The Humanitarian Monitor: OPT (October-November 2012) – OCHA report

The Monthly Humanitarian Monitor

October-November 2012

However, no changes have been observed regarding the ongoing restrictions on the movement of people and goods to and from Gaza through the Israeli-controlled Erez and Kerem Shalom crossings.

The reporting period witnessed another major political development, which may have humanitarian consequences: on 29 November, the UN General Assembly upgraded the status of Palestine to a non-member observer state. As stated in the resolution, this is conceived as a step towards the realization of the two-state vision and the resolution of the Israeli-Palestinian conflict. However, Israel strongly opposed the decision. On 30 November, the Israeli government announced the construction of 3,000 new settlement housing units in the West Bank, as well as the advancement of the E1 settlement plan in the strategic area between East Jerusalem and the Ma’ale Adumim settlement. According to Peace Now, in 2012, prior to this announcement, there had been a threefold increase in the number of new settler housing units issued for tender, compared to 2011. Settlements are illegal under international law and have significant humanitarian consequences for Palestinian communities.

Settlement expansion may also exacerbate two problematic trends observed in the West Bank since the beginning of 2012 and accelerated during the reporting period: rising protests and clashes, and demolitions and displacement. The escalation in hostilities in Gaza triggered dozens of violent demonstrations in the West Bank, during which two Palestinians were killed and 690 others were injured. Since the start of the year a total of 2,865 Palestinians have been injured by Israeli forces in the West Bank, a 120 and 167 per cent increase compared to the equivalent periods in 2011 and 2010. Nearly 60 per cent of injuries in 2012 were due to tear gas inhalation.

Following an almost complete halt in September, during the reporting period the Israeli authorities demolished 117 Palestinian-owned structures in Area C and East Jerusalem, on the grounds of lack of building permits. There is concern that the approval of the E1 plan may expedite plans to transfer 20 Bedouin communities located within and next to the area designated for the plan, in contravention of international law.

Also following the UNGA resolution, senior Israeli officials announced the withholding of tax monies that Israel collects on behalf of the Palestinian Authority (PA). This is expected to further compound the financial crisis facing the PA. The impact is already being felt in the health sector; several of the East Jerusalem hospitals, major providers of referral health care for Palestinians in the oPt, have been forced to take extraordinary measures, such as releasing staff, reducing the number of admissions and curtailing services, because of the PA’s inability to pay its increasing debt to the hospitals.

Despite their negative repercussions, the major developments during the reporting period (the Gaza hostilities and the UNGA resolution on Palestine) have also generated valuable opportunities to address the root causes of humanitarian vulnerability in the oPt. The ceasefire understandings between Israel and Hamas provide a framework for progress towards a full lifting of the Gaza blockade. Similarly, the upgrading of Palestine’s status could serve as a starting point for the resumption of direct negotiations with Israel over a final status agreement, alongside a halt in settlement activities and demolition of Palestinian homes and livelihood-related structures, as well as the improvement of Palestinian access to land and resources in Area C.

ESCALATION IN HOSTILITIES IN GAZA AND

SOUTHERN ISRAEL: 14- 21 NOVEMBER 2012

On 14 November at approximately 1545 hrs, the Israeli Air Force (IAF) launched an airstrike that targeted and killed the acting chief of Hamas’ armed wing. This incident marked the opening of a large Israeli military offensive (‘Operation Pillar of Defense’) in Gaza and a significant increase in rocket firing by Palestinian armed groups into Israel. This escalation in hostilities lasted for eight days, during which the impact on civilians in Gaza and in southern Israel was considerable.

Background

The previous largest Israeli operation in Gaza was launched on 27 December 2008 (‘Operation Cast Lead’). While the violence ended on 18 January 2009, no agreement or understanding between the parties was concluded at that time; rather, Israel and the Palestinian armed groups unilaterally declared separate ceasefires.

Between the end of ‘Cast Lead’ and the start of ‘Pillar of Defense’, OCHA recorded an average of ten limited escalations in hostilities per year in Gaza, each of which lasted for an average of 2.5 days. The number of Palestinian casualties recorded each year suggests that the intensity of the escalations has been on the rise (see chart). However, while the proportion of Palestinian civilian casualties during this period has remained high, a decreasing trend can be observed, with the proportion of civilian deaths and injuries declining between 2009 and 2012 from 54 to 21 per cent and from 89 to 76 per cent, respectively. Notwithstanding the disruptive impact that Palestinian rocket fire had on the lives of Israeli civilians, the number of Israeli casualties during the period (2009-2012) has remained limited: four fatalities, including two civilians, and 73 injuries, including 55 civilians. 

