Health care under occupation

international | miscellaneous | news report Wednesday July 23, 2003 18:25 by Juliana Fredman

news from the graveyard

This from a woman making a film in the West Bank about the state of Palestinian health care under the Israeli occupation.

by Juliana Fredman

Art.55 To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring the food and medical supplies of the population; it should, in particular, bring in the necessary foodstuffs, medical stores and other articles if the resources of the occupied territory are inadequate.

Art. 56. To the fullest extent of the means available to it, the public Occupying Power has the duty of ensuring and maintaining, with the cooperation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory, with particular reference to the adoption and application of the prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics. Medical personnel of all categories shall be allowed to carry out their duties. Geneva Convention.

In the perversity that overwhelms while making a documentary about other people's misery we had to make a conscious effort not to lament the recent, albeit limited, easing of restrictions. 'If only you had been here last year', everyone said. 'You would see they shoot at the ambulances every day. We were so short on supplies that now we keep 6 months worth in all towns'.

So many patients die of kidney failure at checkpoints that first Jenin and now Tulkarim have been forced to establish small dialysis units. The trip to Nablus had become too hazardous, too long, and often the patients were turned around and left to go home and die. More than 70 patients have died in ambulances being held at checkpoints. Many more babies have been born at checkpoints or at home in villages because ambulances could not reach them. Incidents of death during or just after labor for both mother and child have increased dramatically in the past two and a half years. I was here last summer, riding ambulances, doing direct action, too horrified and busy to pick up a camera. But now things appear quieter.


What a relief then to discover a reservoir of despair in the dialysis center of Nablus’ Wantani government hospital. The people are from the many villages that were and still are cut off from the cities. At most they see one general practitioner doctor visiting per week. Many have no primary care whatsoever. For these people curfew never ended, Nablus remains closed to them.

Mohammed from Talfet is blind and he leaves the village at 5 am three times a week to travel for dialysis, he is also diabetic. The trip takes between 4 and 5 hours each way. He takes 6 taxis and walks 5 km between roadblocks and checkpoints. Yet it is a journey of less than 20 kilometers.

His is relatively mild case. His village is not under ordered closure but merely blocked off by the dirt mounds that are not included in any maps of checkpoints, nor are most of them manned to allow the limited discretion available to soldiers staffing the 300 manned checkpoints. He crosses two of these and with his medical papers he is usually allowed to pass after as little as an hour standing in the hot sun. Often, his brother or son is allowed to accompany him across the checkpoint. However, sometimes they are refused and he must depend on the help of strangers.

A trip that once took a half hour each way and cost about 15 shekels now takes 4 hours and costs 70 sheckles each way 3 times per week.

Hiam from Luban pulled me over to talk to her sister whose blood was also being cleaned in Nablus that day. Really Hiam and her two able bodied sisters did most of the talking as Yasma was in terrible condition and could only interject on occasion.

Their village rests between Ramallah and Nablus in the hills. Unfortunately, it also rests between 4 settlements and their satellites, 3 large ones including Shilo and a brand new one that does not yet have a name that the villagers know. The horizon is dotted with their yellow lights. One house in the center of the village has been occupied by the Israeli army for 2 years and there is a base nearby. No cars are allowed in or out of the village. If they are lucky and things are quiet, they begin their thrice weekly journey on a tractor to the place where a taxi or ambulance can pick them up. The private ambulance costs 200 shekels each way but the public one is overloaded, hampered by restrictions of movement and often unreliable.

At the checkpoints the soldiers tell Yasma to show them the hole just above her breast that her blood is cycled through. Perhaps this whole kidney failure thing is an elaborate ruse by the worlds most infirm terrorist. (I am no doctor and neither are the soldiers- but her color is terrible, she cannot walk and her eyes roll back in her head as she writhes). She tries to sit up and points indignantly to her chest- her sister says, "You know this is haram (shameful) for us, to show ourselves- but they demand proof."

Again, 20 kilometers, anywhere from 2-6 hours including the walk (or tractor ride) through settler rich mountains to get to or from the village- itself a death defying feat. The settlers drive past the village down a main road Palestinians are forbidden to use.

