Under international law, as an occupying power, Israel has an obligation to provide and sustain health care in the West Bank and Gaza Strip.
International Law and Healthcare Provision
The Fourth Geneva Convention (1949) stipulates that an occupying power “has the duty of ensuring and maintaining the medical and hospital establishments and services, public health and hygiene in the occupied territories.”
The International Convention on Economic, Social and Cultural Rights was ratified by Israel in 1991. The Committee on Economic, Social and Cultural Rights (CESCR), which is the United Nations body responsible for monitoring implementation of the convention, has confirmed that Israel is obliged under the terms of the convention to protect the right to health as well as other rights of the occupied population in areas A, B and C of the West Bank. Health rights include “the prevention, treatment and control of epidemic, endemic, occupational and other diseases [and] the creation of conditions which would assure to all medical service and medical attention in the event of sickness.”
In 1994, responsibility for health care in the West Bank was turned over to the Palestinian Authority (PA) following the 1993 Oslo Peace Accords.
Medical facilities were already in poor condition when they were transferred to the PA. Furthermore, the Palestinian Authority had neither the expertise nor the equipment to sustain them. As a result , “the PA’s stewardship over health care administration is by and large symbolic. The healthcare system remains subservient to Israel, with the Israeli state retaining ultimate control over health-care budgets, border crossings, building permits and pharmaceutical import/exports.” (Source: Medical Care in Palestine: Working in a Conflict Zone, by Emma Keelan).
Blockades, Checkpoints and Hospitals
In the West Bank, more than 500 blockades, checkpoints and roadblocks hinder Palestinians’ freedom of movement. The Palestinian Red Crescent Society (PRCS), the main supplier of ambulance services in the West Bank, reported that 93% of its ambulance transfers involving acutely unwell passengers experienced “time consuming delays” of 10 minutes or more at checkpoints because of what Israel refers to as “security protocols.” (Keelan).
Hospitals in Gaza and the West Bank have always been severely under-resourced under Israeli occupation. This state of affairs did not change when the PA became responsible for healthcare in the West Bank. As a result, Palestinian patients often need to seek more advanced healthcare treatment in Israel. Travel from the occupied Palestinian territory into Israel for medical treatment requires an Israeli-issued permit.
According to the World Health Organization, “in 2019, the approval rate for patient applications to exit the Gaza Strip was 65%. There has been a decline over time in the approval of patient permits, which peaked at over 90% in 2012 and reached a low of 54% in 2017”. Human Rights Watch reported that 54 Palestinians in Gaza died in 2017 following denial or delay of their permits.
Healthcare in Gaza
In Gaza, the ruling authority, Hamas, co-operates with the PA in providing health care. However, under international humanitarian law, Israel is deemed to be an occupying power in Gaza given the extent of its control over borders, the movement of people and goods, security, taxation, and registry of the population. Israel controls the importation of everything through its control of Gaza’s land, sea, and air borders. Under Israeli occupation, there has been a dire shortage of health facilities, medicine and drugs.
The May 2021 air strikes by the Israeli military in Gaza damaged 17 hospitals and clinics and destroyed the only coronavirus test laboratory. One of the clinics that was damaged was run by Médecins Sans Frontières and had been used to provide treatment for trauma and burns. Because of the limitations imposed by Israel on the construction materials being imported, the damage to Gaza’s medical infrastructure has been impossible to repair.
Covid-19 is currently the most immediate medical concern in Palestine. The United Nations Special Committee to Investigate Israeli Practices expressed “…deep concern over reports that Israel, while donating surplus COVID-19 vaccines overseas, has failed to fulfill its international legal responsibility and obligation to ensure the vaccination of the Palestinian population in the occupied Palestinian territory…in accordance with the Fourth Geneva Convention”.
Even in locations where there is a local governing authority, like the Palestinian Authority, Israel is not absolved of its responsibilities to ensure equal and non-discriminatory access to vaccines in the occupied territory. This was reaffirmed by the International Commision of Jurists and the United Nations Office of the High Commissioner.
In March 2022, the Reuters COVID-19 tracker reported that Israel had administered at least 18,034,461 doses of COVID vaccines, enough to have vaccinated about 99.6% of Israel’s population, assuming every person needs two doses. In the same time period in occupied Palestinian territory, authorities have administered 3,609,984 doses of COVID vaccines. Assuming every person needs two doses, that’s enough to have vaccinated about 38.5% of the territory’s population.
Discussions in the Knesset, Israel’s parliament, revealed that some Israeli lawmakers wanted to exchange access to vaccines for concessions or information from Hamas, such as the release of the bodies of Israelis believed to be held by Hamas.
Five Israeli rights groups submitted a petition to the Supreme Court in response to the decision by Israeli Minister of Public Security Amir Ohana not to vaccinate Palestinian prisoners in Israeli jails, in contravention of directives from his own health ministry. The position was ultimately reversed after the Israeli President wrote to the health minister that withholding vaccines to prisoners was “…inconsistent with our values, the values of the Jewish and democratic state”.