In 2014, the 67th World Health Assembly (WHA) of the World Health Organization (WHO) commissioned a “field assessment” report on the state of health in Gaza, the West Bank (including East Jerusalem) and the Golan Heights, to be presented to the 68th WHA in May, 2015. Unlike reports delivered to other UN bodies such as the UN-Human Rights Council (UNHRC), the authors are listed by name in a rare display of transparency. However, this publication is rife with factual errors based on data provided by unreliable, politicized NGOs and makes false legal claims on key issues. The authors also focus on controversial political issues unrelated to medicine and present a distorted reality that focuses disproportionately on Israeli security restrictions while ignoring the context of terror that necessitated them.
The “field assessment” report was followed by a similar document produced by the WHO Secretariat. This submission focused on many of the same issues as the “field assessment” in addition to listing the WHO’s involvement in Palestinian health issues.
A. “Field Assessment” Report
The Politicized Mandate of the “Field Assessment”
“Areas to be covered by this assessment included: barriers to access to health care (general population and in particular the Palestinian prisoners); the impact of the (situation/occupation) on mental health, particularly on child detainees; the health impact of impeded access to water and sanitation, as well as food insecurity, and the provision of financial and technical assistance and support by the international donor community.”
- Dr. Claude de Ville de Gauyet– Lead author of the paper with an extensive career in emergency preparedness and response.
- Dr. Ambrogio Manenti– Served as acting Head of Office of WHO’s operations in the West Bank and Gaza during the 2014 conflict. In the past he has blamed Israel for the deaths of Palestinian patients waiting for transfer to Israeli hospitals and said, “I think my organisation should stigmatise this behavior.”
- Dr. Kenneth Carswell– Clinical psychologist with a background in torture.
- Dr Mark van Ommeren– WHO official in the field of mental health in emergencies.
Prior to the writing of the report, the authors (excluding Manenti), appear to have had little significant professional contact with health issues in Israel or the Palestinian Authority.
1. Reliance on data provided by unreliable NGOs
The report relies heavily on allegations sourced to biased and unreliable political NGOs such as B’tselem, Physicians for Human Rights-Israel (PHR-I) and the Gaza Community Mental Health Programme. In addition, the report lists as sources papers co-authored by Rita Giacaman, a leading member of the Lancet Palestinian Health Alliance (LPHA), a coalition with a documented history of abusing medicine to promote an anti-Israel agenda. The authors also cite UN-OCHA documents which are themselves informed by data provided by NGOs that lack credibility.
2. Politicized Claims on the Status of Gaza
- “The Israeli occupation of Palestinian territory (the West Bank including East Jerusalem and the Gaza Strip) is now in its fifth decade.”
Israel ended its occupation of Gaza in 2005, removing all Israeli military and civilian presence from the area. Israel no longer exercises effective control in Gaza, leaving healthcare related decisions to be made by the Palestinian political leadership in Gaza. Attempts to portray Israel as an occupying power are a form of “lawfare,” reflecting invented and false legal claims. This strategy is designed to blame Israel for issues for which it has no legal or moral responsibility.
This false assumption that Gaza is occupied leads the authors to demand that Israel grant more permits to Gaza residents to enter Israel for medical treatment. Israel however, has no legal obligation to grant permits. Nevertheless, for humanitarian reasons, Israel gives thousands of permits annually to Gazans to seek medical treatment in Israel.
3. Focus on irrelevant non-medical issues
- “Different facets of the occupation, including reported human rights violations, affect the lives of Palestinians (Batniji et al. 2009). The following facets of occupation are relevant to mental health: … the barrier and its impact on access to land and access to economic opportunities, building of settlements and associated military presence in the West Bank, lack of approval of building permits and demolition of housing… With regards to the relationship between these facets of occupation and mental health, the scientific literature is unequivocal on the negative effects of adversity (e.g. trauma, loss, severe life stressors) on mental health and mental disorder.” (emphasis added)
Here the report abuses the range of mental health to take a position on an unrelated, complicated political issue. To suggest that the building of Israeli homes raises anxiety amongst Palestinians and should thus be seen in the context of mental health is to suggest that any action that Palestinians object to falls under the purview and expertise of the medical community. The same can thus be said about the security barrier or any other policy that Israel adopts in order to guarantee the security of its citizens. This agenda, as well as the blatant removal of the context and conflict as it impacts on Israelis, represents an abuse of a medical platform for political warfare, consistent with the strategy of the NGOs listed above.
- “Unhindered access to health care, water, sanitation and food is restricted by the blockade in Gaza and the fragmentation and Israeli settlements in the West Bank.” (emphasis added)
This claim is completely false. There are no restrictions placed on health care, water, sanitation or food as a result of the blockade which is solely aimed at preventing the smuggling of weaponry to Hamas and other Palestinian terrorist organizations. Similarly, there is no evidence whatsoever that the location of settlements contributes in any way to Palestinian access to food, health, or sanitation. In fact, to the extent that there are difficulties in obtaining these goods – they are almost all directly related to dysfunctional governance by the Palestinian Authority and political infighting between Hamas and Fatah.
4. Ignoring Terrorist use of Medical Infrastructure
- “A close collaboration between the Ministry of Health, UNDP, and WHO produced a detailed field damage assessment of 87 health facilities of which 25 have been severely damaged or destroyed and 52 with minor damage. El-Wafa Rehabilitation Hospital in Gaza , which is the only facility treating long-term injuries and physical disabilities, was specifically targeted and totally destroyed following warnings from the GoI to evacuate its patients and staff.”
