among the leading causes of death in Palestine. All of these are non-communicable diseases that require serious medical care. Additionally, political instability and violence have caused increases in disabilities, amputations, traumatic injuries and mental and psychological disorders.
Accessing Hospitals and Healthcare
Since Gaza and the West Bank are occupied by Israel, Palestinians living in these territories are required to have Israeli-issued travel permits to enter Jerusalem or other cities in Israel. Many Palestinians rely on travel permits to access Israeli health facilities is because hospitals and other care facilities are scarce in the occupied territories. In the West Bank, 62 percent of which is under direct Israeli military and civilian control, approximately 300,000 Palestinians do not have access to a primary healthcare facility or hospital with advanced equipment. This is a significant barrier to healthcare for Palestinians.
Obtaining referrals and travel permits to access health services can be a lengthy and difficult process. Delayed or denied access to medical care can result in death, especially for patients with serious medical conditions like cancer or heart conditions, which require timely interventions. More than 54 Gaza patients died in 2017 because they were denied a permit or had to wait too long for a response.
World Health Organization Data reveals that approval rates for medical travel permits have been decreasing over the past several years. The approval rate was 92 percent in 2012 but dropped sharply to 77 percent by 2015. In 2017, the rate dropped even lower, reaching 52.4 percent. Although the rate had increased slightly by 2018 when 64 percent of applications to travel for medical care were approved. For those whose lives depend on travel approval, 64 percent could mean life or death.
The Problem with Existing Facilities
The hospital shortage in Gaza is a result of the requirement for all construction projects to be approved by Israel. A majority of building applications are denied. Without approval from the Israeli government, Palestinians cannot build their own health facilities. For those health facilities that do exist, Israel has placed heavy restrictions on Gaza to closely control imports and exports. This has created a significant barrier to accessing the needed equipment and supplies for local hospitals.
In early 2018, 40 percent of basic medicines were out of stock. In fact, many hospitals were having difficulty accessing basic medical equipment. For patients with serious medical conditions that require advanced equipment and medicines, hospitals in Gaza often lack the resources to provide necessary diagnostics and treatments. Therefore, if patients are unable to obtain a travel permit for an Israeli hospital, a condition that should have been treatable may become worse or prove fatal.
Efforts to Improve Healthcare
To improve access to health services, the World Health Organization has partnered with CARE International and the Palestinian Ministry of Health. Together, they are supporting mobile clinics in vulnerable and remote communities in the West Bank. Mobile clinics can provide essential primary healthcare services. This initiative has reached more than 150,000 Palestinians in different regions. Health providers are also being trained to provide psychosocial support, addressing the serious need for this kind of healthcare. Unfortunately, mobile clinics cannot always adequately treat more serious conditions.
The World Health Organization and the Italian Cooperation are working together to improve healthcare for Palestinians by expanding health coverage and increasing the quality of services available in Gaza and the West Bank. Specifically, the project will help construct hospitals, address the shortage of mental health care and work to make it easier for patients to receive referrals and travel permits. Beginning in January 2019, the project will last two years and will complement other projects and initiatives by the World Health Organization and Palestinian Ministry of Health.
IntraHealth International is partnering with the Palestinian Ministry of Health to reduce the cost of referrals and decrease difficulties in obtaining travel permits for healthcare. Together, they have been able to reduce the total cost of referrals from the West Bank by 34 percent through a redesign of referral policies. Intrahealth has also made it easier for the Palestinian Ministry of Health and referral institutions to communicate. Furthermore, the organization has managed to establish resource centers in three West Bank hospitals
Further efforts are needed to help overcome barriers to healthcare for Palestinians. Particularly, those barriers created by Israeli policies need to be reviewed in order to make healthcare available to all Palestinians.
– Sara Olk