Select Committee on International Development Written Evidence


Memorandum submitted by Healthlink Worldwide

"The cause of the current humanitarian crisis in the occupied Palestinian territory is fundamentally political. The problem cannot be solved by humanitarian aid alone." [38]

INTRODUCTION

  Healthlink Worldwide (previously ARHTAG) is a UK-based, international NGO established in 1977, and works with over 30 partner organisations in Africa, Asia, Latin America and the Middle East. For 20 years Healthlink Worldwide (HLWW) has been working in partnership with local Palestinian organisations that share a mutual commitment to a socially-inclusive model of health and to the development of participatory health strategies driven by and accountable to local community needs. HLWW and its partners are resolved to develop and communicate appropriate information, research, skills and experience for the attainment of health and well-being as a right and choice for all. We believe that good health is central to the process of development, as are local ownership and the strengthening of people's capacities to work on their own behalf. In the Occupied Palestinian Territories (OPT), HLWW has been working in partnership with these goals in mind with the Institute of Community and Public Health (ICPH), the Health, Development, Information and Policy Institute (HDIP), the Union of Palestinian Medical Relief Committees (UPMRC), and Gaza Community Mental Health Programme (GCMHP).

  Healthlink Worldwide currently has three funded DFID projects in the OPT:

    —  Management Improvements in Primary Health Care: Phase II (AG1950) with ICPH.

    —  Strengthening Civil Society Organisations (CSCF 308) with HDIP.

    —  Information for Mental Health: Influencing Policy & Practice (CSCF 307) with GCMHP.

1.  SUMMARY

  1.1  Since the beginning of the intifada, 28 September 2000, now marking its third anniversary, the prolonged and acute levels of violence in the OPT have resulted in 2,625 Palestinian deaths, of which 594 were children under the age of 18.[39]

  1.2  Against this backdrop of tragedy and loss Healthlink Worldwide welcomes this inquiry and calls upon the membership of the International Development Select Committee to exert its influence with both UK and international governments and donor communities to urgently address the following issues:

  1.2 (i)  The need to focus international governmental efforts to find a political solution to the underlying root cause of the poor health status of the Palestinian population: ie the illegal Israeli occupation of the Occupied Palestinian Territories (OPT).

  1.2 (ii)  The need to ensure that human rights, which are binding in customary international law, of the Palestinian population to health are protected and upheld. Specifically, that the Israeli government policy of closure, viewed under international law as a form of collective punishment[40], is effectively challenged to allow for the free movement of people and goods to ensure:

    —  the Palestinian community of the OPT have safe access to health care services, potable water, sanitation, housing, food supplies and essential facilities necessary for the well-being and health of the population;

    —  that medical personnel, local and international, have safe and unrestricted access to treat sick, injured and disabled persons;

    —  that there is unrestricted movement of ambulances, essential medicines, medical equipment and supplies; and

    —  that the capacity of the local Palestinian pharmaceutical industry is not further compromised and eroded by closure, to the point of a total dependence on external provision of essential drugs.

  1.2 (iii)  The need for the international donor community to develop systematic reporting systems with international and local recipients, for the timely and effective collection of data on damage, loss and wastage of donor funds that are a result of the Israeli occupation. That this information is analysed, communicated and acted upon by UK and international government agencies to hold the Government of Israel (GOI) to account for the direct impact of its occupation on the humanitarian needs of the Palestinian population of the OPT.

  1.2 (iv)  The need for the community of international agencies to be alert to the ramifications of inappropriate donor policies and practices within the health sector that might aggravate, rather than improve, the overall health status of the Palestinian population of the OPT, and negatively influence longer term system building imperatives.

  1.2 (v)  That DFID reviews its own internal structure, most specifically the strategic relationship between funding to the OPT from the West Asia Department, London, and the Civil Society Department, East Kilbride, and the relationship of both with the country office in East Jerusalem, so that a DFID-wide Palestine country plan might be more coherently implemented.

  1.2 (vi)  That DFID is encouraged in its unique capacity to share its learning and good practice with a much broader range of stakeholders, to support widespread dialogue on responsive mechanisms and models of development that are appropriate to the specificity of the Palestinian development context and which begin to address the wide range of human rights violations that are happening on a daily basis.

