Medical Apartheid in Palestine: The Case of COVID-19 Vaccinations

An employee of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) gives a shot of the Sputnik V Covid-19 vaccine for medical staff and the elderly, in the Gaza Strip (3 March 2021). Photo by Abed Rahim Khatib via Shutterstock. An employee of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) gives a shot of the Sputnik V Covid-19 vaccine for medical staff and the elderly, in the Gaza Strip (3 March 2021). Photo by Abed Rahim Khatib via Shutterstock.

Medical Apartheid in Palestine: The Case of COVID-19 Vaccinations

By : Mouin Rabbani

On 25 February 2021 Israeli Defense Minister Benny Gantz announced that Israel was suspending an initiative, previously announced by Prime Minister Binyamin Netanyahu, to provide nineteen countries with some 100,000 surplus jabs from its well-appointed stock of COVID-19 vaccines. The Israeli gesture had not been part of COVAX, the global initiative to ensure equitable access to such inoculations for the world’s poor and vulnerable. Rather, it was conceived as a bribe, one that according to the Times of Israel would “exchange vaccines for diplomatic support”. Identified beneficiaries included Guatemala, which had followed the United States in relocating its embassy to Jerusalem in explicit violation of United Nations Security Council Resolution 478; the Czech Republic and Hungary, which have opened diplomatic missions of their own in the Holy City, also in violation of the Resolution; and Mauritania, with which Israel is seeking to establish formal relations. 

In addition to deploying life-saving vaccines to induce foreign governments to violate international law and further strengthen its position vis-a-vis the Palestinians, Israel is withholding the jabs from the approximately five million stateless Palestinians living under its rule. Given that, as most recently demonstrated by the Israeli human rights organization B’Tselem and the analyst Nathan Thrall, Israel and the occupied Palestinian territories are governed by a single political regime, Israel is as responsible for, yet no less disdainful towards the well-being of the residents of the West Bank Gaza Strip as was South Africa’s former white minority regime with respect to the inhabitants of Transkei, Venda, and the other Bantustans. The result, in the words of Palestinian physician and activist Mustafa Barghouti, is “medical apartheid”.  

Barghouti’s assessment remains valid were one to maintain the fiction that Israel and the occupied territories are governed by separate regimes. To cite Article 56 of the 1949 Fourth Geneva Convention, which sets forth the rights and obligations of occupants:

To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring and maintaining, with the co-operation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory, with particular reference to the adoption and application of the prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics. [Emphasis added.]

Israel has categorically rejected any responsibility for vaccinating Palestinians in the West Bank and Gaza Strip, maintaining this task falls exclusively to the Palestinian Authority (PA), a circumscribed appendage of Israeli governance which on a good day enjoys the sovereign powers of a municipal clerk. The relationship between Israel and the PA bears comparison to that between the US government and the country’s Native American reservations. If it’s a stretch to imagine the US Secretary of Health and Human Services invoking tribal sovereignty to wash the federal government’s hands of the COVID-19 crisis among Native Americans, his Israeli counterpart exhibited no such compunctions. Speaking to the BBC’s Andrew Marr in late January, Yuli Edelstein averred that Israel’s obligations towards the Palestinians are no more than the Palestinians’ “responsibility” to “take care of the dolphins in the Mediterranean”.

Insisting that although it is “not our legal obligation” it would be in “our interest” to vaccinate Palestinians and prevent the further spread of COVID-19, Edelstein duly informed Marr Israel had to take care of its own first. Yet just as the plan to reward foreign governments with surplus jabs put the lie to the scarcity pretext, so Israel’s initial refusal to permit the PA to transfer to the Gaza Strip 2,000 of the 10,000 doses of the Russian Sputnik-V vaccines the Palestinians had independently acquired exposed the hollowness of its assertions about the authority of the Palestinian Authority. For two days it was the Israeli rather than Palestinian parliament that debated the propriety of distributing vaccines to the inmates of the open-air prison that is the Gaza Strip, with Israel’s Coordinator of Government Activities in The Territories (COGAT) – its Bureau of Indian Affairs – informing journalists that the fate of the Palestinian pharmaceuticals "is waiting for a [Israeli] political decision". When it eventually came, the decision to allow the desperately-needed vaccines to enter the Gaza Strip was an Israeli one, made without consulting a single Palestinian. No such deliberations were required when Israel that same month decided to purchase USD 1.2 million worth of Sputnik-V vaccines for Syria, as part of a Russian-mediated deal to secure the return of an ultra-orthodox Israeli woman who had escaped to Syria and was being detained by Damascus.

