Training on

1. Training on The right to health in the oPt From IHL & IHRL perspectives

2. Enhance the knowledge on IHL & IHRL regarding the right to health and health care. Provide a better understanding of the relevant Israeli laws and military orders relating to access, movement and humanitarian assistance work in the oPt. Provide practical legal tools for monitoring and reporting the violations of the law. Training Objectives

3. Presentation of key practical principles and rules of IHL & IHRL Highlighting the practical examples and experiences Presentation of various perspectives on challenges Open space for debates Methodology

4. Interplay between IHL and IHRL. Health care under IHL. Health care under occupation. The right to health under IHRL. Topics covered in this presentation

5. What is the difference between IHL and IHRL? International humanitarian law is applicable in times of armed conflict. Minimum rights to limit the suffering during war. The four Geneva Conventions of 1949, their Additional Protocols of 1977, a number of customary norms such as those in the Hague Regulations of 1907 Human rights are applicable at all times – in war and peace. More extensive rights, including the right to life, health care, education, work, freedom of expression and association etc. Human rights conventions such as the ICESCR, ICCPR, Child Convention

6. Do IHL and IHRL apply to the oPt?

7. “The military operations of the [Israeli Defence Forces] in Rafah, to the extent they affect civilians, are governed by Hague Convention IV Respecting the Laws and Customs of War on Land 1907 . . . and the Geneva Convention Relative to the Protection of Civilian Persons in Time of War 1949.”

8. “In view of the foregoing, the Court considers that the Fourth Geneva Convention is applicable in the Palestinian territories which before the 1967 conflict lay to the east of the Green Line and which, during that conflict, were occupied by Israel, there being no need for any enquiry into the precise prior status of those territories.”

10. Whose interpretation of the law? "Many areas of international law are vague. They can be interpreted in different ways. The situation in Gaza, for example, has no parallel anywhere else in the world. It's all open. So there are interpreters who want to interpret the law in such a way as to limit us as much as possible, and there are interpreters who are more convenient for us."

11. The concept of “health care” covers: all those services whose main purpose is to promote, restore or maintain health, defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”*

12. The right to health for Palestinians Available and adequate health care system, including emergency health care as well as treatment for advanced diseases, such as cancer or diabetes Access to the clinics and hospitals Availability of medicines Availability of electricity and fuel which in turn affects the health system Protection from military attacks on medical installations and personnel Cleanliness Conditions in prisons.

13. Who is protected under IHL? Civilians (including humanitarian workers) Wounded and sick (also combatants) Medical and religious personnel Prisoners of war

14. General protection under IHL The protected population shall always be treaded humanely and be protected against all acts of violence and threats thereof. Measures of control or security taken by the OP in fulfilling this duty must be “necessary as a result of the war.” (Article 27 IVGC)

15. General protection under IHL Civilians and civilian objects should never be the target of attack. Indiscriminate attacks are forbidden: Attacks that are not or cannot be directed at a specific military objective. Attacks that employ means and methods of fighting whose effects cannot be limited according to IHL.

16. Specific protection of medical personnel and property Attacks against civilian hospitals are prohibited at all times and such hospitals must be respected and protected at all times (Article 19 IGC; Article 18 IVGC; Articles 8, 9, 12 AP I) Civilian hospitals loose protection if “they are used to commit, outside their humanitarian duties, acts harmful to the enemy.” (Article 19 IVGC) Medical personnel benefit from special protection and are designated as "protected personnel". (Articles 24, 25, 26, 27 IGC; Article 36, 42 IIGC; Article 20 IVGC, and Article 8 AP I) Medical transport enjoy same protection as long they bear the distinctive emblem of the red cross, red crescent or the crystal. (Article 8 AP, Article 35 IGC, Article 21 AP I, Article 22 IIGC, …)

17. The reality: Jan-Feb 2008 (PRCS) 8 physical attacks on crew 3 ambulances damaged 117 delays and denial of access incidents reported Israeli soldier fired tear gas canister into two ambulances Israeli soldier fired plastic coated metal bullets at the crew at two occasions (driver injured) Israeli settlers stoned an ambulance causing damage to it (Nablus) Israeli soldiers stopped an ambulance and detained the wounded (Nablus)

18. Since 2000, outbreak of the 2nd Intifada, 39 people died because follwoing delay of medical treatment (B’Tselem). Palestinian women giving birth at check points: two cases in December 2008 (B’Tselem) The harsh reality continues

19. Palestine Medical Relief Society 27 February 2008- Gaza: The main pharmacy, a mobile clinic, a loan centre for persons with disabilities and all administrative offices were attacked. The mobile clinic, all the medicine supplies and most of the equipment have been destroyed. The building itself is badly damaged and cannot be used again without extensive repairs.

20. If committed against protected persons or property: Willfully causing great suffering, or serious injury to body or health. Wilful killing. Torture or inhuman treatment, including biological experiments. Unlawful and intentional extensive destruction and appropriation of property, not justified by military necessity. (Articles 50 IGC, 51 IIGC, 130 IIIGC and 147 IVGC)

21. The most comprehensive set of rules relating to occupation is found in the Fourth Geneva Convention of 1949. These rules impose specific obligations—in terms of the treatment of civilian persons, assets and territory—on the parties to an armed conflict. The most comprehensive set of rules relating to occupation is found in the Fourth Geneva Convention of 1949. These rules impose specific obligations—in terms of the treatment of civilian persons, assets and territory—on the parties to an armed conflict.