These are just 2 examples from one time slot of one day in the dialysis unit at Nablus. There is no kidney transplant facility in the West Bank or Gaza. Israel will not take candidates because as dialysis patients they are non critical and besides this is the responsibility of the P.A (and has been for 10 years now). Don't you know that this is peace? The rules of the responsibility of the occupier to occupied visa vi health care has not applied since Oslo- and the P.A does not pay all their bills due to the Israeli hospitals so a quota system exists for Palestinian patients no matter how serious their condition

And now municipalities must use what money they have to provide basic services, such as dialysis, that should be easily served by regional centers. Nablus is well equipped to handle the north of the West Bank (i.e. the Jenin and Tulkarim areas), if the patients could only get there. In this way, what was well on the way to being a functioning medical system is being fragmented and intentionally (of course intentional, why else make an ambulance wait 2 hours at a checkpoint) destroyed by isolation and closure that will be made permanent by the wall and the road map from hell. Each of the projected Bantustans will be forced to sink or swim as a self-contained unit or risk losing patients in time consuming wrangling with the occupied army, and their gates and fences.

At the chemotherapy ward at Watani a stream of relatives meets us. They think we can help them, not realizing the practical uselessness of film makers.

"My brother has B- blood, very rare here. He has Leukemia." Mohammed from Barta leads us to the hospital bed.
"I travel all over Palestine looking for the blood, can you help him?"
Further questioning reveals that their village is one of those trapped in the eerie permanent military zone being established between the wall (security/apartheid) and the Green line.

"The soldiers don't believe that my brother is sick" He says waving hospital papers with the Leukemia diagnosis in front of the camera while his 30 something brother watches silently from bed, absorbing the precious rare blood. It is true he looks like a deceptively strong and healthy young man, the kind that are not allowed through checkpoints. The kind who walk miles around them or try to pass and are detained in lines for 6,8,10 hours in the hot sun every day at Huwara, the main entrance into Nablus.

In the children's ward a mother sits silently, her hairless daughter curled beside her as the doctor speaks over the cartoons

"With this type of Leukemia the treatment is very precise. While I am administering the drugs today, I know that the patient may not be able to get
here next time. This should be treatable, 70-80% curable, but with irregular administration it goes down to 40 or 50%."

I want to tell him not to say this in front of the mother who is from a village that should be 5 minutes away from Nablus but is instead 1 to 4 hours each way depending on the "mood of the soldiers". But instead I say,

"This must be very frustrating for you"

"Yes" he sighs fiercely.

"Is bone Marrow transplant and option?"

"In Israel yes, but here no." He is a hematologist not an oncologist.

According to Dr. Mustafa Bargouthi, head of the UPMRC (Union of Palestinian Medical Relief Committee) there is no one in the West Bank or Gaza who is trained to specialize in pediatric oncology. Just because there is no chemotherapy for children in all of Palestine does not mean that children with cancer go to Israel or Jordan. Some do, some are given an adjusted course of adult chemo, some die. Palestinian medical students from the West Bank and Gaza have never been allowed to study in Israel's medical schools since the beginning of the occupation in 1967.

They go to the U.S and Europe or to the Eastern parts and Russia rather than the occupying nation 10 miles down the road. The restrictions on travel mean that there is no opportunity for the information exchange of medical conferences, or specialization and innovation courses. There is no guarantee that if they leave Palestine they will be allowed back through Israel's borders.

There is a ditch the army dug using one of Catepillars bullet proof bulldozers encircling three lovely villages in the hills around Nablus. Sewage from the refugee camp and the settlement on the hill flow into the ditch making it a toxic moat imprisoning the villagers. The crossing is guarded by a tank and nobody is permitted to pass here. There is a formal checkpoint called Beit Farik several miles way but it is considered a `bad' one, and is often closed. When we filmed the idyllic but stinky valley from a nearby hill we were approached by several jeeps and soldiers weapons leveled. After much argument (and some wrestling over the camera) about just what the problem was, we went through the footage together, tourists with fancy toys. Beautiful valley, beautiful valley, quaint village -
"-There! This is the problem!" One of them said.
"What, the river?"
"This is not a river,” The soldier answered. "This is a military
installation."
Biological warfare then.

The head of the UPMRC which has been operating mobile clinics in the isolated villages for two years found 100 cases of hepatitis in one village of 1,500 where there had been none just a couple of months earlier. Dysentery and bacterial organisms in children have become extremely widespread.

The Palestinian people are being pushed back in time, pushed back in terms of diseases contracted, treatment available and means of accessing basic care (donkeys are now more expensive then cars in many places). Debased by a de facto sanctions regime more effective and murderous than any imagined by the state department or Downing Street, preventable death and disease exist as a central plank of Israeli control. Corralled into these circumstances by an occupation that takes not even the most minimal responsibility for its subject population the Palestinians watch and wait as Israel ruthlessly grabs more and more land, sunders social and economic relations within Palestine, steals the water, vandalizes the infrastructure and calls this graveyard peace.