The latest Israeli assault on Gaza enacted a heavy toll on the besieged enclave’s healthcare infrastructure, with fears that Gaza’s healthcare system is on the verge of collapse. However, Israel’s latest airstrikes that have killed Gaza’s top doctors and damaged medical facilities must be understood in the context of a larger strategy to undermine the health of Palestinians under occupation.
Eleven days of intense Israeli airstrikes on Gaza significantly challenged Gaza’s already weak healthcare infrastructure. Doctor Mouin Al-Aloul, Gaza’s top neurologist, Doctor Ayman Abu Al-Ouf, head of internal medicine and coronavirus response at Al-Shifa hospital, and psychologist Rajaa Abu Al-Ouf, along with their children and relatives were killed in the bombings. Wehda Street, which leads to Al-Shifa hospital, Gaza’s largest, was also bombed to the point of rendering a direct route to the hospital inaccessible to ambulances and emergency first responders. The airstrikes on Sunday also badly damaged a Doctors Without Borders/Médecins Sans Frontières (MSF) clinic, forcing its closure. An Israeli airstrike destroyed the only COVID-19 testing laboratory in Gaza, and the main Palestine Children’s Relief Fund (PCRF) office in Gaza was reportedly bombed. These latest attacks on Gaza’s doctors and healthcare system must not be viewed in isolation. Rather, these assaults are part of a larger, ongoing and systematic campaign to target the health of Palestinians in the occupied West Bank and Gaza.
Just a few weeks ago, the besieged Gaza Strip was being ravaged by the second wave of the coronavirus with record-high rates of cases and deaths. Now, with hospital beds already scarce, Israel’s airstrikes added chaos to the health crisis. As casualties increased, doctors rushed to bandage shrapnel wounds and amputate limbs while patients lined the hallways of overcrowded hospitals and clinics. Medical supplies, including blood bags, oxygen tanks, anesthesia, personal protective equipment, and antibiotics are running dangerously low. Gaza Health Ministry official Abdelatif al-Hajj stated that he fears “a total collapse” in Gaza’s healthcare infrastructure.
As Gaza’s healthcare system is on the verge of collapse under the weight of the coronavirus, military airstrikes, and a fourteen-year-long blockade, Israel’s coronavirus vaccine rollout has been praised as a model of success for other countries to follow. In reality, however, Israel’s coronavirus vaccine policies are a stark example of medical apartheid. Fifty-six percent of the nine million people in Israel are currently fully vaccinated, and sixty percent have received their first dose. As of late April, Israel recorded no new daily COVID-19 deaths. Gaza and the West Bank, however, continue to suffer from new virus variants and the rapid spread of the disease.
The healthcare crisis in occupied Palestine is a reality contrived by Israel. Israel is legally obligated under international law to provide the COVID-19 vaccine to Palestinians under its military occupation in Gaza and the West Bank. In late February, while the majority of Palestinians in the occupied territories were waiting to be vaccinated, Israel made plans to send up to 100,000 vaccine doses to allied countries. As of early May, only 3.6 percent of Palestinians received their first dose of the vaccine in the West Bank, and less than one percent were fully vaccinated. Meanwhile, Israeli settlers living in Jewish-only settlements throughout the West Bank in contravention of international law are provided full access to Israel’s vaccine supply, while Palestinians living in the same area are denied access.
However, Israel refutes its obligation to vaccinate the Palestinians under its military control, instead claiming that under the Oslo Accords, it is the responsibility of the Palestinian Authority (PA) to vaccinate its own people. This is objectively not true. By refusing to fully vaccinate the Palestinian people under its military occupation, Israel is violating the Fourth Geneva Convention, the Hague Convention of 1907, the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the Oslo Accords. As the occupying power, Article 55 of the Fourth Geneva Convention obligates Israel to ensure the “medical supplies of the [occupied] population,” and Article 56 requires “to the fullest extent of the means available” to the occupying power, the “adoption and application of the prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics.” Article 43 of the Hague Convention of 1907, regarded as customary international law effectively binding Israel to its obligations, requires Israel to ensure the public order and safety of the occupied Palestinian people. Article 12 of ICESCR, to which Israel and Palestine are both parties, requires states to take steps necessary for the “prevention, treatment and control of epidemic, endemic, occupational and other diseases.” The same article also requires the “creation of conditions which would assure to all medical service and medical attention in the event of sickness,” which Israel has arguably violated, as demonstrated by Israeli soldiers destroying COVID-19 testing sites in the West Bank, Israeli airstrikes damaging both the MSF clinic and a main road leading to Gaza’s largest medical facility, Al-Shifa hospital, and destroying Gaza’s only COVID-19 testing laboratory.
