Emergency Strategy Paper
1 December 2000 - 31 May 2001
A. Introduction
In order to ensure consistency in health care provision for the Palestinian people, as well as integrity of vision among all Palestinian governmental and non-governmental bodies and organizations in the health care field, the Union of Health Work Committees is proposing an emergency strategy to be implemented during the coming six months. This strategy has emerged from the Union's recent experience within the volatile atmosphere of the Israeli occupation forces' violent aggression against the Palestinian people. In order to situate the proposed strategy, it is necessary to understand more fully the broad political and economic context of the Palestinian occupied territories.
B. Political Considerations
Al-Aqsa Intifada: The Refusal to Surrender
While the present Intifada is based on a number of political realities, it must be clearly stated at the outset that the Israeli occupation of the West Bank and Gaza is the sole entity responsible for the Aqsa Intifada.
The same occupation has been implementing a policy of terror for years toward the Palestinian people including arrests, deportations, killings, and robbery of the national economy, in addition to the confiscation of lands and building of settlements. This same occupying force still refuses to acknowledge the legitimate rights of the Palestinian people, namely, the right for self-determination, the creation of a Palestinian state with Jerusalem as its capital, and the right for all refugees to return.
The spark that ignited this Intifada, moreover, was the provocative "visit" of Ariel Sharon, accompanied by hundreds of Israeli soldiers, to Al Haram A-Sharif. Any attempt to minimize this fact, or to explain the events in any other way would be a deception.
A Refusal to Surrender
There has been an increasing loss of confidence in the peace process designed according to the American-Israeli vision, which implies the exclusive implementation of Israeli terms. These terms include:
a. the separation of the geographic and demographic unity of the Palestinian people by dividing their land into cantons A, B, and C (as well as H1 and H2 in Hebron, and the complete closure of Jerusalem), in addition to the creation of bypass roads that have consumed thousands of dunums of Palestinian lands;
b. the building and expansion of new settlements;
c. the continuing siege over Palestinian cities, villages, and camps;
d. the policy of house demolitions;
e. the rejection of Palestinian basic human rights as well as national rights;
f. the use of Palestinian prisoners as a bargaining chip for more concessions.
In addition, Israel continually refuses to comply with international resolutions (United Nations and UN Security Council) and has replaced these international terms of reference with its own force, and the creation of "facts on the ground." Israel depends exclusively on the completely biased American position which supports and whitewashes Israel's practices against the Palestinian people. The United States, moreover, continues to threaten to use its veto power against any attempt to condemn Israeli crimes.
The recent events, as well as the results of seven years of the Oslo Agreement fiasco and all the subsequent "agreements," are nothing but tools to eliminate the rights of the Palestinian people. None of these agreements have been effective means to achieve a just peace in the region. The extreme violence used by Israel against the Palestinian uprising is nothing but another attempt to coerce the world into buying into its understanding of "peace," namely, a peace based on surrender.
Israel's Intransigence
Although Israel presents itself as a party willing to make compromises, in reality, the "facts on the ground" illustrate clearly its complete intransigence with respect to any and all negotiations. Barak went to Camp David (the beginning of the final status negotiations) and brought with him the following conditions on the Israeli agenda:
a. No withdrawal to the borders of 4 June 1967 (this contradicts UN resolutions 242 and 338);
b. The insistence that the settlements should remain and be annexed to Israel (this also contradicts all UN and UN Security Council resolutions which consider all settlements on the West Bank and in Gaza illegal);
c. The denial of the rights of Palestinian people in East Jerusalem and dealing with Jerusalem in toto as the eternal capital of Israel;
d. The refusal to allow Palestinians to return to the homes from which they have been expelled since 1948 (contradiction of UN Resolution 194);
e. Israel's refusal to have a "foreign" army west of the Jordan River. This implies that if Israel ever accepts the creation of a Palestinian state (constrained, of course, by the conditions previously mentioned), it must necessarily be a state without an army.
It is important to understand the significance of some of these conditions for Palestinians. The settlements are an Israeli political project aimed at crushing Palestinian aspirations for freedom and independence. Any realistic discourse focused on the creation of a Palestinian state with the coexistence of the settlements and bypass roads would imply a state without sovereignty. This has always been one of the main reasons for conflict and confrontation. Israel's vision of annexing the already-existing settlements translates into annexation of an additional 15% of Palestinian lands. At present, there are approximately 200,000 settlers in 140 settlements throughout the West Bank, Gaza and Jerusalem. In Hebron, for example, 400 Jewish settlers live in the midst of 140,000 Palestinians, and control 20% of the city.
