(Updated: 05 Dec 2021)
Health care in Gaza is in jeopardy as one of its chief funders, a United Nations relief agency known as UNRWA, teeters on the verge of collapse, the Palestinian scholar Mona Jebril says.
UNRWA, whose formal name is the United Nations Relief and Works Agency for Palestine Refugees in the Near East, provides aid to Palestinian refugees across the region.
Gaza’s predominantly young population, the presence of 1.4 million registered refugees, and an Israeli blockade that has intensified since 2007 have led to an over-reliance on donor funds.
Refugees make up 74.5 per cent of Gaza’s population, Jebril told Al-Fanar Media, and the territory’s health service is “dependent on foreign aid, particularly on UNWRA’s crucial assistance.”
But UNWRA’s financial stability has been thrown into crisis by a series of foreign governments’ decisions to eliminate or sharply cut their support.
The crisis started in 2018 when former U.S. President Donald Trump halted aid to Palestinians, Jebril said. (See a related article, “U.S. Cuts Threaten Half a Million Palestinian Children”.)
“These significant financial deficits to UNRWA’s budget affect its ability to maintain life-saving services for Palestinians and pay its staff salaries.”Mona Jebril
A Palestinian scholar at the University of Cambridge
While the administration of President Joe Biden restarted funding for UNRWA earlier this year, other governments have since reduced their contributions. These include steep cuts by the United Kingdom and the United Arab Emirates.
“These significant financial deficits to UNRWA’s budget affect its ability to maintain life-saving services for Palestinians and pay its staff salaries,” Jebril said.
“UNWRA’s budgetary fragility threatens health and education for Palestinians, including food distribution for more than one million people,” she added.
A Politicized Health System
Jebril, a research fellow at the University of Cambridge Centre for Business Research, in the United Kingdom, recently conducted an analysis of the political economy of the health sector in Gaza. Her research has just been published in a report called “The Political Economy of Health in the Gaza Strip (Occupied Palestinian Territory)”.
The report reviews the history of Gaza’s health-care services, from the work of charitable organisations during the Ottoman Rule (1516-1917) to the Palestinian Authority’s first Ministry of Health in Gaza (1994-2006), and the following political schism between Hamas, which controls Gaza, and Fatah, which is dominant in the West Bank.
The report sheds light on the impact of the lack of an independent, unified political entity. It quotes one senior policy maker who blames both Hamas and Fatah for the division of the Palestinian people and the duplication of services.
“A history of ‘colonization and military occupation [has] shaped the capacity of the [Palestinian] health system and defined its main actors’,” the report states. “This has made the health sector highly politicized.”
It identifies four providers of health services: governmental, UNRWA, private, and nongovernmental organizations. For specialist health care, Gazan patients have to be transferred to Israel or neighbouring Arab countries.
In its peak between 2007 and 2013, the tunnel economy across the border into Egypt’s Sinai improved Gaza’s economy by providing 10,000 people with jobs. However, smuggling operations through the tunnels reflected negatively on nongovernmental institutions, for example, because the lack of monitoring meant an unknown quantity of drugs were smuggled across.
Struggling Medical Training
The report also contains some insights about Gaza’s struggle to get doctors trained.
“The Ministry of Health in Gaza established a Palestinian Medical Board,” Jebril said. In addition, “Gaza universities offer a few medical degrees that could support the health sector. UNRWA and NGOs may also offer training courses to their staff.”
“However, these sources of medical training may not be consistent in terms of their overall quality and standards,” she added. “Some specializations may not be available in Gaza.”
Jebril explained that the blockade’s restrictions on mobility can prevent medical staff and students from being able to join international conferences and benefit from updated knowledge and expertise. (See a related article, “Mona Jebril, a Palestinian, Looks at ‘Hidden Injuries’ That Limit Education”.)
The political and economic conditions of Gaza have led to a brain drain, further exacerbating the lack of medical expertise in the Strip.
The lack of infrastructure and Gaza’s daily power cuts also affect medical training, making online education and access to digital resources a challenge, Jebril said.
In his foreword to the report, Simon Deakin, a law professor at Cambridge and director of the Centre for Business Research, wrote that the situation in Gaza is one of “continuous suffering and emergency.” He added: “Health care is at one and the same time a priority but also a luxury for most families.”
“Mona’s research is one of the few systematic studies of the conditions of everyday life there. It gives voice to the people of Gaza, and that above all is important.”Simon Deakin
A law professor and director of the Centre for Business Research at the University of Cambridge
In an interview with Al-Fanar Media, Deakin noted that “researching Gaza is difficult for reasons which are well understood.”
“Mona’s research is one of the few systematic studies of the conditions of everyday life there,” he said. “It gives voice to the people of Gaza, and that above all is important.”
Humanising the Situation in a Play
The play was inspired by a true story from Gaza, and includes some insights from her research. “It is not a documentary. It is a creative piece that includes instances of dark humour, and even some fiction,” she said.
Having lived in Gaza for 22 years, Jebril says she could hear and relate to mothers’ sense of helplessness.
“When you talk to people who live under constant emergency conditions about the long-term impact on them, the majority have little faith in what you are doing academically,” she said.
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Jebril therefore thought a research-based play was the perfect medium to capture feelings and humanise the political, something rarely done in news about Gaza.
“People are frustrated about the possibility of change. I felt a responsibility to convey their voices,” she said.
“Their stories were different, but also had common threads as they talked about traumatising health-care experiences under occupation and the challenging conditions resulting from the Palestinian schism.”
Jebril said she was was able to include an analysis of this data in the report, “but I couldn’t include the tears, the shattered voices, the strength and the anger that I heard in my conversations.”