Finally, Israel is incorrectly pointing to the Oslo Accords to uphold its argument against vaccinating Palestinians in the occupied territories. Under the Oslo Accords, the PA is responsible for the oversight of public health and the administration of routine vaccinations, such as polio and measles. However, Annex III of the Accords stipulates that “Israel and the Palestinian side shall exchange information regarding epidemics and contagious diseases, shall cooperate in combatting them and shall develop methods for exchange of medical files and documents.” Furthermore, international law takes priority over these accords, as the Oslo Accords do not erase Israel’s obligations under international humanitarian and human rights law as long as Israel remains the occupying power. The Oslo Accords do not supersede the Fourth Geneva Convention, which is specific about the duty of the occupying power to provide healthcare. Additionally, the Israeli government maintains primary control over both Gaza and the West Bank, as well as exclusive control over Area C of the West Bank, which embodies sixty percent of the territory, leaving Israel no excuse for deflecting the responsibility of vaccinating the Palestinian people on the PA when it simply finds it convenient.
Instead of upholding its international legal obligations to vaccinate the Palestinian people in the West Bank and Gaza, Israel is currently sitting on an unused supply of ten million AstraZeneca vaccines at risk of expiring, with no plans to provide them to Palestinians under their occupation. Meanwhile, Israeli airstrikes that destroyed Gaza’s only COVID-19 testing site has set the besieged enclave further back in its pandemic response. Before the onslaught of Israeli missiles, Gaza’s population of two million people was testing at a twenty-eight percent positivity rate, among the highest in the world, and over half of its limited supply of 122,000 vaccines, mostly acquired through the COVAX initiative, are at risk of expiring as vaccine administration has been immobilized amidst the Israeli bombardment. The fact remains that by inoculating its citizens at one of the fastest rates in the world, including settlers illegally residing in the West Bank, Israel has the means to provide the vaccine to Palestinians under occupation. By refusing to fully vaccinate the Palestinian people, Israel is engaging in medical apartheid.
Recent years have shown that the targeting of Palestinian healthcare infrastructure and Palestinian medical workers is an Israeli strategy to demobilize the healthcare system in Gaza and collectively punish the Palestinian people. In June of 2018, during the Great March of Return protests in Gaza, an Israeli soldier shot and killed 20-year-old Razan al-Najjar, who was working as a medic to treat the wounded. Although Israel later claimed that her killing was unintentional, the Israeli sniper that shot her was firing into a crowd that included medics wearing white coats in plain view. The murder of Razan was not an isolated incident. The UN found that Israel deliberately targeted children, journalists, and medics during the Great March of Return protests, killing three medics within nine months in 2018. In 2019, Israeli soldiers shot dead a 17-year-old medic, Sajid Muzher, at the Dheisheh Refugee Camp near Bethlehem. Israel’s deliberate targeting of medical personnel amounts to war crimes under Article 8 of the Rome Statute of the International Criminal Court. The most recent killings of Doctor Mouin Al-Aloul, Gaza’s top neurologist, psychologist Rajaa Abu Al-Ouf, and Doctor Ayman Abu Al-Ouf, head of Al-Shifa hospital’s coronavirus response, also enacts a heavy loss on besieged Gaza, where a shortage of doctors already exists. Additionally, the recent destruction of Wehda Street leading to Al-Shifa hospital and the MSF clinic in Gaza could be considered a violation of customary international law and Common Article 3 of the Geneva Conventions, which require that the wounded and sick be collected and cared for, and forbid intentionally directing attacks against hospitals and places where the sick and wounded are collected, provided that they are not military objectives.