Israel's expansionist, colonialist policy is a rejection of all decisions of the international community that state unequivocally that all settlements in the West Bank and Gaza are illegal and as such must be dismantled.
The refugee problem is another basic issue at the heart of the Palestinian cause. Refugees were created as a direct result of the Zionist project in Palestine. Seventy-eight percent of Palestine was occupied in 1948 and as a result, approximately one million Palestinians were made refugees. During the 1967 War, another half a million refugees were added to this number. Today there are more than 4 million refugees living in Lebanon, Syria, and Jordan, as well as in Palestine itself.
These are the facts and the foundation upon which the present Intifada was built. The only conclusion to be drawn from all this is that, although Israel speaks eloquently about peace, it acts as a brutal occupying force on the ground that will stop at nothing to maintain its power. Oslo aided the Israeli occupation army in tightening its grip on each and every Palestinian city and village. In addition, the plans for redeployment as articulated in Oslo have only served to improve Israel's strategic military positions rather than precipitate its withdrawal, as some people erroneously imagined.
The recent summit at Sharm a-Sheikh on 17 October, with Clinton, Mubarak, Annan, Solana, Arafat, and Barak was yet another step in perpetuating the deception that has dominated all attempts to deal rationally with the conflict. The Summit described the Palestinian resistance as simple rioting rather than as the profound expression of the aspirations of an entire population for freedom and independence. The Sharm-a Sheikh Summit and its results were clearly controlled by the U.S. vision for "peace" in the region -- a vision that would crush the Palestinian Intifada, block the Arabic national movement, and hinder the broadening of solidarity movements in Europe and elsewhere in the world. One of the most dangerous consequences of the Summit is the equalization of the victim and the victimizer and the effort to ignore the liberation movement's political dimension underlying the action of the Palestinian people. In addition, Sharm a-Sheikh was an attempt to transform the reality of Israeli brute force into political "achievement" in order to dictate Israel's political conditions in any future agreements.
Israel's Strategy of Confrontation: "Bring Them to Their Knees"
Palestinians throughout the world are committed to reaffirming their inalienable, national rights. Sharon's intention, with the blessing of the Israeli government, was to create yet another "fact on the ground." This alone is sufficient to explain Israel's violent reaction toward the Palestinian demonstrators protesting Sharon's visit. Barak's government wanted to deliver a clear message to the Palestinian people that Israel is ready to do everything necessary to protect its own political choice and to safeguard Israel's conditions defined by Barak at the Camp David Summit. If Israel has its way, then, the Palestinians are either to kneel and accept Israeli terms, or to be subject to Israeli terror and killing.
Israeli army tactics thus far have been "hidden" under the cover of political and security "considerations" - in other words, use the utmost level of force, as quickly as possible, in order to crush the Palestinian resistance. In this way, the Intifada will lose its momentum, thus ensuring the attainment of Israeli goals and rendering impotent the Palestinians.
Israel's strategy in dealing with the Intifada is connected to three elements:
a. Maintaining Israeli force through ensuring the highest possible number of losses among Palestinian demonstrators and the least possible in the Israeli army;
b. Tightening the grip and siege over Palestinian cities and villages, as well as severely restricting freedom of movement through the Israeli army's complete control of all roads.
c. Encouraging settlers throughout the West Bank and Gaza to attack Palestinian villages;
d. Attempting to portray the confrontations as a confrontation with a real armed Palestinian force, although Israel knows very well, the kinds of weapons that are in the possession of the Palestinian police. Israel, nevertheless, has used this argument as a cover and an excuse for its disproportionate use of combat helicopters, rockets, and tanks.
The Bottom Line
Confronted with this reality, Arafat has found himself in front of yet another closed door. Any further compromise on the basic points of the final status negotiations would mean defeat in the struggle toward gaining recognition of the legitimate rights of Palestinians. No Palestinian would stand for it.
