ألف ياء – جريدة العرب منبر إعلامي تقدمي يلتزم بقضايا الطبقات الشعبية فلسطينياً وعربياً وأممياً ولترسيخ مبادىء الحرية والمساواة والعدالة الاجتماعية والتقدم والسلم العالمي
مقالات مشابهة
6-may-2023
ABSTRACT
The International Convention on the Suppression and Punishment of the Crime of Apartheid (1974) and Article 7 of the Rome Statute of the International Criminal Court (1998) recognise apartheid as a crime against humanity, characterised by a practice of systematic oppression and violations of human rights with the intent of one racial group to maintain domination over another. The term ‘medical apartheid’, although without a formal definition in international human rights law, has been used similarly to refer to situations of pervasive segregation and discrimination in health care, based upon race, and characterised by stark inequality in health care accessibility, availability, acceptability, and quality. This paper, using a combination of literature review; data on attacks on Palestinian health facilities, workers, and transport; and information from Palestinian and Israeli government authorities on referrals to specialised health care services, examines the ways in which Israeli policies and practices can be understood to constitute a form of ‘medical apartheid’ that deprives Arab residents of the Palestinian territories the full realisation of their right to health.
KEYWORDS: Medical apartheiddiscriminationhuman rightsPalestine
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Introduction
Apartheid is an Afrikaans word meaning ‘separateness’, or ‘the state of being apart’, literally ‘apart-hood’. Its first recorded use was in 1929, but apartheid as a specific ideology supported by the South African National Party (NP) government was introduced in 1948. In South Africa, apartheid was enforced by laws that mandated that racial groups live separately, banning interracial marriage as well as social and residential integration between racial groups (Mhlauli & Mokotedi, Citation2015).
Although the Convention on the Suppression and Punishment of the Crime of Apartheid (Apartheid Convention) was adopted by the General Assembly in 1973 and declared apartheid to be a crime against humanity and a violation of the Charter of the United Nations, contemporary claims of apartheid continue to be made, including in South Africa, China, Myanmar, and Israel (Amnesty International, Citation2017; Kushner, Citation1979; Mhlauli & Mokotedi, Citation2015; Munsterhjelm, Citation2019).
In 2007, South African jurist John Dugard, in his capacity as UN Special Rapporteur on the situation of human rights in the occupied Palestinian territories (oPt), issued a report that Israel’s practices, in place since 1967, in the oPt had assumed characteristics of colonialism and apartheid (Dugard, Citation2007). More recently, Richard Falk (who served as UN Special Rapporteur on the situation of human rights in the Palestinian territories following Dugard) and Virginia Tilley examined the question of whether Israel’s policies amounted to apartheid, finding that they did (Falk & Tilley, Citation2017). Leading international human rights organisations such as Amnesty International (Citation2022) and Human Rights Watch (Citation2021) have also alleged that Israeli authorities have been responsible for the crime against humanity of apartheid.
By contrast, the term ‘medical apartheid’ is not specifically defined by international treaties. Generally, the term has been adopted, especially in the United States, to refer to situations of pervasive segregation of health care, based upon race or ethnicity, as well as discriminatory, exploitative and abusive treatment in health care settings and, in some cases, non-consensual medical experimentation (Brooks et al., Citation1991; Golub et al., Citation2011; Washington, Citation2006). Related to medical apartheid is the concept of ‘vaccine apartheid’ which has, with the onset of the COVID-19 pandemic, increasingly been identified as a type of global apartheid with inequitable access to vaccines among low- and middle-income countries (Parray et al., Citation2022).
In Palestine, the recognition of a broad system of apartheid, combined with the acute recognition of COVID-19 related vaccine apartheid, has led to increasing identification of Israel’s medical policies and practices as a system of medical apartheid (Barghouti, Citation2021). While often used colloquially, an examination of the mechanisms and characteristics of medical apartheid in Palestine, as both a part (and consequence) of the system of apartheid and as an intentional instrument to subjugate Palestinians by depriving them of their health and well-being has yet to be engaged by public health scholars.
Drawing upon an understanding of medical apartheid as a discriminatory system of policies and practices seeking to reinforce racial or ethnic segregation and resulting in direct harm and stark inequality in health care accessibility, availability, acceptability, and quality, this paper seeks to examine if and how current Israeli policies and practices in the oPt in terms of access to medical care may constitute medical apartheid and to explore the consequences on Arab Palestinian’s realisation of the right to health. We will also look at how Israel’s policies favour those Palestinians contributing to the Israeli state. While providing the context of policies implemented over the past five decades, our review looks specifically at data from 2019 through 2022, reflecting current conditions and impacts.
Methods
In assessing evidence of medical apartheid by Israel in the oPt, we examined: (1) the financing of health care in the oPt; (2) attacks on health facilities, workers and transport in the oPt; and (3) referrals to health care services for Palestinians to non-MoH providers in West Bank, Israel, East Jerusalem, and other destinations between 2019–2021. Together these elements examine the basic foundation of health systems, specific threats to their operations, and mechanisms for ensuring advanced and high-quality care.
Drawing upon the framework of Arksey and O’Malley (Citation2005), we conducted a scoping review for literature on financing of health care in the oPt, including information on the history, development, and funding of the health care system. Articles that met the following criteria were sought in our review: (1) Published in a peer-reviewed English-language journal between 2000 and 2022; and (2) Focused on the policies and evolution of the health care system after 1967 (e.g. the occupation of the West Bank and Gaza). Further sources were identified through an examination of citations of those articles identified in our preliminary search. We excluded conference proceedings, abstracts, book chapters, and articles for which the full text was not available in English.
Data about attacks on health facilities, workers, and transport were drawn from a review of reports prepared by the Safeguarding Health in Conflict Coalition (SHCC) and the non-governmental organisation Insecurity Insight documenting attacks between 2019 and 2021. The SHCC and Insecurity Insight reports rely upon diverse sources for documenting and validating attacks on health. For attacks i
