House of Commons - International Development

Select Committee on International Development Fourth Report

5 Crisis in the health sector

118. In situations of conflict and crisis the continued operation of the health sector is vital. Demand for health services tends to increase as a result of increased casualties and deterioration in socio-economic conditions. The basic humanitarian requirement of keeping the health sector operating is thus of utmost importance. For this reason the EU's TIM has focused on payments to health sector employees and essential supplies and running costs for hospitals. Unfortunately the TIM is limited in its funds and its coverage, and, as we have noted, Window I has been slow to start. Payments to healthcare workers were insufficient to prevent them going on strike in August for non-payment of salaries.[181] PA employees make up 57% of the Palestinian health care workforce and supply 64% of needs.[182] The PA depends on aid donations and the revenues collected on its behalf by the Government of Israel for nearly 100% of the non-salary operating costs of the health sector.[183] With only a fraction of its normal budget available, the health sector in the OPTs is facing a crisis.[184]

The West Bank and East Jerusalem

119. In the West Bank there is a shortage of drugs and supplies, some medical equipment is not being maintained, and during our visit the public hospitals were shut because of the civil service strike. Continuing problems with movement and access exacerbate the situation.

120. There are private hospitals still operating which can absorb some of the case-load. The costs of many of these make them unaffordable to most Palestinians. We are not clear how many private hospitals have been waiving or deferring fees in the current crisis. We do know that health services run by the Red Crescent and other Palestinian NGOs are providing what services they can free of charge.[185] David Shearer reported on the impact of the closure of PA hospitals on maternity services:

"I think it was August, 600 babies were delivered in Hebron in the public hospitals. In September it was 100 and they [the WHO] were trying to find out where the other 500 had been delivered. 200 went private or to NGO hospitals that they could track and they do not quite know where 300 went. So possibly private deliveries, possibly midwives at home, but the situation is pretty critical."[186]

The International Committee of the Red Cross noted that in mid-September 2006 the West Bank maternity services stopped for all but those in late stages (5-6 centimetres dilated). From 15 October only top-level emergencies were admitted and on 7 November the Strikes Syndicate instructed hospital emergency rooms to close and to stop admitting maternity patients.[187]

121. On our visit we met Dr Tawfiq Nasser, Chief Executive Officer of the Augusta Victoria Hospital in East Jerusalem. He recounted to us the difficulties he faced in simply trying to get to work in East Jerusalem since he lived in the West Bank. Many staff are not getting their permits, and even with permits they may not always get through.[188] Dr Nasser also told us how the closures were preventing patients from getting to hospitals. The movement of ambulances is also erratic and often dependent on the attitude of the soldier at the checkpoint. The current political situation means that there are no lines of coordination or communication between Israeli and Palestinian liaison officers to facilitate the speedy movement of patients through checkpoints.[189]

122. In December, staff at PA hospitals and Ministry of Health clinics in the West Bank suspended their strike after they received their salaries.[190] This became possible when Qatar agreed to pay the salaries of health and education employees for a period.[191] This should help to improve the situation temporarily.

The situation in Gaza

123. Gaza has been under siege-like conditions since the kidnap of Corporal Shalit on 26 June 2006. The majority of injuries and fatalities amongst the Palestinian population, from Israeli military activity and more recently conflict between Hamas and Fatah, have occurred in Gaza.[192] We have been told that health services continue to function although capacity is stretched due to difficulties in getting to work, non-payment of salaries and a higher surgical case-load resulting from the conflict.[193] In addition shortages of electricity and water after the bombing of the Gaza power station have limited the services which are available.[194]