The demands of the Palestinian people are very simple and clear:
a. end the occupation
b. dismantle all settlements
c. grant freedom and independence to Palestinians in a sovereign state, with Jerusalem as its capital
d. guarantee the right of return to all refugees
The Palestinian people seek a just political solution that brings refugees back to their homes. They seek a just political solution that guarantees freedom and independence for the entire Palestinian people, and not a new, creative form of occupation. This is the reason that the conflict continues and the resistance gets stronger. And this is the reason that the Israeli occupation, with its tactics of terror and aggression, will never be able to crush the Palestinian spirit and longing for justice.
C. Economic Impact
The Palestinian economy, which was gaining a bit of strength prior to the Israeli occupation forces' aggression, has been devastatingly crippled since 28 September 2000. The following section is based on UNSCO's report of 19 October 2000 (Impact on the Palestinian Economy of Recent Confrontations, Mobility Restrictions and Border Closures, Office Of The United Nations Special Co-Ordinator).
Internal Impact
Since 29 September, travel between the different areas inside the Palestinian Territory (PT) has been severely hindered by confrontations as well as roadblocks and checkpoints established by the Israeli authorities. The main economic impact of such mobility restrictions has been the disruption of productive activities and the internal circulation of goods.
The short-term losses in such a situation are difficult to measure. But they include reduced income to workers, farmers and business people who cannot reach their places of employment in the PT and the reduced output and revenues for commercial and business enterprises which are unable to obtain inputs and/or access output markets. Moreover, the uncertain security situation has reduced tourist-generated income. As the crisis persisted, the extent of these types of losses became more pronounced.
An approximate measure of the internal effects of such disruptions can be derived from estimates of the Gross Domestic Product (GDP)-i.e. the value of goods and services produced in the Palestinian economy. The value of the GDP is expected to reach about USD 5,000 million this year while the average work year in the Palestinian Territory is about 312 days. This results in an estimated average domestic product of about USD 16 million for each normal working day. Assuming that recent events have resulted in a 50 per cent reduction in normal economic activity, the losses are estimated at about USD 8 million for each normal working day during the period 30 September-19 October.
External Impact
Labor Flows and Wage Income
In addition to the internal losses, the border closures have effectively halted the outward flow of Palestinian labor. In the first half of 2000, there was an average of about 125,000 Palestinians employed in Israel and Israeli settlements and industrial zones on a daily basis. The average worker was earning a daily wage of about NIS 110 or about USD 27.50. As a group, these workers were earning approximately USD 3.4 million each day.
Losses began to be incurred on Monday, 2 October when daily Palestinian labor flows to Israel dropped precipitously. During 2-5 October, just before the weekend (6-7 October) and the closing of the border for the Yom Kippur holiday (8-9 October), average daily labor flows to Israel were estimated to have declined by 53 per cent as compared to the week prior to the disturbances. This resulted in an average daily loss of about USD 1.8 million in direct household income for Palestinians during that period. The border closure imposed on Monday, 9 October, however, resulted in an almost complete cessation of labor flows and an estimated USD 3.4 million loss for each normal working day thereafter.
Commodity Flows and External Trade Income
In addition, exports from Gaza have been effectively blocked since the closing of the border at the beginning of the Rosh Ha Shana holiday (30 September-1 October). Exports from the West Bank have also been severely constrained during this period. Total registered Palestinian non-agricultural exports to Israel (the main market for Palestinian exporters) averaged about USD 45.1 million per month during the first half of 2000. Assuming that these sales are distributed evenly throughout the working year, this implies a daily loss of about USD 1.9 million in exports, although some portion of these losses can be retrieved once mobility restrictions are removed.
Palestinian imports from Israel have also been negatively affected by the border closures mobility restrictions. The commercial crossings in Gaza have been closed since Saturday, 30 September resulting in a complete halt to goods imports. Trade between Israel and the West Bank has been severely restricted as well. Registered non-agricultural imports from Israel averaged USD 135.9 million per month in the first half of 2000 or about USD 5.9 million each working day. Furthermore, direct Palestinian imports from abroad averaged about USD 3.1 million per day in the first half of the year.
External trade is an integral component of the Palestinian economy and has important effects on the size of the GDP. Exports contribute to domestic production and income-generation while many imported goods are used as inputs in domestic production. Likewise, the inability to export dampens domestic production while a lack of imported raw materials and other inputs creates production stoppages for those businesses and farmers who rely on Israeli or foreign-produced inputs. However, since external (and internal) trade activities are already factored into the calculation of GDP, the trade losses resulting from border closures and movement restrictions are included in the estimated daily GDP losses noted above.
