Impact of Occupation and Siege on Health and Human Rights in the OPT

1. The impact of occupation and siege on health and human rights in the OPT Alice Rothchild Lori Rudolph Marya Farah Peter Cook

2. Focus on Gaza • Presented by Alice Rothchild, MD • Obstetrician/Gynecologist • Author and Filmmaker • Jewish Voice for Peace

3. “3. The Occupying Power shall afford civilian medical personnel in occupied territories every assistance to enable them to perform, to the best of their ability, their humanitarian functions. ...” The First Additional Protocol of the Geneva Conventions, Article 15

4. Health care in the West Bank and Gaza(“fragmented and incoherent” Lancet) • Population of >4.75 million people • Ministry of Health • United Nations Relief and Works Agency (care for refugees, approx. 2.2 million people) • Nongovernmental organizations (NGOs) • Private providers • Role of Israeli government

5. Who is in charge? Health outcomes worse than in Israel • 1948-1967: Egypt & Jordan • 1967-1981 Israeli military control: public health, minimal investment • 1981-1993 Israeli Civil Administration, referrals to Israel, growth of NGOs

6. 1993 Oslo Accords, PA “in charge” Aida Camp, Bethlehem But under Israeli military control, no control over water, freedom of movement, import of meds, specialty training Complex permitting and authorization system Fragmented failing system, worse after 2000, Second Intifada, Separation Wall, attacks on medical personnel & infrastructure

7. Multigenerational trauma 1948 UNRWA Refugee Camps

8. Continued challenges to health care system Northern Gaza 2015 Tightening of all restrictions Psychological and & environmental trauma Medical complicity in torture of prisoners Policy of “de-development” Repeated assaults (Gaza-2009, 2012, 2014) Factional violence & discord

9. The Lancet • 2009: The Lancet published a Series of five reports about health in the occupied Palestinian territory, 37 international researchers, of whom 19 were based in the OPT  • Lancet Palestinian Health Alliance (LPHA) established  • Major pushback 2015 700 medical prof. Concerned Academics Group

10. Focus on Gaza: War in 2014 Shejaia- “sterilized area” 2015 Khan Yunis 2015

11. Post 2014 Gaza Invasion • Killed: Israel 74, 66 soldiers, 4 civilians, 1 unknown, 500 injured, 100 civilians • Killed: Gaza: 2131, 279 armed resistance, 1500 civilians (257 women, 500 children, 370 unknown) • 10-12,000 injured, >110,000 homeless, 450,000 no water, 220 schools damaged, 18,000 houses destroyed, 40,000 damaged, 1000 children with permanent disabilities, >1500 orphaned, 370,000 children in need of direct psychological support for consequences of trauma and war • 20,000 tons of explosives dropped on a strip of land 6 x 26 miles in 7 weeks • 10 tons max shot from the Strip into Israel

12. 2014 UN: $1.4 billion in direct and indirect damages and $1.7 billion in economic losses.

14. Major challenges-Gaza Khan Yunis 2015 • Diabetes & hypertension • Childhood food insecurity • PTSD & depression • Lack of potable water • Rising birth defects • Siege, restrictions (permit for collaboration) • Rift Hamas & Fatah • Hamas & IDF violence

15. Current challenges - Gaza Shejaia 2015 • Explosive remnants of war • Lack of international funding • Unpaid MOH salaries • Lack of essential drugs and medical supplies • Delays in surgery and dx outside of Gaza

16. Erez – Gaza exit/entry Gaza: IDF/COGAT (Coordinator of Government Activities in the Territories (or COGAT) Imagine ¾ of a mile on stretcher, in pain, sick with cancer, child without a parent

17. What is different in 2017? Cement! • Restrictive siege continues • Food insecurity • Severe land restrictions • Hamas/Fatah dysfunction • Some rebuilding, severe shortages of material continues • Erratic electricity 3-12 hrs per day • 95% of water not drinkable • Severe shortages of medicine & equipment

18. Human rights worker 2017 • The most vulnerable have basic services, food, water filters, some psychological interventions and assistance to children, but people are basically hanging on and unable to be independent. • 18,000 homes are still flattened • 55,000 people are waiting for their homes to be rebuilt • “Our problem is politics, but it presents as a humanitarian crisis.”