2.  THE ISRAELI POLICY OF CLOSURE AND ITS IMPACT ON THE PALESTINIAN HEALTH STATUS AND RIGHT TO HEALTH (POINT 2)

  2.1  The 1966 International Covenant on Economic, Social and Cultural rights states:

    "The States parties to the present Covenant recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health."[41]

  Furthermore, the 1989 Covenant on the Rights of the Child affirms that:

    "States parties recognise the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States parties shall strive to ensure that no child is deprived of his or her right of access to such health care facilities."[42]

  2.2  Israel, as a signatory to both covenants, is bound to comply with its provisions.[43]

  2.3  The current internal and external closure of the OPT is implemented through some 120 military checkpoints, in the form of manned roadblocks, earth mounds and trenches. This gives Israel total control over the movement of people, medicines and goods within and between all villages, towns and cities of the West Bank and Gaza Strip. The impact on the provision of regular health care services and emergency medical aid has been devastating, with a blanket effect on all civilians.

  2.4  This policy of closure, the restriction of movement and the use of excessive force against the population of the OPT affects the health status of Palestinians in three ways:

    —  By limiting access to and provision of health services through imposed restrictions on the movement of patients, medical personnel, ambulances and supplies of essential drugs and medical equipment.

    —  By negatively impacting on the key determinants of health: the ability of Palestinians to access adequate food supplies, safe water, sanitation, housing and to live and work within a healthy and safe environment.

    —  Finally, and most directly, by causing the death of Palestinian civilians, both from direct attack and as a result of fatal delays at checkpoints.

  2.5  Since 28 September 2000, there have been more than 254 reported incidents of attacks on medical personnel, of which 15 medical staff have been killed while carrying out their duty. The Palestine Red Crescent Society has reported 197 attacks on their ambulances, damaging 80% of its fleet, with 25 ambulances having been completely destroyed.[44]

  2.6  The obstruction of mobile clinics to areas cut off from services has also been exacerbated by the frequent blocking of access roads. In the rural areas of the West Bank most affected by the obstruction of roads, medical staff are routinely forced to carry patients and equipment over checkpoints, earth mounds and through trenches, posing considerable risks to patients, medical personnel and equipment.

  2.7  The impact of the Israeli policy of closure and the restriction of movement and goods have had a devastating impact on the Palestinian economy with poverty now affecting approximately 60% of the Palestinian population of the OPT. Furthermore, according to a Palestinian Central Bureau of Statistics[45] survey in 2002, 61.9% of households were forced to borrow money for food, 43.2% of households were forced to use their savings or sell their valuables to buy food, and 32.1% were dependent mainly on food aid.

  2.8  This rapid contraction in the Palestinian economy has had a dramatic direct impact on key determinants of health: "three quarters of Palestinian households [have] reported a reduced food intake behaviour during the intifada"[46], which has brought about increased levels of poor nutrition. A national nutritional survey carried out by the Palestinian Central Bureau of Statistics found a significant increase in both chronic and acute malnutrition. Compared with pre-intifada statistics from 2000, the results showed an increase of 22.6% in the number of children suffering from moderate stunting, of 36.0% in children suffering from moderate underweight, and of 50% in children suffering from moderate wasting. These are substantial and rapid increases over just two years.

  2.9  The policy of closure has had a dramatic impact on the supply of drugs. Currently, 45% of local pharmaceutical demand is covered by the local pharmaceutical industry, 25% by Israel and 30%[47] by imported products from elsewhere. The imported products are mainly critical drugs used for life-threatening diseases that cannot be provided by local producers. Furthermore, the production of local products has been severely affected by restrictions, including complete blockage at times on the import of the raw materials needed for medicine production. In addition International NGOs have reported delays of up to three months for the clearance of medical supplies at Israeli ports.

  2.10  The more serious consequence of the disruption to local medicine supply and production has been the necessity to accept gift-in-kind programmes to fill the critical gap in supply. This necessity is a worrying trend, which if not carefully monitored by donors and the MOH could have a detrimental impact on the long-term capacity of the local pharmaceutical industry and which is undoubtedly putting strain on the MOH's erstwhile efforts to put national policies in place for rational use of essential drug list.