22. Beyond the maintenance of law and order, the OP has the duty to: Ensure food and medical supplies for the civilian population, and bring in the necessary foodstuffs, medical stores and other articles if the resources of the occupied territory are inadequate. (Article 55 IVGC) Responsibility of the Occupying Power ARTICLE 55 To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring the food and medical supplies of the population; it should, in particular, bring in the necessary foodstuffs, medical stores and other articles if the resources of the occupied territory are inadequate.The Occupying Power may not requisition foodstuffs, articles or medical supplies available in the occupied territory, except for use by the occupation forces and administration personnel, and then only if the requirements of the civilian population have been taken into account. Subject to the provisions of other international Conventions, the Occupying Power shall make arrangements to ensure that fair value is paid for any requisitioned goods.The Protecting Power shall, at any time, be at liberty to verify the state of the food and medical supplies in occupied territories, except where temporary restrictions are made necessary by imperative military requirements.ARTICLE 55 To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring the food and medical supplies of the population; it should, in particular, bring in the necessary foodstuffs, medical stores and other articles if the resources of the occupied territory are inadequate.The Occupying Power may not requisition foodstuffs, articles or medical supplies available in the occupied territory, except for use by the occupation forces and administration personnel, and then only if the requirements of the civilian population have been taken into account. Subject to the provisions of other international Conventions, the Occupying Power shall make arrangements to ensure that fair value is paid for any requisitioned goods.The Protecting Power shall, at any time, be at liberty to verify the state of the food and medical supplies in occupied territories, except where temporary restrictions are made necessary by imperative military requirements.

23. Responsibility of the Occupying Power The OP, with cooperation of national and local authorities, is responsible for the care of the civilian population, including the protection and maintenance of the “medical and hospital establishments and services, public health and hygiene in the occupied territory.” In particular, the occupying authorities are under the duty to adopt and apply the “prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics,” and to allow all medical personnel “to carry out their duties.” (Article 56 IVGC)

24. What about Gaza? WHO Report: 69 medical patients died because they were denied access. Statistics Electricity and fuel cuts. Sewage catastrophy. Drinking water.

25. What about Gaza? The Israeli High Court of Justice has earlier confirmed that: “supply of electricity needed by the local population is unquestionably a function imposed on the military government, so as to ensure the proper living conditions of the population".

26. What about patients without permits? Permits have been repeatedly denied by the Israeli authorities based on ”security concerns.” The sharpened policy have had severe effects with at least five deaths ince June 2007. Other patients have suffered severe injuries, including amputation, while waiting clearence.

27. The right to humanitarian assistance Civilian population of an occupied territory has the right to call for relief schemes if inadequately supplied, and the Occupying Power is obliged to agree to such schemes on behalf of the said population and “shall facilitate them by all the means at its disposal.” (Article 59 IVGC)

28. The right to humanitarian assistance IHL provides for guarantees to the right to assistance in the Geneva Conventions and their Additional Protocols (Article 3, 23, 55, and 59 IVGC; Articles 69 and 70 AP I; Article 18 IAP I). IHL gives the humanitarian organizations such as the Red Cross the ‘right of initiative’ in offering relief actions (Article 18 (1) IAP I) and of the Parties concerned in such actions (Article 70 AP I). “Protected persons in occupied territories shall be permitted to receive the individual relief consignments sent to them.” (Article 62 IVGC)

29. Humanitarian organisations shall not relieve the OP from its duties Humanitarian assistance delivered to the population of the occupied territory “shall in no way relieve the Occupying Power of any of its responsibilities under Articles 55 , 56 and 59 .” Article 60 IVGC

30. Specific rights for women & children Not to hinder any “preferential measures in regards to food, medical care, and protection against the effects of war” in favor of children under 15 years, expectant mothers, and mothers of children under seven (Article 50 IVGC) To facilitate the proper working of all institutions devoted to the care and education of children (Article 50 IVGC)

31. Every human being has: “a right to a standard of living adequate for the health of himself and his family, including food, clothing, housing, and medical care and necessary social services.” (Article 25(1) of the Universal Declaration of Human Rights of 1948) “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” (Article 12(1), ICESCR)

32. States are bound to: carry out the necessary measures for reducing infant mortality and health development of the child; improvement of all aspects of environmental and industrial hygiene; prevention, treatment and control of epidemic, endemic, occupational and other diseases and the creation of conditions which would ensure access to health services.

33. ICECSR committee sets out four criteria by which to evaluate the right to health: Availability - functioning public health and health care facilities, goods and services as well as health programme to be available in sufficient quantity within the state party; Accessibility – to everyone without discrimination, within the jurisdiction of the sate party;

34. Acceptability – must be respectful of medical ethics and culturally appropriate i.e respectful of individuals, minorities, people and communities, sensitive to gender and life-cycle requirement; and Quality – scientifically and medically appropriate and of good quality. Skilled medical personnel and scientifically approved and unexpired drugs and hospital equipment, safe and potable water and adequate sanitation.

35. Governments have an obligation to progressively realize the right to access health care, they must ensure that: existing services are provided without discrimination. health care services respect a range of other rights, including the right to physical integrity, autonomy, confidentiality and informed consent.

36. “In the present climate, it is easy for a state to justify its repressive measures as a response to terrorism - and to expect a sympathetic hearing. Israel exploits present international fear of terrorism to the full.” John Dugard, UN Special Rapporteur to the Human Rights Council, March, 2008

37. Thank you! You are welcome to visit our website: ”Easy Guide to International Humanitarian Law in the occupied Palestinian territory” www.diakonia.se/ihl