Destruction of Physical Assets
There has also been the physical destruction of private and public assets-buildings, orchards and vehicles-due to the conflict. The material losses have been caused by Israel's use of heavy weapons, including rocket fire, against numerous buildings and vehicles and the destruction of fruit orchards near flash points in the PT. Israeli settlers have also engaged in the destruction of private property such as numerous Palestinian trucks used to transport goods to and from Gaza which were located in car parks under Israeli control. While the value of such losses is difficult to calculate, it is almost certainly in the millions of USD.
Aggregate Economic Losses
The estimated economic losses are detailed in Table 1. Excluding material damage to physical assets, and in the aggregate, the losses to the Palestinian economy are estimated at USD 186.2 million during the 22-day period 28 September-19 October. These losses exceed the value of donor disbursements to the PA during the first half of the year, which were USD 183 million. If these losses are distributed over the normal working days in the Palestinian Territory-of which there were 19-the average daily loss is estimated at about USD 9.8 million.
Table 1 Estimates of Short-Term Economic Losses in the Occupied Palestinian Territory, 28 September-19 October, 2000
Sources Losses (USD) 1. Domestic Output and Income 148,000,000 2. Labour Income from Israel 38,205,750 Total 186,205,750
As indicated in Table 1, these losses consist of: 1) the dampening effects on the production and circulation of goods (inputs and outputs) and services in the PT estimated at USD 148.0 million. These include losses incurred due to impediments to internal and external trade; 2) the labour income lost by workers (and their households) due to their inability to reach job sites in Israel and Israeli settlements and industrial zones. This loss is estimated at USD 38.2 million. While lost labour income is irretrievable, some of the domestic output/income losses may be recuperated once internal and external trade resumes.
Losses to the Public Sector
There have also been losses to the public sector in the form of lost domestic, customs and VAT revenues. These, however, are difficult to quantify as data for the year 2000 have yet to be issued. Most of the losses in revenues related to external trade-the main source of short-term fiscal losses-can be recuperated once the border closures are lifted and trade resumes.
It is also the case that certain public agencies-the PA Ministry of Health in particular-have had to vastly increase the level of spending to cope with the large number of killed and wounded Palestinians. This has imposed added costs, some of which have been covered by emergency assistance provided by donor agencies and NGOs (facilitated by the creation of a Humanitarian Task Force for Emergency Needs, under UNSCO chairmanship.) Such assistance has been partly facilitated by eased restrictions on the movement of emergency care vehicles, workers and medical supplies. Restrictions were eased beginning on 14 October following the direct intervention of the United Nations Secretary-General.
Moreover, some PA agencies have been closed for most of this period as many employees have been unable to reach their jobs due to internal closures imposed by the Israeli authorities. This has meant reduced public services and disruptions in capacity-building and institutional development programs and projects, many of which are supported from donor and multi-lateral sources. Likewise, the crisis has resulted in a near halt to infrastructural development projects-most of which are donor financed-due to the lack of security, the evacuation of project personnel and to the lack of some materials.
Longer Term Impact
One immediate effect of the comprehensive and internal border closures imposed on the PT is the disemployment of some 125,000 workers formerly employed in Israel. This has temporarily raised the core unemployment rate from about 11 per cent in the first half of 2000 to nearly 30 per cent. If such a situation persists, the decline in household incomes will have the secondary effect of reducing domestic purchases of goods and services and thereby further lower income and employment (a reverse multiplier effect). Rates of poverty will also increase, requiring the PA to raise spending on social assistance at a time when its revenue base is being eroded. This would adversely affect fiscal conditions.
Another indirect and lagged cost of the strife is the increased perception of political risk on the part of domestic and foreign investors-both current and potential. The PT (and Israel) will be seen as a riskier place to invest for the long term. This can threaten the short- and long-term growth of the Palestinian (and Israeli) economy and reduce the rate of income and employment growth.
As a result of the Sharm Al Sheikh Summit which ended on 17 October, there has been a reduction in confrontations and an easing of internal movement restrictions in the PT. Should this continue in the coming days, the Palestinian economy may yet resume the significant recovery witnessed over the last 3 years, which has reduced unemployment rates from about 25 per cent in 1996 to about 11 per cent in the first half of 2000. Moreover, the normalization of labor and especially trade flows will allow the Palestinian private and public sectors to recuperate some portion of the significant losses incurred in the past three weeks.
