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In the shadow of war

By Médecins Sans Frontières/Doctors Without Borders - 10th Jun 2024

An MSF team walking in the streets of Jenin refugee camp, north of the West Bank

Médecins Sans Frontières has been responding to the significant healthcare needs in the West Bank since the Israel-Gaza war began in October 2023

“We walk for hours to reach the health facilities. Sometimes we use the donkeys to transfer sick people to the hospital or to the clinic,” says Mahmud Mousa Abu Eram, a Palestinian man from Hebron, in the West Bank.

“There hasn’t been transportation in this area for a long time, and even if there is a car to drop us to any clinic, the Israeli army confiscates the cars,” he says.

An MSF nurse provides medical care to a little child in the Almajaz mobile clinic in Masafer Yatta, south of Hebron

Hebron, located in a dry mountainous region known for its vineyards dating back thousands of years, is considered one of the oldest cities in the West Bank. But its rich history and that of the wider West Bank is also haunted by brutal violence, which has escalated in modern times. While that violence might be nothing new, there has been a spike across the West Bank since 7 October, when the war in Gaza erupted.

According to the United Nations Office for the Coordination of Humanitarian Affairs, in the months following October 2023 to 15 May, 479 Palestinians have been killed in the West Bank, including 116 children. One-third of these Palestinians were killed in refugee camps in or near the cities of Tulkarem and Jenin.

A strip of land situated between Israel and Jordan, the West Bank is an Occupied Palestinian Territory. Over 2.9 million Palestinians live in the area across 11 districts and among the population in the West Bank and nearby East Jerusalem is approximately 630 thousand Israeli settlers.

It is estimated that around 61 per cent of the West Bank is off-limits to Palestinians. Checkpoints, roadblocks, and incursions by the Israeli army and settlers have long cut off towns and villages from each other and blocked Palestinians from accessing basic services including healthcare and food markets. This in turn has caused residents to run out of water, fuel, and other supplies, and hindered Palestinians from reaching their schools, work, family, and friends.

In the Hebron district of Masafer Yatta, for Palestinians, frequent roadblocks, military raids and attacks by settlers make accessing health facilities increasingly difficult. And to make matters worse, no local organisations can provide basic healthcare services due to a lack of funds, restrictions imposed by the Israeli army and poor road infrastructure, which limits access to the town.

Meanwhile, the severity of the violence in Masafer Yatta has left many Palestinians feeling too afraid to leave their homes.

“Most of the time it is forbidden to stand at the window. One day when I was standing at the window, a settler saw me and complained to the soldiers,” says a Médecins Sans Frontières/Doctors Without Borders (MSF) patient who wishes to remain anonymous.

“The soldiers stormed my house and destroyed everything in it”. 

An MSF staff member speaks to a 70-year-old beneficiary from the Al-Majaz Bedouin community in Masafer Yatta. He says: ‘Life has become very difficult with the continued attacks by settlers on us, and life was better years ago’

Even when people in the West Bank can reach healthcare facilities, their safety and that of healthcare staff is not guaranteed. According to the World Health Organisation, since October 2023, Israeli authorities were responsible for over 447 attacks on healthcare in the West Bank. 

In Jenin and Tulkarem districts, in the north of the West Bank, Israeli forces have been carrying out regular ground raids accompanied by air and drone strikes, with deadly consequences. Along with the military incursions, settler violence in the north of the West Bank is one of the main obstacles Palestinians face in their daily lives.

Palestinians who live in the refugee camps in Tulkarem and Jenin are trapped and blocked from accessing healthcare facilities, especially during military incursions. People with life-threatening injuries wait to reach hospitals, and, in many cases, they die before getting there. In both locations, MSF teams have been providing emergency care reinforcement, and supporting volunteer paramedics with donations and training.

His father, also a paramedic trained by MSF, learned the news of his son’s killing while working in the ambulance

On 21 April, an MSF-trained paramedical volunteer was shot in the leg while on duty during a three-day incursion in Tulkarem and Nur Shams refugee camps in the West Bank.

Due to the hostilities, it took seven hours for him to reach the hospital. In another incident, one of our staff members administered cardiopulmonary resuscitation to a 16-year-old child after he was shot in the head, but was unable to save him.

“His father, also a paramedic trained by MSF, learned the news of his son’s killing while working in the ambulance,” says Itta Helland-Hansen, MSF project coordinator in Jenin.

The few medical staff that are still able to carry out their work are pushed to their professional limits. “Most of the time, ambulances are blocked at checkpoints. Even in cases of medical emergencies and when we have the siren on,” says a medic from al Arrub refugee camp in the southern part of the West Bank between Hebron and Bethlehem.

Palestinians on their way back to their homes after visiting the MSF mobile clinic in the Al-Majaz community in Masafer Yatta

“How long they stop us for does not depend on the medical emergency, it depends on the mood of the soldiers. They make us wait for one or two hours…. Or they make us take another road. If the patient has a gunshot wound from the Israeli army, they can arrest the patient and even confiscate the ambulance. We don’t know what will happen to the patient then, if they bring him to a hospital or to a prison and if he receives medical care in the prison,” says a medic from the al Arrub refugee camp.

How long they stop us for does not depend on the medical emergency, it depends
on the mood of the soldiers

The alternative to avoiding long waiting times and harassment at checkpoints is receiving no medical care at all.

“Before 7 October, the situation was somewhat lighter, I used alternative routes to get where I needed to go, and my mental health therapist contacted me to ensure I continued my sessions,” says an MSF mental health patient from Nablus, in the north of the West Bank.

“Coming here for the session comforts me. I don’t feel like I’m in danger when I’m here,” she adds. 

This article was written by Médecins Sans Frontières/Doctors Without Borders.

MSF in the West Bank

Médecins Sans Frontières/Doctors Without Borders (MSF) teams have been present in the West Bank and Gaza since 1989. In the West Bank, teams in Masafer Yatta run three mobile clinics in Um Qussa, Al Majaz, and Jinba until the end of 2023. The clinics include outpatient consultations, reproductive health, mental health support, and nutritional screening. In 2024, MSF increased the number of mobile clinics in the Hebron district to 13 mobile clinics to meet the increasing needs in the community. Between January and March 2024, our team provided over 6,000 outpatient consultations and around 1,400 individual mental health sessions, including assessment of new patients and follow-up consultations, across the various locations.

In Hebron, MSF teams have adapted and expanded their activities to ensure continuous care and access to primary healthcare services for the most vulnerable and isolated patients. In Jenin and Tulkarem MSF teams are supporting and training medical and paramedical staff to provide first aid and lifesaving services in and outside the hospital in case of mass casualty and obstructed access to the premises. MSF teams are also providing mental health support in the clinics in Nablus, and Hebron, aiming to address critical gaps in mental healthcare provision and to ensure that those in need receive the support and care they require. MSF work in a number of hospitals and healthcare facilities in Gaza to respond to the overwhelming needs of people affected by the war since 7 October. MSF medical teams provide surgical support, wound care, physiotherapy, post-partum care, primary healthcare, vaccinations, and mental health services. However, systematic sieges and evacuation orders on various hospitals have pushed our activities into an ever-smaller area and limiting our ability to respond to people’s needs.  

References available on request

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