From the beginning of October 2012 until the launching of the ‘Pillar of Defense’ military operation, there were four rounds of intensified violence, involving Palestinian rockets fire at various targets in southern Israel and Israeli incursions and airstrikes in Gaza. During this period a total of 23 Palestinians were killed, including seven civilians, of whom three were children; 93 other Palestinians, including 77 civilians, as well as 14 Israelis and foreign nationals in Israel, including eight civilians, were injured.1 Limited property damage was also recorded, mostly in Gaza.

Israeli attacks and resultant casualties: 14-21 November 2012

During the eight days of hostilities, Israel targeted over 1,500 sites throughout the Gaza Strip, in air strikes and, to a lesser extent, artillery fired from tanks and naval forces;2 unlike ‘Cast Lead’ operation, no ground incursion took place during the hostilities.

The main targets during the first two days of the offensive included sites used for the manufacturing and storage of weapons, rocket launching sites, training camps, and members of armed groups. From the third day (16 November) onwards, the scope of targeting expanded significantly to include governmental and police facilities, tunnels under the border with Egypt, and private residences. In a number of cases, Israeli official sources stated that residences targeted by the IAF belonged to members of Palestinian armed groups.  From the third day (16 November) onwards, the scope of targeting expanded significantly to include governmental and police facilities, tunnels under the border with Egypt, and private residences. In a number of cases, Israeli official sources stated that residences targeted by the IAF belonged to members of Palestinian armed groups. Members of the Protection Cluster documented 52 Israeli air strikes on residential properties; in at least 35 of these attacks the IAF reportedly dropped a smaller munition a few minutes prior to the main air strike or made phone calls warning people to leave. In a number of cases, Palestinians were reportedly killed or injured whilst trying to flee their properties following apparent ‘warnings’.

Overall, 165 Palestinians were killed in Israeli attacks, of whom 99 are believed to be civilians, including 33 children and 13 women.3 The Gaza Ministry of Health reports that 1,399 Palestinians were injured, the majority of whom are believed to be civilians. The increased targeting of sites located within populated areas as the days passed is reflected in the growing percentage of civilians among the overall death toll (see chart): by the second day of hostilities (15 Nov) civilians accounted for 40 per cent of reported fatalities but this rose to 60 per cent by 21 November.

The vulnerability of civilians in Gaza was exacerbated due to the almost total absence of basic protective measures, such as warning systems and bomb shelters – available to civilians in Israel.

Palestinian attacks and resultant casualties: 14-21 November 2012

During the eight days of hostilities, Palestinian armed factions fired 1,506 rockets towards Israel, according to the IDF spokesperson.4 The majority of rockets affected Israeli localities within a radius of 40 km from Gaza’s borders (including Beer Sheva, Ashdod, Ashqelon and Kiryat Malachi), with a few reaching farther areas near Tel Aviv and Jerusalem.

Of the total number of rockets launched, according to the IDF, 58 per cent (875) landed in open areas; 28 per cent (421) of the rockets were intercepted by the ‘Iron Dome’ anti-missile defense system; ten per cent (152) fell within the Gaza Strip; and 58, or less than four per cent, struck residential built up areas. Information released by Hamas’ military wing indicates that at least some of the rockets were targeted at Israeli military facilities.5

Overall, six Israelis were killed as a result of the rocket attacks, including three civilians, two soldiers and a civilian-military contractor, and 224 other were injured, the vast majority of whom are reportedly civilians. Additionally, information collected by human rights organizations suggests that up to six Palestinian civilians, including one woman and three children, may have been killed by Palestinian rockets falling short within Gaza.

The almost uninterrupted firing of projectiles into southern Israel severely disrupted the lives of about one million Israelis living within the 40 km, radius and placed many people at serious risk. The limited number of civilian fatalities in Israel is explained, primarily, by the protective measures implemented by the Israeli authorities in the affected areas, including the ‘Iron Dome’ system, the availability of bomb shelters in almost every residence, and an effective alarm system.

Displacement

During the period of hostilities, tens of thousands of Palestinians in Gaza are believed to have fled their homes in search of safety, mostly with relatives and friends. Displacement peaked on 20 November when the IAF dropped leaflets in several areas in the northern parts of the Gaza Strip, calling on all residents to leave their area immediately. By 20 November, approximately 12,000 people had sought shelter in 14 schools in northern and central Gaza.

