Restricted Mobility and the Threat to Health

May 6, 2001

Since September 28, 2000, Palestinians in the West Bank, Gaza Strip, and East Jerusalem have suffered under the policies and practices imposed by the Israeli government. Citing "security reasons," the Israeli government has imposed a strict internal and external border closure that has virtually imprisoned the three million inhabitants of the Palestinian Occupied Territories. Roads have been bulldozed or blocked by large concrete slabs to prevent cars from passing, and numerous temporary Israeli checkpoints have been erected. This isolates Palestinian communities from one another and makes all aspects of daily life difficult. Because human rights are interdependent and interrelated, denying one right, such as the right to freedom of movement, can result in a situation in which a multitude of other rights are at risk. In this case, Israeli restrictions on freedom of movement in the Occupied Territories have limited Palestinians' access to health care, thus violating their right to health.

Consider the case of Nada Abdel Jabbar, a Palestinian mother of eight from the village of Beit Furik just outside the West Bank city of Nablus. On February 28, 2001, Nada fell while working in her house and began to bleed severely. Her family called the hospital in Nablus for an ambulance, but Israeli soldiers detained it at a checkpoint just outside of the village. Nada's family then decided to take her to the hospital in a private car. They were stopped at the same checkpoint, where they pleaded with the soldiers to permit them to pass. When the soldiers refused, the family offered to leave the car at the checkpoint and carry Nada through on foot. Still, the soldiers refused passage. The family turned around and took a long, winding, pothole-ridden dirt road through a neighboring village. Nada was clearly in critical condition, yet Israeli soldiers detained them at another checkpoint. In desperation, the family tried another dirt road to Nablus. After forty-five minutes, they reached the hospital, but it was too late. Nada had lost too much blood and died two hours later. Under normal conditions the trip from Beit Furik to Nablus takes only ten minutes.

Our organization, the Union of Palestinian Medical Relief Committees (UPMRC), faces significant obstacles to providing health services to Palestinians in the Occupied Territories. Road closures and travel restrictions often prevent our staff from even getting to work, as most of our clinics are located in isolated, rural areas-the kind most affected by the closures. Villages that abut Israeli settlements are subject to particularly onerous closures, and sometimes our doctors and community health workers cannot pass through certain Israeli military checkpoints for days or weeks, even though their identification clearly marks them as medical personnel. Travel times to and from work have tripled in some cases, and many staff must take circuitous dirt paths to bypass checkpoints, Israeli soldiers, and destroyed roads.

UPMRC has tried to respond to the pressing health needs created by the restrictions . During the first Intifada, we found that mobile clinics were an important component to our strategic emergency health response. Mobile clinics allow us to bring vital, basic services to populations under siege, as well as specialized care normally available only in certain institutions, usually located in urban areas or regional clinics. With the current crisis, mobile clinics are again a necessity, as many patients cannot access basic and specialized services unless the services are brought to them. The UPMRC has cooperated with other groups such as the Palestinian Ministry of Health, the United Nations Relief and Works Agency, and local health organizations in mobile clinic convoys to besieged villages. We have also increased the capacity of our local clinics to provide basic, specialized, and emergency care to Palestinians isolated from medical facilities, and have made every effort to keep normal clinic hours. Clinic stock is being doubled or tripled in all facilities since travel restrictions mean that we cannot always reach our clinics to restock supplies. We have thus had to place special emphasis on empowering communities with skills such as first aid training and childbirth preparation. Enabling communities to address basic emergency needs not only prevents further problems, but also increases local communities' capacity to care for their own people.

We believe it is crucial, however, to develop a comprehensive strategy to end the human rights violations themselves, not just deal with their consequences. Numerous Palestinian and international human rights groups have documented human rights abuses committed by Israeli soldiers despite international laws aimed at protecting the rights of patients requiring medical care and the neutrality of medical personnel. Specifically, soldiers have detained patients (including laboring women) in need of emergency care, denied the passage of ambulances, and prevented patients requiring regular care (such as dialysis) from reaching a hospital. The health care system is showing signs of strain. Some of our programs are in imminent danger of collapse, and our inability to provide services such as vaccinations, pre-natal care, and treatment for chronic diseases seriously jeopardizes the health of patients who rely on these programs for regular care. While trying to ameliorate the acute suffering caused by the conflict, we have also worked to address the underlying political causes of the crisis.

As founding members of the Palestinian NGO network (PNGO), a volunteer group of over eighty charity organizations working in various human rights, social work and development fields, we have worked to raise awareness locally and internationally about the human rights situation in . Locally, we have helped PNGO organize meetings on emergency management and coping with stress for the general public, lawmakers, local activists, and local leaders. We have advised groups on how to manage stress, evaluate injuries and health problems, and decide which facilities offer the necessary services. The PNGO network has also initiated a media advocacy tool called the Palestine Monitor, which is an information clearinghouse that conducts advocacy campaigns and responds to local developments from the perspective of civil society. Through the Palestine Monitor, UPMRC has been able to publicize human rights abuses recorded by our staff in the West Bank and Gaza Strip. By giving real accounts of the conflict's effects, a story often told only in numbers, Palestine Monitor shows how average Palestinians are affected by health rights violations, and raises awareness of the problems.

The UPMRC provides medical services to patients by utilizing the Primary Health Care model, meaning that we address the causes of disease and infirmity, not just the symptoms. We also use the Primary Health Care model to guide our human rights advocacy work, which helps us focus on the linkage between political rights and the right to health. In order to "treat" the violations of health rights and freedom of movement, we must first cast blame on the strangling, illegal military occupation the Israeli government has imposed on the Palestinians for thirty-four years. This occupation is detrimental to many human rights, including the right to health. Our struggle for the right to health must support the struggle for national liberation. Only when Palestinians live in an independent, democratic, territorially contiguous state, free from closures, curfews, and travel restrictions, will we be closer to realizing our right to health.