In what has become an annual ritual, the World Health Assembly adopted a decision on Wednesday decrying the health conditions in the occupied Palestinian territories, and calling on WHO to monitor progress in recommendations for reform by both Israel and the Palestinian Authority.

The decision was approved by 76 votes to 13, with 35 abstentions and 53 countries absent. The decision was a virtual carbon copy of one passed last year, with the exception of two new clauses – which reflect in some sense the recent escalation of conflcit on the ground.

Those new clauses call on Israel “to ensure unhindered and safe passage for Palestinian ambulances as well as respect and protection of medical personnel, in compliance with international humanitarian law and to facilitate the access of Palestinian patients and medical staff to the Palestinian health institutions in occupied east Jerusalem and abroad.”

A second new clause called for WHO to “identify the impact of barriers to health access in the occupied Palestinian territory including east Jerusalem, as a result of movement restrictions and territorial fragmentation, aswell as progress made in the implementation of the recommendations contained in the WHO reports on the occupied Palestinian territory including east Jerusalem.”

The Palestinian-led resolution also asks the UN health agency to assist in improving its health system, ensuring procurement of vaccines, medicine and medical equipment, and ensuring non-discriminatory and equitable access to health in the occupied territories.

United States, UK and Canada led dissenting group

This year’s decision was supported by the majority of Arab and African nations and, notably, a handful of European countries including Belgium, Ireland, Switzerland and Spain.

The United States, United Kingdom, Canada, Australia, Germany and Israel led the group voting in dissent.

Following the vote, Israel said the countries that supported the resolution had chosen to “turn away from logic and reality,” calling the motion “a politicized resolution that has not helped a single Palestinian.”

“It is a tool just like Palestinians use in nearly every multilateral arena to target my country,” said Meirav Eilon Shahar, Israeli Ambassador to the UN in Geneva. “It is devoid of reality.”

The Palestinian delegate, meanwhile, said the language referred directly to United Nations resolutions and terminology that have been accepted in multiple fora in the past.

“This draft decision is procedural and technical in nature,” its delegate said ahead of the vote. “It uses words based on consensus wording of UN and WHO instruments and draws from the outcomes and recommendations of the Director-General’s report.”

Remove “arbitrary” barriers to health for civilians, Tedros tells Israel

The Palestinian-led resolution follows upon the publication of WHO’s annual report on health conditions in the occupied Palestinian Territories by WHO Director-General Dr Tedros Adhanom Ghebreyesus.

The report documented 191 Palestinian deaths and over 10,000 casualties as a result of “occupation-related” violence, with the number of Palestinians killed in the West Bank (154), the highest since 2005, according to the report.  Some 24% of the casualities were related to settler violence, the report stated.

The report also documented some 187 attacks on health care responders, mostly coinciding with peaks in the escalation of Israeli-Palestinian violence.

The report also documents the physical barriers that Palestinians face in accessing routine health care services due to the geographic fragmentation of the West Bank, Gaza and east Jerusalem, as well as particular problems encountered due to the military closure of Gazan entry points into Israel and closures around certain West Bank areas during periods of violence and tension.

The decision requests that the WHO ensure “unhindered” passage for Palestinian ambulances, which Israel does not allow beyond checkpoints on the border of the OPT.

Appeals to Israel to ease barriers and to the Palestinian Authority to improve health care coverage

The report calls on Israel to “end the arbitrary delay and denial of access for Palestinian patients and their companions, and promote unhindered movement for Palestinians throughout the occupied Palestinian territory, including east Jerusalem and between the West Bank and Gaza Strip,” for specialized treatment as well as for more routine care.

The report also calls upon Israel to end “arbitrary delays” of ambulances at checkpoints and facilititate entry of medicines and medical supplies to the Palestinian territories.

Palestinians must also apply for permits to visit hospitals outside the occupied territories, and the “arbitrariness” and unpredictability of approvals costs people their lives, the report states. Cancer patients initially delayed or denied permits to access chemotherapy or radiotherapy were 1.5 times less likely to survive, the report said. The consequences of denying people permits to receive treatment are also evident in individual cases.

Fatma Al-Misri, a 19-month-old girl living in the occupied territories, was twice denied a permit to travel for treatment of an artrial septal defect, which is a treatable condition. She died awaiting the outcome of her third permit application.

The Director General’s report also calls on the Palestinian Authority to assign greater priority to health care expenditures, ensure more “continuity” of essential health care services, and reform “revenue raising and risk pooling mechanisms to strengthen the social protection of Palestinian households against catastrophic health expenditure and impoverishment.”

The lack of comprehensive health care coverage is a factor throwing families into poverty, forcing many families to pay for medical care and medicines out of their own pockets.

The Palestinian Authority also needs to “simplify and streamline the referrals system” including through “identifying and promoting understanding and awareness of patient
entitlements to essential health care services,” the report stated.

Life expectancy is lower in the occupied Palestinian territories

In 2022, the average life expectancy in the West Bank and Gaza was 75.4 years for females and 73.2 years for males. In comparison, Israeli life expectancy wsas 85.1 years for females and 81.8 years for males. In east Jerusalem, where Palestinians have more freedom of movement and can also access Israeli health care systems, life expectancy is much closer to the Israeli averages of 81.9 for females and 78.1 for males.

Israel has one of the world’s best health care systems, ranking alongside countries like Italy and South Korea. In metropolitan areas. The average response time of emergency services in its major cities can be as low as 90 seconds.

In the occupied Palestinian territories, the average response time for ambulances is 59 minutes, the WHO report found.

People living in the occupied Palestinian territories were three times as likely to die from noncommunicable diseases between the ages of 30 and 70 than their Israeli counterparts in 2021, the report added.

A survey of infant mortality rates found Palestinians were four times more likely to die before their first birthday than Israelis – five if the child was born in a refugee camp.

Tedros also criticized Israel’s obstruction of deliveries of key medical supplies, equipment and staff, saying bureaucratic obstacles had caused long delays in the WHO supply chain.

“Dual-use” restrictions put in place by Israel to stop the entry of devices that could be repurposed for military use are also applied too broadly, slowing or blocking the arrival of basic medical equipment like x-ray machines, oxygen cylinders and MRI devices, Tedros said.

“Access to health is limited because of the Israeli occupation and the military administration,” the Palestinian delegate said. “We must ensure the rule of law and logic prevail. We are the ones suffering.”

Politicizing the Assembly

Israel and its allies have long opposed the annual report and vote on Palestinian health conditions, stating that it singles out the Israeli-Palestinian conflict in a way no other regional conflict is highlighted by WHA.

“There is not a public health emergency or crises that this item is addressing,” the US delegate said. “We cannot support an agenda item that does not meet our shared objective of a World Health Assembly focused on public health.”

Canada reiterated its commitment to support efforts towards “a lasting peace” but said that a “technical health body is not the place for political discussions.”

At the same time, as the vote on Ukraine earlier in the same day illustrated, the “politicization” of WHA appears to be an increasingly inevitable consequence of a world beset by regional conflicts – with major powers shifting sides rhetorically, depending on their immediate interests and alliances.

Russia, for instance, whose ongoing invasion of Ukraine has caused a health crisis affecting millions of civilians, called on Israel to stop its “illegal military activities” and attacks on Palestinian “buildings and homes.”

After three days of demanding the assembly “talk about health” and “stop politicizing” the health crisis in Ukraine, its delegate made no such interventions relating to the Palestinian resolution.

Image Credits: Levi Meir Clancy.