Healthcare in the State of Palestine
[6] This article addresses each of these issues in more explanatory detail, giving an overview of the major legal and ethical developments in healthcare within the Palestinian territories, and discussing further obstacles that the region faces due to infrastructural and political barriers.
[8] Between 1993 and 1995, the State of Israel and the Palestine Liberation Organization (PLO) reached a series of pacts collectively known as the Oslo Accords.
[10] The accords transferred jurisdiction over Palestinians living in the Gaza Strip and the West Bank from Israel to the PNA, whose charter calls for the creation of a democratically elected Legislative Council that could write laws pertaining to the economic, security, educational and health care needs of Gaza and West Bank Palestinians.
[11] During this time, HDCA's work was greatly supported by three other major sources of health care: Non-governmental organizations, the UN, and the private sector.
Shortly after Oslo I and the corresponding transfer of jurisdiction, the PNA established a Ministry of Health (MOH) to administrate healthcare in Gaza and the West Bank.
[15] Importantly, the law requires the MOH to offer certain types of health services to Palestinians including preventative, diagnostic, curative, rehabilitative and emergency care.
Palestinian Non-Governmental Organizations (NGOs) bankrolled by private benefactors encompass a sizable portion of the health care economy in the PNA.
Such praise has been met with severe criticism by human rights organizations, citing Article 56 of the Fourth Geneva Convention, which states that "the Occupying Power has the duty of ensuring and maintaining, with the cooperation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory, with particular reference to the adoption and application of the prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics."
Additional contributors to poor health include a large prevalence (38%) of men who smoke, and that 75% of Palestinians who do not engage in any vigorous physical activity at all.
The limited mobility has even more serious ramifications in emergency situations wherein ambulances traveling in between West Bank towns experience delays.
Hamas claims that Israel has severely obstructed the flow of goods to that region since 2007, preventing the importation of essential medical equipment and prescription drugs.
In recent years, periodic battles between Hamas militants and the Israeli Military have resulted in much damage to the medical infrastructure in Gaza which cannot be readily repaired due to limitations on the amounts of construction material being imported to the region.
[31] Additionally, Palestinian officials maintain that the quality of health care professionals in Gaza has been hampered as they are often not permitted to travel abroad to conventions and training sessions where they can advance their skills and knowledge.
It is important to note that the PNA believes that the future policies inherent in its National Health Strategy also apply to Gazans, in spite of Hamas' de facto control of the region.
However, the National Health Strategy makes no mention of the refugees living in Jordan, Lebanon and Syria as the Oslo Accords maintain these individuals under UNRWA jurisdiction until final negotiations can determine their status.
The PNA has identified government expenditure on health care to be unsustainable in the long term absent alterations in financing mechanisms.
Approximately 30.5% of those enjoying health care provisions from the government do not currently pay into the system, causing the PNA to incur debt or rely on donations to cover the difference.
In response, the PNA is currently considering adopting a single-payer health care system whereby all Palestinian residents under its de facto jurisdiction will be mandated to purchase insurance from the government.
To meet the new demands that universal coverage would place on the system, the PNA will first have to make substantial investments in the MOH's administrative capabilities.
[39] With $86 million in assistance from the United States Agency for International Development (USAID), the PNA plans to upgrade its HIS from paper based to electronic, the first such system in the Arab Middle East.
