Examination of Witness (Questions 231-239)
MR DAVID
SHEARER
28 NOVEMBER 2006
Chairman: David, it is good to see you
again.
Mr Shearer: Thank you, it is nice
to see you too.
Q231 Chairman: You gave us a very full
and valuable briefing when we visited you during our visit. I
think the purpose of this is to enable us to put some of that
formally on the record. I understand that you have some more visual
material, which we can make use of afterwards because clearly
your maps are pretty essential to understanding the system and
certainly helped our understanding as well as being able to see
things on the ground. It may be an opportunity for you to update
us on some of the things that have happened even in the last few
weeks. Perhaps I can start by saying—and you obviously sat
through the last evidence session—the difficulties are,
yes, donor aid has gone up but the revenue that Israel has withheld
means that there is still a gap. You have your consolidated appeals
process, which you have increased—and if you confirm that
this is right—from $215 million to $385 million during 2006.
Where are we now? Hearing these figures I guess donors have mixed
views. Are you putting something into a system which will actually
work and deliver, and what is the alternative if you do not? How
are things going in terms of 2007 at the current moment? Can you
tell us?
Mr Shearer: Your last comment
on the last session I think was right on the mark in terms of
where the situation is going right now and it is going downwards;
we are doing what we can, in a sense, to lessen that slope but
it is still downwards. The consolidated appeal for 2006 was $215
million—this was last year when we put that together, when
the picture was more optimistic. With the fiscal crisis of the
PA we saw a very rapid rise in poverty in particular, so the appeal
was revised in May based on where we thought it was going to be
going for the rest of the year. It was revised up to $384 million.
It is now looking likely that for 2007 it will be around $450
million.
Q232 Chairman: That is what you expect
you will receive?
Mr Shearer: That is what we are
asking for. To break that down a little bit, the $384 million
so far is around about 66% either funded or pledged. That is an
increase on what it was last year in absolute amounts, about the
same percentage, interestingly, but it was lower last year in
terms of the total amount. The increase for next year, 2007, will
mainly be in the areas of temporary job creation and cash assistance
and food aid—about 75% are those essentially basic humanitarian
measures. The last 25% is broken up between education, health,
some agricultural support and a number of other areas as well.
Q233 Chairman: Do you get a feel
for the mood of donors? Are donors inclined to say, "We will
have to put more to the CAP and TIM", or do they feel that
that is just maintaining an unsustainable situation?
Mr Shearer: I think all of them
recognise that this is an unsustainable situation and it is getting
worse. There is a search looking for ways in which to slow the
deterioration in the hope that somewhere along the line there
is going to be some sort of a political development or some sort
of a change. The question is, at what point do donors say, "We
cannot do any more", or say, "Actually Sudan is in a
lot worse state than the Palestinian territory and we cannot do
it"? Or they say that Israel—as your last speaker was
saying—is withholding the major PA revenue, which are the
customs revenues, and that there is somehow more pressure on Israel
to pass those over because they are Palestinian revenues. Or the
other aspect, which has not been brought up, is that there still
is an occupation and under international law Israel is responsible
for the welfare of the Palestinians. So it is a question of where
that threshold comes in in terms of paying out in the hope, or,
in a sense, saying "Enough, we need another situation; we
need to change the circumstances."
Q234 John Battle: We had a conversation
a few moments ago with the EU representative about healthcare
and my question is—and I am still very unclear about the
picture—what is your assessment of the current state of
the health sector and its capacity to respond to basic services
and elective surgery in the West Bank, Gaza and East Jerusalem?
Mr Shearer: There are different
things happening in different places. In Gaza effectively the
health services are functioning. There are some shortages of drugs,
100 or so of the basic essential drugs out of 400; so about 25%
of those drugs are not always available. So that is the first
thing. Secondly, in Gaza, the health staff are working pretty
much to capacity, but there are some absences because people are
travelling long distances to work. And, because the health workers
are getting some allowances through the TIM but are not getting
their full salaries, so the pain of getting to work is often a
burden for them. There have been changes in shifts. Thirdly, the
situation in Gaza as well has a higher surgical case-load because
of the military operations that have been continuing there for
the last three or four months. The other thing about Gaza is that
UNRWA is present. There is a higher refugee population in the
Gaza Strip, and UNRWA has clinics which are available there. Vaccinations
and immunisations are continuing to go ahead for those people.
UNRWA also has one hospital. Vaccinations and immunisations are
continuing to go ahead for those people. On the West Bank it is
quite a different story. There are four issues there. One is again
the same shortages of drugs and supplies. The second is the fiscal
crisis, so the payments to many of the hospitals are not going
ahead, so there are also equipment problems where equipment has
not been changed, and spare parts, et cetera. The third
thing is that there is a general strike in the West Bank and that
is by far the most important in terms of providing assistance
to ordinary Palestinians. The public hospitals are effectively
shut in the West Bank. So, for example, the WHO—and I will
try and get the figures right here—was saying in the month
of, I think it was August, 600 babies were delivered in Hebron
in the public hospitals there. In September it was 100 and they
were trying to find out where the other 500 were delivered. Two
hundred went to private or NGO hospitals that they could track,
and they do not quite know where the other 300 went. So possibly
private deliveries, possibly midwives at home, but the situation
is pretty critical. The fourth aspect of the situation in the
West Bank is access—and this applies to Jerusalem as well—and
this is access for patients, obviously, to go through a checkpoint
or a road block, but also access for the doctors and staff to
actually get to the hospitals to work. It is particularly the
case in Jerusalem where all of the six main hospitals are having
real problems in terms of staff being able to get in, because
most of the staff working in the six hospitals are actually from
the West Bank and have West Bank ID cards and therefore they need
a permit to come into Jerusalem.
