Page last updated 29 Oct 2015
As Physicians for Human Rights-Israel makes clear, Israel has an unequivocal obligation under international law to provide medical care services to the population living in the occupied area. But from 1967 onwards it maintained two health care systems: one for its citizens – and settlers living beyond the 1949 Armistice line – and another separate and inferior health care system for Palestinian people living in the occupied territory. This created an unbalanced Palestinian health care system, dependent on Israel’s medical services, when it was transferred to Palestinian control under the Oslo Accords in 1994.
The situation has been made worse by the steady strengthening of movement controls – within the occupied territories, particularly between Gaza and the West Bank; and from the territories to the outside world. The ability to receive medical care is greatly hindered. And the situation is of course much worse for those living in Gaza.
This section focuses on the problem of tackling health issues under occupation, particularly during war. It also looks at debates about health issues and medical ethics, particularly the serious issues of violation of international humantarian law which have prevented people needing urgent medical care from receiving it; and medical complicity in the torture of Palestinian prisoners. Criticism of Israeli doctors and the Israeli Medical Association has led to some vigorous activity in their defence and this is reflected in the links below.
To the fullest extent of the means available to it, the 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…
Among those working on health and medical care issues are:
Physicians for Human Rights – Israel was founded in 1988 with the goal of struggling for human rights, in particular the right to health, in Israel and the Occupied Territories
MAP, Medical Aid for Palestinians is the premier organisation in the UK “Working for the health and dignity of Palestinians living under occupation and as refugees”.
The Gaza Community Mental Health Programme (GCMHP) is a Palestinian non-governmental, non-profit organisation established in 1990 to provide comprehensive community mental health services – therapy, training and research.
Selected articles and reports
1. Hands off The Lancet
15 April 2015
In July 2014, a group of doctors and scientists wrote to the Lancet expressing dismay at the carnage in Gaza and Israel’s propaganda. Since its publication, Sir Mark Pepys, a leading light in the Jewish Medical Association has been protesting about the decision of Lancet editor Richard Horton to publish the letter. In March 2015 Pepys organised a letter of protest, under the name Concerned Academics for Editorial Ethics, to publisher Reed Elsevier. This prompted a counter-letter and campaign, Hands off the Lancet.
2. No More Impunity: Gaza’s Health Sector Under Attack
Lawyers for Palestinian Rights, Al Mezan Center for Human Rights and Medical Aid for Palestinians, 26 June 2015
Introducing a new report on the havoc wreaked on Gaza during Operation Protective Edge (2014), Baroness Helena Kennedy QC called for “unequivocal commitment from all states for the protection of medical infrastructure and its importance in ensuring the fulfilment of the right of all Palestinians to the highest attainable standard of health.”
Seventeen hospitals, 56 primary healthcare facilities and 45 ambulances were damaged or destroyed by Israeli strikes, including the complete destruction of Al Wafa, Gaza’s only rehabilitation hospital, and an attack on the Mebarret Al Rahma Centre for People with Disabilities in which two patients were killed and three injured. Sixteen health workers, many of them ambulance drivers, were also killed while on duty treating, transporting or trying to reach the injured…
3. No Safe Place
Physicians for Human Rights – Israel, Jan 2015
This is the first report on the events of Operation Protective Edge (2014), in order to determine the scope of destruction in body and spirit. It is the only report written by an independent international body granted a permit from Israeli authorities to enter the Gaza Strip during the war. It found prima facie evidence of violations of international human rights and humanitarian law, and “the implacable effects of the on-going occupation itself” on public health, mental health and the broader social determinants of health in Gaza.
4. Report of a field assessment of health conditions in the occupied Palestinian territory
World Health Organisation, Apr 2015
“April 2015 — The Sixty-seventh World Health Assembly requested WHO to report on the health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan, to the Sixty-eighth World Health Assembly, based on a field assessment. This assessment includes: barriers to access to health care (general population and in particular the Palestinian prisoners); the impact of the (situation/occupation) on mental health, particularly on child detainees; the health impact of impeded access to water and sanitation, as well as food insecurity, and the provision of financial and technical assistance and support by the international donor community”.
