Healthcare in the State of Palestine refers to the governmental and private healthcare providers to which residents in the claimed territory have access. Since 1967, there have been improvements in access to healthcare and the overall general health conditions for residents.Barghouti, Mustafa. Palestinian Health: Toward a Healthy Development Strategy in the West Bank and Gaza Strip. Jerusalem: Union of Palestinian Medical Relief Committees, 1993. Advances in training, increased access to state-of-the-art medical technology, and various governmental provisions have enabled per-capita funding to increase, thereby enhancing the overall health of residents in the region.Barghouti, Mustafa and Ibrahim Daibes. Infrastructure and Health Services in the West Bank: Guidelines for Health-Care Planning. Ramallah: The Health Development Information Project, in Cooperation with the World Health Organization, 1993. Additionally, enhanced access to and funding from international organizations, such as the World Health Organization, the United Nations, the Palestinian Ministry of Health, and the World Bank's Education and Health Rehabilitation Project, have contributed to the current state of affairs within the healthcare sector of Palestine.Health in Judea, Samaria and Gaza: 1967-1994. Jerusalem: The Ministry of Health, 1994.
However, while many efforts to advance the state of health affairs within Palestine have shown improvement, there is still progress not yet made. Continued efforts to recognize and address the geopolitical barriers will be necessary to continue to have significant success in this field.The World Bank, Developing the Occupied Territories: An Investment in Peace. Washington D.C.: The World Bank, 1993. Addressing demographic trends within the region, like differing pregnancy rates and mortality rates, will be necessary to enhance the state of health affairs that Palestine faces.
The Human Rights Measurement Initiative (HRMI) uses income-adjusted benchmarks to assign Palestine an overall quality of life rating of 91.4%, based on the fulfillment of core economic and social rights within Palestine. These include education rights at 78.4%, food access at 95.4%, health quality at 84.2%, housing at 99.0%, and work at 100%, respectively. The HRMI health quality scores break up into Child health, ranked at 99.4%, Adult health, ranked at 95.4%, and reproductive health, ranked at 57.7%. HRMI finds Palestine overall has "some way to go" to reach international standards. Additionally, when compared with other countries in South-East Asia, Palestine found to perform "lower than average".
History
Oslo Accords and the establishment of the PNA
Between 1993 and 1995, the State of Israel and the Palestine Liberation Organization (PLO) reached a series of pacts collectively known as the Oslo Accords.Shehadeh, Raja. From Occupation to Interim Accords: Israel and the Palestinian Territories. London: Kluwer Law International, 1997. Print. The accords were facilitated by the international community, led by the United States and the Russian Federation. The accords established an autonomous Palestinian National Authority (PNA) that could administer the occupied territories. The accords transferred jurisdiction over Palestinians living in the Gaza Strip and the West Bank from Israel to the PNA, whose charter calls for the creation of a democratically elected Legislative Council that could write laws pertaining to the economic, security, educational, and healthcare needs of Gaza and West Bank Palestinians.
Establishment of the PNA's Ministry of Health
Since 1967, a division of the Israeli Military known as the Health Department of the Civil Administration (HDCA) has been responsible for overseeing healthcare in the occupied territories. During this time, HDCA's work was greatly supported by three other primary sources of healthcare: Non-governmental organizations, the UN, and the private sector.
Shortly after Oslo I and the corresponding transfer of jurisdiction, the PNA established a Ministry of Health (MOH) to administer healthcare in Gaza and the West Bank.
In 2012, the HDCA set aside 2 million NIS ($500,000 USD) to send Palestinian medical staff to HDCA training. In 2013, the HDCA's roles primarily involved overseeing the transfer of Palestinian patients to hospitals in Israel.
De facto secession of Gaza from the PNA
Until 2007, PNA healthcare policy was fully exercisable in both the West Bank and the Gaza Strip. However, in the 2007 Battle of Gaza, Hamas militias forcibly expelled all rivals from Gaza, bringing Gaza firmly under Hamas control. Hence, as of 2007, the PNA's control does not extend to Gaza de facto. Despite its lack of de facto control, the PNA still contributes financially to healthcare in Gaza by assisting with the salaries of some healthcare officials and sending medical supplies.
Legal basis According to the World Bank, the two documents that comprise the legal framework of PNA healthcare are the 2003 Palestinian Constitution and the 2004 Public Health Law. In its articles concerning healthcare, the constitution requires that the PNA regulate health insurance and guarantee healthcare to the following classes of people: the injured, prisoners of war, families of dead resistance fighters, and the disabled. Additionally, the 2004 Public Health Law comprises 13 chapters and 85 provisions covering issues such as women's and children's health, combating disease, environmental health, and public health infrastructure. Notably, the law requires the MOH to offer certain types of health services to Palestinians, including preventative, diagnostic, curative, rehabilitative, and emergency care. In addition to establishing the MOH as the governmental source of healthcare provision, the law assigns the ministry responsibility for regulating the other three healthcare sectors.
