Dateline ACT

Palestinian Territories 0203

Churches fight for Palestinian health rights

Jerusalem, September 17, 2003--The right of Palestinians to access quality health care continues to be impaired by the Israeli occupation of the Palestinian Territories, so hospitals supported by Action by Churches Together (ACT) International are reaching out in new ways to deliver health care to isolated and besieged communities.

Since the beginning of the current intifada–or popular uprising–in 2000, the Israeli military has severely limited the access of Palestinians to health care facilities. Towns and villages are placed under curfew, earth and rubble are bulldozed into piles that block roads, and checkpoints run by Israeli soldiers regularly refuse to let Palestinians pass. Hundreds of people have died because patients traveling in ambulances or on their own were prevented from reaching clinics and hospitals–what human rights statisticians coldly term "death after medical delay."

Travel restrictions under Israel’s state of siege constitute "a flagrant breach of human rights" that "impairs the ability of the sick to reach hospitals for treatment and of ambulances to transport the sick and wounded," according to a report by B’Tselem, an Israeli human rights group that monitors conditions in the occupied Palestinian territories.

"Access is part of the definition of quality health care, and it’s a fundamental right for any patient to access their health care provider. Except in this country," said Tawfiq Nasser, the executive director of the Augusta Victoria Hospital in East Jerusalem.

Besides patients who can’t get to the hospital, Nasser said staff are also blocked or delayed when they travel from their home to work. "So the hospital has to expend enormous amounts of funding to try and cover for them, to transport them back and forth. All of a sudden the hospital is carrying out all kinds of peripheral programs in order to ease the emergency situation that is precipitated by these decisions of collective punishment," Nasser said.

Perched on the Mount of Olives, Augusta Victoria Hospital is run by the Lutheran World Federation (LWF), an ACT member. Two-thirds of the hospital’s patients come from refugee camps, and the 100-bed facility is a key referral hospital for the region. Yet patients often face an overwhelming odyssey in order to reach the hospital, at times passing through three or four checkpoints just to enter East Jerusalem.

"As a result, patients come to us, when they do come to us, much later, much sicker, much more acute, which means we have to spend more money, give more medication, practice more interventions. That makes the emergency impact us financially," Nasser said.

Funding from ACT has been "the spinal cord" of the hospital’s operations during the last two years, according to Nasser. In addition to helping the hospital treat direct casualties of the conflict, ACT funds have helped Augusta Victoria transport patients in and out of closed regions. For some patients, like those needing kidney dialysis every two or three days, ACT funding has helped Augusta Victoria house them on the hospital grounds instead of sending them home to closed villages.

ACT has also made it possible for Augusta Victoria to send medical professionals into isolated areas. A trauma surgeon supported by ACT provides critical care in the hospital in Qalqilya, a town along the West Bank’s border with Israel that has been isolated by an eight meter-high concrete "separation fence" constructed by the Israelis. Another ACT-supported physician provides orthopedic services at a clinic in the besieged southern city of Hebron.

In the Ama’ri refugee camp in Ramallah, Augusta Victoria uses ACT funding to provide a pediatrician for the United Nations-run clinic tucked inside the labyrinth of narrow streets where Palestinian homes occasionally come under sniper fire from a nearby hilltop where Israelis have constructed the illegal Psagot settlement. And in several besieged villages around Bethlehem, an ACT-supported midwife assists with prenatal care and childbirths.

Augusta Victoria is also using ACT support to operate "mobile clinics." Six days a week, a physician, lab technician, and nurse leave early from Augusta Victoria and navigate their way to four rural villages where they provide medical care in a borrowed building and visit patients in their homes who can’t make it to the clinic.

In the overcrowded Gaza Strip, pinned between Israel and the Mediterranean Sea, another ACT-supported hospital has also had to adjust its practice of medicine to the state of siege. "Before, patients came to us. Now we have to go to them," said Suhaila Tarazi, director of the Ahli Arab Hospital, a ministry of the Episcopal Diocese of Jerusalem. The hospital daily buses in patients from remote villages, often just women and children since Israeli soldiers regularly prohibit men from passing through the checkpoints.