5. Israeli doctors ‘failing to report torture of Palestinian detainees’
Harriet Sherwood, Guardian, 3 Nov 2011
The issue was revisited in The campaign about doctors and torture in Israel five years on (Derek Summerfield, letter in the BMJ, Jul 2014).
1. Palestinians: The Crisis in Medical Care
Richard Horton, New York Review of Books, 54/4, 15 Mar 2007
“In a survey completed by the Gaza Community Mental Health Program, over 90 percent of children below the age of eleven experience severe anxiety, nightmares, and physical expressions of stress, such as bed-wetting. Half fear that their parents will not be able to provide essential family necessities, such as food and a home. Forty percent have relatives who died during the second intifada, which began in 2000…
…During the past twelve months, the health systems in Gaza and the West Bank have begun to disintegrate rapidly.”
An exchange between Yair Amikam of the Israeli Ministry of Health and Richard Horton followed and can be read here.
2. Pregnant Palestinians give birth at Israeli checkpoints
Middle East Online, 21 Oct 2006
“Since the beginning of the second Intifada…in September 2000, 68 pregnant Palestinian women gave birth at Israeli checkpoints, leading to 34 miscarriages and the deaths of four women, according to the [Palestinian] Health Ministry’s September report.” It said “that pregnant Palestinian women are often prevented by Israeli forces from reaching hospitals to receive appropriate medical attention, causing many miscarriages and the deaths of some women”.
[The situation has “improved” since this time. In particular, external donating agencies funded the opening of specialised centres even in big villages and small towns, to decrease the dependency on access to bigger towns; and women went back to home deliveries (after shifting to hospital deliveries as recently as the 80s and 90s).
The problem still persists, not specifically for childbirths, but for all emergency evacuations, in areas of the West Bank around East Jerusalem, where ambulances can’t freely take people from villages to Palestinian hospitals in the city. They still get stopped at checkpoints around the city and there is a complicated process of ‘back-to-back’ transfer to other ambulances which are allowed to be in the city…]
3. Medical ethics, the Israeli Medical Association, and the state of the World Medical Association (see links below)
“Persistent concerns have been raised about the role of the World Medical Association (WMA), the international watch-dog on medical ethics, in respect of their approach to the Israeli Medical Association (IMA) in particular” wrote Derek Summerfield in the letter below. “In 1996 Amnesty International concluded that Israeli doctors working with the security services ‘form part of a system in which detainees are tortured, ill treated, and humiliated in ways that place prison medical practice in conflict with medical ethics.’ Other major human rights organisations, such as Physicians for Human Rights (USA) and Human Rights Watch, published similarly. The IMA did nothing, although when challenged tended to dismiss criticism as ‘political’ and point to their membership of the WMA as evidence of their probity.”
The letter triggered off a robust debate in the British Medical Journal in 2003. Here are links to the indictment by Derek Summerfield; responses by Vivienne Nathanson, director of professional activities of the BMA and by IMA president and now chairman of the WMA, Yoram Blachar; and finally the author’s response to both Blachar and Nathanson. (You need to register for access the full texts, and get a two-week free trial.)
Letter from Derek Summerfield
BMJ 2003;327:561 (6 September)
Reply from the BMA
BMJ 2003;327:561-562 (6 September)
IMA president’s response to open letter to the BMA
BMJ 2003;327:1107 (8 November)
Author’s response to allegation and to BMA
BMJ 2003;327:1107-1108 (8 November)
Contents of this section
Israel’s human rights violations – an introduction
Settlement building and land issues
Restrictions on movement
House demolitions, forced displacement, denial of residency rights
The Green Line
The economics of the occupation