Health and politics: war by other means on the Palestinian minority in Israel

Introduction

The adage ‘health is politics’ is widely accepted in the health profession. International humanitarian law attempts to guard against the potential abuse of this relationship particularly in considering the right to equality and the right to health (United Nations 1965, 2000), the prism through which this paper is presented.

In the Nakba of 1947–48 some 85% of the Palestinian residents of what was to become Israel were forced to cross the borders and become refugees in neighbouring countries. The remaining 15% found that ‘a brutal border crossed them’, becoming Israeli citizens through no choice of theirs as a one Palestinian scholar put it (Ghanim 2010). Those Palestinians, together with residents of the 1967 annexed East Jerusalem and the Golan Heights, now make up over 20% of the total population of Israel. In the Nakba, between 1/4 to 1/3 of those homebound Palestinians were internally displaced to become what is officially known in Israel as ‘Present Absentees’. Laws were promulgated to deprive members of this oxymoronically designated subgroup of their homes and private property, including their land and bank accounts. The remaining 2/3–3/4 gradually lost most of their land to confiscation by the state through dozens of specifically designed and finely tuned laws and ordinances that claimed to serve the ‘public good’ or the security needs of the state. Simultaneously, the Jewish majority population proceeded to define the state it dominated to become coterminous with itself, thus defining the Palestinian minority for all practical purposes out of the emerging ‘public good’ and the state’s security concerns. Thus, the Arab minority now owns less than 3% of Israel’s land at the same time that it is exempted for all practical purposes from benefiting from 93% of the total area of Israel that is owned by the Jewish National Fund or defined as state lands. Israel’s discriminatory land laws are a major topic that is repeatedly revisited by Adalah, the Legal Centre for Arab Minority Rights in Israel on its website <www//adalah.org>, the source of the above quoted figures.

Such aggressive disenfranchising of the Palestinian minority was bound to affect its overall wellbeing. This process was in full force under the ‘liberal’ rule of the Labour Party in the first decades of Israel’s existence. After Israel’s 1967 occupation of Jerusalem, the West Bank and Gaza (as well as the Syrian Golan Heights) successive Israeli governments, including those led by the Labour Party, have promoted the related process of settling Israeli Jewish citizens in those areas. This has led directly to the dominance in Israeli politics of fundamentalist messianic Zionism and settler extremism. With the onset of the Oslo Process, the tide of extremism and rightist settler political hegemony spilled over to the Israeli side of the 1949 armistice line, the Green Line, leading to the 1995 assassination of Prime Minister Rabin (Remnik 2013).

Health indicators and their determinants

In this commentary, I focus on two main health indicators of the population groups under consideration. Life expectancy at birth is a composite figure reflecting the overall mortality experience of a total population at a given time. In contrast, the Infant Mortality Rate is defined as the number of infant deaths per one thousand live births in a given community in a given year. As Reidpath and Allotey (2003) point out, especially the IMR reveals the health condition of the most vulnerable segment of the population, ‘reflecting the intuition that structural factors affecting the health of entire populations have an impact on the mortality rate of infants.’ Hence, IMR is considered a reliable and convenient indicator of a community’s general wellbeing and health. This paper posits that for the Palestinian minority in Israel proper, as distinct from the Palestinian Occupied Territories of the West Bank, Gaza and East Jerusalem, the widening relative gaps in the two indicators mirror its experience of increasing marginalization resulting from the recent rightward shift in Israeli politics.

In its annual abstract, the Israeli Central Bureau of Statistics (CBS 2016) publishes statistical information regarding every aspect of life in its two main constituent communities, Jews and Palestinian Arabs. A critical look at the comparative statistics as to the welfare and progress of the two communities reveals a relative ratio of anywhere from approximately double to sixfold to the advantage of the Jewish majority. Such comparisons beg the question of separation between the two communities in the first place. The great majority of Israeli citizens reside in segregated communities. In some so-called mixed cities, Arab slums are separated from Jewish better-off neighbourhoods by concrete walls and barbed wire fences. As Arshad (2014) points out, the efficiency of pauperization of the Palestinian minority was heightened at the start by placing its towns and villages for the first two decades after the Nakba under a strict military rule that controlled the residents’ access to work, to education beyond elementary school, to hospitals, to commercial centres and to friends and relatives in other communities. The secret security apparatus, the Shin Bet, has since taken over such control functions. It continues to manipulate welfare and employment in such communities, and especially the fate of their youth.

Infant mortality rates

Graph 1 shows the standard presentation of the IMR figures for Jews and Moslems aggregated over five-year periods. Note the closing gap in absolute terms.

Graph 1. IMRs of Moslems and Jews in Israel.

In Graph 2 the relative ratio of the IMR for Moslems to the IMR for Jews is shown with figures aggregated in five-year periods. Moslems are 82% of the total non-Jewish citizens of Israel. These figures are derived from vital statistics tables in the Israel CBS (2016) and from earlier versions of the same publication.

Graph 2. Relative ratio of IMR of Moslems to Jews in Israel.

Life expectancy at birth

Similarly, Graph 3 represents figures derived from Table 3.24 of Israel CBS (2016) to show the lag of Arab life expectancy at birth behind that of Jews aggregated in five-year periods since 1970, the first year such data is provided. Notice the climb in this differential statistic since 1995.

Graph 3. Gaps in life expectancy at birth between Arabs and Jews in Israel.