While the majority of the displaced, including all those accommodated in schools, returned home immediately after the ceasefire, approximately 15,000 people were estimated to still be residing with host families during the following week. As of 5 December, the number of people still displaced was estimated at approximately 3,000, primarily those whose homes had been destroyed or severely damaged.

Many Israelis in southern Israel also fled their homes during the period of hostilities to other parts of the country and are believed to have returned home upon the declaration of the ceasefire.

Damage to housing and infrastructure

Preliminary assessments indicate that some 450 houses (including structures with single and multiple housing units) in Gaza were totally destroyed or severely damaged as a result of the Israeli military offensive, displacing most of their residents; an estimated 8,000 houses sustained minor damage.

Despite the intensity of the Israeli bombardment, the scope and gravity of damage to public infrastructure supporting the provision of basic services across the Gaza Strip remained relatively limited:

Additional public infrastructure damaged during Israeli attacks includes two bridges, a number of mosques, universities, media and research centers and sports facilities, and several government buildings.

Israeli media sources have reported that 80 housing units in southern Israel were destroyed or severely damaged by rockets, displacing their residents

INTERNATIONAL LAW

AND ACCOUNTABILITY

The escalation in violence in Gaza and southern Israel triggered serious concerns with regard to the respect by all parties for international humanitarian and human rights law in their conduct of hostilities. The main concerns raised regarding the Israeli armed forces related to adherence to the principles of proportionality, precaution and effective warning in attacks, and distinction between military and civilian objects. Protection Cluster members are documenting incidents that resulted in civilian casualties and destruction of civilian property, as well as assisting victims to seek accountability and access to an effective remedy. With respect to Palestinian armed groups, there were concerns related to the targeting of Israeli civilians, the use of indiscriminate weapons, and the firing of rockets from densely populated areas; reports about summary executions of suspected collaborators in Gaza are also of serious concern.

Humanitarian response

The escalation in hostilities exacerbated an already precarious humanitarian situation, illustrated by the fact that 80 per cent of Gazan families were already receiving some type of humanitarian aid. Over the eight days of hostilities and despite the security risks, UN agencies continued working to ensure, to the extent possible, that beneficiaries received their regular assistance and accessed essential services. For example, UNRWA and the World Food Programme (WFP) continued their regular food distribution cycles, which target a total of 1,085,000 beneficiaries; UNRWA health clinics remained operational, except for those damaged, and the World Health Organization (WHO) continued facilitating the delivery of essential drugs and disposables to public hospitals.

During the hostilities and in the immediate aftermath UN agencies, NGOs and international organizations also responded to the most urgent humanitarian needs resulting from the hostilities. This included:

Within 48 hours of the ceasefire, OCHA launched an Inter-cluster Initial Rapid Assessment (IRA), which was completed by 28 November. UNRWA also conducted an assessment to identify the priority needs of the refugee population. These complementary assessments were designed to gain an overall picture of the humanitarian situation resulting from the hostilities; to guide an immediate humanitarian response; and, where appropriate, to inform more in-depth assessments. A joint methodology and questionnaire was agreed upon beforehand to ensure a uniform approach.6

Addressing the immediate shelter and other needs of those displaced who require international assistance emerged as one of the key priorities in the coming weeks. Additional priority activities include ongoing provision of psychosocial support for children; ongoing clearance of and raising awareness of the risks of ERW; addressing critical shortages in essential drugs and medical disposables (many of which pre-dated the current escalation but were exacerbated during this period); and rehabilitation of damaged residences, schools, and productive assets.

The specific timing of the events posed a challenge in terms of financing the humanitarian response; the 2012 CAP is about to expire and the 2013 CAP is already finalized. Based on the findings of the assessments and taking into account existing stocks under the inter-agency contingency plan for Gaza, OCHA coordinated a rapid review of the 2012 and 2013 CAPs:

1. A rapid review of the 2012 CAP identified specific projects that are relevant to the identified needs and response and are currently unfunded or only partially funded. Together with one additional project in the area of health, the total funding requirements amount to $12-13 million.

2. A review of the 2013 CAP identified relevant Gaza projects that will need a cost revision due to the projected increase in caseload or other parameters. The revised cost of these projects is estimated to be between $60-70 million. Early funding for proposed 2013 project will be crucial to allow partners to step-up the immediate response.

In addition to requested requirements under the CAP 2012, UNRWA requires $17.7 million to respond to the most urgent needs of refugees in Gaza affected by the recent escalation in violence. This figure will cover the most urgent needs in food, refugee shelter repairs, NFIs, health and repairs to UNRWA installations.

