Back “Health is political.” Report of the fifth Policy Dialogues session

“Health is political.” Report of the fifth Policy Dialogues session

On Thursday, July 21, the JHU-UPF Public Policy Center delivered the fifth session of the Policy Dialogues series, entitled: “Health Inequity and Medical Apartheid in Palestine.” Speakers Osama Tanous and Yara M. Asi, experts in public health and human rights in Palestine, presented the theoretical, historical and practical framing of the health care system in Palestine and emphasised the urgent need to decolonize politics and public health in order to achieve health equity and justice in the region.

31.08.2022

 

Framing Health Inequity and Medical Apartheid in Palestine

In recent years, multiple Human Rights organisations (including Human Rights Watch, Amnesty International and the Israeli organisation B’Tselem) have drawn attention to the political situation in Palestine, stating that it is no longer a prolonged occupation but, rather, a system of apartheid with only one sovereign state. These conclusions are based on the systematic segregation of the population living within the Palestine/Israel borders, whereby Israeli citizens enjoy far more rights, power, protection and freedom than Palestinians. Under this system, alienation and oppression affect all aspects of Palestinians’ living conditions: access to food and water, freedom of movement, education, and healthcare, to name a few. “Whether it is slow violence, structural violence, or direct violence, Palestinians are exposed to these stressors and experiences simply because they are Palestinians,” speaker Yara M. Asi noted.

For Osama Tanous, a specialised paediatrician and researcher focused on structural violence and health disparities, it is essential to analyse the health system in Palestine in its political and historical context, in order to understand which framework best captures the situation. “We need to understand that there is no such thing as a state of Israel and a state of Palestine; Israel actually does not have a clear border and they are constantly expanding as a colonial frontier,” Tanous pointed out. 

For this reason, he believes, the situation is most accurately framed within what is known as Settler Colonialism. Throughout history, what is particular about settler colonialism is that, unlike migrants and refugees, settlers move with sovereignty; moreover, they do not integrate with existing society, but create a new community, a new population, a new set of rules, and a new political structure, and in the process, eliminate the native populations.

So, “How can we understand this in the context of medical apartheid?” asked Tanous. He explained that medicine has always been entangled with colonialism and used as a crucial tool for enabling soldiers to conquer territories; medicine is an essential part of the colonial infrastructure, used to shape the new nation. In this case, Israel’s health system has its origins in colonialism: “at the beginning it would be small settlements [moving into the West Bank], then they would have governmental support, electricity, highways, schools and the health care system follow the settlements…finally, you move your civil population there to create this permanent infrastructure, all of this violates international laws,” said Tanous, adding that “these health clinics in the West Bank provide health care only to Jewish settlers”. In addition, Palestine is seen as a not progressive place where you need to bring western medicine.

This project of settler colonialism caused Palestinians to lose sovereignty over their land, making social and political organisation  conditional to Israeli law. “During the British mandate, they allowed settlers to create their health care system; Palestinians have been prevented from doing that and are locked out of any access to planning. This creates a very mediocre [Palestinian] health care system that is largely dependent on foreign funds, especially after the Oslo process, this system, can’t provide health care to Palestinian patients”, explained Tanous. As a consequence, the Palestinian health care system is captive. As it cannot provide the care that many Palestinian patients need, it ends up acting as a contractor that refers patients to external providers such as the Israeli healthcare sysem, foreign countries or private businesses. Besides benefitting the Israeli system, this model entails significant bureaucracy, delays and costs for Palestinian patients, which, compounded by the restrictions on Palestinians’ movement imposed by the Israeli state, end up causing many avoidable deaths.

To conclude, Tanous explained how this system goes beyond apartheid and domination and slides into “Necropolitics,” whereby the dominant political force (in this case, Israel) decides who is allowed to live or die, for example by determining what kind of access to health care someone is allowed based on which side of the green line they were born in.

The Responsibilities of the Occupying Power

“This framing of settler colonialism is relatively new. What we typically see is the framing of occupation, which is a military process,” stated Yara M. Asi, a postdoctoral scholar at the University of Central Florida, USA, and a researcher focused on global health and development in fragile and conflict-affected populations. 