  2.11  Crucially, in a situation where Israel has absolute military control over all movements of persons and goods both within and between the West Bank and Gaza Strip, Israel bears ultimate responsibility for the health of the Palestinians.

  2.12  All four of Healthlink's partner organisations, ICPH, HDIP, UPMRC and GCMHP, can cite daily examples of infringements of the rights of Palestinians to health care, brought about by the Israeli policy of closure and restriction on movement, the regular harrassment of medical personnel and attacks on their premises, the use of health personnel as human shields, destruction of clinic premises and detention for periods of time without charge. This has resulted in the routine denial of treatment of patients in need of emergency, chronic, critical and rehabilitative treatments, affecting most acutely the most vulnerable communities within Palestinian society.

  2.13  During our work with partners, Healthlink Worldwide staff have witnessed firsthand the severe obstacles that lie in the way of implementing the right to health on the ground. These take the form of routine delays to ambulances at checkpoints, the inability of project staff and patients to reach clinics and the impossibility of movement when Israel imposes complete military closure. The rescheduling of project work and endless planning meetings have become the norm.

  2.14  Furthermore, there is an abundance of documented, verifiable case studies, not only from Palestinian sources but also from Israeli and international human rights organisations and bodies. These case studies clearly substantiate the direct contravention and infringement of the individual and collective rights of Palestinians by the Israeli occupying power.

  2.15  However, what seems lacking is either the collective will or the effective deployment of mechanisms, checks and balances by international governments and bodies to ensure that the Israeli government is held to account for humanitarian rights violations.

  2.16  Healthlink Worldwide, in common with local and international organisations working in the field of health and development, is calling for international bodies to combine forces to demand that the government of Israel, as a matter of urgency, removes restrictions on movement of peoples and goods, as these have had such a devastating direct impact on the health, social and economic status of the Palestinians.

  2.17  Furthermore Healthlink Worldwide, with its partner organisations, urges that the International Development Select Committee does all within its power to sensitise and activate all parties and agencies within the UK government over these human rights violations. They should exercise their authority to ensure that all possible avenues of leverage, economic, military and aid-based, are effectively deployed so that Israel is no longer allowed to over-ride its responsibilities for the Palestinians' right to health under customary international law.

3. THE EFFECTIVENESS OF AID: HOW IT IS TARGETED AND WHAT COULD BE DONE TO PREVENT IT FROM BEING WASTED OR DESTROYED (POINT 1)

  3.1  Development in any context is a complex and problematic process, and in the OPT even more so, given the fragility and vulnerability of the political situation. The continuing destruction of infrastructure in the OPT, and direct attacks on civil society groups who are supporting the most vulnerable groups in Palestinian society, and who have no military agenda, have now become significant issues for both donors and politicians. Urgent consideration is needed to ensure joined-up thinking when developing policy and making funding decisions.

  3.2  There is a grave danger of donor fatigue or even a cutting of funds, due to the high level of instability, difficulty in scenario planning and, more recently, the less obvious impact of donor aid, where it has had to be directed to shore up the budgetary deficit of the Palestinian Authority (PA) due to the withholding of Palestinian tax revenues by the Government of Israel (GOI). In such a situation of vulnerability it is even more critical that donors increase rather than reduce their budgetary assistance, but do so with a clear strategic medium- to longer-term focus that is based on addressing the causes as well as the effects of a continuing military presence.

  3.3  Furthermore, donors need to recognise the disproportionate influence that they can have on the development of effective health systems. A recent review of health sector reform by our partner ICPH particularly highlights the inherent dangers of this:

    "In many cases external assistance has mobilised excessive human resources and created more fragmentation than co-operation. The efforts of many professional cadres in the health sector are often directed towards acquiring and maintaining donor funds, keeping them out of their fields of practice where they are most needed to maintain continuity in the implementation of projects. In some cases, donor preferences for funding rather than the actual needs determined in a perspective of sustainable development have defined the very nature of the projects themselves."[48]

  3.4  HLWW believes that there is an important distinction between programmes that are strategically developed with medium- and longer-term goals in mind, and which can be adapted to be responsive in an emergency situation, and projects that are developed purely from a perspective of emergency and relief. Both are needed, but one must not take over the other, as has happened recently where relief operations have been substituted for development work and the longer-term imperatives of building the nation.

