Health in Gaza

March 19, 2010
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lancetConference and Gaza Visit: Health Under Occupation

Richard Horton, editor, the Lancet, 16 March 2010, published on the Medical Aid for Palestinians website

This March, the second annual conference on health in the occupied Palestinian territory was held at Birzeit University. Following the successful conference, MAP lead a delegation into Gaza to investigate the health impact of the ongoing blockade. Richard Horton, editor of The Lancet, describes his visit:

“One year after the launch of our report on health in the occupied Palestinian territory, many of the scientists who took part in that work reassembled in Ramallah last week. We were there to hold the second meeting of The Lancet-Palestinian Health Alliance, a loose network of health researchers committed to illuminating the conditions under which Palestinians live today. One goal of the conference was to report the best available evidence for policy and practice. The unfortunate reality is that health remains neglected by all those who have a role in shaping the future of the occupied territory. There is worsening poverty and a deteriorating state (the education system, for example, is measurably disintegrating).

Social inequalities are deep. Violence is increasing. The health system is becoming ever more fractured. Access to health services (and their quality) is poor. Health workers are under immense stress. So, amid these bleak circumstances, are there any signs of hope? Yes, there are. The Palestinian health community is determined to study, measure, analyse, and describe the predicaments they face-and take full responsibility for solving those predicaments. They are also dedicated to using research findings to tell their policy makers and ministers, as well as international actors, what their people need-urgently.

Thanks to Medical Aid for Palestinians (MAP), a small group of us-Iain and Jan Chalmers, Graham Watt, and myself, together with MAP staff -were able to get permits to enter Gaza. In early 2007, Gaza City was tense. Armed militia were on most street corners. Now Hamas has achieved public order. It feels safer. Others say this is not so: Hamas is facing dissent and splits among its supporters, creating more dangers for visitors. Whatever the security situation, the lives of Gazans themselves are more primitive. The aftermath of the Gaza war has left poor families poorer. We saw ordinary Gazans rebuilding homes with their bare hands out of the debris left behind by Israeli bombing and tank demolitions.

At Shifa Hospital, there are shortages of basic laboratory and diagnostic equipment (test tubes). What they do have is of poor quality (dialysis materials). Medicines are lacking (chemotherapy). There are too few or no specialists (urology, vascular surgery). There are not enough nurses. Doctors have no postgraduate training, no opportunities to study abroad, and no chance to upgrade their skills.

Meanwhile, electricity is off eight hours each day. Water is unsafe. And the Ministry of Health building remains bombed and wrecked.

Despite these privations, the West Bank of the occupied Palestinian territory is a beautiful land. Driving through the hills around Ramallah reveals a lattice of intricate roads laid down between steep terraces thick with olive trees (like old men defending their ground, as Jan Chalmers insight fully put it). The hillsides have been carefully layered to provide grassy plains for grazing sheep and growing crops. Shepherds still walk ancient paths. Villages fix lives and livelihoods to the earth. The future health of Palestinians must be based on the fact that the West Bank, Gaza, and East Jerusalem are Palestinian lands, demanding a contiguous health system that is allowed to grow and flourish.

But put politics aside for a moment. Examine the epidemiological evidence. Child malnutrition is deepening. There are no coherent health services across the occupied territory for children. Young people face a double burden, wide spread wasting, stunting, underweight, anaemia and increasing rates of overweight and obesity. A fifth of children eat no breakfast. Too many eat sweet and salty foods. Children are the future of the territory. But their future is invisible to many policy makers who say they care about this region.

I had dinner on my final night-in East Jerusalem-with a British Government official who works in the occupied Palestinian territory. Despite the burdens affecting Palestinian people, he was optimistic. The Palestinian Authority has dramatically improved its governance. Salam Fayyad, the Palestinian Prime Minister, is a great asset. And, as Iain, Jan, Graham, and I departed from Tel Aviv’s Ben Gurion airport, so American officials-George Mitchell, Joe Biden-were arriving to restart proximity talks: talks about talks, for peace and justice. So should we be optimistic? Our next conference will be in a year’s time. We will see”.

Richard Horton, Editor, The Lancet

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