Abstract
BackgroundIn the occupied Palestinian territory (oPt), access to maternal and child healthcare (MCH) services are constrained due to the prolonged Israeli military occupation, the Separation Wall, army checkpoints, and restrictions on the movement of people and goods. This study assesses the relationship between conflict intensity and access to Maternal and Child Health care in occupied Palestinian territory (oPt). To the best of our knowledge, the impact of conflict on access to health care has not been measured due to the lack of data.MethodsWe analyse pooled data from household surveys covering a fifteen-year period (2000–2014) of children (n = 16,793) and women (n = 8477) in five regions of the oPt. Conflict intensity was used as a continuous variable defined as the square root of non-combatant conflict mortality taken from monthly death rates of non-combatants by region. We use multilevel logistic models to explain four outputs: child vaccination schedules, antenatal care, caesarean sections, and complications during pregnancy.ResultsLocality is important with results showing the negative impact of conflict intensity on access to care, especially in the South West Bank for maternal health services and Central West Bank for vaccination (B − 0.161 p = 0.000 for DPT). Wealth is only significant for DPT vaccinations with poorest (B − 0.098 p = 0.005) and poor (B − 0.148 p = 0.002) individuals less likely to access services. Otherwise conflict does not show a differential effect across socio-economic conditions.ConclusionsThis study shows how locality is the strongest factor when looking at the impact of conflict in the oPt. Preventative services (ANC and vaccinations) are the most affected by conflict. We recommend a greater use of community health care to improve access to maternal and child care when barriers impede access to health facilities during times of conflict.
Highlights
In the occupied Palestinian territory, access to maternal and child healthcare (MCH) services are constrained due to the prolonged Israeli military occupation, the Separation Wall, army checkpoints, and restrictions on the movement of people and goods
Complications during pregnancy show several setbacks during this period which seem to be in line with the reported conflict intensity trends
Complications decreased in 2006 and 2010 compared to 2004, this is the survey data point most affected by the greatest intensity of conflict overall and this is evident in separate analysis we conducted by single surveys
Summary
In the occupied Palestinian territory (oPt), access to maternal and child healthcare (MCH) services are constrained due to the prolonged Israeli military occupation, the Separation Wall, army checkpoints, and restrictions on the movement of people and goods. In the occupied Palestinian territory (oPt) the continued Israeli military occupation, the Separation Wall, Israeli army checkpoints, and the restrictions of the movement of people and goods have limited the access of Palestinians to healthcare services [3] This conflict is unique due to its protracted nature spanning decades, with variations in the intensity and nature of the conflict [3,4,5]. Access to East Jerusalem (area C), where the major Palestinian hospitals are located, is largely restricted to local residents with an Israeli-issued Jerusalem identity card [6] This fragmentation of the territory makes movement within the West Bank challenging even in the absence of violent conflict
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