CEASEFIRE UNDERSTANDINGS RESULT IN IMPROVED

ACCESS TO FISHING AND FARMING AREAS

No change regarding restrictions on the movement of people and goods  

As part of the 21 November ceasefire between Hamas (along with other armed groups) and Israel, access to the sea and to the restricted areas near the fence separating Gaza and Israel has been eased. However, no changes have been observed so far regarding the ongoing restrictions on the movement of people and goods to and from Gaza through the Israeli-controlled Erez and Kerem Shalom crossings.

The text of the ‘Cease-Fire Understandings’ released by Egypt calls for, “opening the crossings and facilitating the movements of people and transfer of goods, and refraining from restricting residents’ free movements and targeting residents in border areas,” stating that, ”procedures of implementation” would be negotiated 24 hours after the start of the ceasefire.

Shortly after the announcement of the cease-fire, Gaza fishermen began sailing up to six nautical miles (NM) from shore and the Israeli Navy subsequently moved the sea buoys marking the open areas to the new six NM limit.7 According to the Oslo Accords, Palestinian fisherman should have access up to 20 NM off the Gazan coast. This area had been progressively reduced; a limit of 3 NM had been enforced since December 2008, devastating the livelihoods of Gazan fishermen. While the recent expansion of the accessible area in the sea is a positive step, according to FAO, the significant recovery of the fishing sector would require access to areas up to at least 12NM. This would increase the fishing catch by an estimated 65 per cent and allow fishermen to exploit high value bottom fish. The fishing industry is currently the main source of livelihood for over 3,000 Gazan families.

There has also been an easing of restrictions on Palestinians’ access to land adjacent to the fence between Gaza and Israel. The Israeli military has verbally indicated to OCHA that Palestinian access to areas within 300 meters from the fence remains restricted, except for farmers, who are allowed to access up to 100 meters from the fence.8 However, it remains unclear how the Israeli military intends to enforce the new regime, particularly regarding the distinction between farmers and other Palestinian civilians. Prior to this, farmland located within 500 meters from the perimeter fence was totally inaccessible, and access to areas up to 1,500 meters from the fence remained risky due to frequent ‘warning shots’ fired by the Israeli army. Approximately 19,800 dunums, or one-third of Gaza’s agricultural land is located in the previously access restricted areas, with farmers losing an estimated 75,000 metric tonnes of produce each year as result of limited access. If the current restrictions on the transfer of commercial goods to the West Bank and Israel are also lifted, the potential impact of the recent easing on the access to land could be significant in increasing livelihood opportunities for Palestinian farmers.

By contrast, there has been no easing of pre-existing constraints on the movement of people and goods. While the volume of imports at the single crossing for commodities (Kerem Shalom) has returned to levels recorded prior to the escalation, this represents only a small portion of the imports recorded prior to the blockade. The import of basic construction materials remains restricted to international organizations implementing projects that have been approved by the PA and Israel. However, the approval process is costly, complex and lengthy and thus impedes the ability of international organizations to address urgent needs. Similarly, while four truckloads of agricultural produce were permitted to exit Gaza for export abroad in November, there has been no easing of the long-standing ban on the transfer of commercial goods from Gaza to the West Bank and Israel.

The movement of people to and from Gaza via the Erez and Rafah crossings is subject to the same restrictions as those prior to the escalation in hostilities. Access through the Erez crossing remains restricted to a limited number of humanitarian cases and businessmen with pre-approved permits. In 2012, an average of less than 200 permitted Palestinians and internationals passed through the Erez crossing each day, compared to an average of 26,000 per day in 2000, before the beginning of the second Intifada. Male travelers between the ages of 14 and 40 also face difficulties in travelling through the Rafah crossing due to Egyptian security clearance procedures; in November, over 1,000 travelers were denied entry to Egypt on security grounds.

Given the ongoing restrictions on the movement of goods into Gaza via the single land crossing (Kerem Shalom), the tunnels underneath the border between Egypt and Gaza remain a critical lifeline for the Gazan population, particularly for restricted construction materials and fuel. Dozens of tunnels sustained significant damage in Israeli airstrikes during the escalation in hostilities. However, following repairs performed since the ceasefire, activities have resumed, reportedly reaching 80 per cent of the level observed prior to the escalation.

