Health Inforum News
Volume 2, No.32, 1 August 2003
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Welcome to the twenty-second edition of the Health Inforum Newsletter.
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In this Issue:
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Minister of Health appeals to insure access for health services
Minister of Health Dr. Kamal Al-Sharafi appeals to World Health Organization, International Red Cross and International Red Crescent to insure free access for ambulances, health workers and patients to health services.
Dr. Al-Sharafi mentioned that Israeli’s prevented the referral of 30 chronic patients form Gaza to East Jerusalem and West Bank hospitals, he added that checkpoints and closures in West Bank still delay health workers to arrive on time to their hospitals and primary health care departments which affect health services very badly.
Dr. Al-Sharafi himself and his Deputy Dr. Munther Al-Sharif were delayed on Qlqiqlya Checkpoint for 75 minutes on August 3, 2003.
Health Under Siege1
Joint Expedition of the World Health Organization, UN Agencies, and Human Rights Organizations Points to Severe Impact of Closures on Health, Sanitary Conditions and Environment in Two Villages East of Nablus.
Location:
Deir Al Hatab and Salem, eastern outskirts of Nablus,
Participating organizations:
World Health Organization (WHO), Health Inforum, OCHA (UN Office for Coordination of Humanitarian Affairs), UNFPA (UN Population Fund), UNICEF (UN Children Fund), UNRWA (UN Relief and Works Agency), Physicians for Human Rights-Israel, MachsomWatch
Testimonies provided by:
Dr. Barkat Allawneh of the Ministry of Health clinic, newly opened in March 2003 at Deir Al Hatab; Dr. Ibrahim Mubarak of the Union of Health Work Committees clinic at Salem; Patients who were mistreated while trying to access medical care and residents whose relatives had lost their lives due to restrictions on movement; local residents who described the state of the water supply and indicated the obstacles placed around the villages.
Access to Health Services at Nablus:
October 2002-March 2003
The three villages Deir Al Hatab, Azmut and Salem are on the eastern outskirts of Nablus, some 5-7 kilometers from the city center.
Since the last quarter of 2002 two deep trenches were dug by the Israeli army around the three villages totally preventing access of both pedestrians and vehicles to Nablus or to manned army checkpoints leading to the city. A petition was submitted to the Israeli High Court of Justice (by Physicians for Human Rights-Israel and the Association for Civil Rights in Israel) demanding that access be ensured for residents.
One primary healthcare clinic existed in Salem, to serve all three villages, manned by one general doctor and two nurses. Secondary and tertiary care, available only in Nablus, was virtually denied due to these restrictions.
March 2003-July 2003
In the course of April part of one trench was repaired, and later replaced by an iron gate at the Azmout Junction, monitored by soldiers at all times. In July, a dirt track was opened to the south of the villages, leading to Beit Fouriq checkpoint – a fully staffed army checkpoint which also monitors passage between Nablus and the villages of Beit Fouriq and Beit Dajjan.
Access via checkpoint:
At Azmout Junction sporadic passage of merchandise is possible, but passage of residents into Nablus is denied and they are diverted to Beit Fouriq checkpoint.
Beit Fouriq checkpoint is heavily monitored by soldiers, and overloaded at all times by residents requesting passage in both directions.
Vehicular passage is forbidden, and vehicles, including ambulances, perform back-to-back unloading. In exceptional cases ambulances are permitted passage, but prior coordination is necessary.
Pedestrian passage: all women, and males under 15 years or over 35 years are permitted passage provided they present documentation to justify their passage to the soldiers' satisfaction. Males aged 15-35 are not permitted passage, since army regulations now demand that they procure a permit from the Israeli District Coordination Office (DCO) at Hawwara. Since Hawarra is inaccessible to the residents, such permits are not issued. During our visit, some 50 pedestrians were waiting for several hours in the sun, in 35 degrees centigrade, with no protection, for soldiers to interrogate them and decide whether or not to permit their passage into the villages.
Residents attempting to bypass the checkpoint through the fields are in danger of being shot. Dr. Barkat mentioned one resident who was shot in the hand last week while trying to cross over from Salem.
In March, due to the ongoing restrictions of movement, the clinic at Deir Al Hatab was opened by the Ministry of Health, in order to provide primary health care and follow-up for chronic patients unable to access Nablus.
