Health in Palestine   The Intifada for Independence     Statistics About Palestinian Victims   Read UPMRC's Urgent Appeals   Medical Access Deaths   Medical Neutrality Violations	The Intifada for Independence Background The current Intifada is a direct response to people's frustrations after 37 years of Israeli military occupation of the West Bank, Gaza and East Jerusalem. More specifically, it is a manifestation of the public's general disillusionment with the Oslo Accords. Since the Oslo Peace Process, the military occupation remains, settlement activities have increased, and Israeli governmental policies continue to stifle Palestinian economic and political life. Israel's continued military occupation was topped by the provocative visit of former defense minister Ariel Sharon to the Haram Al-Sharif in Jerusalem in late September 2000. This visit was the event which specifically triggered the Intifada. Sharon, who was responsible for massacres of Palestinians in Lebanon, arrived at the Muslim sanctuary with 1,500 heavily armed Israeli security forces. The next day, these forces responded to Palestinian protests against Sharon's visit with excessive force, firing tear gas, rubber-coated metal bullets and live ammunition at worshipers and protestors. Around 200 civilians were injured and six killed. Demonstrations and clashes erupted throughout the West Bank and Gaza Strip in direct response to the killings in Jerusalem, and Palestine entered into a state of emergency as Israeli aggression against civilians intensified. The Israeli army continues to escalate its deadly use of force, attacking men, women and children with tear gas, rubber-coated metal bullets, explosive high-velocity ammunition, anti-tank missiles, tank shells and attacks from helicopter gunships and F-16s. Israel's policies during the Intifada have led to devastation and disruption in all areas of Palestinian life. From 29 September 2000 until 20 July 2004, 3,209 Palestinians were killed, and more than 50,000 injured.* Approximately 3,000 of those injured will be left permanently disabled-500 of whom are children according to an estimate by the Ministry of Health. As of July20, 2004: of those killed 399 were Palestinians aged 15 years-old or younger. 1,918 Palestinians were killed by live ammunition, and 704 were killed by heavy weapons 56 were killed by Israeli settlers. In conjunction with its excessive use of force against civilian demonstrators, the Israeli government has systematically destroyed houses, industrial plants and orchards. Furthermore, it has imposed various collective punishment measures which have served to choke the physical, mental, political, economic and social life of Palestine. The Israeli government has imposed arbitrary curfews preventing Palestinians from leaving their homes. It has also imposed a strict internal and external border closure, which has severely restricted mobility between the West Bank and the Gaza Strip and between the cities and villages throughout the Occupied Territories. * Unless otherwise indicated, all statistics were obtained from the Health, Development, Information and Policy Institute. The Economic Effects of the Closures The closures imposed by the Israeli military forces violate freedom of movement in Palestine, which is now made up of 220 discontinuous geographical entities. Hundreds of Israeli checkpoints have been erected at entrances of Palestinian villages and cities, and the Israeli government imposes frequent and lengthy closures of the Gaza international airport, the borders with Egypt, Jordan and Israel and the "safe passageway" between Gaza Strip and the West Bank. The closures have prevented Palestinian workers from reaching their workplaces (whether in Palestine or Israel), exporting Palestinian products, and importing raw materials, such as basic food supplies and basic building materials like cement. On many occasions, fuel supplies have been stopped as well. There has been a 51% drop in GNP. There has been a total wage income loss of $59.4 million The unemployment rate is now 67% in Gaza and 48% in the West Bank. 75% of Palestinians now live in poverty (earning less than $2 per day)- a number that has more     than doubled since before the Intifada. 84.6% live in poverty in Gaza and 57.8% in the West Bank Total income losses to the Palestinian economy are estimated to be between $3.2-10 billion. This     number includes income only and does not take into account the cost of destruction of public and     private property. Because of the unemployment caused by Israeli measures, many families are now unable to afford their basic living needs including food supplies, medication and other health care needs. This economic hardship will have severe long-term effects, especially for the most marginalized groups including women, children, the elderly and the handicapped. Health Consequences Palestinians in the West Bank and Gaza Strip have suffered from numerous direct and indirect health consequences of the Israeli attacks and collective punishment measures. Obviously the direct health difficulties Palestinians face include the deaths and injuries that occur on a daily basis from Israeli aggression. However, Israel's policies of collective punishment also have severe health consequences. Closures prevent Palestinians from accessing health services, and approximately 70% of the population is cut off from hospital care for weeks and months on end. Closures also prevent medical staff from reaching clinics, especially those located in the isolated, rural areas which are most affected by the closures. Sometimes our doctors and community health workers cannot pass through particular Israeli military checkpoints for days or weeks, even when they show identification that clearly marks them as medical personnel. Ambulances are also often denied passage through checkpoints. Palestinians have faced numerous obstacles to obtaining health care such as: Access restricted or denied to health centers or hospitals. There are numerous documented cases of: women delivering their babies at checkpoints, suffering miscarriage because Israeli soldiers denied them access to health facilities, patients dying at checkpoints because of heart troubles, and patients with renal failure and cancer patients dying for lack of access