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The outbreak of coronavirus disease 2019 (COVID-19) in the occupied Palestinian territories, and Gaza specifically, highlights the effect of an ongoing blockade on public health. In 2007, following Hamas’s takeover, Israel and Egypt imposed a land, air, and sea blockade of Gaza. According to Israel’s cabinet decision at the time, Gaza was declared as being governed by a “hostile entity” due to Hamas’s attacks on Israeli citizens. The blockade included prohibitions on what is known as dual use materials (that can be used for both civilian and military purposes). However, the prohibition includes items that have nothing to do with security—eg, certain kinds of food—and others that were aimed as punishment—such as electricity limitations. The extensive nature of the blockade has had a devastating impact on the health and wellbeing of residents in Gaza.
The Palestinian Ministries of Health in both Gaza and Ramallah have acknowledged that their capacity to contain the spread of COVID-19 is limited by ongoing and pre-existing shortages in health-care equipment, including medications and disposable equipment. Public health measures have erred on the side of caution and largely contributed to a very low infection rate during the first 3 months of the crisis; for example, Gaza has recommended that individuals returning from outside Gaza through the Rafah or Erez crossing remain in quarantine for 21 days, instead of 14 days.
Yet these efforts are hampered by the unique restrictions faced by the Palestinian health system. If even well equipped health-care systems in European countries have found handling this crisis difficult, then the Palestinian health-care service, which bears the burden of budget shortages and decades-long fragmentation, is likely to fare much worse. The separation between East Jerusalem, Gaza, and the West Bank, and the restrictions that Israel imposes on the freedom of movement of patients, medical equipment, and health-care personnel, structurally impedes the proper functioning of the Palestinian health-care system.
Although Israel has security concerns, the restrictions it has placed leave thousands without access to adequate care. There are encouraging initial indications that cooperation between Israel, the Palestinian Authority, and Hamas has taken place, at least indirectly. However, further steps must be taken.
To enable the Palestinian health systems to manage the outbreak, Israel must lift its closure of the Gaza Strip to enable the proper functioning of Gaza’s health-care system and other essential services in the face of the COVID-19 pandemic. Lifting of the closure must include removing barriers to the movement of goods. Where medication and equipment are unavailable because of budgetary shortages or arguments of dual use, Israel should help to ensure the supply of the missing materials to the greatest extent possible. Simultaneously, the Israeli authorities must work with Hamas and the Palestinian National Authority to find solutions for patients who currently cannot leave the Gaza Strip but must receive treatment unavailable therein.
PHRI filed a petition with Israel’s Supreme Court demanding the aforementioned aid. In its response on May 7, Israel detailed some of the very limited aid that has been provided thus far. Yet, given the aforementioned shortcomings in the health systems in Gaza and the West Bank and the extent of Israel’s responsibility, the aid it has provided thus far is largely symbolic. The petition has been withdrawn, but PHRI will continue to push for increased assistance to Gaza, especially in light of a potential second wave.
We declare no competing interests.
References
- 1.
Coronavirus disease 2019 (COVID-19) situation report 27.
- 2.
Daily report for COVID 19 virus.
- 3.
Right to health 2018.
- 4.
Coronavirus disease (COVID-19) situation report 33.
- 5.
Health access. Barriers for patients in the occupied Palestinian territory.
- 6.
Geneva convention relative to the protection of civilian persons in time of war (fourth Geneva convention).
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Published: September 2020
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