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MSF in Palestinian Territories, 2007
Field Staff: 91
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Poverty, restricted movement and increasing violence in the Palestinian Territories have inflicted a tremendous toll on mental health, yet there are few trained psychologists. MSF focuses on supplying psychological support to victims of violence in the Israeli-Palestinian and intra-Palestinian conflict. MSF also provides medical assistance to people without access to health services. Teams work in the West Bank and Gaza.
Patients live in exposed and insecure conditions such as refugee camps or areas where they are subject to frequent incursions, often close to checkpoints and Israeli settlements. People suffer from depression, anxiety, posttraumatic disorder and psychosomatic troubles. They are burdened with symptoms such as disrupted sleep, flashbacks and nightmares.
MSF supplies psychologists to provide individual and group therapy for children, adolescents and adults. This clinical care is aimed at reducing symptoms and helping people develop coping mechanisms. Teams comprise a psychologist, medical doctor and social worker. The program has remained flexible and reactive in order to meet patient needs while operating in a volatile and unpredictable context. Travel is difficult due to closures and restrictions, so consultations and therapy are often provided through home visits. A total of 4,617 consultations (1,284 in Hebron, 1,851 in Nablus and 1,482 in Gaza) were provided in 2007. Almost half (42 per cent) of patients were under 12 years old.
Emergency post-operative program
Following violent clashes with the Fatah in May and June, Hamas took control of the Gaza Strip. The violence left more than 1,200 people injured and several needing specialized care. By July, MSF had established a post-operative care program to help people recover from their injuries and gain maximum mobility. The service included follow-up consultations, pain management, antibiotic supply and physiotherapy for several hundred people. As well as meeting medical criteria, patients were admitted to the program as a result of financial, security or mobility problems.
Supplying drugs and medical material
The 2006 embargo by western states has led to a general deterioration in the health system and numerous strikes by health workers. The Ministry of Health is completely dependent on donations from the international community. Although a mechanism is now in place to alleviate financial pressures and supply medical materials, health workers still do not receive full salaries and recurrent strikes in the public sector have disrupted healthcare access, particularly in the West Bank. MSF made periodic drug donations in Hebron to help cover critical shortages, as well as donations of drugs and emergency medical material to hospitals in Gaza.
As with the whole of the occupied Palestinian territories, the Gaza strip had been subject to an international embargo since early 2006. The already difficult situation deteriorated significantly in mid-2007 when Hamas took control after weeks of bitter internal fighting. With an array of security services and militia allied along factional lines, the bloody takeover was the culmination of an increasingly intense Hamas-Fatah rivalry. The remainder of 2007 saw violent repression of anti-Hamas demonstrations and an emerging insurgency by disgruntled members of the former security establishment.
While Israel and international donors quickly recognized and engaged the new Palestinian government in the West Bank, the Gaza strip effectively remained under Hamas control and subject to tougher sanctions. Israel limits passage into Gaza to basic food and medicine and the number of medical referrals abroad is decreasing. Fuel and electricity supplies have been reduced in an attempt to pressure the Hamas regime, which the Israeli cabinet officially labeled a ‘hostile entity’ in September.
Alongside the political and economic isolation of the Gaza strip, the Israel-Palestinian conflict fluctuates. Hamas and smaller groups continue to target neighboring Israeli communities and military bases with rocket and mortar-fire. Targeted air strikes and limited incursions from the Israeli side ostensibly aim to limit the rocket fire but inevitably lead to civilian casualties.
During the peak of internal Palestinian clashes in May and June, at least 200 people were killed and some 1,200 injured. However, the subsequent split in the Palestinian Authority has had the most far-reaching consequences. The already fragile health sector has become highly politicized, with the two opposing parties often issuing contradictory instructions. Disputes result in political appointments, strikes and a demoralized staff. With the embargo making the re-supply of hospitals with drugs and equipment highly problematic and a general economic collapse, access to healthcare has been significantly reduced. MSF has, therefore, expanded its activities beyond the mental health sphere to include post-operative care in addition to rehabilitation and pediatrics.
The increased need for external medical assistance is a result not only of the violence and reduced capacity of secondary medical structures but also of the political climate. As the positions of the main antagonists become increasingly polarized, individuals with specific or perceived affiliations have correspondingly limited access to health services.
The parallel Ministries of Health and many local organizations are seen as directly influenced by Hamas or Fatah while some international non-governmental organizations, particularly those funded by key institutional donors, are believed to have wider political motives. Therefore, being financially independent as a medical relief organization is not just relevant but also necessary in order to operate in Gaza. MSF repeatedly explains and highlights this independence to the recognized Palestinian authorities in the West Bank, the Israelis and, of course, local actors on the ground, in an effort to gain as much access as possible to the communities in need.
Disputes continue however, and healthcare becomes simply another political tool through which pressure can be applied. As positions remain entrenched, health services are likely to deteriorate further, making independent humanitarian action increasingly relevant and important.
MSF has worked in the Palestinian Territories since 1988.