Furthermore, Israel’s policies prevent Palestinians in the West Bank and Gaza from accessing medical treatment. Gazans must apply for Israeli-issued medical permits to leave the blockaded enclave in order to seek medical treatment. The arduous permit system that Israel imposes upon West Bank Palestinians’ freedom of movement also requires patients and hospital staff to apply for Israeli-issued permits in order to access the main specialized hospitals in East Jerusalem. These permits are difficult to obtain and are commonly denied. Sometimes, the issuance of permits is conditioned on providing information about family, friends, or colleagues to security authorities. Even with a permit to seek medical treatment, Palestinians still face limitations on the number of family members allowed to accompany children and the elderly to the hospital and doctor appointments, and West Bank Palestinians with permits to enter East Jerusalem must overcome the additional barriers to healthcare access imposed by lengthy delays and closures of military checkpoints. For example, in 2019, preschooler Aisha a-Lulu was forced to travel alone from Gaza to Jerusalem because Israel denied her parents a permit to accompany her. When she emerged from brain surgery in the Jerusalem hospital, she cried for her parents, who were only an hour away in Gaza, but were unable to be by her side. As her condition deteriorated, she was returned to Gaza unconscious, and a week later, she was dead. Also in 2019, Israeli authorities refused Laith Abu Zeyad a permit to accompany his mother to her chemotherapy treatments in Jerusalem fifteen minutes away from their home in the West Bank, and he was prevented from seeing his mother one last time before she died of cancer in Jerusalem. Israel’s permit system enacts a deadly cost on Palestinians. The World Health Organization reported that fifty-four Palestinians in Gaza, forty-six of whom had cancer, died in 2017 after their permits to travel for medical treatment were delayed or denied. The system of permits and military checkpoints throughout the West Bank forced sixty-seven women to give birth at checkpoints between the years 2000 and 2005, putting the lives of both the mother and child at risk and resulting in the death of thirty-six babies.
Palestinians are subjugated to a permit system in order to seek medical treatment outside of the West Bank and Gaza because of the poor medical infrastructure in the occupied territories. However, this medical permit system must not be viewed in isolation – rather, one must connect why the medical infrastructure in Palestine is poor and under-resourced to the broader context of the occupation. The lack of resources and adequate medical care available to Palestinians in the occupied territories is a reality fabricated by the occupation itself. Israel has complete control over the borders of the West Bank and Gaza, including what can be imported or exported. Israel’s dual-use policy prohibits the importation of any items that can be considered a security risk or have potential military applications. Under this policy, Israel bans the importation of vital resources such as medical equipment, communications equipment, and raw materials used for construction, such as cement. Because the dual-use policy prevents advanced medical supplies and medical equipment from reaching the occupied territories, the Palestinian healthcare system is forced to function with a lack of resources and Palestinians must be dependent on Israel for medical permits to access basic medical care. Israel’s policies that restrict access to medical treatment and prevent medical supplies from reaching those under occupation are in direct contravention of their obligations as the occupier under the Fourth Geneva Convention.
Israel’s latest assault on Gaza, including the airstrikes on healthcare infrastructure and killing of Palestinian doctors, must be viewed in the context of a larger campaign to target the health of Palestinians under a system of medical apartheid in the occupied West Bank and Gaza. The ongoing fourteen-year blockade of Gaza has created chronic shortages of essential medicines and resources, and the latest series of airstrikes has added to the already dire health situation brought on by the coronavirus and lack of vaccines. The killing of doctors and medics, destruction of medical facilities, refusal to vaccinate the Palestinian people under occupation, the system of military checkpoints and permits functioning as barriers to healthcare access, and the prevention of vital resources from entering the occupied territories under the dual-use policy must all be viewed as connected to a larger strategy of targeting the health of the Palestinian people.