In the first paper in The Lancet Series on Health in the Occupied Palestinian Territory, written by Dr Rita Giacaman, Birzeit University, Ramallah, West Bank, and colleagues, the authors look in detail at how the demographic characteristics, health status, and health services of the Palestinian population have been affected by 60 years of continuing war conditions and 40 years of Israeli military occupation of the West Bank and Gaza Strip.
Although health, literacy, and education are better for the 3.8 million residents in the OPT than in several Arab countries, all are at substantially lower levels than in Israel. Some 52% of Palestinian families (40% in the West Bank and 74% in the Gaza Strip) were living below the poverty line of US$3•15 per person per day in 2007. Since 2000, life for Palestinians has become much harder, more dangerous, and less secure.
Unemployment in the Gaza Strip was around 33% in 2007, rising to 38% in 2008. Food insecurity has continued to rise, reaching 56% in 2008; and 60% of households regard emergency assistance as a secondary source of income even before the December 08–January 09 invasion of the Strip, and with the crisis intensifying since then.
As with other nations, the OPT is undergoing an epidemiological transition, in which cardiovascular diseases, hypertension, diabetes, and cancer have overtaken infectious diseases as the main causes of illness and death. But the OPT is faltering where other modern, western nations are progressing. Infant mortality in the region has stalled at 27 per 1000 live births during 2000-06; the same level as that reported in the 1990s. The rate in Israel is 3.9 per 1000 live births. The rate of stunting in children under 5 years has risen from 7.2% in 1996 to 10.2% in 2006. From 1999 to 2003, the rate of tuberculosis in the OPT has risen by 58% and meningococcal meningitis by 53%. Mental disorders have risen by around a third from 32 per 100,000 in 2000 to 43 per 100,000 in 2003.
The current Palestinian health system is made up of fragmented services that grew and developed over generations and across different regimes. At present, all four main health service providers (the Palestinian Ministry of Health, UNWRA*, non-governmental organisations, and the private medical sector) contribute to all areas of health care. However, various factors, including lack of development under Israeli military rule together with poor governance and mismanagement by the Palestinian Authority, mean that Palestinian health services are inadequate and many patients must be referred elsewhere (Israel, Egypt, Jordan).
The authors say: "We have shown that, after a period of improvement in Palestinian health in the occupied Palestinian territory, socioeconomic conditions have deteriorated since the mid-1990s, with a humanitarian crisis emerging in the Gaza Strip and intensifying as a result of the Israeli army invasion in December, 2008, and January, 2009, because of destruction of homes and infrastructure, the death and injury of civilians, and shortages of food, fuel, medicines, and other essentials, requiring urgent world concern."
They conclude: "Hope for improving health and quality of life of Palestinians will exist only once people recognise that the structural and political conditions that they endure in the occupied Palestinian territory are the key determinants of prevailing health conditions."
Dr Rita Giacaman, Birzeit University, Ramallah, West Bank. T) +972 2298 8654 E) rita@birzeit.edu
Notes to editors: *UNRWA: United Nations Relief and Works Agency for Palestine Refugees in the Near East
For full Article see: http://press.thelancet.com/opt1.pdf
Journal
The Lancet