Questions raised by the comparative data

Let me first register my dislike of the Israeli CBS categorization of population groups by religion until the mid 1990s when the influx of so many secular Russians forced it to adopt the racial classification of Jews, Arabs and others. From the critical perspective of equity the first question to be asked is why should there be a gap between the two population groups, Jews and Moslems, in the first place, whether in IMRs or life expectancy? Nearly half of the constituent Jewish population of Israel arrived from the countries of the Middle East and North Africa with socio-economic attributes not unlike those of the Palestinians, if not worse. The main ensuing difference was that the state, backed by the world Jewish community, invested massive funds and efforts in well-coordinated programmes for the socio-economic betterment of one group. Not only did no parallel programmes exist for Palestinians, but also their agrarian communal underpinnings were undercut with massive land confiscations and limitations on crop selection and marketing and on irrigation schemes for the benefit of Jewish cooperative farms. As the oriental Jews (Sephardim) in Israel were corralled into Ashkenazi cultural hegemony, members of the Palestinian community were further marginalized to become day labourers in construction and agriculture in Jewish cities and new settlements. They lost their agricultural subsistence self-sufficiency while lacking an alternative base for development such as industry or commerce. The image of their villages as peripheral enemy locales added to their isolation. They became bedroom communities to which men returned nights and weekends. This was the actualization of Zionist biblical dreams of using the Palestinians as ‘hewers of wood and carriers of water’.

Innumerable laws, rules and regulations functioned to disadvantage the Palestinian minority citizens of Israel in comparison to members of the Jewish majority in central resource distribution. Published statistics reveal a range of disparities between the two groups of citizens to the advantage of the latter in terms of access to central state resources. In a special document, Adalah (2011) addressed this issue thoroughly with detailed facts and comparative figures. Rothchild (2017) offers an extreme example of such discriminatory resource allocation practices: In the Galilee, where the numbers of Arab and Jewish citizens of Israel are nearly equal, over 99.8% of the budget of the Ministry of Development goes to Jewish communities.

Putting the data in context

When Israeli officials present the graph of IMR for Jews and Moslems in international forums they proudly take credit for the fact that the figures for ‘Israel’s Arabs’ have been better than those of any Arab country, and especially better than the IMR figures for other Palestinian groups. To this I always register my reservation on basis of my right to equal resources and equal treatment under the law: I am an Israeli citizen since day one and I pay my taxes in Israel and not in Egypt or Jordan. To accept any standard of comparison other than the highest attainable by any group in my country of citizenship is to betray both my public health profession and my human rights commitment.

Israeli officials also point to the significant and continuing decline in both groups’ IMRs and the narrowing of the gap in absolute terms between the figures for the two groups over time. Granted, on the face of it this is impressive. But, as per my double allegiance to principles of public health and human rights, I choose to address this issue from the critical angle of equality and justice for the minority group. That is why I focus here on the relative ratio of the IMR for Moslems to the IMR for Jews. Graph 2 shows the change in this over time. Notice that this RR hovers around two for the first half century of Israel’s existence and rises only in the last two decades.

Conclusion: bad politics leads to poorer health

The effect of the marginalization process on the health, and hence on the IMR and on life expectancy at birth of Arabs, is to be expected. Such differences between Arabs and Jews became part of Israel’s accepted reality and part of the system’s standard of reference. When the Ministry of Health experts in the 1980s devised a special project to combat excess infant deaths, the cutoff point for selecting participating Arab towns and villages was set at twice that for Jewish ones, 20 vs. 10 infant deaths per thousand live births. His objection to this and to similar apartheid policies eventually cost the highest-ranking professional Arab employee in the ministry at the time his job (See Kanaaneh 2008).

In considering the health statistics of the two groups from a perspective of equality, other than the existence of a gap between the two groups, the second prominent feature to point out is the widening of that gap in relative terms in the last two decades. This comes on the heels of a major and continuing rightward shift in Israeli political views and legal manipulations to the disadvantage of the Palestinian minority. Again, Adalah’s website <adalah.org> is an excellent source of up-to-date information on this topic. The essence of this ultra-right shift is a change of conception among the majority of Jewish Israelis from that of the classic Zionist colonialist framework to the religious fundamentalist views avowed by many current Israeli leaders. In his scholarly dissertation, Macgillivray (2016) points out the permutations of this trend even among Israel’s left. Others, including Bresheeth (2014) for example, have predicted the likely effects of this trend in all aspects of Israeli society including in the literary field.

The chronological coincidence of worsening trends in the political environment and in health indicators, suggests a causal link between the two. To prove such causality in this specific case beyond doubt we need to study the changes over the decades in Israel’s two constituent population groups in such independent contributing factors to community health as levels of education, levels of income, housing conditions, environmental health and health service adequacy and accessibility. To be meaningful, such comparisons have to be considered in relative and not in absolute terms.

Wall (2014), among others, pointed out that Israeli Generalss call their repeated attacks on besieged Gaza ‘mowing the grass’. The historian Pappe (2015) calls it ‘incremental genocide’. Admittedly, the likely effects of Israel’s internal politics on the health of its Palestinian citizens fade in comparison. Still, the possible effects of the rising infringement of the latter’s rights can well be called ‘time-lag genocide’. The two share the same ideological roots.

Notes on contributor

Hatim Kanaaneh is a Palestinian citizen of Israel who studied medicine and public health in the USA. From 1972 to 1992 he was the Israeli Ministry of Health’s Sub-district Physician in Western Galilee. He doubled as the first Physician in his home village. In 1981, he cofounded the Galilee Society for Health Research and Services, an NGO dedicated to advancing the health and development of the Palestinian citizens of Israel. In retirement he has published a book of memoirs, ‘A Doctor in Galilee’ (Pluto Press, 2008) and a collection of short stories, ‘Chief Complaint’ (Just World Books, 2015).

Disclosure statement

No potential conflict of interest was reported by the author.