19. Gaza Community Mental Health Program: training and service • “I feel crazy, but I come to work every day. We have 1.9 million crazy people.” 2015 • 51 days of intense fear, insecurity, death, staff mobilized • High level of trauma, political, environmental catastrophe, no coping strategies, no hope, continuous PTSD: frequent relapses 2017 • Lost 28 family members • “I cannot offer patient something I cannot have for myself.” Dr. Yasser Abu-Jamei, executive director

20. The Gaza Community Mental Health Program Deir al Balah Community Center Dr. Amal Bashir, only female psychiatrist Art therapy for PTSD, 34 6-14 yo, 24 cured

21. The Gaza Community Mental Health Program Deir al Balah Community Center- 300 drawings

22. The Gaza Community Mental Health Program Deir al Balah Community Center

23. So you killed my child, you think you are strong?

24. The Gaza Community Mental Health Program Deir al Balah Community Center

25. The Gaza Community Mental Health Program Deir al Balah Community Center

26. The Gaza Community Mental Health Program Deir al Balah Community Center

27. 2017 GCMHP child therapy continues

28. GCMHP new building -2017 • Psych evaluation and therapy • Telephone hot line • Outreach to schools, mediation programs, counseling • Education for school counselors • Training programs for psych and medical students • Post graduate research and diploma program • Human rights work

29. Aisha Association for Woman and Child Protection (north): 2015, 2017 • Intersections between war, patriarchy, psychological illness, domestic violence and the cultures that make this all possible • “What Israel did in this war, they turned a child into a soldier and women became unafraid of anything.”

30. El Wafa Rehabilitation Hospital 2014 Before After

31. Inside after bombing El Wafa Rehabilitation Hospital • 30 yo modern facility: comprehensive rehab • Repeatedly bombed • Appealed internationally • 8 international “human shields” • Nighttime emergency evacuation, no electricity, lights, patients carried in sheets • Almost total loss, 19 clinics destroyed

32. El Wafa Rehabilitation Hospital Share with elderly care home, Zahar City, all donations, 20% of staff lost their homes Dr. BasmanAlashi, director drone attack

33. El Wafa Rehabilitation Hospital Hamad al Reify, 10 yo, missile to C2, most of family killed

34. El Wafa Rehabilitation Hospital Dr. Basman: “Another part of the tragedy, of the siege: killing the victim is part of the crime but also forbidding the victim to say we are victims and are human beings. This is a human feeling.” “Gaza is fine. What you see from the outside, it looks devastated. But if you live among the Gazans, you won’t leave. I choose not to return to America [where he lived for a number of years]. We are human. I am born here. You don’t have a choice where you will be born, but I have a choice for whom I am.”

35. Breast cancer surgeon May 2016Al Ahil Hospital Gaza -  Philippa Whitford Lack of critical meds, including chemotherapy, interruption of treatment dues to lack of drugs. Radio isotopes used in bone scans or for guided biopsy of axillary lymph nodes are forbidden entry into Gaza despite having no potentially dangerous application. Gaza’s surgeons are prevented from travelling out to attend conferences or further develop their skills, freezing surgical practice many years behind the rest of the world. A Harvard Medical School study has shown that five-year survival rates for breast cancer patients are as low as 30-40%, compared with around 85% in England. https://www.theguardian.com/commentisfree/2016/may/18/breast-cancer-gaza-women-struggling-vital-treatment

36. Gaza consequences continue unabated • Radiotherapy completely unavailable. Need permit from Israel to travel to hospitals in East Jerusalem. Application is time-consuming, patients must cover the cost of their own transport and accommodation. • 2/16 World Health Organisation, > 28% of those applying for permits to travel out for treatment were either denied or received no response to their applications. • Vast majority of women having full mastectomies and lymph node dissection, which would be deemed unnecessary in the UK or US

37. Gaza Khan Yunis 2015 “When you are living in hell, and someone turns up the heat a little, it doesn't change much. You're still in hell.” Rajaie Batniji, Searching for Dignity, The Lancet Volume 380, No. 9840, p466–467, 4 August 2012

38. Human Rights Watch (banned from Israel) Jan-Oct. 2016 I/P • Palestinians killed 11 & injured 131 Israelis • Israeli security killed 94 & injured 3,403 Palestinians • PA & Hamas, multiple human rights violations, 4 executions in Gaza • 20 rockets from Gaza Gaza: PCHR: 87 incidents of Israeli shellings, shooting, incursions, detentions in August 2016

39. What is the role of a clinician or solidarity activist or a humanitarian worker in a conflict situation? • Heal the patient • Heal the society • Bear witness, see the human face • Use listening and diagnostic skills to increase understanding • Use lens of health care and human rights to investigate and report on difficult areas of conflict: apartheid, torture, ethnic cleansing

40. Banksy: Wall in Gaza City