Improving Gaza Health Care is a Major Challenge for Palestine

By Stephen Sosebee

Whether one considers the Gaza-Jericho-first accords a sellout of the Palestine refugees of 1948 or a breakthrough toward a comprehensive Middle East peace, the principles of peace signed by PLO Chairman Yasser Arafat and Israeli Prime Minister Yitzhak Rabin on Sept. 13 offer an historic opportunity for the Palestinians to demonstrate that they are prepared to administer their own sovereign affairs. History will judge harshly those who fail to contribute to this opportunity to begin rebuilding Palestine.

The Gaza Strip, where Palestinians have their first opportunity to rule themselves, has been neglected for so long that an entire infrastructure must be created from scratch. One essential component of both the welfare of the Palestinians and the development of Palestine is the establishment of adequate health care. Even for those most opposed to the accords, there is no excuse for not contributing to the building of an efficient, modern and independent health care sector.

Improving the quality of medical care in the Gaza Strip is a major undertaking. The neglect of Gaza over the past 40 years has created a shortage of quality medical institutions and specialists, while Israeli occupation forces have inflicted a huge number of injuries on Palestinian civilians.

Calling it a medical crisis does not do justice to its magnitude. Medical obligation might be a better term, considering that the Gazans have carried the brunt of the Palestinian intifada that finally has forced an Israeli government to face up to the fact that it cannot sustain indefinitely the level of force and brutality required by the military occupation of Palestine.

When Israel seized Gaza from Egyptian control in 1967, its national hospitals became Israeli government hospitals administered by the Israeli Ministry of Health through the Israeli civil administration. Since then, three types of medical institutions have functioned in the Gaza Strip: Israeli government hospitals, the private or non-governmental (NGO) hospitals, and clinics run by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA). Since 1967, Gaza's health care system has faced very fundamental problems.

Between 1967 and 1991, all requests to build new facilities, even private hospitals, were rejected by the Israeli Ministry of Health, resulting in a catastrophic shortage of hospital beds in Gaza. As the population soared during that period from fewer than 500,000 to more than 750,000 persons, the number of available hospital beds decreased from 1,030 in 1977 to 877 in 1992.

A Near Breakdown of Services

By contrast, there are 27,000 public and private hospital beds in Israel to serve a population of about 4 million. According to the World Health Organization (WHO), adequate medical care requires at least two hospital beds per 1,000 persons. In the Gaza Strip there are 1.2 beds per 1,000 persons. The consequences manifested themselves in a near breakdown of services during the several recent massacres in Gaza, in which the numbers of victims with gunshot wounds or other severe injuries ranged from dozens to hundreds.

In 1991, the Israeli government granted permission to UNRWA to begin construction of a 220-bed $30 million hospital in the southern Gaza Strip. Though construction of this much-needed institution has been slowed by a delay in European Community funding, that should change with increased international interest in improving life in an autonomous Gaza Strip.

Another conspicuous problem in Gaza is the lack of health insurance. Before 1967, all health services in the Gaza Strip were free of charge to both refugees and permanent residents. That changed under occupation, when Israeli national health insurance was made available in the occupied territories. By 1992, however, only 30 percent of Gazans could afford such insurance. Israeli insurance coverage costs more than $36 a month per person. The average family income in Gaza is about $200 per month. Health coverage for a family of six would exceed the average family income.

For the uninsured, a night in a hospital costs $190. Medical care for refugees is free, but that is only at UNRWA clinics, which function in the eight refugee camps. A health insurance system in Gaza that will assure all citizens and refugees adequate treatment is an immediate need.

As in other oppressed or under-developed areas, the shortage of medical doctors in the Gaza Strip is acute. There is one physician for every 600 persons in Israel. In Gaza, there is a doctor for every 1,435 persons. The shortage of specialists is even greater. There is only one plastic surgeon, one neurosurgeon, and one vascular surgeon working in the Gaza Strip. For cancer and major cardiac problems, there is no treatment available at all in Gaza, and obtaining care in Israel would be extremely unlikely, even if the border were not so frequently closed, or difficult to cross.

Even the specialists who do work in Gaza suffer from a lack of trained nurses and other medical personnel. and a shortage of key medical equipment. For example, there is a dire need in Gaza for a CAT scan, ultrasound machines, audiogram facilities, a panoramic X-ray machine and a complete histopathological laboratory. Without such modern diagnostic equipment, it is difficult for Palestinian physicians in Gaza to allocate their scarce resources effectively.

The fact that Gaza has been under military occupation for the last 25 years, and that the occupier cared little about the physical well-being of the population there, is not unique. That is the nature of any foreign military occupation. What exacerbated the Gaza crisis was the intifada. Since it broke out in Gaza in December 1987, more than 60,000 unarmed civilians, eight percent of the population, have been seriously injured. Often wards were so full of shot and beaten youths and bystanders that ordinary patients who needed further care were sent home to make room for the serious emergency cases. If Palestinian self-rule brings about a halt to the daily shooting of civilians in the Gaza Strip, it will provide a breathing spell for harried medical personnel to begin to solve the fundamental problems that have taken root in Gaza during the occupation.

One solution can come in the form of rehabilitation facilities and personnel. Since the intifada began, hundreds of young people in the Gaza Strip have suffered permanent injuries requiring long term physical and occupational therapy. While two new rehabilitation centers have been built in the West Bank, no such center exists in Gaza. Permanently injured Gazans, who sacrificed themselves for independence, need and deserve an adequate rehabilitation center.

Using the Gaza Strip to prove the PLO's ability to govern is like learning to climb mountains on Mount Everest. Unless adequate resources are focused on the huge social, economic and political problems in Gaza, the current historic chance for peace in the Holy Land could slip away. This is an international obligation which, if met, will be a major step toward a comprehensive peace in the Middle East.

Stephen Sosebee, a free-lance writer, is a founder of the Palestine Children 's Relief Fund, P.O. Box 2698, San Bernardino, CA 92106. He invites inquiries from readers interested in participating in specific projects to improve the quality of medical care in the Gaza Strip.