Gender and Health in the occupied Palestinian territory 2023 – WHO Report

Executive Summary

Gender disparities in the health system of the occupied Palestinian territory (oPt) are exacerbated by social norms, gender discrimination, and gender roles, especially during humanitarian and health crises, such as the COVID-19 pandemic or escalations.

Although efforts have been made to integrate gender analysis into humanitarian response, the focus has largely remained on traditionally perceived “women’s issues” such as sexual reproductive health rights (SRHR) and genderbased violence (GBV). Challenging gender norms, promoting gender equality, and creating an inclusive health environment that specifically addresses the health needs of women, men, girls, and boys in all their diversity is critical to achieving sustainable progress.

Sociocultural norms in oPt may contribute to health disparities. For example, men are more likely to smoke due to societal norms and expectations, while women and girls may face mobility restrictions, which promotes a sedentary lifestyle and associated health problems. Health inequities are exacerbated by the ongoing Israeli occupation, Palestinian political fragmentation, the blockade of Gaza, restrictions on movement, and the implementation of the permit regime. The lack of basic necessities such as quality water and electricity in some areas further impacts people in precarious situations. However, gender roles can become fluid due to poverty and unemployment, which often increases the burden on women as they navigate patriarchal structures while taking on dual roles as providers and breadwinners for the family.

Examining the role of Health Cluster partners in delivering gender-responsive care reveals both challenges and opportunities. While gender policies exist, gaps remain in their implementation. Organizations often reduce the concept of gender to women’s issues and neglect its relevance to men and broader social constructs. Given the needs on the ground, gender equality principles are put into practice only sporadically and inconsistently.

The limited participation of women in policymaking needs to be addressed, with efforts to review policies, eliminate discriminatory laws, and strengthen accountability. The Palestinian Ministry of Health (MoH) has demonstrated welcome commitment, but comprehensive integration of gender analysis across all health sectors has yet to realised. Women are the majority in the nursing sector, but decision-making functions are predominantly performed by men. Disaggregating data by gender, age, and disability is critical to developing effective health programs.

Gender equity significantly influences health care service accessibility and quality. Discriminatory practices, high costs, and long waiting times often impede access to health care, especially for women affected by lower insurance rates and poverty. Mechanisms are in place to address violence against women and sexual harassment, but awareness among health care providers and those who use services remains limited. Integrating gender sensitivity into health care delivery, improving monitoring systems, and enhancing project funding are critical.

Prioritisation of short-term humanitarian interventions also affects the scope and volume of activities. Women’s right to accessible, nondiscriminatory, and quality sexual and reproductive health (SRH) care is often violated due to cultural norms and patriarchal authority, leading to problems such as early marriage, recurrent pregnancies, and blame for infertility. The decline in maternal mortality rates, high fertility rates, and the culture of shame surrounding sexual issues due to stigma are of concern. Access to family planning services is lower than the regional average due to supply constraints, inadequate resources, and financial constraints.

SRH projects should address women’s health needs beyond reproductive age and address the specific needs of single and postmenopausal women. It is critical to promote gender equality in contraceptive practices and raise awareness of SRH among male community members.

GBV significantly impacts health and well-being, a situation that was exacerbated by the COVID -19 pandemic. While the National Referral System and the Ministry of Health have made progress in providing specialised GBV services, problems such as stigma and discrimination, lack of consistent policy implementation, and limited clinical management for rape protocols persist. This underscores the urgent need for collaborative training of social and health care providers and improved infrastructure.

Stigma often discourages people with symptoms of mental disorders from seeking help. Men who seek help for mental health problems may be seen as less “manly” or less able to cope with stress and adversity. In many cases, women are seen as weak or unstable when they seek mental health services, which can have negative social consequences. Therefore, there is an urgent need to further reform the mental health care system, invest in resources and knowledge, and integrate mental health services into existing health facilities.

Emergencies disproportionately affect women and girls, exacerbating their mental and physical health problems and caregiving responsibilities. At such times, essential services such as obstetric care are often neglected. Cultural beliefs and social norms, such as the requirement for companions during medical visits, mobility restrictions, and the stigmatisation of certain diseases, further limit access to health care.

In summary, the interplay of gender, cultural norms, economic hardship, and emergency situations creates multiple barriers to health care in the oPt. Prioritizing gender, promoting mental health awareness, reducing stigma, and ensuring accessible services are urgently needed to improve health outcomes. To enhancing access to health care in oPt, a comprehensive approach is needed that challenges discriminatory practices, promotes gender equality, raises awareness of the importance of timely health care, and trains health care providers on inclusivity and sensitivity. Further legislative reforms, increased funding for gender-specific projects, improved SRH services, and increased awareness of mental health and related services are needed.