While the easing of access to fishing and farming areas has been a positive step, the ceasefire understandings provide an opportunity for progress towards a full lifting of the blockade on Gaza, in line with international humanitarian law. While Israel has legitimate security concerns, it also has an obligation to ensure that the people of Gaza can maintain a normal life, access health, education and livelihood opportunities, and are able to travel to engage in cultural, educational, commercial and social life.

GAZA EVENTS TRIGGER WIDESPREAD PROTESTS

AND CLASHES ACROSS THE WEST BANK

Following an upward trend, the number of injuries reaches an historical record

The Israeli military offensive in the Gaza strip, launched on 14 November, triggered dozens of protests across the West Bank, mostly in the vicinity of Israeli military posts and checkpoints. The majority of these protests evolved into violent clashes, during which demonstrators threw stones at Israeli forces and the latter responded by firing tear gas canisters, rubber-coated metal bullets and, in some cases, live ammunition. As a result, two Palestinians were killed and almost 700 other demonstrators, alongside four members of Israeli forces, were injured.

One of the fatalities occurred on 17 November in An Nabi Saleh village (Ramallah), when an Israeli soldier fired live ammunition at a 29 year old demonstrator.The demonstrator was injured, and died of his wounds two days later. Eyewitnesses reported that the man was shot from a distance of approximately 10 meters. Demonstrations in this village take place on a weekly basis to protest against the expansion of the nearby Halamish settlement  onto the village’s land. The second fatality was a 22 year-old man who, on 19 November, was shot with live ammunition by Israeli soldiers during clashes in Hebron City; according to Israeli sources the man attempted to stab a soldier. Both incidents triggered the opening of criminal investigations by the Israeli Military Police, which are ongoing. Following a policy change introduced in 2011, such investigations are automatically opened into cases resulting in the killing of Palestinian civilians in the West Bank.

The demonstrations and ensuing clashes in the context of the protests against the Gaza offensive resulted in the injury of 690 Palestinians. About half of the injuries occurred in a series of protests held at two sites: next to Rachel’s Tomb in Bethlehem (185 injuries), and in Hebron City (147 injuries). Other locations recording large numbers of injuries include Huwwara checkpoint south of Nablus city, Beituniya checkpoint west of Ramallah city, the eastern entrance to Qalqiliya city, Qalandiya checkpoint north of Jerusalem, and various sites inside the Old City of East Jerusalem. Approximately half of those injured were treated for tear gas inhalation; about a third were wounded by rubber-coated metal bullets, and the remainder  were injured after being physically assaulted, or hit by live ammunition or tear gas canisters.

Gaza-related clashes bring the total number of Palestinian injuries recorded in November 2012 in the West Bank to 733, and to 2,865 since the beginning of 2012. November marked the highest number of injuries recorded in a single month since OCHA began recording conflict-related casualties in a database, in January 2005. Similarly this month’s occurrences, most peaks in Palestinian injuries were recorded in months that witnessed one/a few days of intense clashes (see chart below).

A multiyear perspective suggests that November’s peak follows a consistently increasing trend in Palestinian injuries by Israeli forces, with the total number recorded in the first 11 months of 2012 representing over a three-fold increase, compared to the equivalent figure for the whole of 2009 (see chart below).

Another feature of this month’s clashes is the large number of people treated due to tear gas inhalation. This, too, seems to reflect Israeli forces’ increasing use of tear gas, as the main crowd-control method during demonstrations, at the expense of rubber-coated metal bullets, live ammunition, physical assault and other means. While in 2009 only six per cent of all recorded injuries were caused by tear gas inhalation, this percentage increased to 21 in 2010, to 35 in 2011, and to 56 per cent in 2012.

DEMOLITIONS AND DISPLACEMENT IN AREA C

AND EAST JERUSALEM RESUME

Communities in ‘firing zone’ amongst the worst affected

Following an almost complete halt in September, in mid-October the Israeli authorities resumed the demolition of Palestinian-owned structures on the grounds of lack of building permits.

The authority for planning and zoning in Area C lies with the Israeli Civil Administration (ICA), which is responsible for the issuance of building permits and for the demolitions of structures built without such permits. The existence of a valid master plan (officially referred to as a ‘Special Partial Outline Plan’) is considered by the ICA as a pre-condition for the issuance of building permits. However, of the 270 communities located entirely or mostly in Area C,9 only 46 (17 per cent) have a valid master plan. The population of these communities is estimated at 37,000, or 57 percent of the total population of the 270 communities. Typically, the existing master plans only cover the current built up area of the communities, leaving little space for development. 10 In total, the combined area of all these valid master plans is less than 20,000 dunums, or less than one per cent of Area C.

