6) The Health Situation in the Palestinian Territories

 The health conditions in the Palestinian areas have remained poor due to certain problems and difficulties which prevent giving appropriate medical care. Since the coming of the Palestinian Authority, which took over responsibility of health services in these areas, no major development has been witnessed in this field. On the contrary, the situation has deteriorated. There is low distribution of hospitals in the West Bank and Gaza Strip, a lack of medical equipment in government hospitals and clinics (especially in necessary units like emergency and heart units) and low salaries of medical staff and workers.

 Yet it is difficult to understand the deterioration in the health sector if we know that the Ministry of Health has a budget of 165 million shekels for this year, 49 million of which were already received, and 17 million from last year. The total revenue from health insurance for the last five years was 501 million shekels, plus more than 7 million US dollars has been received as assistance from donors. These sums of money, make the ordinary Palestinian citizen question the credibility of the Palestinian Authority.

 

There are nine government hospitals in the West Bank: Jenin, Tulkarem, Jericho, Ramallah, Beit Jala, Bethlehem, Hebron, al-Watani and Rafidia in Nablus. In the Gaza Strip there are three government hospitals: al-Shifa, Nasser (in Khan Younis) and al-Nassr Children's Hospital. All these hospitals lack beds, equipment, medicine, and emergency facilities.

 

The existing bad health situation encouraged people to complain about it, therefore, complaints and cases in this field increased in the Courts. Most of these cases were regarding the bad medical treatment that people get in public hospitals, where usually doctors in training give medical care to the public. The PHRMG has recorded many cases of carelessness and the incorrect diagnosis of illness.

 

A) Health Problems

 

Problems and obstacles in the field of health care in the Palestinian Autonomous areas could be summarized in the following:

 

-The available hospitals are so antiquated that they could not possibly offer appropriate medical care. For example, al-Watani hospital in Nablus is 100 years old.

 

-An extreme shortage in medication, equipment and ambulances.

-Very little cleanliness.

 

-Lack of certain medical services, such as chest surgery, nerves, and radioactivity treatment.

 

-Lack of some medication for chronic illness, such as heart problems.

 

-Inability to cope with any case of emergency.
 

A) Difficulties in Hospitals

 

Case # 1

Living with cockroaches

 

Yahia Mohammed Abu Saqer, 54, married with 3 children, a lieutenant in the Palestinian National Forces, Resident of Jabalya camp, block 40/50.

 

He told the PHRMG:

“I entered the hospital on 25 September 1999 suffering from pains in my testicles. Then the pain spread to my back and legs. They gave me 3 units of blood, but until now (date of testimony is 3 March 1999) they didn’t “discover” the reason for the pain and the swollen testicles. The only thing that they told me was that they wanted to move me to the surgery ward.

 

“As you can see, here in the hospital I live with cockroaches. They are everywhere -- in the closets, in the bathroom under and over the bed. They mainly come out at night. They didn’t change the bed-cover since the day I arrived. I even brought a pillow from the house!”

 

Case # 2

Medical Insurance in the Palestinian Autonomous Areas is Invalid

 

Many hospitals in the Palestinian Territories refuse to receive people who have medical insurance because the Ministry of Health in the PA owes these hospitals large sums of money.

 

“On Saturday 18 September 1999, a Palestinian police vehicle was involved in a road accident on the main Jerusalem-Ramallah street in which eight Palestinian policemen were injured. They were taken to Ramallah government hospital, where first aid was provided, but they were not hospitalized because there were no vacant beds. So they were referred to Khaled private hospital which refused to allow them in, because the Ministry of Health already owed them a lot of money. At the end and after long discussions, two of the injured policemen were received at al-Hilal hospital in Ramallah, and four others to Rafidia and al-Ittihad hospitals in Nablus. Taken in turn, as there was only one ambulance available that could only take two on each journey.”

