The typical perception of the relationship between the Palestinian territories and Israel is of two neighboring states in a conflict over land. Yet, as news has broken about Israel’s highly effective vaccination program, which has reached nearly 15 percent of its population in less than a month — but no more than 100 Palestinians outside of Israeli-annexed East Jerusalem — the reality obscured by this basic framing has become evident. The truth is that Palestinians depend on Israel for lifesaving medical care not because of poverty but because of politics.
While the Palestinian health-care system was developed with the Oslo Accords in the mid-1990s, it has never stood autonomously. Article 17 of Oslo Annex III stated that responsibility for Palestinian health will shift to the Palestinian Authority for routine vaccines, such as polio. But Oslo was meant to be an interim agreement, leading to a political settlement within five years. Almost three decades later, it is being used to justify Israel’s lack of responsibility for Palestinian well-being during a pandemic, though few provisions meant to empower Palestinians were ever implemented, even on issues as fundamental as water rights.
Almost all international bodies — including the United Nations Security Council and the International Court of Justice — and nations — including Israel’s own Supreme Court — recognize Israel as the occupying power in the Palestinian territories, giving it specific responsibilities under the Fourth Geneva Convention. These protections, which include duties to maintain public health and medical supplies, persist regardless of any agreement between the occupied and occupier.
Early in the pandemic, it seemed possible that strict controls in the West Bank and Gaza Strip could spare the Palestinians from a public health catastrophe that would overwhelm their already beleaguered health system. Until the beginning of July, there were few cases in the territories and fewer than a dozen deaths. But by the beginning of 2021, more than 160,000 of the 5 million Palestinians in Gaza, the West Bank and East Jerusalem have been diagnosed with the virus, and more than 1,800 have died. While active cases have started to decline, infection rates among those being tested are still high, and many infected are older than 60, a cohort that is more likely to require hospitalization.
The dependence on Israel for vaccinations is a continuation of years of necessary outsourcing of Palestinian health care because of Israeli restrictions. For decades, Palestinians with cancer and other severe illnesses, like my uncle, have had to apply for medical permits to enter Israel and receive treatment, in part because Israel bans some advanced medical equipment from entering Palestinian lands as part of a blanket security policy, deemed “collective punishment” by the United Nations. Even in the beginning of the pandemic, humanitarian organizations that wanted to ship much-needed ventilators, masks and testing kits had to coordinate with and receive approvals from Israel. Palestinians do not have a direct way to receive the vaccine, after Israel bombed the only Palestinian airport in the early 2000s and has not permitted plans to construct another to proceed.
The Palestinian Authority has devolved into a security subcontractor for Israel and a jobs program for Palestinians, who lack the resources to build a robust private sector. Indeed, the state of Palestine, as nominally recognized by the United Nations General Assembly in 2012, has little control over its imports, including masks, ventilators and now vaccines, or its economy, which is expected to lose up to 35 percent of its gross domestic product as a consequence of covid-19. The Palestinian Authority’s coordination with the World Health Organization’s Covax initiative, or provision of vaccines from countries such as Russia, does not absolve Israel of its responsibilities, as echoed by the U.N. and human rights groups such as Amnesty International and other civil society organizations. To say Israel has no role in vaccine provision for Palestinians is to accept the fringe viewpoint that there is no occupation at all.
The approval of several coronavirus vaccines toward the end of 2020 provided some hope in a year that, to many, was devoid of positivity. So much attention was paid to the development of the vaccines, however, that not enough consideration was afforded to the logistics of vaccine distribution. Who gets the vaccine? When? Who pays? Where do we get the syringes, how do we find the health personnel we need, and where should people go to get vaccinated?
These questions are not unique to Palestinians. But few populations have as little control over the answers.
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