124. The non-payment of salaries coupled with the lack of medications and perishable supplies means that all elective surgery has been postponed. Many cancer patients have not received their drugs and referrals to Israel are greatly reduced. The Israeli organisation Physicians for Human Rights reports that hospitals have been forced to deal with large numbers of injured with decreased resources. Kamal Adwan hospital, for example, has only two operating rooms and they often have up to 20 patients requiring immediate surgical procedures at the same time.[195] Ongoing medical treatment for chronic health conditions such as hypertension, diabetes and respiratory infections has become increasingly difficult with the shortage of drugs. Médecins du Monde UK report that there has been an increase in traumatic conditions over chronic conditions in the period between June and July 2006 reflecting, additionally, the psychological impact of continued fighting in Gaza.[196]

125. Physicians for Human Rights also reports that the IDF has delayed ambulance access to the injured for up to two hours, and that medical staff have been the target of IDF fire. We were told by the Government of Israel that ambulances are allowed to use the VIP lane at checkpoints and should not have to wait for long periods, but delays still frequently occur. This was an issue when the previous International Development Committee reported in 2004.[197] The situation has not improved. A report by Physicians for Human Rights suggests that within the Israeli Government there is a level of indifference regarding the ability of essential civil systems, such as health care, to function.[198] If this is true, it is unacceptable.

126. When we asked the Secretary of State about the possibility of excluding the health sector from the financial boycott of the PA, his view was that the Quartet principles would not allow this but that the TIM was focused on health precisely because there was a recognition that health care was crucial.[199]

127. We were told by a number of people that when the state health services failed them, people turned to clinics run by NGOs associated with Hamas itself rather than the PA and other groups. These appear to have received support directly from sources outside the Occupied Palestinian Territories and they play an increasingly important part in maintaining vital health and social welfare services to some of the poorest people in the West Bank and Gaza. This reinforces the positive attitude of many Palestinians towards Hamas compared with perceptions of the international community.

128. We consider a health sector which can meet the needs of the whole population in a time of conflict to be of fundamental importance. If the government is unable to provide such a service humanitarian assistance should be provided to meet these needs. The situation in the OPTs is one where the health sector is struggling to meet the increased demand for its services. Reports by credible international agencies attest to this. Staff who are at work have received a fraction of their normal salaries. Some staff cannot get to work. The demand for emergency services has increased in Gaza at a time when the hospitals do not have all their supplies and are operating with reduced power supplies. Services in the West Bank have been severely curtailed over a prolonged period and the end of the strike was only brought about after a third party, Qatar, agreed to pay PA salaries.

129. If people cannot get access to basic health services they will become discontented and angry. If emergency services are stretched, avoidable casualties result. Such outcomes may contribute to an escalation of violence. The TIM cannot, and does not, meet the needs of the health sector. The UK Government and other donors in the international community have indicated that if a PA led by or including Hamas agreed to accept the Quartet principles, normal funding mechanisms would be resumed. We hope the Government of Israel would take a similar view. In the meantime, however, we believe there are humanitarian reasons to exempt the health sector from the financial boycott of the Palestinian Authority, especially given the difficulties which restrictions on movement and access continue to cause for this sector. We recommend that the UK Government investigate the possibility of achieving such an exemption. Using existing health provision structures would be more effective and efficient than the creation of alternative funding mechanisms such as the Temporary International Mechanism.

181 ICRC, Declining Government Health Service: provision in the West Bank, 15 November 2006. Back

182 Physicians for Human Rights, The Gaza Strip--state of disaster, September 2006, p 4. Back

183 Physicians for Human Rights, p 4. Back

184 Q 235 [David Shearer] Back

185 Qs 236-237 [David Shearer] Back

186 Q 234 [David Shearer] Back

187 ICRC, Declining Governmental Health Service, p 5. Back

188 Q 236 [David Shearer] Back

189 Q 236 [David Shearer] Back

190 OCHA, Protection of Civilians weekly report, 6-12 December. Back

191 'Qatar to pay thousands of Palestinian salaries', 3 December 2006 www.moderate.wordpress, and www.bbc.co.uk. Back

192 OCHA, Occupied Palestinian Territories 2007, p 17. Back