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A View from Jerusalem: Challenges for Palestinian Health Care
"When a person has a heart attack and calls for an ambulance, he may have to meet the ambulance at a checkpoint; or if the ambulance travels to retrieve him, Israeli soldiers decide whether they will allow the ambulance to pass through the checkpoints."
At the Chicago Sabeel Conference Dr. Tawfiq Nasser spoke about the restrictions of Palestinian access to health care caused by Israel’s wall and military occupation.
Nasser is the CEO/Director-General for Augusta Victoria Hospital, the second largest hospital situated on the Mount of Olives in East Jerusalem. He is in charge of managing the clinical outreach program of the Lutheran World Federation. AVH is the largest hospital that serves Palestinian refugees through a contract with the United Nations Relief and Works Agency (UNRWA).
The six major hospitals in the West Bank face many challenges in providing humanitarian services to patients who must travel through checkpoints and roadblocks to receive medical care.
“One of the major issues we are facing on the ground with this whole restriction of access is that the civil society is being punished indiscriminately,” Nasser said. “We live the reality of segregation and annexation wall.”
If a Palestinian needs to travel for medical care, then she has her doctor issue a medical report. When she applies for an Israeli permit to access medical treatment she presents the report. Since these movement restrictions have a direct impact on Palestinian access to health care, Nasser established a bus system to meet the needs of his hospital’s patients. There are four bus routes in the West Bank that bring patients to East Jerusalem.
“The wall is basically separating the patients from the hospitals,” he said. “The six major hospitals are facing slow death because they (the Israeli forces) are chopping up the land like Swiss cheese.”
As a medical planner Nasser explained that emergency services are so shocked by the occupation’s restrictions that it is difficult to talk about a coherent, first responder system.
“We are getting stuck in the reality that everything is designed around the presence of theses settlements,” he said. “With dirt-blocked roads we have no way of getting people into the hospital.”
When a person has a heart attack and calls for an ambulance, he may have to meet the ambulance at a checkpoint; or if the ambulance travels to retrieve him, Israeli soldiers decide whether they will allow the ambulance to pass through the checkpoints. In the area around Qalqiliya, the wall stands 25 meters high and cuts into the West Bank. The snake like structure weaves between Palestinian communities thereby forcing people to travel the winding pattern of the wall to reach Qalqiliya’s main hospital. For people who live just south of the city, they travel 90 km around the wall. For a person in distress, the stress of the travel may cause further health complications.
The information in Nasser’s presentation has been echoed in a September 2005 report entitled, “Health and Segregation II: The impact of the Israeli Separation Wall on access to health care services,” published by the Health, Development, Information and Policy Institute (HDIP), which plans and researches for Palestinian health care and development. The report’s author, Joan Jubran found that “80,000 Palestinians have difficulty accessing emergency care and curative medical services, a further 80,000 have trouble reaching hospitals, and 35,000 lack sufficient health care services.”
Moreover, movement restrictions affect hospitals’ staff because doctors who live in the West Bank do not always acquire access to East Jerusalem. For doctors who have access to the hospitals and clinics where they work, the daily wear of extended commute times through checkpoints, “flying” (mobile) checkpoints and roadblocks deters West Bankers from working in East Jerusalem. Since AVH is one of two hospitals that provide medical education, medical conferences have been postponed because students under the age of 24 are denied access into East Jerusalem. While travel restraints exists Nasser finds innovative, tenacious ways to retain medical specialists so that the hospital can continue providing high-quality, medical services.
As a result of movement restrictions many hospitals and non-governmental organizations (NGOS) set up mobile clinics throughout the West Bank. However, Jubran pointed out that “…many mobile clinics are funded only for six or nine months, after which people must do without until new funding is found.” The end result is people live without medical services.
Nasser explained that AVH has outreach clinics in the West Bank also, where people can receive primary care. However, health care institutions have to be careful about creating satellite locations because alternative, medical centers outside of Jerusalem can cause the financial and infrastructural collapse of Palestinians health care institutions.
AVH depends on LWF and numerous international donors to fund the hospital’s operations. The establishment of satellite, medical centers with specialized care can exhaust a hospital’s budget. Nasser stressed the importance of retaining specialized care within East Jerusalem, where the hospital has been serving the community without regard to race, creed, sex, or national origin for 55 years.
Another financial issue looming for AVH is Israel’s potential withdrawal of the tax exemption agreement it has with the LWF. The Israeli District Court in Jerusalem issued LWF its decision about the potential exemption and it has been in the court system for almost three years. Nasser explained that if the hospital loses its tax exemption, the tax alone would be approximately US $700,000 dollars annually. “It would severely impact our services and we would have to go into a smaller scale operation to sustain ourselves,” he added. Increasing the price of medical services to recover the cost is not an option since the majority of patients are refugees barely surviving economically-difficult times also.
One audience member asked if Israel imposed the tax, then the hospital would still receive state benefits like Israeli hospitals. “We don’t qualify for state benefits like Israeli hospitals,” he said. “Since 1967 we have been on the periphery of the Israeli system.”
As the only hospital that provides cancer and kidney services to the entire population, the hospital’s livelihood is imperative for the survival of cancer and kidney patients in the Palestinian community. According to Nasser, Israeli policy has created a push-pull mechanism in its matrix of control that is pushing Palestinian health, cultural and educational infrastructure. If these Palestinians institutions cannot make financial ends meet, then their deterioration only fuels the anger on the ground.
Although the U.S. Agency for International Development (USAID), a U.S. federal government agency provided $51 M for a reproductive system in the West Bank, it did not give funding for East Jerusalem. Two weeks ago Nasser spoke to the United Nations about the success of the busing system when he received a call that Israeli forces stopped the bus system from entering East Jerusalem. Phone calls were made to high-level officials to allow a busload of 30 children to reach the hospital.
Nasser focused on the hospital’s successes including the First Cancer Center, which opened last August. AVH has the sole pediatric dialysis unit in Palestine. After four years of bureaucratic tape, AVH received licensing for a radiation ecology unit. “Medicine can be a powerful example of Palestinian successes,” he added.
However he stressed the importance of support by Americans and the international community. He said their advocacy for an end to the military occupation and a viable Palestinian state with East Jerusalem as its capital will help the people in their continued focus on building civil society.
“We need your advocacy,” he said.
Through advocacy, solidarity and shared vision for a Palestinian state that becomes reality, the Palestinians will be able to sustain themselves.
by courtesy & © 2005 Sonia Nettnin
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