According to Asi, global entities such as the UN Security Council, the General Assembly, the International Community of the Red Cross, and even Israel’s Supreme court continue to recognize and acknowledge the belligerent occupation of the West Bank, the Gaza Strip, and East Jerusalem. “The occupying power is not just a descriptive phrase but a legal phrase; belligerent occupation is when the forces of one state exercise effective control over a territory of another state without the latter state’s volition. Because such control has often been the outcome of the exercise of military force, this regime has been titled “belligerent” occupation.” This means there are military checkpoints and a constant presence of soldiers in the West Bank, in the Palestinian border crossings, who routinely enter houses and block off Palestinian villages: all aspects of Palestinian lives are controlled and affected by the manifestations of Israel’s military policy.

Part of Asi’s presentation explored the question, “what does Palestinian occupation look like? And how does this feed into this medical apartheid framing?” According to the Geneva Convention, occupation is sometimes a necessary component of war; however, the occupation must be a temporary structure. Such occupation is subject to several mandates of international humanitarian laws, in which the occupying power has specific responsibilities and obligations to the population they are occupying.  

Asi explained some fundamental obligations that the occupying power must adhere to under the Geneva Convention: destruction of the occupied people’s property, including property owned individually or collectively, is prohibited; Food and medical supplies must be provided for the occupied population; it is responsible for providing and maintaining medical and hospital establishments and services, public health and hygiene in the occupied territory; and, persons who are in the occupied territory shall not be deprived of the benefits of the Convention.

However, Asi described the current situation in Palestine as failing to meet these conditions: “you can see houses being demolished, Israelis demolish Palestinians homes, accusing them of not having sufficient permits to build them; you have the checkpoint systems, a form of collective punishment [that is] incredibly dehumanising and an incredible waste of time, as [the soldiers] often block or delay your travel. You can see soldiers arresting children, killing people with gun fire, and you can see the night raids of Palestinians homes in the middle of the night.”

Moreover, she claimed, Israel as the occupying force is failing to comply with its obligations to the Palestinian population in terms of health and healthcare provisions, practising instead a system of medical apartheid. This was evident before the COVID-19 pandemic, as Palestine had a “de-developed” health care system due to Israeli restrictions on funding and movement (of people and medical equipment), as well as a brain-drain of medical staff due to the lack of quality of life of trained professionals in Palestine. For Asi, the movement restrictions, including the permit system, the separation wall, and the checkpoints, have created a captive population entirely dependent on a system designed by the occupying power. The significant differentials in life expectancy and other health outcomes between Jewish Israelis, Palestinian Israeli citizens, Palestinians in the West Bank and Palestinians in Gaza - as presented by Tanous - clearly show the deep inequalities in health care provision and other determinants of health between the various demographics.

However, this system worsened with the arrival of the pandemic, not just because of the slow efforts by the Israelis to support Palestinians in protecting themselves against COVID-19, or because Gaza’s central COVID-19 lab was destroyed after Israel’s bombing, but principally because of the vast differences in vaccination rates between the Israeli and Palestinian populations. This disparity clearly demonstrated Israel’s neglect of its duties to the Palestinian population as an occupying power, and its deepening of a system of medical apartheid.

Moving Forward

To conclude, Osama Tanous and Yara M. Asi highlighted the need to move forward from the humanitarian framework in which Palestine has been locked and the need to deconstruct the entire power structure in order to create sovereignty for the Palestinian people in economic, political, and health system terms. “We believe that it is long past time to move past this humanitarian framework. Palestine is not just a victim of a natural disaster that just needs temporary support and that can move on, this is an active political project, and until we recognize it as such, and stop treating it as a further receiver of aid, we will continue this paradigm. Health is political, and you have to understand health systems in their political and historical contexts, but that history is way too often left out of the conversation.” They emphasised the need to recognise Palestine as a colonial frontier in conversations around decolonising politics and public health, claiming that it is often excluded from these conversations, to the detriment of Palestinian health, equity and justice.

After the presentations, questions were asked from the participants about topics such as: mental health and its impacts on the struggle for Palestinian liberation; cooperation efforts between Palestinian and Israeli medics; the transformation of the Palestinian health system over time; and how race relations in other countries such as the US influence understanding of the situation in Palestine.

The full video of this Policy Dialogue can be watched on the Center’s YouTube channel.


Follow us on Twitter to hear about our upcoming Policy Dialogues seminars: @pubpolcenter

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