D. General Effect on the Occupied Territories
Among the measures taken by the Israeli government to crush the Palestinians are the following:
Israel is prohibiting all clearance procedures at the airport and the ports of Haifa and Ashdod. The prevention of clearance for several containers stocked with goods has caused additional financial losses for trade in the Palestinian territories, which has been severely hampered.
The Gaza airport and harbor have been closed.
All cities and villages in the Palestinian territories have been cut off from each other. Huge stones and rubble are blocking the entrances and the exits of the towns.
World Vision-Jerusalem reports, "…we (WV) have had access problems at every step of the (relief) operation: getting to the location to conduct the needs assessment, the ability of our partners (UHWC) to travel to nearby communities, the ability for trucks to deliver, our ability to get back, the families to get to and from the distribution site."
Palestinian cars are routinely stopped at bypass road number 60, south of Jerusalem on the main road to Hebron at the crossing to Husan. Israeli soldiers not only prevent our medical team from reaching the three villages, Husan, Battir, and Wadi Fouqin, but they also shoot all four wheels of every car. Our team must travel on foot ( if they are allowed to) carrying all their medical supplies (including an ultrasound machine), and walk about 500 meters to get a taxi. The drivers from Husan are very hesitant to drive out of the village, fearing violence from the Israeli soldiers and settlers. At the same time, Israeli settlers have erected a tent at the western entrance of Husan and have closed all other exits.
On 22 November 2000, a villager from Husan was injured in front of the village mosque. Several villagers telephoned the Clinic, asking us to send an ambulance. We called the Red Crescent emergency services from Beit Sahour and were told that they are not permitted to enter Husan, as all entrances have been closed by the Israeli army. Also this morning the Israeli army has been shooting the wheels of the Palestinian cars prohibiting every movement in or outside the village. Twenty-nine persons from Husan have been arrested so far.
In Gaza, two civil cars were shelled causing four deaths and injuring eight. The ambulances were not allowed to evacuate the wounded or even reach the dead.
Booby traps (three grenades) were laid by Israeli soldiers between the barricades that are blocking the entrance of Bani Naim village near Hebron.
World Vision humanitarian aid staff, together with the representative of the Canadian Government to the Palestinian Authority and three of his staff, were trapped behind an Israeli barricade and boulders at the entrance leading to the town of Salfit for more than two hours. Israeli settlers issued threats via megaphone when Palestinians tried to remove the barricade.
Through four Spanish NGOs, the UHWC received emergency medical supplies and disposable materials. The distribution of these items proved to be very difficult especially to Gaza. Only through the help of the Red Cross were we able to transport the materials in two separate trips. Red Cross personnel told us of their fear of just driving the long way. They recounted numerous stories of frightening encounters with Israeli settlers on the roads near Nablus.
The village of Saalim near Nablus was subjected to several attacks by the Israeli army and Israeli settlers. Till now, confrontations with Israeli settlers are still going on in Saalim, whose borders have been closed.
Hebron's so-called H2 area (a premature monster born through the Hebron/ Oslo agreement) has been under curfew for the past 50 days. 35,000 people are being threatened daily by Israeli settlers and Israeli soldiers. There are 400 Israeli settlers backed up by an unknown number of Israeli soldiers who are terrorizing the city. The health situation, the economic situation and the hygienic situation is worsening day by day. Children are prevented from going to school, as many schools in the area have been ordered closed.
Hawwarah village near Nablus has been under siege for over a month. In Deir Ballah near Jenin, 50 % of the students are unable to reach their schools and in Ein Elbeda 25 % remain at home. Fourteen percent of the teachers in Salfit and 10% of the teachers in Ramallah cannot reach their jobs.
The closure of twenty-eight schools in Hebron has affected 13,000 students and 460 teachers. Four schools in Hebron have been turned into Israeli military compounds.
The Tulkarem industrial school has been hit by missiles. The Ministry of Education's curriculum design center in Al Bireh was severely damaged in a rocket attack.
The schools in Al Khader near Bethlehem were subject to attacks with tear gas, rubber bullets, and live ammunition. The school in Tuqua was rampaged by Israeli soldiers.