  3.5  Throughout this complex emergency, HLWW has remained committed to working with partner organisations, keeping a clear focus on medium- and longer-term development outcomes, working to develop the human resource base in primary health care and civil society in order that communities and practitioners are able to better analyse, adapt, communicate and respond to community needs.

  3.6  There is strong evidence from two of our current DFID-funded programmes (Management Improvements in Primary Health Care, AG1950 and Strengthening Civil Society, CSCF 308) that such a medium-term strategic process can be highly effective, even in times of conflict and emergency.

  3.7  Recent evaluations undertaken with both HDIP and ICPH have revealed that there are common features that are key to successful implementation in the current situation of crisis. These are:

    —  Structures and processes that are flexible and sensitive to rapid local changes in context.

    —  Planning, monitoring and evaluation mechanisms that allow for regular reflection.

    —  The ability of all stakeholders to adapt.

    —  Good levels of communication between all of the actors.

    —  A strong sense of open and shared partnership.

  3.8  DFID West Asia Desk's response to emergency during the past two years is a case in point: a changing context and a serious increase in every-day difficulties were met with a genuine understanding and flexibility by DFID personnel, allowing for dialogue with partners. This enabled the field projects to continue operations, leading to the same expected outcomes, albeit via slightly different processes identified as suitable in the exceptional circumstances.

FINDING MECHANISMS TO PREVENT WASTAGE AND DESTRUCTION

  3.9  However, despite successes, a great deal of wastage and overt destruction of the infrastructure necessary for development is still predominant in the OPT. The World Bank estimates that by the end of August 2002, after 23 months of intifada, the Israeli army had inflicted some US$728 million of raw damage in the OPT.[49] Furthermore, this figure is believed to have risen substantially since that time.

  3.10  HLWW believes that as long as the international donor community can only give overall benchmark estimates of damage, the GOI will never be effectively called to direct account for the financial and human cost ramifications of their military policies in the OPT. Furthermore, Israeli society and public opinion will not be sensitised to the level of impact the military occupation has on Palestinian civil society.

  3.11  Systematic and standardised reporting mechanisms are needed across all streams of DFID funding to effectively document the levels of damage, loss and wastage of UK funds that have been a result of the Israeli occupation. Findings need to be analysed, communicated and acted upon to ensure there is flexibility in responding to unplanned needs and building a catalogue of evidence to use in future discussions with the Israeli and Palestinian authorities.

  3.12  On 29 March, 2002, the Israeli Army launched a military incursion into Ramallah, and the four other main towns of the West Bank, placing the civilian population under sustained military curfew and leaving substantial damage in its wake.

  3.13  During this period Healthlink Worldwide developed a preliminary standardised reporting format with which to work with affected partners, to measure and assess the levels of damage to capital items, physical infrastructure and documentation as well as time lost from injury, convalescence, curfew or lack of access.

  3.14  The worst damage directly occurred to the offices of our partner organisation HDIP, which was taken over and used as a military operation centre for just over three weeks until 22 April 2002. The new office space and computers co-financed by DFID CSCF were vandalised and destroyed, the data base upon which all initial mapping and needs assessment for the project was held, was stolen and graffiti, garbage and even pornography were left behind.

  3.15  The audit of damage showed a total loss of just under £90,000: 36 days of staff time, capital and infrastructural damage, destruction of communication infrastructure, maps and publications. However, the greatest loss, which is immeasurable, was the removal of databases holding 13 years of research on Palestinian health and development.

  3.16  During the same period the staff of our other West Bank partner, the ICPH, had already been equipped under the DFID West Asia programme, through an agreed input of funds to allow for the continuation of essential home working.

  3.17  The result was that during the military closure ICPH staff-members were almost fully operational. Staff undertook research on a range of topical health issues, often using mobile phones and the few hours of curfew lifting to collect information, and then documenting and writing once the curfew was imposed again. Sixteen reports[50] were researched written and published during the period, of which one series explored the health, social and humanitarian impact of the siege in the major West Bank cities. These research papers provided the first insight into the situation and were an important planning tool for many international and national agencies at the time. Other staff initiated direct emergency responses with the community within their own locales to ensure public health awareness.

