Elsevier

The Lancet

Volume 373, Issue 9669, 28 March–3 April 2009, Pages 1133-1143
The Lancet

Series
Health as human security in the occupied Palestinian territory

https://doi.org/10.1016/S0140-6736(09)60110-0Get rights and content

Summary

We describe the threats to survival, development, and wellbeing in the occupied Palestinian territory using human security as a framework. Palestinian security has deteriorated rapidly since 2000. More than 6000 Palestinians have been killed by the Israeli military, with more than 1300 killed in the Gaza Strip during 22 days of aerial and ground attacks ending in January, 2009. Israeli destruction and control of infrastructure has severely restricted fuel supplies and access to water and sanitation. Palestinians are tortured in prisons and humiliated at Israeli checkpoints. The separation wall and the checkpoints prevent access to work, family, sites of worship, and health-care facilities. Poverty rates have risen sharply, and almost half of Palestinians are dependent on food aid. Social cohesion, which has kept Palestinian society intact, including the health-care system, is now strained. More than US$9 billion in international aid have not promoted development because Palestinians do not have basic security. International efforts focused on prevention of modifiable causes of insecurity, reinvigoration of international norms, support of Palestinian social resilience and institutions that protect them from threats, and a political solution are needed to improve human security in the occupied Palestinian territory.

Introduction

Although many determinants affect health in the occupied Palestinian territory, only a few have been discussed in the preceding reports in this Series.1, 2, 3 In this report, we describe health in the occupied Palestinian territory (figure 1) using WHO's broad definition of “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.5 We use a human-security approach to describe the threats to survival, development, and wellbeing in the context of protracted conflict and occupation in the Palestinian territory.6 “The objective of human security is to safeguard the vital core of human lives from critical pervasive threats while promoting long-term human flourishing”, according to the Commission on Human Security.6 Protection from critical (severe) and pervasive (widespread) threats is emphasised in this definition, as is the idea that what is vital varies between different populations. Thus, this definition is dynamic and should be adapted to the context in which it is used. Two key aspects for the analysis of Palestinian security are the distinction between direct and indirect threats to survival6 and the psychosocial domains of security (panel 1).7

Section snippets

Measurement of threats to human security

A landmark report about human security emphasised the “need to focus on a core of insecurities within each specific context.”8 Threats to the security of Palestinians might be direct, such as gunfire or home demolition, or indirect, such as economic restrictions leading to widespread poverty;6 classification is based on the main threats identified from the data sources. However, the two types of threats might overlap in some instances.

We quantified the burden of threats to human security in

Direct threats to human security

Aerial bombings of civilian areas and use of gunfire by Israeli military, in addition to fighting between Palestinian factions, constitute severe and pervasive threats to life (figure 2). The increase in numbers of people killed since the beginning of the second Palestinian uprising in 2000 is unprecedented (figure 3; table 2). More than 4700 Palestinians—mostly civilians, including more than 900 children—were killed by Israeli military action between September, 2000, and November, 2008,12

Indirect threats to human security

Indirect threats have their origins in an interlocking web of checkpoints, barriers, border closures, curfews, and the permit system imposed by Israel. These restrictions affect every aspect of Palestinian life, such as the ability to travel, work, marry, study, worship, and be with family. Indirect threats compromise the social determinants of health57 by increasing social exclusion, unemployment, and creating barriers to food, social support, and transport.

Restriction on the movement of

Social resilience and insecurity

The long-term exposure of Palestinians to security threats has led to a state of long-term insecurity and demoralisation.1 Social resilience, seen as a positive adaptation amid adversity,70 is holding together Palestinian society and its economy, including the health system. For many Palestinians, the struggle for a normal life and justice is rooted in sumud—the determination to persist through steadfastness and a sense of connection with the land. For Palestinian teenagers, the capacity to

Enhancing human security: the way forward

Palestinians do not have an autonomous state to safeguard them from “critical pervasive threats while promoting long-term human flourishing”.1 A political solution is needed to prevent many of the identified threats to Palestinian security. The recent Israeli military attacks on the Gaza Strip with the massive damage to lives and property draw attention to the urgency of this issue. In the absence of a political solution, social resilience has provided some of the protection usually offered by

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