To speak of the Palestinian conflict in 2020 can start to become repetitive. For decades this small section of land has played an important role in the geopolitical balances in the Middle East area and stokes indignation over the human rights violations against the Palestinian people. Herein lies the problem: treatment of the Palestinian people creates indignation rather than specific policies to bring about major change.
It didn’t take the COVID-19 pandemic for countries such as Spain to practically forget about the situation in the West Bank and Gaza Strip, and years of compiling testimonies and proof from local associations, international NGOs and United Nations (UN) agencies, who have all voiced concerns on numerous occasions to demand a response from the international community regarding these violations, have not had the desired effect. In fact, from the field, describing the extent to which chronic occupation and a prolonged conflict has negatively impacted every aspect of daily life for Palestinians is hard to describe.
For over 50 years, policies implemented by Israeli authorities have fragmented the West Bank territory and isolated the Gaza Strip in a way that acts discriminatorily towards the Palestinian people and compromises basic rights, such as people’s free movement and access to safe drinking water. The combination of occupation, conflict and a fragmented social fabric is accompanied by the ensuing deterioration of Palestine’s economic crisis, which in recent years has recorded a decline in its Gross National Income (GNI) per capita and increased poverty. At the same time, the inordinate use of violence towards the population is a violation of basic human rights, among them the right to health. Moreover, the fragile Palestinian health care system, unable to consolidate an organic development plan owing to geographical, political and institutional fragmentation, is now even more pronounced with the COVID-19 crisis, which has laid bare a profound imbalance between the demand and supply of health services.
Médicos del Mundo has worked in Occupied Palestinian Territory since 2006, supporting the most vulnerable communities in exercising their right to health by strengthening primary health care, sexual and reproductive health, integral mental health, gender-based violence support, and surgical responses to war emergencies. Despite high levels of exposure to chronic political violence, poverty, unemployment and other factors that pose a risk to conditions of mental health, and although the World Health Organisation (WHO) has defined mental health and psychosocial well-being as an essential part of health, in Palestinian territories there is still a huge stigma attached to mental health, making a suitable response difficult, along with the existence of underreporting.
In recent years in the West Bank, we have witnessed a systematic policy of demolishing Palestinian housing and attacks by Israeli settlers. Equally, the construction of illegal Israeli settlements has intensified in Area C — according to the 1993 Oslo International Accords, it is a territory designated for the creation of a future Palestine State. Most Bedouin communities we work with live in this area, communities in which lives are under the constant threat of eviction, forced displacement or the demolition of homes. Our projects with Bedouin communities in the West Bank are carried out with the aim of strengthening resilience and mitigating the effects of political violence on the psychosocial well-being of affected people and communities, and the testimonies of Bedouin women Médicos del Mundo works with demonstrates how mental health and psychosocial well-being continue to be a priority.
The Gaza Strip, meanwhile, has been under a land, sea and air blockade since 2007, which, according to the UN, is a “collective punishment” and, in addition to violating international law, represents a serious humanitarian crisis. The impossibility of leaving or entering the Strip has turned it into an open-air prison, gravely affecting the population’s right to health and making access to vital health care services in hospitals and clinics outside the Strip extremely difficult. Estimations in a UN report pointed to the Gaza Strip being uninhabitable by 2020. Today, two million people live in a surface area of 363 km2. The reality of the blockade, an unemployment rate exceeding 50% — more than 80% of that rate affecting women — and a situation where 53% of the population live under the poverty threshold all contribute to more people requiring all types of services, including psychosocial support. Furthermore, bearing in mind that WHO considers that mental disorders multiply among people in the wake of emergencies, violence-related psychological traumas in Gaza, the wars in 2008–2009 and 2014, and the military response to the Great March of Return in 2018 have affected hundreds of thousands of Gaza inhabitants, particularly children, who require short- and long-term psychosocial and mental health support to recover. Within this context, Médicos del Mundo has strengthened its traumatology and orthopaedics surgery services during conflicts and works to bolster integral mental health services from a community level and from health and education systems.
The challenge of COVID-19 is now a part of this scenario and, as in other countries, there is confirmation of the significance of the social determinants of health. The pandemic affects everyone, but does so unequally, and depends on access to information, gender and age, existing social protection structures, economic status, the capacity to save, available resources, support networks, housing conditions, family size, etc. Furthermore, the frail Palestinian health care system comes up short in terms of the availability of staff to carry out contact tracing, provide treatments and maintain operational primary care, as well as material shortages in carrying out sufficient samples and treating the most serious cases. Politically, the health emergency is intensified in a situation of perpetual conflict, made worse in recent months by the presentation of a plan by Israeli Prime Minister Benjamin Netanyahu to start annexing parts of the West Bank from July onwards. Since April, Médicos del Mundo has continued to support competent health care authorities in the West Bank and Gaza, informing the population of prevention measures, distributing hygiene kits, protective material and analysis for health care staff, and providing remote psychological support and primary health care during lockdown to the most vulnerable communities, with the support of local and international organisations.
In Palestinian territories, more than in the rest of the world, the pandemic brings to the fore the specific effects of chronic injustices in people’s health. Further still, the threat of illegal annexation in parts of the West Bank will deepen part of the shortages in Palestine’s structures, making existing vulnerability even more pronounced. In Palestine, COVID-19 runs the risk of becoming a humanitarian, social and economic catastrophe.