Palestinian painters work on a mural to draw attention to the novel coronavirus pandemic in Khan Yunis, Gaza, on March 28. 
BY ZAHA HASSAN, HALLAAMAL KEIR | The total number of reported coronavirus cases in the occupied Palestinian territories has, thankfully, been relatively low up to now, with 108 cases as of March 29. One person has died, a woman in her 60s whose son is suspected to have contracted the coronavirus while working in Israel. But how is it that a state under military occupation appears to be managing the virus better than developed countries like Italy and the United States?
The answer is quick action by the Palestinian Authority (PA). After the first cases of COVID-19, the disease caused by the coronavirus, were diagnosed on March 5 in Bethlehem, apparently transmitted to hotel staff by a group of Greek tourists, Palestinian President Mahmoud Abbas acted swiftly to declare a state of emergency. The PA worked with Israel to prevent further spread by shutting off the Bethlehem governorate from the rest of the West Bank and Israel. PA security forces imposed restrictions over the area, established quarantine facilities in various locations around the West Bank, stopped nonessential travel between governorates, closed all schools, shuttered establishments of public accommodation in urban centers like Ramallah within days, and restricted foreign visitors from entering PA-controlled areas. On March 22, the PA then ordered all 5 million Palestinians in the occupied territories to shelter in place.
But while the PA’s rapid response has bought it time, it is not a solution. The coronavirus doesn’t care about borders, geopolitics, or any other man-made obstacles to cooperation. The PA projects that in a worst-case scenario, 12,500 Palestinians will be infected with the virus in the coming weeks. To deal with this surge, it says it will need 40,000 test kits and 2,800 ventilators in the West Bank alone. Unless Israel acts now to relieve restrictions on the movement of goods and people to the occupied territories, many Palestinians, Israelis, and others in the region and the world will suffer.
Israeli authorities should start by releasing tax revenue belonging to the PA that they have been withholding. This would allow the PA to make needed procurements, without which the situation will spiral out of control, with implications for the entire region. The international donor community must also help to prevent catastrophe by providing expertise and assistance to the West Bank and Gaza so that Palestinians may meet the challenge posed by the pandemic.
[Mapping the Coronavirus Outbreak: Get daily updates on the pandemic and learn how it’s affecting countries around the world.]
While all countries now are facing shortages of supplies, staff, and space to treat those infected with the virus, the challenges facing the Palestinian territories are exacerbated by more than half a century of Israeli military occupation and its hampering of economic development, which has devastated Palestinian capacities to contain the virus and treat the infected. Israel, as the occupying power in the West Bank and Gaza, holds the overarching responsibility to ensure that Palestinians get the health care they need. However, it has been withholding over $11 million per month in Palestinian tax revenues over the issue of payments to the families of Palestinian fighters. This is one reason why the Palestinian health care system, of which 88 to 90 percent is funded by PA taxes and international donors, is now cash-strapped. When added to other Israeli charges, such as between 3 and 5 percent levied on Palestinian imports, Palestinians have lost more than $47.7 billion since 2000, according to the United Nations. Under normal circumstances, these losses are destructive to Palestinian economic development. During a pandemic, they risk lives and undermine Palestinian health care delivery. In fact, the PA treasury has had to compensate these losses by cutting the salaries of public sector employees, including health care workers. That is why, even before the virus outbreak, the donor-dependent Palestinian health care system was experiencing shortages of equipment, medicines, and essential supplies. The “lack of sovereignty and effective control over natural resources or other potential sources of State revenue hamper” the PA’s ability to adequately finance public health care and fulfill its duties, according to the World Health Organization (WHO) in a 2018 report.
Testing for the virus is also a challenge in the occupied territories. Palestinian health care is short on nursing staff and testing kits for those suspected of having contracted the virus. As of March 26, Palestinian authorities had conducted only 4,890 tests. In contrast, Israel had already conducted 10,864 by March 18. Though Palestinian labs are able to process swabs with results in a matter of hours, testing is not happening as it should because of the lack of swabs. Again, many countries are facing similar problems, but unlike Israel, where its chief intelligence agency alone has obtained 100,000 kits, Palestinians must depend on others—Israel, WHO, as well as Egyptian and Jordanian authorities—to get essential supplies into the occupied territories because they lack capacity and have no control over their borders.