In December 2020, after the Israeli Ministry of Health determined that prisoners and not just their guards form a priority group for vaccination in view of their high risk of exposure, Public Security Minister Amir Ohana issued instructions to the Israel Prisons Service to exclude “security prisoners”, virtually all of whom are Palestinian, from the inoculation campaign. Several weeks, a number of additional infections and a widespread outcry later, Israel announced they would be vaccinated after all. 

The racism that drives Israeli policy is at its most visible in the West Bank. There, the hundreds of thousands of residents of Israel’s numerous illegal settlements, including Jewish non-citizens, have full access to the government’s vaccination program. It would however no longer be accurate to say that West Bank Palestinians have none. On 28 February Israel approved plans to inoculate the roughly 130,000 Palestinians to whom it has extended permits to work in Israel and its West Bank settlements. In a further act of noblesse oblige as Palestinian hospitals reported that intensive care units for COVID-19 patients had reached 95 percent occupancy, Israel pledged a “symbolic quantity” of 5,000 doses for use by Palestinian medical personnel. As of this writing, it has delivered only 2,000. 

At around the same time the Nieuw Israelitisch Weekblad, the house organ of Dutch Zionism, ran an article by the editor-in-chief, Esther Voet, under the headline “Unique Offer: Vaccination Holiday in Israel”. “Thanks to our intimate cooperation with the Israeli authorities,” she wrote, “we can proudly offer a unique vacation in April .... You can choose the Pfizer vaccine and get a certificate for your second jab in The Netherlands, or the Johnson & Johnson vaccine that requires only a single dose”. A “Druze lunch” was also part of the package. When contacted by Dutch journalist Tineke Bennema, the travel agency identified in the article dismissed the offer as a “Purim joke”; apparently offering vaccines to medical tourists a continent away while denying it to the undeserving natives is, apparently, a real knee-slapper. 

No country has vaccinated a larger proportion of its citizenry than Israel. Its compact size and relatively small population, its largely centralized and digitized health system, and experience with logistics in times of crisis tells only part of the story. In 2020, Israel concluded a mutually beneficial manufacturing and supply agreement with Pfizer Inc. in which the government agreed to purchase the BioNTech mRNA vaccine developed in Germany at premium prices – reportedly double that paid by European buyers – and share vast troves of patient data with the pharmaceutical company in exchange for a guaranteed supply of 10 million doses by the end of March. Had Belgium or Singapore been as profligate with their finances and data, they could easily have achieved the same. The difference of course is that Belgium’s Walloons have equal access to the Kingdom’s health care system, and its federal government has not limited the country’s vaccination program to Flanders and Wallonian residents of Flemish heritage. As any Palestinian could have predicted, Israel is also the first state to introduce color-coded identification documents to differentiate the vaccinated from the potentially infectious. 

As with other Israeli policies towards the Palestinians, its practice of medical apartheid is enabled and sustained by international support and indifference. One can imagine how the European Union and United Kingdom would react to an Iranian policy to use vaccines manufactured on European soil to inoculate only Muslims, and leave Baha’is and Jews to fend for themselves. On this occasion, perhaps also out of deference to their own vaccine nationalism, the Europeans have yet to muster the courage to issue their usual vapid statements calling on both sides to show restraint. 