 

From a letter written by the Deputy Director of the Palestinian police in Ramallah, addressed to the Minister of Health, published in al-Quds Arabic daily newspaper on 25 September 1999

 

This incident provides an explicit picture of the health situation in the PA areas, even though the injured people were members of the Palestinian police with medical insurance. Yet because of the debts owed to hospitals, they refused to receive them. The question is: How would the PA and its government hospitals react in the case of natural disaster, or the spread of an epidemic?
Case # 3

Perfect Irresponsibility

 

Hasan Aref Freihat, 65, married with 6 children, from al-Yamoun, Jenin, unemployed.

The family of the victim complained to the Jenin military headquarters and the Jenin police asking for an investigation into the circumstances surrounding the death of Hasan Freihat. The family accused the doctors and workers at Jenin government hospital of negligence and irresponsibility.

 

Iyad, one of the sons of the victim told the PHRMG the  following:

 

“On Thursday 10 June 1999 at about 5am my father fell down some stairs outside the house. We found him unconscious, so we took him to Jenin hospital, where they checked him and made some X-rays that showed he had a fracture in his skull, and he had high blood pressure. The oxygen machine in Jenin hospital didn’t work, so they decided to transfer him to Ramallah hospital.

 

“We waited 40 minutes for the ambulance, and when the driver of the ambulance came at last, he was holding a coffee in his hand and was completely careless. It took him more than 10 minutes to get going, after a fight broke out between the workers over who would accompany us to Ramallah.

 

“The ambulance was not equipped with the necessary facilities. The oxygen machine didn’t work, so my father had difficulty in breathing. Then after 17 minutes he passed away.

 

“They formed a committee to investigate the matter from the Ministry of Health, but a source from the ministry told us that there was no fault from their side. Until now we don’t know the result of the report of the committee. How long are things going to continue in this manner? Complete ignorance and irresponsibility, no facilities available, no skilled nurses, no qualified doctors, no respect or value for the lives of ordinary citizens.”

 

Case # 4

No Oxygen, No medication …No comment.

 

On Firday 3 September 1999 at about 9 am, Salah Arar, 37, who had had some heart problems in the past, complained from a pain in his heart, so his family took him to al-Watani hospital in Nablus. When he was led into the emergency room, there was only one oxygen machine available, so they took it off a woman and gave it to him. The doctor on duty then asked a nurse about a certain medication, but he replied that it wasn’t available. Salah’s brother, Imad, told the PHRMG, "They asked us to take him upstairs, but the lift was closed. We managed to open it, but it wasn’t working. My brother died then, simply because of carelessness, unavailability of equipment and medication."
B) Problems of Medical Staff and Personnel

 

The low salaries paid to medical staff in government hospitals and clinics in the Palestinian areas force many of them to leave their jobs, seeking better conditions. In 1999, 127 employees left the government public health services. There is also the medical ignorance of some of the staff in public health institutions, which makes the situation even worse. Carelessness and bad treatment are very common in those places. The refusal of treatment is another problem in these public health institutions.

 

Case # 1

Doctors “Forgot” a Bandage Inside A Woman’s Abdomen

 

 Hana’ Mahmoud Abdel-Rahman Jasser, 30 years, from Jabalya camp in Gaza Strip,

Told the PHRMG the following:

 

In June 1998, I entered al-Awdah Hospital, because there was a swelling and pain in my abdomen. They checked me up, and decided to perform surgery.  They removed my appendix, and returned my colon to its natural place. My health improved a bit after that. On 6 March1999 I entered al-Awdah Hospital again suffering from severe pains in my abdomen. They took X-rays and decided to perform another surgery to cut away the colitis. I stayed in hospital for one week after that, all the time suffering from pains in the abdomen.  I stayed in hospital for one week after that, all the time suffering from pains in the place of the operation. Then I went home on 13 March 1999.

