Health in the occupied Palestinian territories

Abstract

Rita Giacaman and colleagues (March 7, p 837) misrepresent trends in public health and health services for Palestinians in the West Bank and Gaza in 1967–94, before the Palestinian National Authority assumed leadership. Population health improved sub stantially under the Israeli Civil Administration. Major sanitation and disease-control projects included eff orts to bring chlorinated running water to homes, which increased from 24% (1972–74) to 79% (1992) in the West Bank, and from 14% to 93% in Gaza. In the 1970s, oral rehydration campaigns reduced morbidity, hospital admission, and mortality from diarrhoeal diseases. Israeli Civil Administration health priorities included the full spectrum of primary prevention, screening, and workforce development. Vaccine coverage was more than 95% and reached the smallest villages; polio and measles were eradicated. Routine vitamin K for neonates was introduced, along with screening for phenylketonuria and congenital hypothyroidism, and routine vitamin A, D, and iron supplements were provided for infants and pregnant women. The gains from this period persist. UNICEF data (2009) show that immunisation coverage in the “occupied Palestinian territories” is 99%, above Israeli and Jordanian rates; the proportion of Palestinian infants with low birthweight is 7%, compared with 6% in Lebanon, 7% in Kuwait, 12% in Jordan, and 11% in Saudi Arabia. The Palestinian mortality rate among children younger than 5 years fell from 38 per 1000 livebirths in 1990 to 27 in 2007. Life expectancy at birth rose from 54 years in 1970 to 68 years in 1990 and 73 years in 2007. The commitment of the Hamas government in Gaza to the destruction of the State of Israel has made cooperation between health establishments very diffi cult. Yet past successes in public health off er a model of the potential of cooperation, mutual benefi t, and hope for the future.