Healthcare is a unique issue in international politics and
discussions of modern civilization. As an institutional entity, it has
both a substantial and direct implication regarding the very existence of human
populations. That's in contrast to markers such as employment, GDP, or
literacy that have effects that are slightly harder to trace out. Indeed,
the authors' 2010 World Health Report recognized that "promoting and protecting
health is essential to human welfare and sustained economic and social
development" and that people "rate health one of their highest priorities"
(1). As a majorly accepted sentiment, it becomes morally difficult to
justify institutional healthcare inequalities if we choose to believe in
principles of democracy and Rawlsian equality of opportunity.
If, as a nation, we
impose economic sanctions on another country as a method of foreign policy,
it's okay for that nation's economy to suffer because it puts pressure on the
government and state leaders to capitulate. What you're not allowed to
talk about are the direct outcomes on the population because the point is to
get the boogey man--Saddam or Osama--but not to cause a humanitarian crisis
characterized by the starvation of children in, say, Afghanistan (2). Unfortunately, severe
economic decline and mass suffering are inexorably linked as is clearly
demonstrated by the Palestinian condition.
Starting in 2009, one of the world's medical journals, The
Lancet, began publishing a series of studies and commentaries concerned
with the socioeconomic condition in the occupied territories. The chief
editor of the journal, Richard Horton, recognized that "since 2000, the
occupied Palestinian territory has experienced increased human insecurity, with
the erosion and reversal of many health gains made in earlier years" and that
"these setbacks, together with the latest Israeli air and ground attacks on
Gaza, have plunged the region into a humanitarian crisis" (3). Indeed, a
February 2012 poll by the Palestinian Center for Public Opinion reported that
54.7% of Palestinians are concerned about their subsistence of themselves and
their family. Furthermore, when asked about their main present concern,
39.6% said it was employment and 22.4% said it was security (4).
The reason for their
bleak outlook is pretty straightforward, let's just look at the facts.
The aftermath of the Second Intifada and the blockade of the Gaza Strip left
the population of 1.7 million in a devastated state. In 2008, 37% of the
active workforce in Gaza was unemployed and 74% of the population lived below
the poverty line of $3.15 per person per day. Unemployment in the West
Bank was 19% and 40% lived under the poverty line. Though physical,
institutional, and trade restrictions imposed on the Occupied Territories since
the Oslo accords had been deteriorating the internal Palestinian economy,
foreign aid allowed for continued development (32% of GDP according to the
World Bank) (5). However, the situation collapsed upon the popular
election of Hamas: "Diplomatic ties and international donor funding were cut,
and Israel withheld Palestinian tax revenues, which together form about 75% of
the budget of the Palestinian National Authority." (6).
Health outcomes also
deteriorated sharply as a result of economic penalties and restrictions.
Electricity and cooking gas to Gaza was heavily diminished which subsequently
"disrupted the operation of water and sewage pumps throughout the Gaza
Strip." In addition to continual shortages of medicines and medical
supplies, a WHO report found that "medical devices are often broken, missing
spare parts, or out of date" (7). Amnesty International's 2011 Report
revealed that the infant mortality rate in the occupied territories is 23/18
(m/f) per 1000 in contrast to 6/5 in Israel. Furthermore the life
expectancy in the territories is 72.9 years as opposed to 80.3 years in Israel
(8). Proper access to healthcare has also been severely impaired by the
stringent restriction on travel outside of the occupied territories.
Reports by Physicians for Human Rights revealed an increase in the medical
referrals outside of Gaza coupled with a decreased in travel permissions
allowed for these cases by Israeli officials (9). The population
inexorably suffers.
The fundamental barrier
Palestinians face in attaining healthcare is ubiquitous: inability to afford
high costs. There is no realistic way of implementing a system of pooled
risk to decrease up-front costs and the distribution of healthcare resources
(including personnel) among the sick. It is extremely inefficient for several
different reasons. Because of the stipulations of the Israeli occupation,
the "Palestinian National Authority is expected to perform as the government of
a state while lacking control over its borders, basic resources, and many of
the social determinants of health" and "vague institutional arrangements have
hindered the establishment of a proper governance system" (10).
Modern medicine is built
upon basic principles of inter- and intra- state trade. This is in sharp
contrast to an advanced profession such as law where an expertly trained
professional can provide legal counsel just about anywhere and to anyone.
In addition to the physician's knowledge-base and skill set, he/she requires
material goods and resources such as medicines and biomedical equipment.
The internal economy of Palestine is deeply impoverished and exchange with external
parties is severely hindered by check points, roadblocks, and blockades.
There are no economic and logistical frameworks to get patients what they
need.
The bottom line is that
the population suffers due to external forces beyond their control (and desire
as revealed by the polls). A crippled economy left the people without
jobs or an infrastructure for societal development: they're stuck. In the
ghetto that is Gaza Strip: "social solidarity and resilience have nurtured the
Palestinian health response to occupation." However, in light of
continued political and economic degeneration, "the social fabric of
Palestinian society is eroding (11)." Ordinary Palestinians are
completely disenfranchised. Even if they were to engage in popular
demonstration which has been used globally to achieve egalitarian health
objectives (12), the Palestinian Authority does not have the capacity to react
significantly in any way. If the only parties that enter the discourse
are Fatah, Hamas, Israel, and the United States, then health outcomes will
decline. Poor healthcare has become an effective means of nonviolently
undermining a population. Sadly enough, the same strategy was employed in
Apartheid South Africa.
(1) http://www.who.int/whr/2010/en/index.html
(2) http://www.pbs.org/frontlineworld/stories/iraq/sanctions.html
(3) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60100-8/fulltext
(4) http://www.pcpo.ps/polls.htm
(5) http://siteresources.worldbank.org/INTWESTBANKGAZA/Resources/AHLCReportSept.08final.pdf
(6) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60107-0/abstract
(7) http://apps.who.int/medicinedocs/en/m/abstract/Js16445e/
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