According to Defense for Children International/Palestine Section(DCI), 64 children were killed in the first 6 weeks of the Intifada. According to their statistics, 73.4% of the cases of death were caused by live bullets, 14% by explosive bullets and 3 % by rubber coated metal bullets. In addition to missiles and tear gas effect. DCI documented 1,330 cases in which 29.6% of the injuries were in the upper part of the body and 32.7% in the limbs.
It is important to note that the Israeli occupation army defines "children" as those under 12 years of age.
Hundreds of trees have been uprooted in the West Bank and in Gaza, "justified" by the Israeli army as increased "security measures" to protect Israeli settlers.
Other examples are too numerous to document in this present paper.
The Union of Health Work Committees has written and distributed several periodical reports and political analyses of the current situation in order to raise general awareness throughout the world. These reports have been greatly appreciated.
E. Specific Impact on Health
The Situation in General
Since the beginning of the Intifada, over 200 people have been killed and more than 6,000 wounded, many of whom will be disabled for life. The following statistics gathered from the Palestinian Red Crescent Society illustrate the devastating impact of Israeli aggression on Palestinians throughout the occupied territories.
Date Deaths Live Ammunition Injuries
Rubber/Plastic Bullets Tear Gas Misc. Total
Sep 29 - 31 Oct 141 1,136 2,855 1,490 503 5,984
Nov 1 6 43 30 59 7 139
Nov 2 3 19 47 68 8 142
Nov 3 3 29 139 275 9 452
Nov 4 1 39 38 95 6 178
Nov 5 2 14 30 72 2 118
Nov 6 3 21 33 41 2 97
Nov 7 4 34 23 50 18 125
Nov 8 7 32 22 39 93
Nov 9 4 38 18 24 4 84
Nov 10 5 44 90 196 10 340
Nov 11 8 20 36 40 18 114
Nov 12 1 24 28 30 30 112
Nov 13 4 7 21 22 6 56
Nov 14 5 24 26 49 16 115
Nov 15 10 48 66 48 38 200
Nov 16 3 38 44 37 19 138
Nov 17 6 30 62 111 7 212
Nov 18 1 14 10 57 4 85
Nov 19 3 37 11 3 5 56
Nov 20 3 34 10 16 79 139
Nov 21 5 53 20 32 9 114
Nov 22 6 8 24 17 13 62
Nov 23 2 39 16 129 14 198
Nov 24 7 41 41 93 32 207
Nov 25 4 21 18 12 29 80
Nov 26 1 13 18 1 8 40
Total 248 1,900 3,778 3,106 896 9,680
According to the Palestine Red Crescent Society, live ammunition, rubber bullets, and/or stones thrown by Israeli settlers in 77 separate attacks have hit to date (18 November 2000), 37 ambulances. Fifty-four emergency medical technicians have been injured and one killed. There have been 68 incidents of denial of access to ambulances at roadblocks.
Psychological Effects
Psychological trauma caused by the violence and stress of the past weeks has manifested itself in many forms on the general public and health professionals. The following are the main issues addressed at present through mental health services:
-psycho-trauma due to violence
-emotional reactions to violence
-coping mechanisms
-crisis intervention
-helping mothers and families to deal with the death of a loved one
The Union of Health Work Committees and the Intifada
The Union was alert from day one in organizing its staff to cope with the emergency situation. All UHWC centers were prepared to work full time during the day and some of them continue to open at night when necessary.
Several meetings were held jointly with the Ministry of Health (MOH) and with Palestinian health NGOs regarding the coordination of efforts and planing for emergency units. For example, since the very beginning our team was joined by the teams of Makassed Hospital and the Red Crescent at Al-Haram Al-Sharif each Friday.
The UHWC coordinated its efforts with the Ministry of Health and signed an agreement stating that the UHWC is responsible for all health care clinics in the western villages of Bethlehem (Husan, Battir, and Wadi Foukin). In Husan, the UHWC clinic will move into the former premises of the Ministry of Health, and in Battir, the MOH will move into our premises. This plan was able to be implemented based on the mutually successful experience in the villages of Al Mazra'a A-sharqiyyeh and Kufer Ni'imeh that we began two years ago.
The Union nevertheless continues to face difficulties in implementing its outreach programs for those villages. The Israeli army is prohibiting our team on a daily basis from entering the villages. One of the tactics used recently is the shooting of all four tires of each vehicle that attempts to enter.
