Health under Fire: When Ordinary Lives are Trapped within Extraordinary Circumstances

The fight to protect the right to health of populations living within a state of conflict and armed struggle continues to challenge the capacity and stability of both local health care providers, and that of the global health community at large. Whilst there has been an increased and co-ordinated effort across the international platform to address some of the most salient health concerns that manifest during times of crisis, the difficulty in managing and sustaining these initiatives, often in conjunction with conflicting agendas and/or duplicative efforts of the many actors involved, has meant that many gaps still exist in targeting some of the most pressing health concerns. As such, we continue to face the sombre reality that ‘insecurity of healthcare is one of the biggest, most immediate, and yet unrecognised humanitarian problems in today’s conflicts.

Insecurity of healthcare is one of the biggest, most immediate, and yet unrecognised humanitarian problems in today’s conflicts

Across the occupied Palestinian territories (oPt), hostility between warring factions has increasingly engendered unpredictable and unstable access across all aspects of health care. With little success over the past few years to forge any concrete, sustainable path towards a peace agreement between the two central parties to this conflict, any gain within the health care arena is often short-lived as a consequence of both increasing internal dispute and escalating external tensions. Within a setting such as this, the question of equity is something of an unsettling matter: How can the delivery of services be protected at all stages? How can we ensure both appropriate and timely services in the face of regional instability? What are the best methods to target those more vulnerable groups when the data for which we must base our assessment of need is often incomplete?

The most recent conflict between Israeli and Palestinian forces in Gaza has further destabilised the health network across the two regions

Moreover, the most recent conflict between Israeli and Palestinian forces in Gaza (that commenced in July of this year) has further destabilised the health network across the two regions, causing further infrastructural and apparatus damage, and creating widespread displacement across the region. Largely overwhelmed by this latest episode of violence, the health system is now experiencing additional strain on chronically declining resources, increasing and exposing its dependency on external channels and agencies and further fragmenting the availability and delivery of health care.

With so many averse factors at play across the oPt, we are often exposed to the idea that guaranteeing the health and well-being for both the current and future population is something of a futile task- but by no means should this be considered an impossibility.

The paper ‘A health system under siege: ensuring equity across the continuum of care within the occupied Palestinian territories’ presents the current context in which health services operate across the oPt, exploring pertinent issues and impacts generated as a consequence of the disjointed system of health provision: a system that is markedly fragmented, disorganised, and inefficient in providing safe, affordable and timely care. Inherent facility-based deficiencies, the prevalence of unsafe clinical practices, substantial regional inequities reinforced by the imbalance in the provision of care by the various extant providers (within a markedly regressive health financing system), and excessive physical barriers sustained as a consequence of political animosity, contribute to a system that adversely effects secured health provision for many sects of the Palestinian population.

The volatile political environment, however, should not allow for compliance in allowing for the health status of many sections of the population to be compromised : progress is possible, despite the odds. Encouraging increased co-ordination and communication between health care providers and other partner sectors can help to build a more cost efficient and system across the oPt; developing pro-poor financing schemes can help to alleviate some of the financial burden faced by many pockets of the populace; and building upon existing initiatives to establish a more cohesive and integrated data collection and management system can provide a more informed evidence base, fundamental in pushing for the development of a more equitably-led health care system.

This assessment makes one thing clear: now, more than ever, we are facing a situation of deteriorating status. Without implementing a more definite co-ordinated, and pragmatic approach to health care provision across the territories, and developing a more regionally focused analysis, we are likely to see increased deterioration in the health status of the Palestinian population- a situation we cannot, and should not, allow to become a reality any longer.