Sample Cases:
January 8 2003. At 7pm, Azzam Azzam, a pharmacist from Deir al Hatab, had symptoms of a myocardial infarction (heart attack). He called the local doctor, who immediately ordered an ambulance. In the meanwhile he took him in his own car up to the trench dividing the village from the access road to Nablus. The trench was overflowing with sewage and rain and was impassable. Soldiers stationed there refused to allow them to exit the car until the ambulance arrived, and threatened to shoot them.
The ambulance arrived only 2 hours later, at 9pm, due to delays at other checkpoints. the doctor and other relatives attempted to find a way of carrying the patient across the trench to the ambulance, but failed. The ambulance driver finally succeeded in crossing the trench on foot, at 10pm, but by then the patient had died.
February 26 2003. S.A., from Salem, was nine months pregnant when she felt her first contractions. She set out in her uncle's car to attempt to reach Rafidya hospital in Nablus. When they reached the trench at Azmut junction they saw it was full of water. They tried to use a tractor in order to cross the trench but it almost overturned. They then tried to place a ladder across the trench and to crawl over it, but failed. In the end she walked across the fields, up to her hips in mud.
It took her close to four hours to reach the road and find a car to take her into Nablus. On their way they were delayed many times at different checkpoints. In was cold and raining. Altogether it took her 8 hours until she reached the hospital, usually just a ten-minute drive away. Her son was born safely in the hospital.
May 2003. G.D. from Deir al Hatab had a miscarriage and began hemorrhaging badly. She attempted to cross Azmout checkpoint but was delayed for several hours, despite the fact that an ambulance was waiting for her on the other side. When her passage was finally permitted, she had lost large amounts of blood, and her recovery at the hospital took several months.
May 2003. D.A., an 80-year-old woman from Salem attempted to return from Nablus to her home accompanied by two young men. While they were trying to cross Azmout junction, they saw soldiers coming towards them. The men escaped, and since then no trace of the woman was to be found. She was searched for in all regions except for that immediately adjacent to the junction, due to the constant prohibition by soldiers. Only 35 days later the remains of her body were found, mauled and eaten by stray dogs.
Sanitary Conditions and Environment:
There is no garbage disposal site within the precincts of the three villages, since in the past waste was dumped on the outskirts of Nablus.
For this reason large accumulations of waste were recorded during the visit, and large numbers of insects, pests, and rats were reported as well as unpleasant odors. Moreover, large packs of stray dogs were seen roaming both among the garbage and freely in the fields. The dogs are not vaccinated or supervised and pose a health hazard, as well as direct physical danger to the residents. The trench, although dry during the dry season, was not cleaned after being flooded by sewage and rain during the rainy season, and may be expected to be once again filled with polluted water when the rains begin – posing a severe sanitary hazard, and a nesting ground for insects and bacteria. According to Dr. Barkat, a sharp increase in Hepatitis A was recorded in the second half of 2002 as a result of sanitary conditions.
Water: residents testified that the water supply to the residents of Salem living on higher altitudes was stopped by the Israeli national water company , Mekorot, each year for the past 3 years, in the summer months (May to September), and diverted to the nearby settlement of Elon Moreh. Residents are obliged to buy water or subsist from rain reservoirs – finite and sometimes undrinkable sources.
Conclusion:
The expedition confirmed our suspicions that the impact of the recent opening of an access route to the staffed army checkpoint at Beit Fouriq is superficial and has not brought about a significant improvement in access of residents to healthcare and other daily needs in Nablus. Access to health is still severely curtailed. We note at this opportunity that these restrictions are implemented, not on passage into Israel, but on passage from three small neighborhoods on the outskirts of Nablus, into the city on which they depend for most essential services. In effect, the residents of these villages are imprisoned in their homes. We request that daily routine access of residents be ensured, and that restrictions on access to health be lifted. Moreover, we warn that the impact of the environmental situation in this region may pose a severe health hazard over a widespread area if not addressed immediately.
Access & Health Incidents
PRCS Health Incidents 12 July –1 August 2003
Jenin 12 July 2003 (14:30): Israeli soldiers at the Jannat checkpoint, which controls access to Jenin, stopped a PRCS ambulance on its way to the Ya’bad station. Israeli soldiers searched the ambulance and the crew and arrested one of the EMS medics at gunpoint, tying his hands behind his back and forcing him to sit on the ground next to the tank. As of this writing, the medic is still in detention.
Tubas 12 July 2003 (11:40): A PRCS ambulance transporting a patient from the Nablus EMS station to the village of Sadet Qarara was stopped by an Israeli jeep at the Sadet Qarara intersection. The crew was ordered to stay in the ambulance as the soldiers inspected their IDs and license. Twenty minutes later, the soldiers returned the IDs and the license but issued two fines without giving any explanation.