The UHWC's center in Beit Sahour is cooperating fully with the MOH and the Beit Jala Hospital. The center in Beit Sahour has been designated for eye trauma, in addition to minor and moderate injuries, whereas the hospital in Bethlehem takes care of the severely injured people. In addition, the Beit Sahour Center performs all necessary CAT scans for all patients whether or not they were directly injured or participate in the national insurance scheme.
A most disturbing fact that severely affects the Beit Sahour Center is that the Israel army regularly prevents our specialized physicians from entering Beit Sahour. Our Pediatric Cardiologist, Dr. Mahmoud Nashashibi, has been prevented each week from coming to our Center in Beit Sahour from Jerusalem. Each week there are up to 20 mothers who have brought their infants for an echocardiography examination. We have had to send them home because Dr. Nashashibi is unable to come. The Caritas Baby Hospital in Bethlehem, which relies on our Center to perform this procedure for their pediatric patients, has nowhere else to turn. The same thing goes for our neurologist, our diabetes specialist, and our dermatologist who come from Jerusalem.
In Halhoul, where the movement of the people was strongly impeded by the Israeli army, our physician slept at the Halhoul clinic for 6 days. The Red Crescent worked from and through our center in Halhoul during a three-week period, including 24-hour on call service. In addition the ambulance of the Red Crescent was stationed at out center.
In Qalandia Refugee Camp where many violent incidents take place, the UHWC's center in the refugee camp was put on 24-hour alert. Over 170 patients wounded by live ammunition have been treated there.
Many of our staff throughout the West Bank have been subject to harassment by the Israeli soldiers. Mostly at the entrances of the villages the Israeli soldiers are giving our nurses a hard time.
The UHWC started a campaign to train many communities in First Aid and the principles of evacuation. All over the West Bank more than 65 courses of First Aid have been given to the public, mainly for school children ages 14- 18, and school teachers. The UHWC has distributed First Aid "cabinets" filled with all necessary first aid materials to all institutions that participated in the training courses.
All UHWC clinics and centers have experienced a sharp decrease in the total number of patients since the beginning of the Intifada. This is due to several factors:
1. Regular health care gets to be a second or a third priority in times of war.
2. The economic situation does not allow people to seek a doctor, although most of our centers are providing full or partial subsidies to poor patients.
3. Many doctors are not allowed to reach their workplaces and many patients are prevented from reaching the medical facilities, especially in the villages.
Until now, the Union has been able to cover its basic operating costs. A project with ECHO (implemented through four Spanish NGOs) enabled the Union to supply its reserves with emergency medication and disposable materials. The Ministry of Health has also provided some medication. There has only been a very small amount of direct financial aid to the Union.
F. Proposed Strategy (1 December 2000 - 31 May 2001)
Based on this grim reality, the UHWC proposes that an emergency health strategy be articulated and implemented in coordination with all Palestinian governmental and non-governmental bodies and organizations. This strategy would have as its foundation the following basic points:
1. Protect the present health care sector by ensuring that basic health care services be accessible to all Palestinians
2. Upgrade and expand emergency services
3. Ensure the continuation of present vaccination services
4. Guarantee freedom of movement for all medical and health care personnel as well as patients
5. Ensure adequate rehabilitation services for the wounded
6. Support the Palestinian pharmaceutical industry
7. Guarantee availability of medication for the poor
8. Develop and upgrade mental health services, ensuring accessibility to all in need
9. Strengthen coordination among health and social service providers
10. Work in coordination with governmental and non-governmental bodies and organizations to ensure that adequate infrastructure is in place throughout the Palestinian territories (water, electricity, sewage systems, etc.)
In order to implement this strategy a number of factors are required:
1. Acquisition of funding to ensure that basic operating costs of all medical and health facilities are covered;
2. Acquisition of funding to ensure that necessary emergency and other medical equipment is upgraded and/or replaced according to need;
3. Assurance that medical personnel and outreach teams have free access to their workplaces;
4. Acquisition of funding to ensure ongoing medical and health care staff training, including training in basic mental health services;
Although the basis for this strategy is the current emergency situation within the Palestinian occupied territories, it must be remembered that any planning (long- or short-term) must take into consideration that Palestinian resistance to the Israeli occupation and steadfastness in the goals and aspirations of the Palestinian people will remain a reality until the occupation ends Union of Health Work Committees Palestine 27 November þ2000þ