 

After I left the hospital, the pains increased and my health deteriorated, so I went back to the hospital on 18 March 1999 in very bad condition. They told me that there was something blocking my intestines, so they had to do an operation for the third time. They took X-rays and repeated it again. My husband suspected that, so he followed the doctor and insisted to know what was going on. So the doctor told him that there was “a piece of cloth inside my abdomen” left there from the second operation. My husband took the X-ray and showed it to several doctors that he knew who told him the same thing, so he refused to make the surgical in al-Awdah hospital, that is administered by Dr, Rabah Muhanna. But they convinced him to stay there so that they would take the “strange object” inside my abdomen away. My husband insisted that Dr. Mahmoud al-Yazegi carry out the surgery, so he did on 19 March 1999.  I was in surgery 3 hours. It was very difficult.

 

The doctors discovered that it was true. The surgeon who had performed the colon operation had “forgotten” a piece of bandage inside. I remained in hospital for 11 days, during which time we received “excellent – extraordinary” treatment, although at first they refused to receive me until my husband brought them papers of medical insurance.

My health didn’t improve well until May. I was unable to carry out any household work for two months after that.

 

Case # 2

They used chemotherapy with no need.

 

“In mid-April 1999, I took my wife Iman to al-Shifa hospital (in Gaza) because she had a swelling in her neck. I took her to a surgeon who examined her and said that she needed to be seen by a specialist in tumefaction. Several doctors in al-Shifa hospital checked my wife and the result they came out with was that my wife had a malignant tumor (cancer).

 

“Then Dr. B.B. in al-Shifa hospital informed us that my wife needed to undergo chemotherapy, which she took for two months, four sessions in total, each of one hour, at al-Shifa hospital. But her situation didn’t improve or change. The swelling should have melted by the chemical medicine, but that didn’t happen. So I started to suspect the tests and identification of my wife’s case.

 

“I went to a private doctor who told me that the tumor needed a surgery before he could examine its nature. So he sent us back to al-Shifa hospital for the surgery. My wife’s health was very bad. There was no more resistance left in her body because of the use of the chemical treatment.

 

“At this stage I didn’t know whether to cry or laugh, because my wife, and all the family, suffered a lot when they told us the diagnosis (that she had cancer), and that she would require chemotherapy, especially that at the same time, as it was soon after the death of King Hussein of Jordan, and the whole atmosphere was bad. She started to loose her hair and feel very bad.”

 

Case # 3

Tonsillectomy causes death

 

 On 23 April 1999, Suzan Khattab a child of 3 years and 9 months, died in the Palestinian Red Crescent Hospital in Tulkarem, a few hours after she entered the hospital suffering from her tonsils. Suzan’s mother told the PHRMG:

 

“Within 10 minutes the doctor finished the surgery for Suzan (tonsillectomy – removing her tonsils) because they were so large for her age. He informed me to take the child to his clinic after few days. But Suzan didn’t awake after the surgery. Three doctors gathered around her but it was too late. One of the doctors said that this was, unfortunately, her fate. It is very simple, carelessness led to the death of my child.”

 

Case # 4

From Israel Yes, From the PA No!

 

The administration of al-Ahly Hospital in Hebron refused to admit an ex-prisoner (Omar al-Hasayeh, detained by the Palestinian Authority), although he was suffering very severe pains in his stomach, because the PA owed the hospital a big sum of money. The administration told his family, “You have to pay cash in advance, because the Authority doesn’t pay us. If it was from an Israeli hospital it would have been different.” Finally, a citizen who was present paid the sum of money from his own pocket.
CONCLUSIONS and RECOMMENDATIONS

 

This report has covered some cases that give examples of the carelessness of medical staff, the lack of qualified doctors and vital equipment, and the lack of proper medical care in general. In spite of the fact that five years have passed since the Palestinian Authority took over responsibility of health in the Territories, there are continuous problems and obstacles in the way of offering suitable medical care to the public. And so, hundreds of complaints have been filed about the medical services in the public institutions in the Palestinian areas. Therefore we demand that the Palestinian Authority:

 

1.Give this report the needed concern, and to plan careful expenditure of the budget on the health situation, especially since the Palestinian citizens pay their medical insurance, thus they deserve proper treatment.

 

2.Conduct careful monitoring and supervision on all hospitals (government and private).

 

3.Conduct investigations regarding serious complaints from individuals and human rights organisations, and make the necessary decisions regarding this subject.