An update from the author: This piece was written and edited two weeks before its publication date and contingently does not cover the important and developing situation in Palestine. However, the recent atrocities only serve to highlight more intensely and urgently the injustices described in the following article, and the proactive position scholars must take to challenge them.

There has been understandable interest in the speed at which Israel has vaccinated its population against COVID-19, with subsequent massive declines in COVID-19 cases, hospitalisations, and deaths, all while re-opening the economy. As of late April, almost 60% of Israelis had been fully vaccinated. This statistic is worthy of critique however, because the denominator used does not represent everyone living under Israeli rule; it only includes Israeli citizens, excluding 5 million Palestinians living under Israeli occupation. So why are those Palestinians excluded, and why should the public health community care? 

Separate and unequal 

The politico-legal system built by Israel over decades has effectively segregated Israeli citizens from Palestinians in the West Bank and Gaza Strip. This is not about geography, as Israeli settlements throughout the West Bank are counted as Israeli towns while the surrounding Arab towns and villages are not. The Israeli settlements are connected to the Israeli road network, supplied by Israeli water and electric companies, and provided public services by the Israeli government.

All so that these basic amenities are rendered inaccessible to Palestinians, whose land was confiscated to make way for the illegal settlements. Except for some workers - mostly in construction, manufacturing, and agriculture - Palestinians living in the West Bank and Gaza Strip are segregated from those with Israeli citizenship. This segregation is not just physical: a Palestinian would find themselves in an Israeli military court with a 99% conviction rate for the same infraction that would land an Israeli citizen in civilian court. 

Segregation and injustice have evident parallels in public health. Palestinians face frequent power outages and water shortages, precarious employment, and widespread poverty. The health system and other public services are poorly resourced. Many of the poor conditions in these important determinants of health can be traced back to Israel’s deliberate policies to cause de-development in the West Bank and Gaza Strip. 

The pandemic strikes 

We have seen the COVID-19 pandemic highlighting inequities in health and social conditions globally. Palestine is no different, where the conditions were ripe for the pandemic to inflict a heavy toll on Palestinians after decades of injustice. Israel’s actions during the pandemic only served to magnify that inequity. While Israel spent more than $24 billion in economic aid alone from March to September 2020 (more than eight times the Palestinian Authority’s total annual expenditure), $0 went to Palestinians who set up private philanthropy channels to support those in need. Furthermore, Israel took steps to exacerbate the COVID-19 pandemic among Palestinians. The Israeli army destroyed COVID-19 testing sites, shut others down, and linked COVID-19 aid to political concessions. 

Israel then embarked on one of the fastest vaccination drives in the world, while excluding more than one-third of the population living under its control. Even when Palestinians managed to secure vaccine doses, Israel held up a shipment of 2000 doses from the West Bank to the Gaza Strip. While nearly 60% of Israeli citizens have been fully vaccinated, only 0.9% of Palestinians in the West Bank and Gaza Strip have (as of 25 April). This injustice is happening while Israel has more than 17 million doses available for use. Israel even signalled its desire to use spare doses for international diplomacy rather than accept its responsibility to vaccinate Palestinians. 

What’s the excuse? 

Israel excuses their actions on the basis that the Palestinian Authority is responsible for health of West Bank and Gaza Strip Palestinians, as per the Oslo Accords of 1993. This must not be taken at face value however, as this contention is at the very centre of the injustice. First, the Oslo Accords do not confer sovereignty to Palestinians, only limited self-rule over small and disconnected Palestinian population centres. Israel’s ability to hold up shipments of COVID-19 vaccines and testing kits attest to that. Second, the system passed through the Oslo Accords was designed to keep Palestinians of the West Bank and Gaza Strip separate and unequal to Israeli citizens. For example, the economic agreement attached to the Oslo Accords ties key financial policies in the Palestinian economy to the much wealthier Israeli economy. One method of doing so is through customs arrangements which mandate that Value Added Tax (VAT) in the Palestinian economy closely track VAT of the much wealthier Israeli economy. Another section of the agreement bestows all tax collected from Palestinians to the control of the Israeli government, who have frequently withheld this tax as a means of political pressure. This form of self-government bears striking resemblance to that of the South African Bantustans, which was rightly rejected globally. 

Another important rebuttal can be found in the Geneva Convention IV which places a duty on an occupying power: 

Other articles in the Convention make it clear that any agreement signed between the occupied and occupier do not absolve the occupier of its responsibilities under the Convention. Lastly, the Oslo Accords were signed as a temporary agreement to endure 5 years, and so were technically due to expire 24 years ago. This leaves no doubt that Israel bears ultimate responsibility for the pandemic response for everyone living under its control, citizen or not. 

The way forward 

If Israel is able to reopen its economy following a mass vaccination campaign, it can only do so because it has totally segregated Palestinians living under its military occupation. Some argue it is possible to isolate Israel’s vaccination campaign and other public health measures from the ethical and political questions arising from its treatment of Palestinians living under its rule. But the public health community is not in the habit of ignoring important structural factors, as we know they are crucial determinants of population health. When a British Government report recently dismissed the role of structural racism in health inequity, the public health community loudly condemned this denial. Israel refuses to even count Palestinians, purely because of their ethnicity. Why is it, then, that the same community is so uncomfortable to speak out when it comes to the massive injustice being inflicted on Palestinians? 

At the very least, we must not be complicit in the erasure of Palestinians. We can do this by demanding that the statistics count everyone who lives under Israeli rule, not just those the Israeli State confers citizenship to on the basis of their ethnicity. When discussing Israel’s vaccination campaign and its consequences, we must talk about the segregation of those who do not have access to vaccinations: segregation is as important as the vaccination campaign itself. Going beyond those basic steps, we can champion the call for solidarity issued by Palestinian civil society. It has called for the boycott of Israeli institutions, divestment from the Israeli State and companies, and sanctions against the Israeli government to pressure Israel to fulfil the international law obligations of an occupying force. This call for solidarity may be too big a step for some, but inertia allows injustice to persist unchallenged. Israel’s actions make it clear that maintaining the injustice experienced by Palestinians is more important than public health. This should leave no doubt that the public health community must speak truth to power on this issue, as it would on any injustice. 

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