The sociology of health affirms that an individual’s health cannot be evaluated solely in terms of biological phenomena, and that social and economic conditions have definitive impacts on one’s health. This is demonstrated by the 2003 World Health Organization report which supports this asserted connection between external conditions and health status. Therefore political realities such as war, occupation, poverty, and displacement must be understood as significant determinants of the physical and mental health status of a group of people in question. This is the analysis of Palestinian medical organizers who continue to witness the Israeli occupation’s persistence in obstructing Palestinian patients of their basic medical needs.
The roots of this analysis can be found shortly before the outbreak of the first Intifada, during which there was a developing attitude by members of the Palestinian health sector that continuing to work within the confines of the military occupation bureaucracy was an overall counterproductive strategy. The alternative medical movement which arose from this attitude derived its legitimacy from the needs of the people and refused to acknowledge the legitimacy and authority of the Israeli occupation. From this movement arose the Union of Palestinian Medical Relief Committees (UPMRC) in 1979 – now named the Palestinian Medical Relief Society (PMRS).
The initiation of the first Intifada in December 1987 continued the legacy of the Palestinian people’s rebellion against colonial rule and the deprivation of its national existence. The Intifada was a revolt against Israeli beatings, shootings, killings, economic exploitation, demolition of Palestinian homes, mass imprisonment, occupation and ultimately the suppression of Palestinian sovereignty. The first Intifada must be understood as a mass-based resistance revolt, which coordinated revolutionary action with clear political objectives. From this understanding we can appreciate the deep-level of organization which produced the Unified National Leadership of the Uprising and the popular committees that specialized in addressing various economic and social issues in the oPT, such as agriculture, women’s empowerment, poverty, and healthcare.
What informed PMRS activities in the oPT during the Intifada was the increasing awareness that primary healthcare in the rural areas and refugee camps was being neglected due to the Israeli government’s unequal distribution of health services. Additionally, it became apparent that Israeli policy intentionally sought to breakdown and reduce basic Palestinian healthcare infrastructure to dependency on Israeli services. Israel imposed heavy taxes on medical institutions, refused permits to expand or build new ones, and closed professional medical unions. In the first year of the Intifada, PMRS newsletters made it clear that its activities are voluntary and that they focus on bringing medical and health services to the rural areas and refugee camps where the people are denied access to healthcare.
In the first twenty-two months of the first Intifada, PMRS established five first-aid centers in the West Bank. During this time period they trained 22,000 people in basic first aid and distributed over 19,000 first-aid kits. These actions demonstrated PMRS’s commitment to a core principle exemplified during the first Intifada – of community self-sufficiency and empowerment.
One of PMRS’s significant contributions to the Palestinian health sector was the creation of a national blood donor system. In 1988 PMRS campaigned to collect relevant blood data from participants to be listed and distributed on their new donor cards, and registered in a computerized system. Hospitals in need of blood for transfusions would contact PMRS who would then relay back information on the names and location of donors per the requested blood type. The donor system became so efficient that young activists on the ground would match their cards with the wounded, and then immediately accompany them to the hospital for transfusions during popular confrontations with Israeli occupying forces. The PMRS blood donor system saved hundreds of lives.
Oslo and Onward
The Intifada came to an end with the signing of the Oslo Accords of 1993. The Oslo Accords changed the dimension of the Palestinian anti-colonial struggle, in particular by establishing the Palestinian National Authority (PA), the PLO-led executive body of the quasi- “State of Palestine.” In this phase of the Palestinian struggle, the PLO abandoned the politics of total liberation from river to sea in favor of international funding and diplomatic relations.
The PA accepted responsibility for Palestinian healthcare, but it did not secure for itself control of movement, border crossings, water, housing, and land. Therefore the Israeli occupation continues to directly influence the healthcare situation in the oPT, despite the supposed agency of the PA Ministry of Health. For example, in the West Bank, Israeli settlers use four times to six times more water than Palestinians. In Gaza, the Israeli siege prevents the import of construction materials, necessary for repairing Gaza’s broken water infrastructure. More than 90% of Gaza’s water supply is estimated to be polluted. Israel’s control of Palestine’s water resources has led to a hydro-apartheid system in which there is an unequal distribution of water, indirectly impacting Palestinian health.
Furthermore, the PA depends on the following financial sources: tax funds collected from Palestinian residents of the oPT, funds from donor countries, and funds collected by Israel on products entering the oPT. This third source, which is under Israeli control, constitutes 44-70% of the PA budget. This control over the PA budget allows Israel to punish the PA whenever its actions deviate from the status quo. For example, after the PA requested observer state status at the UN General Assembly in November 2012, Israel delayed the transfer of funds. This has serious implications for the efficiency of the Palestinian MoH, which cannot foresee if and when the PA will receive a significant source of its funding. This makes it difficult for the MoH to plan its annual budget. Additionally, due to a lack of advanced medical equipment and medical expertise, the PA is forced to refer many patients to Israel, as well as Egypt and Jordan.
Where does PMRS fit in the Israeli-PA medical-occupation complex? PMRS maintains its grassroots ties and activities dedicated to bringing primary care to underserved Palestinians throughout the oPT. The PMRS has proven itself to be more effective than the MoH in some cases, as when in October of 2015 the healthcare NGO released an Emergency Activity Report that revealed numbers of injured not included in figures released by the MoH.[
PMRS runs various health programs throughout the oPT, such as community-based rehab, psychosocial counseling, women’s health-centered and youth-centered programs. Notably, PMRS operates mobile clinics throughout the oPT daily. Many of these mobile clinics operate in “Area C” of the West Bank – under complete Israeli control – where many Palestinians live under threat of settler harassment and Israeli government demolition orders. The mobile clinics ensure routine primary care to the Palestinian residents of these villages, who would otherwise not have physical and financial access to clinics.
As the Israeli settler-colonial occupation of
Palestine continues, the Palestinian people are not able to fully develop a
self-sufficient, indigenous-run healthcare system. The Israeli apartheid regime
will not seek to promote access to healthcare for the Palestinians living in “Area
C” while at the same time implementing colonial policies intended to expropriate
their land and demolish their homes. This is where PMRS comes in, to supplement
the healthcare system with grassroots, bottom-up driven healthcare programs and
services for the people.