From Bad to Worse

The worldwide outbreak of a new coronavirus, Covid-19, is exacerbating the never-ending human rights crisis in Israel/Palestine. Ghada Majadle, director of the Occupied Palestinian Territories department for the NGO Physicians for Human Rights-Israel, is deeply concerned. A Palestinian citizen of Israel from the city of Baqa al-Gharbiyye, Majadle oversees a team that helps Palestinians from Gaza—which is severely under-resourced—access healthcare in Israel and the West Bank; her team is also responsible for organizing mobile clinics to reach rural communities in the West Bank. These are always urgent needs, but the pandemic has heightened them. At the time of this writing, there are 48 confirmed cases of the virus in the West Bank. Seventeen of those patients have recovered. Thursday brought news that a group of Palestinian prisoners in Megiddo prison (30 minutes south of Nazareth) may have been infected, though Israel says the prisoners are only in quarantine and that there are no confirmed cases of the virus in the prison. There’s also widespread fear about an outbreak in Gaza, whose medical sector has been decimated by Israel’s harsh blockade and three punishing military assaults since 2007. So far, no cases have been reported in Gaza.

Yesterday, I spoke with Majadle by phone about the obstacles to accessing healthcare under military occupation, the unique problems in Gaza, and what the coronavirus means for Palestinians in general. This conversation has been edited for length and clarity.

Alex Kane: Before we get into the coronavirus, can you help me understand how Israel’s military occupation impacts the Palestinian healthcare sector in general? 

Ghada Majadle: It’s a huge question. First of all, the repeated Israeli attacks on Gaza—whether it’s attacks on medical facilities, such as hospitals, or on infrastructure or other buildings—affect the healthcare system. And then there’s the blockade: we’re talking about restrictions on the movement of medical staff in Gaza, and also in the West Bank. These restrictions on movement mean that medical staff don’t have access to professional updates, training, or workers. There are also restrictions on other medical staff, from foreign countries, entering Gaza. And then there are the shortages of medication and medical devices. Israel does not allow all supplies to enter, and many needed medications are not available.

AK: How has the coronavirus changed your job so far?

GM: We’re still learning about this. Two weeks ago, we were working on the same issues, continuing our projects while monitoring the situation. But a week ago, all of our activities were paused because of all the new restrictions by both the Israeli Ministry of Health and the Palestinian Ministry of Health in the West Bank and in Gaza, which means our mobile clinics and delegations cannot enter the Palestinian territories. Non-urgent patients can no longer exit Gaza or the West Bank for surgeries or for treatment in East Jerusalem. The patients who have gained permits from the Israeli army now are cancer patients or other urgent cases. 

We’re facing a new challenge: we’re trying to understand the scope of the coronavirus outbreak within the West Bank and in Gaza, and with more focus on what is going on in Gaza, since [the state of medical care] there is worse than in the West Bank generally.

AK: So people in Gaza are getting permits to get cancer treatment? [Editor’s note: Israel’s blockade bars people in Gaza from leaving unless they obtain an Israeli permit—a labyrinthine process involving multiple bureaucracies. In 2018, Israel effectively denied 39% of Palestinian applications for medical permits.]

GM: Yes. The Israeli authorities have issued new criteria saying that cancer patients and patients needing complicated surgeries and other urgent cases can still obtain the permits. Yet we know that even some of the patients who obtain the permit don’t want to leave Gaza, given the risk of being infected—because of the situation in hospitals, and because they need to travel all the way to East Jerusalem or to the West Bank without any protective measures. And with the latest instructions, the people who come back to Gaza are supposed to be quarantined for 14 days in schools, which are equipped with minimal supplies, and the situation there is not so good.

The patients don’t want to leave Gaza. And sometimes, at the crossing—the Hamas crossing, before the [Israeli] Erez crossing—they do not let people out even if it is an urgent case, because they don’t want people to leave Gaza. It will raise the chances that people will be infected, and that they will come back and infect other people. 

AK: What do you think will happen if the coronavirus reaches Gaza?

GM: We’re very concerned. Everyone who knows the situation in Gaza should be concerned, because the healthcare system in Gaza is already in dire condition. It can’t meet the needs of the population. When the coronavirus hits, the healthcare system will be overloaded. There are patients in Gaza who still need treatment that’s not available there, and they cannot be referred to hospitals outside of Gaza where they used to be treated. The hospitals in Gaza must somehow find alternative solutions to treat the people who once used to be treated outside of Gaza. I think it’s going to be very difficult for them to handle this.

AK: The coronavirus is already in the Israeli-occupied West Bank. Is the West Bank health sector holding up?

GM: What we understand is that, so far, they are sort of controlling it. They have facilities with the medical equipment and the drugs that they need to be able to monitor and treat people with the coronavirus, designated for quarantine and for isolation. If there is an outbreak, the numbers of patients will increase, and they won’t be able to control it or to treat it properly, and will need help from Israel, from the World Health Organization, and from other international organizations. 

AK: You oversee mobile clinics in the West Bank. Why is there a need for them?

GM: In many areas in the West Bank—outside the big cities such as Ramallah, Bethlehem, Tulkarem, and Nablus, in the villages and towns and Bedouin communities around these cities—they don’t have proper access to medical treatment. They don’t have big hospitals with needed expertise, and there is widespread poverty and unemployment, which affects the healthcare systems. They only have family doctors who come to the clinics once a week, or they have orthopedic doctors coming once every two weeks or once a month. They don’t always have the privilege to travel to cities like Ramallah and Bethlehem to receive treatment, so embassies and organizations like ours have mobile clinics and delegations of physicians who come to these villages to treat people or help them access medical care. But we are not trying to replace the Palestinian healthcare system. We think that Israel has a duty in the West Bank and in Gaza to ensure that all Palestinians in these territories have access to proper medical care.

AK: If the coronavirus were to hit one of these rural communities, what do you think would be the impact?

GM: I think it will be difficult, because they won’t have trained medical teams that can monitor which people are infected. They cannot ensure that those people will be quarantined or receive proper treatment if they need to be isolated. I think the Palestinian Ministry of Health should ensure that patients will be transferred to facilities where they can be in isolation. The capabilities of the Ministry of Health and the big hospitals to provide medical care in these villages are very limited and will continue to be limited if there will be an outbreak of the coronavirus.

AK: Israel holds about 5,000 Palestinians in prison. What will happen to them? 

GM: It was reported on Thursday that there are four political prisoners in Israeli prisons who might be infected with the coronavirus, and it happened after they were interrogated by an Israeli officer who tested positive. It is a huge concern; we don’t know the policy in Israeli prisons. We know that Muhammed Shtayyeh, the Palestinian prime minister, has called for the Israeli prisons to release all political prisoners. I don’t believe that will happen.

AK: What’s the most important thing that the world should know right now about the situation in Palestine?

GM: Israel is now struggling to combat the coronavirus, and they have their own problems—they can’t meet their own population’s needs. They lack the beds for emergencies, and they’re not doing the tests for everyone. 

Still, they do have a duty, as an occupier, to ensure access to healthcare as a basic right. They cannot just close their borders. In fact, they don’t actually have borders with the West Bank, since they have settlements and soldiers all over the territory. This means that if they think that they can just close the borders and not deal with Palestinians, it’s going to be very problematic. I do think that officials in the Israeli Ministry of Health understand this, and they do have some kind of dialogue with the Palestinian Ministry of Health. But we tried to contact the Israelis to understand if they are prepared to fulfill their responsibilities in the West Bank, and we didn’t receive any answer.