Reportage. Palestine has already begun to reduce its dependence on Israeli hospitals. But cutting ties is easier said than done: developing the Palestinian healthcare system will take years and transferring patients to Jordan and Egypt is subject to strict controls.

Ramallah’s attempt at independence, at least in healthcare

With the coronavirus emergency a thing of the past (seemingly, at least), the only issue on the Israeli-Palestinian front at the moment is the annexation by Israel of a large portion of the West Bank.

Netanyahu was clear on this issue when he met with the leaders of his party, Likud, on Monday: “This is an opportunity we cannot allow to pass us by … to apply sovereignty to the territory of our homeland. We have a historic opportunity that we haven’t had since 1948 to apply sovereignty wisely in Judea and Samaria [the West Bank], as a diplomatic and sovereign step,” he said, describing the Palestinian territory occupied in 1967 as part of Eretz Israel, the biblical Land of Israel.

His words disprove the rumors of a slowdown in his plan for unilateral annexation beginning on July 1, on account of warnings addressed to Israel by some European countries and the United Nations.

Meanwhile, the Palestinians have few remaining avenues at their disposal, considering the insufficient support they are receiving from the EU and the Arab world. For now, the PNA insists on the line of disengagement from the Oslo Accords, announced by President Mahmoud Abbas and confirmed by the government.

Prime Minister Mohammad Shtayyeh said that the Authority would maintain order and sovereignty in the West Bank, while defending the civil rights of the Palestinians. “This is an important battle,” he stressed, “a battle over the Palestinian national presence in the territory and to prevent the annexation of Palestinian territory for the benefit of the settlement enterprise.”

Doubts remain, however, about the true intentions of the PNA. It is not easy to determine whether the interruption of relations with Israel and the US and the end of cooperation with the intelligence community represent the crossing of the Rubicon or remain just a threat aimed at discouraging Israel and gaining international support.

In Ramallah, Palestinian leaders are insisting that that the announcement made by Mahmoud Abbas is entirely serious. However, truly pulling the plug is complicated for the PNA, which is not able to make any serious decision without the green light from Israel. The Palestinian economy and finance are under Israel’s control, as are its imports and exports. As it has done countless times in the past, the Israeli government can at any time stop the transfer of Palestinian funds deriving from the collection of taxes and customs duties, which represent about 40% of the PNA’s revenue. And it is important to remember that “Zone A,” the territory fully administered by the PNA, represents only 14% of the West Bank.

At the beginning of the week, Shtayyeh gave orders to restrict relations with the Israeli healthcare system and to stop as soon as possible the transfer of seriously ill Palestinians who cannot be treated in the West Bank and Gaza to Israeli state hospitals. Mai Al Keile, Minister of Health and former Palestinian Ambassador in Rome, told us that “in 2019, the NPA spent 850 million shekels (about €220 million) for the treatment of our citizens in Israeli hospitals. We have already reduced this flow, and aim to develop an independent and improved healthcare system.”

“My ministry is preparing a plan to improve our facilities and medical care,” Al Keile assured us. “Meanwhile, Jordan and Egypt are willing to receive those whom we cannot treat in the West Bank and Gaza, between 1,000 and 2,000 people per year.”

Independence from Israel is something much easier said than done. Even if the plan is implemented flawlessly, the development of the Palestinian healthcare system will still take years, and the transfer of patients abroad to Jordan and Egypt is subject to very strict restrictions and controls.

“The problem mainly concerns cancer patients who need immediate care and very expensive special treatments,” says Steve Sosebee from PCRF, a Palestinian NGO that provides free care to ill children. PCRF has opened pediatric oncology departments at two public hospitals in the West Bank and Gaza in recent years.

“Children with cancer can be treated at our departments. But it’s different with adult cancer patients,” Sosebee adds. “Local hospitals have few devices and not enough doctors and nurses specializing in oncology. I hope that the agreements with Jordan and Egypt are already well underway, otherwise I don’t see how the more seriously ill can be treated properly.”

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