Quality of life for families living in East Jerusalem's Kafr ‘Aqab urban sprawl: a qualitative study

Abstract

BackgroundSince 1967, about 14 000 Palestinians have had their Jerusalem residency rights revoked by Israel, and thousands more struggle to maintain their permanent residency. As stipulated by the “centre of life” policy, Jerusalem residents must provide regular proof of residence within Israeli-defined municipal boundaries. In 2003, an amendment to the Israeli Nationality Law prohibited Jerusalem residents who were married to Palestinians from the occupied Palestinian territories to apply for residency rights to live in Jerusalem. The location of Jerusalem's Kafr ‘Aqab neighbourhood was physically separated from the city by the Separation Wall and Israeli military checkpoint, but was included within Israeli-defined administrative Jerusalem municipal boundaries. This inclusion allowed families who held different legal status to live together and maintain their Jerusalem residency. We aimed to investigate the effect of disrupted family life and insecurity on health and wellbeing of Palestinians living in this area. MethodsIn-depth qualitative interviews with 25 women were done with a locally-developed semistructured interview schedule that explored living conditions and quality of life. We selected participants through purposeful-convenience sampling methods to include Palestinians with Jerusalem residency who were married to residents of the occupied Palestinian territory, and vice versa. The Institute of Community and Public Health (ICPH) Research Ethics Committee granted ethical approval. Data were analysed by reading and rereading transcripts for recurring themes and subthemes. FindingsResidents of Kafr ‘Aqab were exposed to various life stressors, including anxiety resulting from legal and administrative battles to maintain residency, increased financial strains, economic exploitation, and the distress of relocating to areas with poor living-conditions to maintain Jerusalem residency, and at the same time living with spouses who are residents of the occupied Palestinian territory. Most women expressed strong feelings of insecurity for the future of their families' residency, given Kafr ‘Aqab's situation outside the Separation Wall. Heightened by fear of local Palestinian investigators working with the National Insurance Institute and perceived increase in crime, some women noted that they increasingly mistrusted newcomers and did not feel part of a community or integrated social fabric. Physical barriers (ie, the Qalandia-checkpoint and Separation Wall) restrict access to families and social support, and pose obstacles to access health-care services in Jerusalem. Most women reported harmful environmental conditions (including filth, sewage, and water concerns) because of increased urban sprawl and inadequate access to municipality services, despite taxation. InterpretationThe Kafr ‘Aqab predicament attests to poor conditions to live in for a vulnerable group, ruled with ambiguity and uncertainty, existing within an already volatile context. As a result, this raises concerns of the effects on health and wellbeing of families living in these conditions. FundingReproductive Health Working Group, Arab World and Turkey.