A second Comment address the politics behind aid given to the oPt, and is written by Angelo Stefanini of The University of Bologna, Italy, and Enrico Pavignani, Independent Public Health Consultant, Bologna, Italy.
They say: "Aid to Palestinians looks like an inappropriate political tool, provided to limit the damage created by a political problem that donor countries dare not address."
The authors point out that the International Court of Justice has ruled that states are under an obligation not to render aid that might maintain a situation created by occupation. They give as an example financing of highly localised health facilities to mitigate the delays caused by Israeli closures, which effectively normalises an unacceptable situation.
They add: "In view of the fact that 45% of aid goes to Israel and the remaining 55% is divided between waste on occupation measures and actual project benefits,8 aid subsidises the Israeli expansion in the occupied Palestinian territory….Generous and unconditional assistance to the health sector has led to punishing levels of donor dependency: 42% of the health expenditure is financed by donors.
The role of donors and beneficiaries is put under the spotlight in the Comment. The authors say: "Donors perceive their role in different ways, as mere cash providers or as active players. Their choice of interventions is often opportunistic, thus fostering a competitive environment in which joint ventures are resisted and open discussion evaded. The resulting aid landscape is not yet populated by the good donor practices embodied in the Paris Declaration. Conversely, beneficiaries tend to favour aid as bilateral deals, biased towards generous donors who avoid awkward questions. Such an environment does not help meaningful consultations, and formal coordination mechanism might be sidelined. The result is that generous aid is taken for granted and services develop free of fiscal constraints, with costs exceeding future foreseeable internal resources. Above all, donors fail to address a crucial health determinant in the occupied Palestinian territory: human security and the structural violence imposed by the occupation."
They conclude: "What can be done?…Both technical and political aspects should be tackled...Above all, the split between the assistance provided by donors and their geopolitical views should be addressed. Outspoken advocacy is needed to encourage the mutual understanding of the diplomatic and the technical sides. A move towards an approach based on human rights and international humanitarian law is long overdue."
Angelo Stefanini, Centre for International Health, Department of Medicine and Public Health, University of Bologna, 40126 Bologna, Italy. T) +39 051209400 E) angelo.stefanini@unibo.it
Full Comment: http://press.thelancet.com/optstefanini.pdf
Journal
The Lancet