  3.18  Following are some examples of how flexibility and reorganisation of work in response to the emergency led to the continuation of activities serving the community. One faculty member in Nablus, the city that has suffered the most prolonged level of closure, found himself under an extended siege of three months, during which he developed a training course with local hospitals on medical waste management; given the siege situation, this had become an issue of public health liability. Another staff member with an international passport who was able to cross checkpoints when no local staff could, visited the main hospitals in all the districts of the West Bank to investigate the impact of siege, curfew and closure on child birth and maternal health. He brought back important data for the use of others. A third member managed to mobilise his family living in the northern West Bank by phone, to obtain basic information about how siege and closure were affecting the life and health of villagers in the area, at a time when most of the attention was focused on the invasion of towns rather than villages.

  3.19  However, despite the ability of the ICPH programme staff to adapt and develop creative opportunities out of situations of adversity, there is still a cost to working in such conditions, in both financial and psycho-social terms.

  3.20  The audit of damage and loss undertaken with the ICPH also revealed a formidable financial cost, estimated at just under £200,000 over a nine-month period from September 2001 until May 2002. The largest single drain was time lost through curfew or lack of access, which amounted to £108,000. Damage also included the destruction of the ICPH vehicle, donated by DFID, as a result of F16 shelling in Ramallah. These costs generally go unreported and cannot be reclaimed as they tend to be absorbed directly by staff who work longer hours to ensure that project outputs are met, despite and in spite of the situation.

  3.21  The level of loss and damage, not only in overt cases such as that of the destruction of HDIP offices, but also in terms of the more insidious drain on resources over time, has reached such a level that it is now affecting the outcomes of programmes and projects funded by donors. Time loss and poor efficiency due to the policy of closure have unfortunately become the rule rather than the exception.

  3.22  In this context HLWW welcomes the initiative taken by the DFID West Asia desk to develop a joint working group with the Palestine Platform[51] of NGOs, to follow up recommendations from the IDSC inquiry. This could also provide an ideal forum in which to explore effective mechanisms for the systematic reporting of damage and loss, and responsive mechanisms and models of development to meet the specific demands of the OPT.

ANOMALIES WITHIN DFID'S STRUCTURE

  3.23  HLWW's experience of working with two DFID funding streams—the West Asia desk, London and the CSCF, East Kilbride—has highlighted some interesting questions around the effectiveness of DFID development processes in the specific context of the OPT. Central to the differences in approach are the structural distinctions between the two. The DFID West Asia desk, which funds the Management in Primary Health Care programme, has staff and an office in the field, an intimate relationship and knowledge of the programme on the ground, discretion over larger budgets, and can respond to emergency situations. The DFID Civil Society Challenge Fund (CSCF), East Kilbride, does not have staff in country, is working through a decentralised structure, has limited links with the DFID country office and the London West Asia desk, and is restricted and bound to the project grant contract.

  3.24  The two distinct structures offer very different experiences when it comes to the practical implementation of projects on the ground, and have very different capacities and mechanisms with which to take prompt and informed decisions in response to the changeable nature of the complex emergency situation in the OPT.

  3.25  This difference is highlighted most strongly by the differing abilities of the departments in responding to reported levels of loss. Despite their sympathies, the East Kilbride CSCF was unable to respond to the need to get the HDIP office quickly operational. Essentially, the CSCF programme is specifically aimed at supporting innovative areas of work and is not set up to respond to more diverse needs that arise outside the original contract grant. The only appreciable support that the CSCF structure could allow was to sanction the use of a small budget under spend for the purchase of a removable hard drive for the server computer, to ensure against such future potential loss of data.

  3.26  By contrast, when presented with evidence DFID West Asia is able to review and respond, due to its more flexible structure. As a result, the audit damage report prompted additional funds to replace the destroyed ICPH vehicle, and, following an output-to-purpose review, additional support was given to ensure the successful relocation of the ICPH programme from Birzeit to Ramallah.

  3.27  The direct results of this relocation were the rejuvenation of programmes that were gradually becoming difficult to operate, a doubling of the rate of applications for the training programmes, and a dramatic reduction in the stress and humiliation previously experienced by ICPH staff and students in their daily burden of crossing the Surda checkpoint dividing Ramallah from Birzeit village. Furthermore, time that was previously consumed by checkpoint crossing—ranging from 1-3 hours each day, depending on conditions—was reallocated to work, and to collective strategy-building and planning.

