Comment
Offline: The Palestinian health predicament worsens
The United Nations Relief and Works Agency (UNRWA),
which administers health services to 5·3 million
Palestinian refugees through 143 primary health facilities,
is in acute crisis. After President Trump cut almost
US$300 million from UNRWA’s 2018 budget, services
will run out of money by the end of May. Irrespective
of one’s views about the complex politics of the Middle
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East, America’s decision to threaten the provision of
basic health care to millions of dependent people seems
utterly cruel. This emergency was a major theme of last
week’s annual Lancet Palestinian Health Alliance (LPHA)
scientific meeting, held in Beirut, Lebanon. In response,
UNRWA has launched a #DignityIsPriceless campaign
to protect its services to Palestinians in Gaza, the West
Bank, Jordan, Lebanon, and Syria. UNRWA is more than a
service provider, as Claudio Cordone (Director of UNRWA
Affairs in Lebanon) pointed out. UNRWA provides the
social protection that maintains stability in much of this
region. A financing conference held in Rome this month
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attracted promises of an additional $100 million. But this
money is still insufficient to save UNRWA. The Palestinian
people who depend upon UNRWA services now face an
existential crisis. Lebanon illustrates the extent of that
crisis. UNRWA provides care to about 200 000 people,
distributed across 12 camps and through 27 clinics.
Two-thirds of Palestinians live below the poverty line of
$6/day. The Lebanese Government isn’t helping matters.
They refuse to grant Palestinians even basic civil rights.
One senior UNRWA official noted that the international
community does not see Palestinians as human beings.
Tarek Mitri, Director of the American University of Beirut’s
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Issam Fares Institute for Public Policy and International
Affairs, called the prevailing global attitude nothing less
than “blatant discrimination”.
*
On May 6, Lebanese voters go to the polls in the first
parliamentary elections to be held in the country since
2009. As one would expect, news media are absorbed
by the rivalries between politicians who compete within
a delicately balanced Christian and Muslim multi-
confessional democracy. What is not discussed is how
future political leaders will address the plight of their
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Palestinian communities or the 1·5 million Syrian refugees
who have travelled to Lebanon since 2011. Palestinians
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and Syrians are politically invisible in Lebanon. Part of the
reason is sectarian. To recognise the rights of Palestinians
might upset the balance between different religious
groupings. Part of the reason is also political. Palestinians
claim the right to return to their homeland. If they were
granted meaningful rights of citizenship in Lebanon,
their lives would become more comfortable and their
incentive to leave diminished, so some argue. Palestinians
in Lebanon are therefore trapped. They are unable to leave
to live in a fully recognised nation state. And yet they are
ignored by the governments of those countries where
they currently reside. President Trump’s decision to inflict
further carnage on their already challenged lives is simply
impossible to understand.
*
Prospects for Palestinians are about to become even more
precarious. Hopes for a new and successful Palestinian–
Israeli peace initiative from the Trump administration
look poor. The decision to move the US embassy to
Jerusalem has poisoned trust between Palestinian
leaders and the one country that could catalyse positive
change. And the viability of the Palestinian leadership
itself is in question. The LPHA is a scientific network of
Palestinian health scientists and international partners
who are committed to describing and solving the health
predicaments of Palestinians. LPHA annual meetings are a
convening point to discuss and strategise about what we
know and what should be done about what we know—
strengthening solidarity, building hope, and enabling
a new generation of young Palestinians to be the next
health leaders of their country. The LPHA is a platform
to hold all those in the region responsible for Palestinian
health accountable for their often harmful actions. And
the LPHA can help translate the evidence it gathers into
action and policy. The LPHA is about voice and agency.
Although the circumstances for the health and wellbeing
of Palestinians look increasingly bleak, those who
attended the conference in Beirut last week left energised
by their work and the opportunities it provided. For a
people in jeopardy, science is about more than research. It
is about affirming an indissoluble identity.
Richard Horton
richard.horton@lancet.com
www.thelancet.com Vol 391 March 31, 2018