U.S. must act to end Palestinian health crisis

September 12, 2006|By Michael Morse

CAMBRIDGE, Mass. -- To look a cancer patient in the eyes and tell her, `I am out of medicine' - this is the most difficult thing I have ever done as a physician," Dr. Isa Janina, medical director of the Palestinian Government Hospital in Bethlehem, told me. "Because both she and I know that this means she will die."

Yet, for more than six months, physicians all over the West Bank and Gaza have been saying these words to their patients.

The Palestinian health care system is in a crisis that is deepening daily, a crisis that is undermining not only patients' well-being but also U.S. interests in the region. One week ago, physicians across the Palestinian territories joined a strike that was begun by teachers a day earlier. This strike, since expanded to include government and security service workers, is the latest in a series of blows to health care in the West Bank and Gaza.

When Hamas won a plurality of seats in the Palestinian parliamentary election in January, the international community, led by the United States, responded by isolating the Hamas government. When this occurred, most humanitarian assistance was cut.

The United States halted all USAID projects that brought money into the Palestinian Authority. The European Union suspended transfers of more than $500 million annually. And Israel stopped transferring customs payments that it collects on behalf of the PA, almost a billion dollars annually.

For two months this summer, I traveled around the West Bank, interviewing Palestinian doctors and patients, learning firsthand how the drastic reduction in aid has affected medicine. Simply put: These cuts have devastated health care in the Palestinian territories.

According to Physicians for Human Rights-Israel, the Palestinian Ministry of Health's governmental hospitals and clinics provide 65 percent of the health care in the territories. Before the election, international aid paid nearly 100 percent of the operating costs at these hospitals and clinics. Now that this funding has disappeared, many patients are not receiving lifesaving care.

The first and most profound effects were on cancer patients and those receiving dialysis, because their critical illnesses require timely, consistent and expensive treatments. The Palestinian Ministry of Health had provided a universal insurance program that paid for many of those treatments, but the halt in funding has rapidly eliminated the PA's ability to replenish its stockpiles of cancer drugs and dialysis supplies.

A combination of international efforts and local ingenuity has only patched the system, and a patchwork solution does not supply the consistent treatment that is necessary to care for critically ill patients.

Three months ago, dialysis patients in Bethlehem were going without treatment because the hospital lacked dialysis filters. "Now we have filters, but two weeks ago the pump broke," says Dr. Janina. The Ministry of Health has no money to replace it. So patients die.

Because the Palestinian Health Ministry lacks funding, no government hospital employee has been paid in six months.

The U.S. faces a formidable challenge in finding a way to circumvent Hamas while funding health projects in the Palestinian territories. The Hamas government bears significant responsibility for the problem, because it has rejected international efforts to pay government doctors through nongovernmental organizations.

Hamas apparently prefers to let patients and physicians suffer rather than accept extra-governmental funding arrangements that might undermine its authority.

The U.S. would profit from growing disillusionment with the Hamas administration if we were to act creatively - and quickly - to enact a major relief program in the Palestinian territories. From my conversations with Palestinian physicians and patients, it is clear that Palestinians are not only angry with Hamas, but they also blame the United States for their health care crisis, because they know that the U.S. has been the international leader in the effort to prevent funding from reaching the PA.

A robust USAID program that provides needed medicines and equipment throughout the Palestinian territories would be a major step in relieving suffering and improving our image in the territories. If we channel the aid through the moderate PA President Mahmoud Abbas, our aid would support those striking against the Hamas government, strengthen Fatah opposition and demonstrate U.S. desire to be a force for prosperity in the region.

Our only other choice is to allow preventable deaths to continue to occur, reinforcing Islamist propaganda that portrays us as a nation that cares nothing about the welfare of the Palestinian people.

Michael Morse, a student at Harvard Medical School, spent this summer living in Bethlehem and researching health service provision in the Palestinian territories. His e-mail is Michael_Morse@hms.harvard.edu.

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