Major sources of healthcare and health expenditure
Public sector
Through its Ministry of Health (MOH), the PNA provides health services to Palestinians under its jurisdiction in accordance with the Constitution and the Public Health Law. Additionally, the PNA government insurance plan is the principal insurance provider in the PNA run territories. Since the ascendancy of the Hamas government in Gaza, the PNA's MOH no longer serves a governmental function in Gaza healthcare, having been replaced by Hamas. The majority of funding for MOH services emanates from foreign aid and taxes. Public sector spending represents about 32% of healthcare expenditure in Palestine.Hamdan, Motasem, Ph.D. "Health Care Policy in Palestine: Challenges and Opportunities."
UNRWA sector
Since its inception in 1948, the United Nations Relief and Works Agency, (UNRWA) has had jurisdiction over the social services of Palestinian refugees. The organization maintains funding, (determined by the UN) to provide free health services to eligible Palestinians living in the West Bank and in Gaza, provided that they are registered as refugees. As of 2012, the UNRWA provides health services to 727,471 people in the West Bank through some 42 primary health centers and to 1,167,572 Gazans through 21 Primary Health centers. The UNRWA finances about 24% of all healthcare spending in Palestine.
NGO sector
Palestinian Non-Governmental Organizations (NGOs) bankrolled by private benefactors encompass a sizable portion of the healthcare economy in the PNA. A survey conducted by the World Bank found that 11.7% of Palestinians used NGOs most frequently for their health needs. 13.3% of households in the West Bank relied on NGOs compared to 8.1% of households in Gaza. The World Bank report explained that fewer NGOs operate in Gaza than in the West Bank and that Gaza residents are more likely to be classified as refugees and therefore to have access to services provided by UNRWA. Palestinians are most likely to visit NGOs when they require mental health counseling, physical therapy and rehabilitation, and medical training and they are least likely to use NGOs for emergency care, routine check-ups, and maternity and pediatric needs. The Department for International Development, a British government agency, found that a visit to an NGO-run primary health clinic cost twice as much as a visit to a government clinic and four times as much as a visit to a UNRWA facility. In 2004, DFID reported that NGOs employed 33% of workers in the Palestinian health sector, while the Palestinian Central Bureau of Statistics put the figure at 26% in 2005. In 2003, Palestinian NGOs received $54 million from donors, out of about $240 million donated for healthcare in Palestine.
Private sector
The private healthcare space has grown in recent years with the advent of privately held hospitals, pharmacies, laboratories, and rehabilitation centers. A nascent pharmaceutical industry has also developed, which is able to supply about one half of total Palestinian demand for prescription medicine. Some private health insurance programs have been established, though with limited popularity. Many Palestinians with means self-pay for health services not available to them through other avenues and private expenditure comprises roughly 37% of all spending on healthcare in Gaza and the West Bank.
Data about the healthcare system
To provide an informative overview of the current state of healthcare within Palestine, some statistical information about the current system will provide greater clarity on the state of affairs. Currently, Palestine has approximately sixty hospitals and medical centers within the region, with numerous other medical research institutes pursuing initiatives on various medical advances including issues like cancer and Parkinson's Disease treatments, as well as stem-cell research. However, the Palestinians lack a fundamental and substantive primary care system that can reach out to the local population. Infrastructural challenges restrict the movement of physicians and medical supplies, and lack of efficient logistics prevents a coordinated effort by all healthcare service providers to provide the necessary primary care. Because all medicines must be sourced through Israel, the PA is unable to take advantage of lower prices often available in Arab countries.
The ongoing COVID-19 pandemic emerged in the State of Palestine on 5 March 2020. Currently, 7.32% of the population within the recognized State of Palestine have received COVID-19 vaccinations, which is a total 4.21% below the global average of 11.53% and 55.76% below the State of Israel's total vaccination of 63.08%, drawing praise to Israel's "successful COVID-19 vaccine program". Such praise has been met with severe criticism by human rights organizations, citing Article 56 of the Fourth Geneva Convention, which states that "the Occupying Power has the duty of ensuring and maintaining, with the cooperation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory, with particular reference to the adoption and application of the prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics." However, the recent escalation of violence between Israel and Hamas between 10 May 2021 to 11 May 2021 exacerbated this disparity by spiking cases in Gaza after Israel's bombardment of Gaza's "central testing laboratory for COVID-19 at Rimal Clinic"; of over 2,300 housing units, driving 77,000 new Palestinians of Gaza into internal displacement and thus homelessness, further exacerbating the overcrowded conditions of Gaza; and through the 16 May 2021 Israeli airstrikes of the residential building, which resulted in the killing of Dr. Ayman Abu al-Auf, physician chief of internal medicine at Gaza's Al-Shifa Hospital, where he also served as the director of coronavirus response efforts.