  3.28  Additional direct benefits of the relocation include the re-institution of team work, the reduction of feelings of isolation and frustration, and dramatic improvement in attitudes and performance. The ICPH resource centre, which, previous to the current uprising, provided important public health literature and documentation to the larger community, is now once again accessible to a wide audience. This year the ICPH has once again been able to accept students with a disability into the programme.

  3.29  These differing experiences highlight the centrality of ownership, partnership and effective, timely communication to the development process. The DFID West Asia desk is more actively engaged and has a close working knowledge of projects, which undoubtedly equips it to take better-informed decisions.

  3.30  The CSCF department has carried out the effective transfer of funds, monitoring and accountable reporting and has a more limited role in the development of projects. Its relationship with projects is more removed, technical and narrow, having neither a direct relationship with DFID country staff, nor implementing project staff. Most fundamentally, the potential to appreciate the full impact of its funded work on the ground, and engage and learn from its outcomes within the broader context, is weaker than it could be.

  3.31  This state of parallel funding streams could potentially provide for greater learning, particularly through the sharing of resources, knowledge and expertise. However, current evidence would suggest that this linkage does not take place at present.

  3.32  The anomaly is that while DFID recognises that within its overall position papers it is committed to the development of sustainable and dynamic participatory civil societies, in reality the important role of the Civil Society Challenge Fund seems to suggest, strategically at least, that the business of engagement of civil society is a separate process, divorced from the broader country context of dialogue and engagement with the larger bilateral and multilateral programmes of support.

  3.33  The structure of the Civil Society Challenge Fund is not mandated to work through country offices, but there is a case for considering the mutual benefits to both funding streams in the very particular situation of the OPT, where closer cooperation and coordination with DFID country staff would be more effective.

  3.34  The advantages of such a policy decision by DFID would be two-fold: technical support in country to projects during times of severe conflict and the more coherent policy advantage of supporting closer meaningful dialogue between the PA and Palestinian civil society.

  3.35  In such a situation HLWW strongly advises that in the particular circumstances of the OPT mechanisms are created to allow for important support through the DFID West Asia desk and the country office to facilitate the work of The Civil Society Challenge Fund.

4. THE ROLE OF CIVIL SOCIETY, INCLUDING NGOS, IN ENSURING A BROADER POPULAR PARTICIPATION IN THE DEVELOPMENT OF PALESTINIAN SOCIETY (POINT 6)

  4.1  Given the complexity and sensitivities of the Palestinian political context, where, following the breakdown of the Oslo accords, scepticism and mistrust exists amongst the Palestinian public, donor aid is often viewed as overtly political and driven by external foreign agenda.

  4.2  In such an environment, it is even more crucial for all involved in the development process to openly engage with the full range of stakeholders and to ensure dialogue that will support coherent strategies that are participatory and answerable to the needs of the Palestinian society as a whole, and not merely separate or interested parts of it.

  4.3  Support to broadening the diversity and range of participants is crucial. Not only will this create more open and dynamic societies for the furtherance of development goals, but importantly, in the Palestinian context, it could mean the difference between having an enfranchised and more cohesive society and one that is fragmented, marginalised and disillusioned.

  4.4  The Civil Society Challenge Fund is providing important support to innovative projects that empower citizens to hold their own government to account. In the OPT case the existing government is not allowed to function and the role of civil society is therefore not merely about holding the PA to account but also highlighting the GOI's responsibility for the its use of military force to bind Palestinian citizens into a situation of poverty.

  4.5  The DFID CSCF-funded civil society projects that HLWW is currently undertaking with Gaza Community and Mental Health Programme (GCMHP) and HDIP provide an important opportunity to try out innovative initiatives to develop the capacity of Palestinian civil society to enter into effective dialogue in the process of nation building. These initiatives are crucial during this formative period, where the building blocks of a future Palestinian state are being laid.

  4.6  Furthermore in the long term, interest of peace and stability within the region, a great deal is resting on the ability of Palestinian civil society to remain cohesive and to effectively engage in the political process. Given the external pressures of outside interests, it is even more critical that an empowered and capable Palestinian civil society fully participates in the shaping of a future Palestinian state.

