In the aftermath of a delicate ceasefire coming on the heels of 10 days of Israeli airstrikes that killed some 230 Palestinians, Gaza’s health care infrastructure has weathered serious damage: Bombs hit 17 hospitals and clinics, interrupted importation of medical supplies, and slaughtered one of the area’s top pulmonologists in charge of coronavirus response efforts. Shrapnel from one Gaza City explosion reportedly careened into the Ministry of Health offices across the street, rendering the besieged strip’s sole Covid-19 testing lab inoperable. Meanwhile, health officials reportedly fear that the United Nations–run schools that became makeshift emergency shelters for thousands of fleeing Gazans could drive a surge in new cases at the very moment hospitals spared from bombardment are overwhelmed by casualties from the attacks.
But if the scale of devastation caused by airstrikes is especially acute, it would be wrong to think of the so-called “Israeli-Palestinian conflict”—itself a phrase that obfuscates the power dynamic between two staggeringly unmatched sides—as something that erupts every few years while otherwise lying dormant. It would likewise be wrong to conceive of a few suddenly decimated hospitals as an anomalous emergency besetting an otherwise functional Palestinian health care system. Israeli dominion over all aspects of Palestinian life doesn’t start and stop. It’s a daily process, maintained by violence. This experience—the ongoing nakba that many Palestinians swear never ended—has influenced every conceivable indicator of well-being. And as communities scramble to rebuild in the wake of a simultaneous siege and pandemic, one thing has never been clearer: Settler colonialism is terrible for public health.
As Jeff Halper describes in his book Decolonizing Israel, Liberating Palestine, the 1948 war culminating in Israeli independence drove some 75 to 80 percent of the region’s Palestinian residents out of their homes and villages, which were then transferred to the Israeli state through the 1950 Absentee Property Law. After a subsequent war in 1967, Israel occupied even more land, as it continues to do today. At present, the land “from the river to the sea” is split roughly evenly between Jews and Palestinians. Around 1.6 million of the latter are citizens of Israel, while the rest live in occupied territories with a variety of legal statuses—conditional legal residents in East Jerusalem, refugees under military occupation in the West Bank and a total blockade in Gaza.
Meanwhile, Israel has continued to construct settlements—new towns and roads often financed by speculative developers from the United States and elsewhere and accessible only by Israelis—on ever-shrinking Palestinian swaths of land, essentially kettling millions of Palestinians into only 10 percent of the overall territory. Palestinians in the West Bank and Gaza have little freedom of movement, no control over their natural resources, and no meaningful avenues to democratic change. While they can vote for limited civic leadership, their freedoms of speech and assembly are severely curtailed, and they’re wholly unable to vote away the terms of their occupation or citizenship status. They aren’t permitted to come or go freely, face ubiquitous military checkpoints, and are constantly surveilled and harassed by Israeli soldiers. Should any Palestinian run afoul of the armed forces governing their every move, they can only fight their case in military court. The Israeli military’s power to maintain decades of occupation is bolstered by fervent U.S. support, both political and financial.
Unsurprisingly, decades of apartheid have impoverished Palestinian communities, in which per-capita incomes are less than one-tenth of those in Israel. Unemployment in the West Bank and Gaza hover at around 27 and 42 percent respectively. Around 25 percent are food insecure; water and electricity are controlled by Israel and lacking in the occupied territories, especially in Gaza. Over 80 percent of Gazan children are believed to experience moderate to severe PTSD.
The suffering imposed on Palestinians is measurable: Life expectancy is around 10 years shorter in the occupied territories than in Israel; maternal mortality is four times higher, and infant mortality is eight times higher. Palestinians are more vulnerable to many chronic and infectious diseases.
And just as a two-tiered system produces two levels of health, so too does it filter people into divergent systems for managing it: Health spending per person in Palestine is around one-eighth that in Israel; the latter has 1.6 times as many doctors and eight times as many specialists, whereas Palestine has fewer hospitals and beds while paying more out of pocket. Because Palestinians legally require Israeli permission to travel and receive medical care elsewhere, they suffer high rates of denial and mortality while waiting. For Gazans, even the movement of medical supplies and ambulances is curbed by the blockade.
Given the status quo in Palestine, the dual wallop of a pandemic alongside airstrikes conducted by its nuclear-capable ruling power is almost unbearable to fathom. In an especially resonant example of the two societies’ contrasting realities, Israel was recently feted worldwide for its supposedly impressive coronavirus vaccination rollout that decidedly wasn’t shared with Palestinians, only 1 percent of whom had gotten jabs by the time they crowded into improvised bomb shelters last week. In light of airstrikes sparked by clashes over forced evictions of Palestinians from the neighborhood of Sheikh Jarrah in East Jerusalem, thousands of Gazans are also reportedly newly homeless: a devastating blow that I shouldn’t have to tell you will only worsen the mind-boggling statistics I’ve listed above.
What these numbers broadly reflect is simply who has the resources to thrive and who does not, which is as close a definition of “health” as you’ll ever get. Long, happy lives are contingent on safety, autonomy, housing, food, exercise, joy, love, and purpose—things that can be surprisingly hard to come by in a vastly unequal world, particularly for millions of stateless people surviving through a generations-long siege. Individual variance aside, rich countries are healthy because they have those things—often because they extracted them from poor countries, which do not. In this sense, Israel is hardly unique: Imperial powers, the U.S. chief among them, have amassed staggering wealth and the health that comes with it by stealing land, labor, and treasures at gunpoint from exploited and colonized peoples. Such historic and present-day crimes demand a reckoning, redistribution, and reconciliation to result in anything approximating justice. Until then, the story told by global health indicators will be a tragic one, and the Palestinian nakba will go on.