to treatment. Furthermore, due to road closures and travel restrictions, many patients referred for follow-up or specialized care cannot reach secondary and tertiary care centers to get the services they need. PREGNANT WOMEN IN DANGER On July 10, 2001, 30-year-old Furial Idries gave birth at an Israeli checkpoint in the Jordan Valley. Despite her condition, Israeli soldiers prevented Furial and her husband from traveling to a clinic in the northern West Bank village of Tubas. The family finally managed to reach the hospital, but the baby had died on the way. In another incident, a woman from the village of Deir Abu Deif in her 6th month of pregnancy aborted her baby when settlers shot at her car. In the village of Beit Dajan, Israeli forces made a woman in labor wait at a checkpoint for many hours. She was ultimately denied access to the hospital and delivered a stillborn baby. The mother suffered from a nervous breakdown. Disruption of Antenatal care. A majority of pregnant women who used to give birth with the attendance of a doctor or a midwife are now unable to do so, thus risking the lives of the mother and the infant. The percentage of pregnant women unable to access antenatal care is nearly fives times higher now than before September, 2000 (20% as compared to 4%). There has been a 100% increase in home deliveries, and a shocking 56% increase in stillbirths since the Intifada began (Figures from the Ministry of Heath). Psychological trauma. The least documented, but perhaps the most long-term and devastating effect of the aggression is the psychological trauma that people, especially children, are experiencing. Medication Shortages. Israeli soldiers regularly denied access to staff and vehicles transporting medication and laboratory supplies to Palestinian villages. As a result, there is now high demand for specific medications in the most isolated areas of Palestine, especially drugs for patients suffering from chronic diseases. Interruption of vaccination program. UPMRC and The Ministry of Health work together in operating mobile teams to deliver vaccines to small, remote villages. This work is at risk because of the closures. The Ministry usually transports vaccines to health centers in a special cold chamber vehicle, which is necessary because many vaccines are heat-sensitive and will expire if they are not kept cold. Israeli soldiers have regularly turned away this vehicle and the vaccines cannot reach our centers. This is creating a vaccine shortage and there is a serious risk of disease outbreaks, such as mumps and measles in children. Lack of follow-up on Chronic Diseases. Patients with chronic diseases such as diabetes, cancer and heart disease need regular monitoring and follow-up care. Inability to access specialized care centers or inability of doctors and health staff to reach clinics means that these patients are not getting the follow-up care they need. In addition, because they cannot reach the clinics, patients cannot purchase necessary medicines. We have seen patients try to "stretch" their medications (i.e. take less than the recommended dosage each day in order to make the supply last over more days) and suffer complications as a result. UPMRC's Response With its 22-years of experience providing health services to Palestinians, UPMRC was able to face the massive wave of violence by mobilizing all its resources to sustain health provision. It addressed the emergency situation by maintaining a solid connection to its long experience in primary health care service provision and its understanding of the reality and implications of closures. Historically, UPMRC has had to adapt to political and military developments in order to continue providing health care to disadvantaged communities. This was the very reason that UPMRC's was created in the late 1970's, when a group of Palestinian doctors and health professionals sought to supplement the decayed and inadequate health infrastructure caused by years of Israeli military occupation. In the first days of the Intifada, UPMRC focused on ensuring that basic medical services would continue to be provided in the face of Israeli aggression and policies of collective punishment. The violent clashes during the first weeks were a signal to reinforce our first aid program, with field hospitals and abundant training for first aid volunteers. Later, concern shifted towards the closure as a fundamental problem. UPMRC had to develop a quick response that took economic hardship and skyrocketing poverty levels into consideration. The best example of this adaptive response is the Mobile Clinic Program. UPMRC rapidly devised a plan to enable mobile clinics to reach communities living under tight closure and/or curfew. Mobile clinics became a necessity because many patients cannot access basic and specialized services unless the services come to them. Another example of UPMRC's adaptive response involved increasing the capacity of our local clinics to provide emergency, basic and specialized care to Palestinians isolated from secondary and tertiary medical facilities. In conjunction with its immediate response, UPMRC has also implemented a long-term plan to address the continuing effects of the health crisis. For example, UPMRC has developed comprehensive First Aid training programs in order to ensure that there are individuals in communities throughout the West Bank and Gaza Strip capable of handling emergency situations and saving lives. Another example consists of courses and training sessions on Management of Emergencies and Crises given to public institutions and teachers, parents, and education professionals to enable them to react correctly in dangerous situations. The emphasis now is on preparing people and communities to solve their health and development problems. This is especially important in light of the fact that the Oslo peace process and the harsh Israeli closure policy have created a de facto fragmentation of the Palestinian territories. UPMRC has therefore followed a decentralized approach, whereby each community is given the knowledge and tools to respond to acute demands and problems. UPMRC is helping to prepare people to create their own structures and learn to mobilize to the utmost of their capacity. For more information please see the Palestine Monitor