  4.7  In a situation of crisis it is understandable that the development focus narrows to become one of short-term emergency relief. However, it is at such times that it becomes even more critical to invest in the longer-term development of civil society; not to do so would be to further compound a situation of oppression and marginalisation.

  4.8  However, in order for DFID to have an effective stake in supporting civil society, formal links between the West Asia Desk and CSCF need to be explored, to allow for the effective sharing of learning from civil society initiatives and to inform the broader DFID country strategy debate.

5.  RECOMMENDATIONS

  5.1  That UK government departments develop systematic and coherent strategies in dealings with the Government of Israel to ensure a clear and unambiguous position is presented; for Israel's compliance with UN resolutions and the upholding of international law. That DFID continues to build and develop investment in medium-term development programmes that can also be responsive to situations that have gone beyond emergency and involve one country imposing its will upon another.

  5.2  That support to the development of Palestinian civil society is not overlooked or lost in the overwhelming face of needs in the OPT but is instead seen as one of the key factors in ensuring long-term political, social and economic sustainability.

  5.3  That DFID undertakes a review of the present anomalies currently evidenced in the DFID structure, in order to support better avenues for policy development, learning and project management between the Jerusalem, East Kilbride and London offices.

  5.4  That the members of the International Development Committee endeavour on their visit to the OPT and Israel to meet with the following Palestinian and Israelis working within the health sector, who can furnish the issues raised in this memorandum in much greater detail and who have had a long experience of the impact of changing donor policies and practices over the years:

    —  Dr Rita Giacaman and Dr Rana Khatib, ICPH, Ramallah.

    —  Dr Mustafa Bargouthi and Mr Abbas Melhim HDIP, Ramallah.

    —  Dr Jihad Mashaal and Dr Alam Jarrar, UPMRC Jerusalem and Nablus respectively.

    —  Dr Eyad Saraj and Dr Salah Abdul Shafi, GCMHP, Gaza.

    —  Hadas Ziv and Miri Weingarten, Physicians for Human Rights Israel, Tel Aviv.

  An appendix was submitted with this submission—"Health sector reform in the Occupied Palestinian Territories (OPT): targeting the forest or the trees?". This has not been printed. A copy has been placed in the Library.

September 2003




38   Humanitarian Action Plan for Occupied Palestinian Territory 2003, Office for the Coordination of Humanitarian Affairs (OCHA), 19 November 2002. Back

39   Source Palestine Monitor. Back

40   The Israeli policy of closure, often instigated following indvidual acts of violence, is in direct violation of the principles accepted in the Hague Regulations, Article 50, and the Fourth Geneva Convention, Article 33, which states that: "No protected person may be punished for an offence he or she has not personally committed. Collective penalties and likewise all measures of intimidation are prohibited." Back

41   Article 12 (1). Back

42   Article 24 (1). Back

43   For a thorough analysis of Israel's obligation under international law to uphold the right to health of the Palestinian population of the OT, see Ziv, H., A Legacy of Injustice: A Critique of Israeli Approaches to Health of Palestinians in the Occupied Territories. Physicians for Human Rights Israel, November 2002. Back

44   The Effects on Closure on Health Care in the West Bank and Gaza Strip, Palestine Monitor. Back

45   Nutrition Survey 2002, Palestinian Board of Statistics, 1.8.02 P.7. Back

46   Twenty-Seven Months-Initfada, closures and Palestinian Economic Crisis: An Assessment, The World Bank, May 2003, P.36. Back

47   Khatib Rana, & Daoud Amal, The impact of the Israeli Military Invasion of the West Bank on Pharmaceutical Supply and Availability, ICPH, Birzeit University, May 2, 2002. Back

48   "Health sector reform in the Occupied Palestinian Territories (OPT): targeting the forest or the trees?", Giacaman, R., Abdul-Rahmim, H. F. and Wick, L., Health Policy and Planning, 18(1) p59-67 OUP, 2003. Back

49   op.cit p 17. Back

50   These reports are available on the website of Birzeit University (Palestine), Institute of Community and Public Health at http://icph.birzeit.edu/emergency_eports.htm Back

51   The Palestine Platform is a group of UK development NGOs that have programmes of assistance in the OPT. Back


 
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