Marwan Khawaja

Health status and health services in the occupied Palestinian territory

Summary We describe the demographic characteristics, health status, and health services of the Palestinian population living in Israeli-occupied Palestinian territory, and the way they have been modified by 60 years of continuing war conditions and 40 years of Israeli military occupation. Although health, literacy, and education currently have a higher standard in the Israeli-occupied Palestinian territory than they have in several Arab countries, 52% of families (40% in the West Bank and 74% in the Gaza Strip) were living below the poverty line of US

Maternal and child health in the occupied Palestinian territory

3·15 per person per day in 2007. To describe health status, we use not only conventional indicators, such as infant mortality and stunting in children, but also subjective measures, which are based on peoples experiences and perceptions of their health status and life quality. We review the disjointed and inadequate public-health and health-service response to health problems. Finally, we consider the implications of our findings for the protection and promotion of health of the Palestinian population, and the relevance of our indicators and analytical framework for the assessment of health in other populations living in continuous war conditions.

Violent conflict and population health in the Middle East

The Countdown to 2015 intervention coverage indicators in the occupied Palestinian territory are similar to those of other Arab countries, although there are gaps in continuity and quality of services across the continuum of the perinatal period. Since the mid 1990s, however, access to maternity facilities has become increasingly unpredictable. Mortality rates for infants (age </=1 year) and children younger than 5 years have changed little, and the prevalence of stunting in children has increased. Living conditions have worsened since 2006, when the elected Palestinian administration became politically and economically boycotted, resulting in unprecedented levels of Palestinian unemployment, poverty, and internal conflict, and increased restrictions to health-care access. Although a political solution is imperative for poverty alleviation, sustainable development, and the universal right to health care, women and children should not have to wait. Urgent action from international and local decision makers is needed for sustainable access to high-quality care and basic health entitlements.

Public health in the Arab world.

The United Nations estimates that 2135 Afghan civilians were killed in the first nine months of 2010; 350 of those deaths were a result of attacks by US, NATO and Afghan forces, while the remainder were caused by insurgents (Human Rights Watch 2011). In Lebanon, cluster bombs left behind from Israel’s 2006 attack have wounded 300 civilians (Human Rights Watch 2011). The ongoing colonisation of the occupied Palestinian territory has created a situation in which much of the Palestinian population lives with ‘acute and constant insecurities’ (Giacaman et al. 2009), and the Israel Gaza conflict of 2008 2009 furthered the humanitarian crisis already under way in Gaza, causing the deaths of over 700 Gazan and 3 Israeli citizens (Human Rights Watch n.d.). Lebanon, the occupied Palestinian territory and Afghanistan have all been in protracted states of humanitarian crisis over the last 70 years, resulting from armed conflict or occupation. They have all experienced increased rates of mortality and morbidity, widespread displacement of their populations and deterioration of health and social services. As a result of their shared history of violent conflict, they are taken in this Special Issue as case studies from which to analyse the complex interrelationship between conflict and population health in the Middle East. The focus of this Special Issue is not on the direct mortality or morbidity rates attributed to conflict in the occupied Palestinian territory, Lebanon and Afghanistan; instead, we address issues of population displacement and community resilience, and speak to larger issues of human rights and social justice that must be taken into account when analysing the health impacts of conflict. Our aim is to examine the broader contexts in which conflicts develop and to better understand the implications of violent conflict on the movements of people and their health and mental well-being. Further, we make a case for policy-makers, programme managers and researchers to include a human rightsand social justice-based framework in their approach to working in situations of violent conflict. Authors also speak to larger questions of political will, economic impacts of conflict and on-the-ground realities facing civilians living in war-torn societies. Throughout this Special Issue, we make a call for public health practitioners, researchers and medical organisations to become more vocal in speaking out about conflict that harms civilians. Others have made this call before (Singh et al. 2007, Inhorn 2008, Waterston 2011), and we add here our voices to the urgency of this collective call for action against human rights violations taking place against civilians. This Special Issue of Global Public Health, ‘Violent Conflict and Population Health in the Middle East’, is the result of a unique and groundbreaking symposium on ‘Health and Conflict in the Middle East’, which received funding from the Wellcome Trust, the Center for Research on Population and Health at the Faculty of Health Sciences at the American University of Beirut (AUB), and Yale University’s Global Public Health Vol. 6, No. 5, July 2011, 467 471