Rather, as the self-proclaimed civilized world celebrates Israel’s dubious achievement, it has once again been left to activists, professionals, and the occasional journalist to expose its racist practices. And, one might add, comedians. Presenting the satirical “Weekend Update” on the US variety show Saturday Night Live, Michael Che – not coincidentally an African-American – joked that "Israel is reporting that they've vaccinated half of their population, and I'm gonna guess it's the Jewish half." 

Within minutes Jonathan Greenblatt, CEO of the Anti-Defamation League, and others the late Alfred Lilienthal used to ridicule as “professional anti-anti-Semites” went into polemical overdrive. Referencing that Israel is vaccinating those Christian and Muslim Palestinians who are also Israeli citizens, while conveniently elid­ing the stateless millions who live under its rule, the squalid accusations against Che quickly piled up. It was left to Palestinian analyst Omar Baddar to fact-check the outrage: “Jokes are by definition parodies of reality. If they’re supposed to pass a literal fact-check they would no longer be jokes or parodies. They would just be straight-up news reports”. 

Israel’s apologists also got the better of Anthony Fauci, who as director of the US National Institute of Allergy and Infectious Diseases became a global superstar for refusing to indulge Trump’s ravings about curing COVID-19 with potentially fatal anti-malaria drugs and lethal bleach injections. Now Biden’s chief medical adviser, Fauci was asked during an interview with the Times of Israel if Israel “should help” vaccinate Palestinians. His spine instantaneously liquified: “You’re asking me a political question, and I don’t want to go there. That only gets me into trouble.” Rather meekly, Fauci hailed Israel’s vaccination strategy as “a model for the rest of the world.”

[An earlier version of this article was published in London Review of Books.]

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Setting New Precedents: Israel Boycotts Human Rights Session

The Universal Periodic Review (UPR) is a unique mechanism that intends to review the behavior of states without distinction. The UN General Assembly established it in 2006 as part of the functions of the Human Rights Council. It is a state-driven process to comprehensively assess a state`s compliance with human rights law. The Human Rights Council is to hold three two-week sessions each year during which time they review the files of sixteen member states. Accordingly each state will undergo the review every three years. As of 2011, all 193 UN member states had undergone a review.

The Human Rights Council conducted Israel`s UPR in 2009.  In response to the findings, Israel`s ambassador to the UN explained that it took the Review process "very seriously" because it is "an opportunity for genuine introspection, and frank discussion within the Israeli system" 

Israel`s second UPR is scheduled to take place in 2013. A coalition of Palestinian human rights organizations submitted their concise report on Israel`s violations between 2009 and 2012.  This document will not be read, however, because Israel is boycotting the UPR, citing bias.  In May 2012, Israel described the Human Rights Council as “a political tool and convenient platform, cynically used to advance certain political aims, to bash and demonize Israel.”

Israel`s condemnation of the Human Rights Council followed the body`s initiation of a fact-finding mission to investigate the impact of settlements in the Occupied Palestinian Territory. Today, the Council released its report at a press conference in Geneva. It states that Isreal must cease all of its settlement activity  "without preconditions" and  "must immediately initiate a process of withdrawal of all settlers", or face prosecution before the International Criminal Court. Sources in Geneva tell me that Israel`s threats of boycott aimed to derail the Council`s fact-finding mission`s report. Failing to do that, Israel unilaterally withdrew from its Universal Periodic Review all together.

This is not Israel`s first attack on the UN. It has cited bias in the past in response to the UN`s critique of its human rights violations, specifically after the World Conference Against Racism (2001); the International Court of Justice proceedings on the route of the Separation Barrier (2004); denial of entry to Special Rapporteur to the OPT, Richard Falk (2008); and its refusal to cooperate with the Human Rights Council`s fact-finding delegation to Gaza in the aftermath of Operation Cast Lead (2009). 

Israel is unique for its boycott, which evidences the tenuous nature of the voluntary compliance process. In fact, human rights advocates and governement officials worry that Israel will open the door to non-cooperation by other states. The battle for accountability continues even in the UN. Despite its acceptance of international law & human rights norms, even within the multilateral human rights body, the last word on human rights matters is political.