While focusing on Israeli military action in Gaza, the report ignores the use of medical facilities and equipment by Hamas to launch deliberate attacks on Israeli civilians and carry out military operations against the IDF. In particular, the Shifa and El-Wafa Hospitals were used by the terrorist organization as command centers and rocket launching sites. The WHO immorally takes no steps to condemn or prevent further explotation and abuse of medical infrastructure by Palestinian terror groups.
- “Restrictions to ambulance transport of patients are perceived by interviewees as unnecessarily affecting the welfare and dignity of the patients. The “back to back” procedure as it is known requires the ambulance from the Palestinian side to stop at the crossing point, to unload the patient even if under oxygen or perfusion treatment, submit to security check and “walk” to the other side where an Israeli ambulance is waiting.”
During the 2014 conflict, terrorists used ambulances in Gaza to transport Palestininan fighters and these medical vehicles were reportedly used as car bombs targeting Israeli soldiers. The use of ambulances for attacks is a well documented practice commencing before and extending beyond the 2014 conflict and constitute Palestinian war crimes. Any discussion motivated by a desire to understand the state of Palestinian healthcare must address the abuse of medical infrastructure by these terror groups and demand these grave breaches of the Geneva Conventions.
5. Justification of Terrorism
- “Interviewees reported that a substantially negative aspect of the occupation of the West Bank is the sense of insecurity and unpredictability created by aspects such as people having to regularly re-apply for permits, uncertainty about being detained at checkpoints and insecure living conditions due to threat of house demolition, whilst at the same time, few building permits are reportedly provided… In particular, interviewees expressed that experiences of humiliation could be a driver of violence.” (emphasis added)
The report ignores that the vast majority of Palestinians live under Palestinian rule in Areas B and C of the West Bank and are subject to Palestinian building and zoning regulations. No data is provided in the report regarding the permitting process in Area C (Israeli control) and whether, in fact, only a “few” are issued. In addition, the report suggests that Palestinian terrorism is a result of Israeli policy in the West Bank, including security policy. This not only provides an unwarranted measure of justification for acts of terrorism committed against Israeli civilians but also erases history, and fails to correctly identify Israeli policy as a response to acts of terrorism committed against its citizens.
6. Claiming restricted Palestinian access to water
- “A ‘Fact Sheet’ issued by the Israel Civil Administration of Judea and Samaria stressed that West Bank Palestinian “have access” to 124 m3 /capita/year (340 Liters/day) including the 21 million cubic meters Israel ‘supplies beyond its obligation’. In practice access is prevented by denial of permits or economic restrictions.”
It is completely false to claim that Israel restricts access to water, as documented in NGO Monitor research. It appears that the authors have simply parroted baseless NGO claims on water usage. Israel supplies the Palestinian Authority with more water than required under the Oslo Accords. Similarly, decisions regarding water usage in the West Bank are made by consensus in the joint Israel-Palestinian Joint Water Committee (JWC).
7. Referring to East Jerusalem as part the West Bank
As seen in the previous section, the report refers to East Jerusalem as part of the West Bank. However, East Jerusalem residents posses Israeli residency status and/or citizenship and therefore have the same social benefits as Israeli citizens and full access to Israeli health services. These residents are integrated into the Israeli health system and should not be considered alongside the Palestinian residents of the West Bank.
B. Secretariat Report
During the course of the 68th WHA, the WHO Secretariat submitted a report on Palestinian health similar to the “field assessment” and referring to it as a “more detailed account of health conditions in the occupied Palestinian territory.” This second submission does not go into the level of detail as does the “field assessment” and is therefore much shorter. In addition to addressing many of the same issues as the “field assessment,” it also devotes a section to WHO efforts to support Palestinian health.
“In 2014, the Sixty-seventh World Health Assembly adopted decision WHA67(10), which requested the Director-General, inter alia, to report on this matter [the state of Palestinian health] to the Sixty-eighth World Health Assembly.”
This report suffers from many of the same faults as does the “field assessment,” highlighting a systemic issue not limited to one single publication. These errors include:
1. Reliance on data provided by unreliable NGOs
The Secretariat report similarly relies on NGOs and UN agencies (which in turn rely on the same NGOs) for data. The document cites NGOs B’tselem, PHR-I, the Madaa Creative Center and UN agencies OCHA and UNICEF.
2. Falsely Claiming Gaza to be Occupied
- “The current population of the occupied Palestinian territory is 4,550,368 (2,790, 331 of whom live in the West Bank, including east Jerusalem, and 1,760,037 in the Gaza Strip).” (emphasis added)
- “In 2014, the number of Palestinian fatalities and injuries resulting from violence associated with military occupation was the highest since 1967… primarily occurring during the conflict in the Gaza Strip in July?August 2014.” (emphasis added)
3. Ignoring Terrorist Exploitation of Medical Infrastructure
- “In 2014, the number of Palestinian fatalities and injuries …primarily occurring during the conflict in the Gaza Strip in July?August 2014. The conflict had a significant impact … Widespread damage to infrastructure, including hospitals, clinics and ambulances, and educational, water and sanitation facilities, has limited access to basic services.”
Despite the seemingly neutral language, this paragraph leads the reader to attribute this damage solely to Israel. The report does not mention that much of the damage was as a result of Hamas and other Palestinian terror groups commandeering medical facilities to carry out military operations and attacks on Israeli civilians. Without directly addressing on-going Palestinian exploitation of this infrastructure, WHO will not address the root causes of the conflict and therefore, cannot expect to play any type of constructive role in improving conditions in Gaza.