Q235 John Battle: When we were there
we saw that; we saw the ID card the doctor needed to get through.
Could I put to you, then, in the West Bank do you think that there
is a humanitarian health crisis?
Mr Shearer: Absolutely. There
are no hospitals functioning, except for the private ones, and
we actually have no idea what the human toll of this is because
there are no statistics coming through as yet. There are anecdotal
statistics and we have all heard of babies being delivered outside
a hospital. I was at a checkpoint on Thursday where two days before
a mother and a father were trying to get their one-week old baby
through the checkpoint to the hospital—this was in Nablus—and
took a taxi because an ambulance was not available; they waited
three hours at the checkpoint and they could not get through.
The taxi driver pleaded with the soldiers; he was beaten, he was
actually hospitalised himself, and the baby got to hospital and
was dead before it could be treated. The trouble at the moment
partly because of the breakdown of the PA and partly because of
the Palestinian Central Bureau of Statistics we are not getting
the data that we know is out there to be able to know exactly
the scope or the scale of this.
Q236 John Battle: If I could put
it to you then, in any other crisis, and even in this situation,
the Red Cross was there first and then the Palestinian health
ministry was set up so the Red Cross withdrew as there was medical
provision for the people. If then the Palestinian health ministry
cannot function is there not a need for a conversation, at the
very least, to press for, for example, exemptions from the withholding
of resources and access for medical staff and supplies? I was
left with the impression after our last conversation that the
action of the EU and the World Bank is actually making things
much worse. It is at a distance from reality on the ground and
if there is a crisis absolutely, as you say, is there a case for
exempting, in some way finding a way through for health care?
Or saying we abandon the Palestinian health ministry and send
the Red Cross in straight away?
Mr Shearer: On the first one,
most health staff have permits—for example, to get into
Jerusalem—but the problem is that some of them are not getting
permits. For a couple of hospitals, I cannot remember off the
top of my head, but around 10 or 15% of the staff do not get through.
They try to obtain a permit but now with all Palestinians getting
from the West Bank, they have to come through four check points.
At the beginning of this year it was 12, they had the possibility
of coming through 12 different entry points, but it is now only
four. What it depends often a lot on is the mood of the soldier
at the checkpoint in order to come through. That is often the
case. In the case of ambulance movement, it is erratic; sometimes
they come through without any problems but often they are stopped
and there is what they call a back-to-back situation, where the
patient either has to walk or they are carried across to another
ambulance waiting on the other side. There are six Palestinian
Red Crescent ambulances which have been licensed to come across
from the West Bank into Jerusalem, but my understanding is that
they are also having problems getting across and again it is very
much up to the checkpoint. A soldier, in a sense, is making the
medical determination of whether this person should be going to
hospital or not. Complicating this issue—before I get on
to your second question—is the fact that a lot of the co-ordination
between the Israeli side and the Palestinian side used to happen
through what they called the DCO, basically the Palestinian liaison
office and the Israeli liaison office. With the Hamas government
in power now the IDF will not deal with the Palestinian side,
so it has made it more complicated. On your second question, of
bringing in the Red Cross, there are Palestinian Red Crescent
hospitals in Jerusalem, in Hebron, and I think in Ramallah, and
they are partly funded by the Red Cross. As I understand it, their
core funding—and I could be wrong here—is paid by
the Red Cross and then they are paid by the PA for each individual
referral that goes to the hospital.
Q237 John Battle: If they have the
money to pay for it.
Mr Shearer: And they do not. This
is the problem—the hospitals are not being paid for the
referrals, they are basically doing them for free.
Q238 John Battle: Has anybody put
the case to exempt healthcare of the Palestinian people from the
current political and financial restrictions?
Mr Shearer: We have been doing
this pretty much continually. A lot of our work is actually helping
people to get through checkpoints, to be perfectly honest with
you.
Q239 Chairman: A few people have
said to us that in reality you will not sustain a viable health
service if you do not use the Palestinian Authority. Because the
international community refuse to deal with Hamas, if they are
not doing that then anything else will fall short of sustainability.
Mr Shearer: That is the key point,
that pretty much all the hospitals and two-thirds of the primary
healthcare clinics are PA run. It is a little bit like the UK—there
are private hospitals but people rely basically on the public
system, and currently in the West Bank the public system has effectively
stopped operating, so people are now forced to go to the private
ones. UNRWA, for example, has one hospital in the West Bank, which
is based in Qalqilya, which mainly deals with births. It has had
a 135% increase in the number of patients coming to its hospital
as a result of the fact that they cannot get care anywhere else.
So it is completely unsustainable. As I say, I have no idea, in
a sense, of the scale of it except that it is perhaps much bigger
than we think. But when the results come out at some point we
will find out.
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