East Jerusalem’s approximately 340,000 Palestinians face particular obstacles to obtaining testing and treatment. Though they have access to Israeli health insurance, tens of thousands of them have become physically separated from their hospitals and clinics by the separation wall. Now that Israel has instituted total closure over the West Bank and may be closing key checkpoints, Jerusalem’s Palestinians may be cut off indefinitely from their health care facilities on the Israeli-controlled side of the wall and be forced to seek care in the PA-controlled areas. Even before the West Bank closure, a Palestinian father in Jerusalem told me that his coughing and feverish 8-year-old son, who had been in contact with a child who’d recently traveled to Europe, had been refused testing because he didn’t meet Israeli Health Ministry testing criteria. The PA Health Ministry, however, with far fewer testing kits on hand, accepted the child for testing at a Ramallah lab. The lack of common standards between the PA and Israel, and the access restrictions in Jerusalem, does not bode well for long-term coordination between Israel and the PA to combat the virus.
Limited health care infrastructure is another problem Palestinians face. According to Israeli epidemiological modeling, at a low contagion rate, 130 Israelis per day will need hospitalization during the course of the coronavirus outbreak. At a high contagion rate, that number rises to 1,450. Even adjusting for a population about half as large as Israel’s, the West Bank, Gaza, and East Jerusalem together would see their 6,440 hospital beds and 200 ventilator-equipped intensive care units quickly overwhelmed at such contagion rates. Amid the instability, the Palestinian health care system—along with the PA—could collapse. Palestinians living under occupation have neither military engineers to call on to build field hospitals nor the ability to staff and equip such hospitals could they be built.
Time is of the essence now. In Israel, the peak of the virus is projected to occur in 130 to 440 days.
As Israel’s Unit for the Coordination of Government Activities in the Territories noted, it is in Israel’s interest to slow the rate of transmission in the occupied territories so as to prevent the virus’s spread in Israel. More than being in Israel’s interest, however, it is its obligation under international law.
Israel’s responsibilities mean that it must take swift action:
First, Israel must end restrictions on the movement of people and supplies, particularly in East Jerusalem and Gaza, which is still under a 13-year-old Israeli blockade, so that Palestinian patients and supplies may be able to get to hospitals and clinics without delay. Palestinian workers inside Israel who become infected must be given treatment at Israeli hospitals and not dropped off sick at checkpoints.
Second, Israel must ensure that Palestinian health care facilities are properly equipped with testing kits and ventilators. The 1,500 kits Israel has given the PA are token at best.
Third, Israel must release all Palestinian revenues it has been withholding to enable Palestinian medical procurement from China and South Korea and allow entry of these imports through Israeli ports without delay. Though Israel’s finance minister has freed part of the withheld funds (approximately $33 million out of $181 million), Palestinians will need all the remaining funds owed to them, and more, to confront the virus and keep the economy afloat.
Fourth, Israel must prepare a plan with the responsible Palestinian authorities in the West Bank and Gaza, and with WHO, on how to deal with the surge in Palestinian patients needing hospital care when the PA health care system is overwhelmed.
Fifth, Israel and the PA must establish common criteria for COVID-19 testing and ensure Palestinians have all the test kits they need.
Sixth, Israel must enact measures to prevent settler gatherings in the West Bank, like those during the celebration of Purim in Hebron, which increase the risk of contagion among both Palestinians and settlers.
Seventh, Israel must release Palestinian prisoners held in Israeli detention centers, many of whom are being held without charge and who are currently being denied legal representation, health care, and sanitation material to prevent spread of the disease.
The coronavirus has shown little regard for borders, but access to health care for Palestinians is severely constrained because of them. Without swift action, both Israelis and Palestinians will face the consequences.