The hospital experienced the violence directly on January 24 when an Israeli guided missile, fired from a U.S.-supplied Apache helicopter, slammed into St. Philip’s Episcopal Chapel in the middle of the hospital complex. The missile landed a meter from the chapel’s altar, leaving a gaping hole in the roof and blowing out century-old stained glass windows. In addition to causing extensive damage throughout the hospital and provoking a fatal heart attack in one elderly patient, the blast wrecked the hospital’s x-ray machine, sending Tarazi in search of donations for a new one. Church officials accused the Israeli Defense Force of deliberately targeting the hospital complex, which is clearly marked with Red Cross flags.

According to Dr. Maher Ayyad, the hospital’s chief surgeon, the state of siege has left the people of Gaza, and the hospital, feeling isolated from the rest of the world. "Before the intifada, we had Israeli surgeons come here once a week to help out, and they often took patients with them back to Tel Aviv. We used to have a surgeon or a specialist come here every month from the United States or Britain, but since the tensions have grown they are too scared to come. We used to send off our physicians to train and specialize in other countries, and we could refer patients to hospitals outside of Gaza. But now we watch patients die because we can’t send them elsewhere," Ayyad said.

Tarazi said the siege of Gaza makes it virtually impossible to send pathology specimens to the Jerusalem hospital that used to perform such tests, leaving cancer patients and their physicians to guess at diagnoses. Each individual specimen they want to ship needs special written permission from the Israeli minister of health, something the hospital has yet to acquire. And getting supplies and medicines into Gaza can entail a Byzantine trail of paperwork and endless waits for Israeli acquiescence. An ambulance donated to the hospital spent three months at an Israeli checkpoint before being allowed through.

In addition to helping bus in staff and mobilize health care professionals to visit isolated villages, ACT is helping Ahli Arab Hospital conduct public classes in first aid. Tarazi said a study conducted by the hospital revealed that 90 percent of injured patients who came to the hospital suffered complications because of improper treatment before they arrived. Part of the problem is the means used to get to the facility. Because Israeli soldiers regularly detain ambulances, patients are often transported in private cars or taxis, and inappropriate handling aggravates their condition. In addition to public education programs, the hospital is publishing a manual about appropriate first aid.

In the war-torn West Bank city of Nablus, St. Luke’s Hospital is using ACT funding to reach out to villagers trapped by curfews and road closures in villages throughout the hilly region. The hospital, run by the Episcopal Diocese of Jerusalem, sends health professionals into the countryside who at times have to sneak from village to village in order to evade Israeli military patrols. Several have been shot at.

"Nablus is a big prison and people can’t reach the facilities in the city, so the hospital has to make the move and take the initiative to reach out to the people in their homes with medical services and health care," said the Rev. Hosam Naoum, the Episcopal priest in Nablus. Citing the hospital’s founding in the 19^th Century, Naoum said ACT is "helping us revive and regain our strength in order to continue the ministry we’ve carried out over the years."

At the same time they are reaching out in creative new ways, ACT-supported hospitals in the region remain constantly at the ready for new episodes of intense violence, such as that which occurred in 2000 at the beginning of the current intifada when Augusta Victoria Hospital received 80 patients in just the first 30 minutes. Within hours, the halls and grounds of the hospital were covered with the injured. As recently as April, St. Luke’s Hospital opened a field hospital in a mosque in the old city of Nablus in order to more quickly treat the wounded from an Israeli military incursion.

While they prepare for the worst and reach out to those separated from quality medical care, ACT-supported health professionals in the Palestinian Territories are also wary of Israeli initiatives to restrict their ministries. Israeli tax authorities have taken the Augusta Victoria Hospital to court over what they claim are unpaid back taxes. Hospital officials say they were officially exempted from taxes while East Jerusalem was under Jordanian control. When Israel annexed the area in 1967, government officials ratified the agreement in recognition that the hospital receives no financial support from the state of Israel. At stake is roughly $350,000 per year in employer taxes from 2001. Should Augusta Victoria have to pay the tax to Israeli authorities, it would put the hospital in extremely difficult circumstances, with the potential of having to dramatically cut back on the services it provides.

(LWF continues a process of dialogue with the Israeli authorities to find an amicable solution to this problem.)