Jericho 17 July 2003 (10:15): A PRCS ambulance transporting two patients to Al-Maqassed Hospital and St. John’s Ophthalmic Hospital, both in Jerusalem, was stopped by Israeli soldiers at the Za’em checkpoint. The soldiers demanded to see the crew’s and the patients’ IDs and the letter’s referral slips. One of the patients was not carrying a referral slip, but had an appointment card for the Ophthalmic Hospital. After waiting for one half hour, the soldiers told the crew that they would be granted permission to cross the checkpoint. Forty-five minutes and still waiting, the soldiers changed their minds. They ordered the crew to turn back using threatening language. In total, the ambulance was detained for 75 minutes.
Nablus 19 July 2003 (08:05): Israeli soldiers at the Al Ram checkpoint ( south of Ramallah) stopped a PRCS ambulance from the Nablus EMS station on its way to transport three patients to Jerusalem. The soldiers initially denied access to the ambulance but after ICRC coordination, only allowed one of the three patients permission to cross the checkpoint. The other two patients were denied permission and were obliged to return to Nablus.
Jenin, 26 July 2003 (9:30): A PRCS ambulance was on its way to Nablus transporting several patients to hospital. At the Shafi Shamron checkpoint, Israeli soldiers took the crews’ and the patients’ IDs. One of the patients, a nine-year-old girl suffering from an acute case of kidney malfunction, started crying, but the soldiers refused to return the IDs and the ambulance was detained for three hours before finally being allowed to pass.
Jericho, 28 July 2003 (14:50): A PRCS ambulance from the Jericho EMS station was on its way back after having transferred over a female patient to a second PRCS ambulance from the Nablus EMS station. At the Nwaemeh checkpoint, on the northern entrance to the town of Jericho, a soldier started to shout at the crew, brandishing his rifle and ordering them to move further back from the checkpoint. The driver complied, but the soldier did not consider that the ambulance driver had driven back far enough and started shouting again and banging on the right door of the ambulance with his rifle. The ambulance was eventually permitted to pass after intervention from the army officer in charge.
Hebron, 29 July 2003 (10:25): A PRCS ambulance was on its way back to Hebron after having transported a patient to a hospital in Jerusalem when it was stopped by an Israeli border police jeep at Beit Omar. The policemen checked the medics’ IDs and ordered the driver to open the ambulance’ door. The driver was answering questions about the patient who had been admitted to hospital when one of the policemen started hitting him in the face. The other policemen stopped him, but he continued insulting and threatening the driver.
In addition to the above, the following table lists incidents of delay of access during this reporting period.
Care International Deliveries of Medicines
USAID through Care International has delivered the following medical kits for the period 19-25 July ,03. The following table shows deliveries of Medical Kits & Pharmaceuticals from July 19th to July 25th, 2003.
Union of Health Care Committees (UHCC’s) Activities (Medical Days),
1/1/2003 – 30/6/2003
Through coordination with different Palestinian civil societies UHCC conducted 60 voluntary medical days in the northern districts of the West Bank. Those days covered 46 locations in the cities, villages, & camps. 322 health workers participated in those days including doctors, nurses, & paramedics, in addition to 292 volunteers.
During the different medical days 11665 were seen & given the proper treatment. 1292 of the cases were referred for specialized medical centers & hospitals for medical follow-ups. 243 of Al-Aqsa Intifada injured or wounded were examined. 102 of them were referred to our Al- Amal Physiotherapy Centers in the northern districts along other specialized medical centers for medical follow-ups & rehabilitation.
The voluntary medical days included many specialties starting from orthopedics, gynecology, GP, ophthalmology, pediatrics, cardiology, internist, to diabetic care & many others. Our medical statistics showed major prevalence for chronic diseases such as hypertension, heart diseases, diabetes, osteoporosis, anemia in women, & dental problems in children in villages, besides ophthalmic problems.
All this made us see the need for intensifying the medical days & expanding its geographical zone so that it can reach all remote areas or villages. Our small help would lessen some of the peoples’ health problems particularly nowadays, days of Israeli siege & closures that forbid people or patients from getting to the medical centers & hospitals in the cities.
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FOR MORE INFORMATION_________________________________________________________________________________________________
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1 Physicians for Human rights report -Israel
Document Sources: World Health Organization (WHO)
Subject: Health, Humanitarian relief, Incidents
Publication Date: 01/08/2003