Between mid-October and the end of November, a total of 117 residential and livelihood-related structures were demolished due to lack of building permits, including 109 in Area C and 8 in East Jerusalem. Over a third of the structures demolished (42) were residential, displacing 175 people, more than half of whom were children. The remainder of the structures were livelihoods-related, including water cisterns, animal shelters and agricultural rooms, and impacted up to 450 people.

These demolitions bring the total number of structures demolished and people displaced in these circumstances since the beginning of 2012 to 577 and 853 respectively, a slight decrease compared to the equivalent period in 2011 (605 and 994).

Communities located in areas designated by the Israeli authorities as “firing zones” for military training, which cover about 18 per cent of the West Bank, are amongst the most vulnerable in Area C. There are approximately 5,000 Palestinians residing in 38 communities located in firing zones. One such community, Ibziq in the northern Jordan Valley, was among the most affected by demolitions during the reporting period, with 52 structures demolished and 127 people displaced as a result. Moreover, this and other communities in the same area (including Khirbet Tana, Hamamat el Maleh, Khirbet Ar Ras al Ahmar and Humsa), were further affected during November due to a military training exercise carried out by the Israeli army. Following the issuance of evacuation orders, about 100 families were displaced from their homes for one day, for the duration of the exercise.

The lack of adequate planning and zoning by the ICA, compounded by the designation of large areas as ‘firing zones’, are among the main drivers of vulnerability and humanitarian need among many Palestinian communities in Area C.

EAST JERUSALEM HOSPITALS FACE A SEVERE

FINANCIAL CRISIS IMPACTING SERVICE DELIVERY

The unpaid debt by the Palestinian Authority is the primary trigger

Unprecedented financial crisis is undermining the delivery of health services by the six East Jerusalem Hospitals (EJHs), which are major providers of referral health care for Palestinians in the oPt

The World Health Organization reports that an unprecedented financial crisis is undermining the delivery of health services by the six East Jerusalem Hospitals (EJHs), which are major providers of referral health care for Palestinians in the oPt. The crisis is a result of the Palestinian Authority’s (PA) failure to pay for patient care; the PA owes over NIS 85 million as of the end of November2012. The Palestinian Ministry of Health (MOH) refers to these hospitals more than 20,000 patients from the West Bank and Gaza, who need specialized services and procedures unavailable elsewhere in the oPt.

The financial crisis has affected all six EJH – Princess Basma Rehabilitation Center, Augusta Victoria Hospital, Maqassed Hospital, St. John Eye Hospital, St. Joseph Hospital, and the Palestinian Red Crescent Society Hospital. However, more than half of the PA’s debt is owed to a single hospital, Augusta Victoria. This hospital specializes in oncology and kidney dialysis: 70 per cent of all oncology cases from Gaza and 40 per cent from the West Bank, primarily breast, colon and blood cancers, are referred to Augusta Victoria for chemotherapy and radiotherapy..

Augusta Victoria’s Director, Dr. Tawfiq Nasser, reported that most chemotherapy and pre-chemotherapy drugs are at zero stock and suppliers are not resupplying due to unpaid bills. The drug shortages due to lack of funds mostly affect breast cancer patients, who represent 60 per cent of oncology cases at the hospital. If one drug is lacking from the chemotherapy treatment regimen, their response rate will drop precipitously and negatively impact the outcome of treatment. The hospital is trying to cope by limiting drug procurement to the highest priority items, but cancer treatment is costly; for example, patients on Herceptin need weekly doses for one year, at a cost of NIS 9000 per dose.

According to Dr. Nasser, “If the crisis continues we will not be able to accept any new patients, or pay our employees’ salaries.” The PA had previously agreed to make monthly payments but has been unable to do so; the last payment received was a transfer, in early September, of NIS 7 million, about 10 per cent of what is owed to Augusta Victoria. The PA, in turn, is looking for donor funding to be re-established at levels that will allow it to fund these basic services.

In order to maintain their operations, all hospitals are reviewing running costs, including staff levels, to find reductions. Some hospitals have already taken extraordinary measures such as releasing staff, reducing the number of admissions and curtailing services. Some patients who have turned up for appointed surgeries or treatment have had appointments rescheduled because of the lack of drugs needed for their treatment.

The EJH have played a critical role in providing health services to the Palestinian people for decades, especially for the poor. In addition to patients referred by the MOH, 20 per cent of the patients who access care at the EJHs are social cases without insurance or sufficient resources.