Healthcare in Palestine was already in a worrying state, well before 7 October. It is now on the verge of complete collapsing. In Gaza, the war has reduced the healthcare system to rubble. In the rest of Palestine, stringent movement restrictions imposed by the Israeli government together with repeated financial crises have led to looming healthcare breakdown.
Healthcare for Palestinians in Gaza: a near impossible challenge
As widely reported, the ongoing military operations in the Gaza Strip have reduced Gaza’s already fragile healthcare system to rubble. This is creating an immense indirect human cost that adds to the more than 39,000 Palestinians killed in Gaza since 7 October[1].
In addition, as noted by UN OCHA, the few remaining health facilities also face the spread of infectious diseases fuelled by the desperate sanitary conditions, the extreme heat, and the lack of clean water.
Furthermore, thousands of people in Gaza who were dependent on getting permits from the Israeli authorities to access treatment outside of the Strip, mainly in the West Bank including East Jerusalem, have been denied that possibility for close to 10 months now. Only a very few patients have been allowed to exit Gaza to access lifesaving treatment in the West Bank or abroad.
Less reported, however, is the fact that access to healthcare for Palestinians in the West Bank has been heavily impacted in the past months as well.
Increased restrictions on movement in the West Bank
Following Hamas’ attack in Israel on 7 October, the Israeli authorities have imposed increased restrictions on movement for Palestinians in the West Bank. This takes the form of new checkpoints, road closures, and the closure of entire villages or towns.
Moreover, the rise of settler violence and military interventions has deepened insecurity for Palestinians in the West Bank which contributes to a decrease of movement in the area.
Finally, from 7 October 2023 to the end of May 2024, the WHO has documented 480 attacks on health care in the West Bank. The attacks affected 54 health facilities, 20 mobile clinics and 319 ambulances.
In this context, many patients prefer not to get treatment rather than face the journey to hospitals and clinics.
In addition, WHO figures show that between October 2023 and May 2024, 44% of applications for patients from the occupied West Bank to get medical care in annexed East Jerusalem or in Israeli health facilities have been denied or remain pending.
The lack of permits and restrictions on freedom of movement also impacts doctors, nurses, and other medical personnel. They may have lost their work permits and may no longer be able to reach East Jerusalem or they may be unable to reach their workplace because of unexpected roadblocks, checkpoint closures or increased controls at checkpoints leading to people waiting for hours to cross.
Financial collapse in the West Bank
According to the 1994 Paris Protocol, the Israeli government collects tax revenues on Palestinian imports and exports on behalf of the Palestinian Authority (PA). In addition to earning a 3% commission on the collected revenues, the Israeli government has also regularly used this mechanism as a tool to reprimand or put pressure on the PA by withholding parts or all of the funds. The withholding of Palestinian tax revenues by the Israeli government is an issue that has been raised recently by third states including Germany and the US.
This loss of income by the PA has direct repercussions on Palestinians in the West Bank with public employees, including healthcare workers, only receiving parts of their salary. Moreover, the PA has been unable to maintain its financial support to healthcare structures in the West Bank. Therefore, hospitals and clinics have had to reduce their working capacity and battle shortages of material.
In addition, since 7 October, the Israeli authorities have imposed a ban on almost all Palestinian workers from entering Israel, leading to 148,000 Palestinians losing their employment.
Overall, according to UNDP figures, the Palestinian economy – taking into consideration the West Bank including East Jerusalem, as well as the Gaza Strip – is estimated to lose 25.8% of its GDP in 2024 and the number of people living in poverty is expected to increase by 1.86 million. This will without a doubt negatively impact people’s capacity to access healthcare and treatment.
The case of the East Jerusalem Hospitals Network
The East Jerusalem Hospitals Network (EJHN), comprising six hospitals in East Jerusalem, was established in 1997 to unify the health facilities in East Jerusalem and emphasize their significant role within the Palestinian health system.
The Augusta Victoria Hospital (AVH), operated by the Lutheran World Federation and located on top of the Mount of Olives is part of the EJHN and a partner of several ACT Alliance EU member organisations.
Over the past years, and even more so in the last months, the AVH has been vocal on the financial hardships faced by the hospitals in East Jerusalem as well as the increasing difficulty for Palestinians to access treatment.
Before 7 October, about 30% of the AVH patients were Palestinians from Gaza. Since 7 October these patients, most of whom are in need of treatment for cancer, have been unable to get access because of the Israeli authorities’ refusal to issue exit permits. Moreover, as described above, the AVH also underlines the difficulty for patients or staff from the occupied West Bank to get to the hospital.
The need for financial and political support
Through the PEGASE instrument, the European Union financially supports the PA by contributing to the payment of salaries and pensions of civil servants in the West Bank, providing assistance to the most vulnerable Palestinian families through cash transfer and helping to pay for health referrals to the East Jerusalem hospitals. As one of the biggest donors to Palestine, the EU’s support is much need in the occupied Palestinian territory.
Nevertheless, over the past years, the EU’s financial contribution to the PA has been dangerously unpredictable. For instance, EU funds approved in 2021 were delayed for months leading to what the PA said was, at the time, its worst financial crisis. This delay had a disastrous impact on the East Jerusalem hospitals with the AVH reporting that at least 500 cancer patients were unable to access life-saving treatment in that period. To this day, patients in need of expensive chemotherapy medication cannot be accepted due to the lack of funding for treatment of patients referred to the AVH by the Palestinian Ministry of Health.
Furthermore, following the attack of 7 October, an announcement by the DG NEAR Commissioner again cast doubt on whether EU funds to Palestine would be disbursed at all.
Such unpredictability in funding is clearly at odds with EU guidelines and has direct consequences on the life of the most vulnerable in Palestine. For this reason, the EU institutions, in this instance the European Commission, should therefore respect their own commitment and avoid delays in the disbursement of vital aid.
Finally, the EU should also ensure that it supports Palestine not only financially but also politically by acknowledging that the main obstacle to development in Palestine is the Israeli occupation.
[1] UN OCHA reports that between 7 October 2023 and 29 July 2024, at least 39,363 Palestinians were killed and 90,923 were injured in Gaza, according to MoH in Gaza.
