Position Paper 22.4.2007
Gender and Health
Traditionally, attention to women’s health has focused on maternity, childbirth and family planning. Physicians for Human Rights-Israel believes there is a need to raise awareness with regard to women’s health as a whole, taking into account not only reproductive health, but also the variety of factors affecting the health of women in their communities. In the Occupied Palestinian Territories the challenges facing women who seek to fulfill their right to health are especially great. For this reason PHR-Israel has initiated a series of activities for the promotion of awareness among women to the right to health, addressing various factors that constitute basic preconditions for health. In the course of this project, PHR-Israel also runs Mobile Clinics to the West Bank that are run solely by women for women, in which medical assistance as well as other activities, such as lectures and workshops, are provided in cooperation with Palestinian partner NGOs and women members of civil society.
In-Depth Interviews
In the course of two Mobile Clinics held as part of PHR-Israel's Gender and Health project in the village of Rihiyya on 24.02.07 and 31.03.07, Gender and Health project coordinator Mrs. Iman Aghbariyya and PHR-Israel volunteer nurse Itaf Yunis held in-depth interviews with a small number of women, in order to learn about their own views on their needs and conditions in the field of health. Their answers paint a grim picture of severe restrictions on the lives of women, which deny them adequate healthcare services as well as the underlying determinants of health. Below are the results of an analysis of the interviews.
Rihiyya: Background
Socio-economic conditions: Some 4,000 inhabitants live in the village of Rihiyya, which is located south of Hebron, between the towns of Dura and Yatta. The residents of the village subsist from agriculture and cattle-raising, and suffer from severe financial difficulties due to the prevention of employment in Israel over the past decade, restrictions on movement for purposes of work and trade in other parts of the West Bank, and restrictions on access to the lands adjacent to their village. In the past year, non-payment of infrastructure costs and salaries to Palestinian Authority workers was added to this list, due to the sanctions against the PA initiated by Israel, the US and the EU following the success of Hamas in the elections of January 2006. All these factors have caused severe financial and social difficulties in a village that was already relatively isolated and lacking in services before the economic sanctions.
Health services and access to them: There is one governmental primary healthcare clinic in the village, normally staffed by a general doctor once a week and by a gynecologist once a fortnight. For secondary and tertiary care residents must travel to the nearest city, Hebron. However, since February 2007 the Palestinian public health system has been on strike along with the rest of PA civilian personnel, due to non-payment of their salaries, and healthcare services are now limited to emergency and lifesaving care only. In order to reach the nearest urban center, Hebron, residents in need of medical care must cross Al-Fawwar checkpoint, next to Al-Fawwar refugee camp, via organized transportation, which does not function at night or during closure.
Subjects
Seven women aged 20 to 48 were interviewed, of whom five are married with children and two are single. One interviewee completed intermediary high school, three completed high school, and three continued vocational or academic training. One interviewee is employed, two were employed in the past and the rest work at home.
Summary of the Interviews
In the course of each interview the interviewer completed a questionnaire in which women were asked questions regarding health and healthcare services. Interviewees were free to answer shortly or in detail. Below is a summary of their answers:
1. Factors negatively influencing the health of women
A. The main factor mentioned by the women as negatively affecting their health was poverty and deterioration in their financial conditions. The women stated that poverty leads to poor nutrition and prevents them from purchasing medicines or private medical services. The married interviewees stated that this influences both their health and the health of their children. According to the women, a recent factor severely impacting health has been the strike of the public health system [since February 2007 ], which impedes access to healthcare at all levels. The village, which has one governmental clinic normally staffed by a general doctor once a week and by a gynecologist once a fortnight, has only been visited by a doctor once in the past two months. The crisis is even worse for them, said the women, since they cannot afford to pay for treatment or medicines privately. One of the interviewees stated that not all the residents of the village are registered for [Palestinian] governmental health insurance, for which reason even when there is no strike their access to services is limited.
B. Another factor mentioned was the ongoing occupation and its effects, including the prohibition on work inside Israel, restrictions on access to Hebron, the checkpoints system and the most recent financial crisis [which stems from economic sanctions imposed on the PA since the Hamas victory in early 2006]. The women connected the factor of poverty to the factor of occupation, stating that it is the occupation that has led to financial distress, due to lack of employment possibilities and impeded access to lands. According to the interviewees, In addition to severe cases of checkpoint delays in emergency medical cases occurring at night, medical transfers and transportations to operations in medical centers in Hebron are as a rule very slow. Moreover, access to Hebron is only possible through organized transportation, which is not available at night. The interviewees stated with regard to childbirth that many women are obliged to deliver at home due to difficulties at the Al-Fawwar checkpoint.
C. A third factor mentioned as negatively affecting women's health was social limitations placed on the lives of women in the village, which do not grant them the freedom to acquire an education or to be employed. According to the interviewees, these limitations prevent the possibility of a second salary for the family and block opportunities in the lives of women. Interviewees stated that the status of unmarried women is lower than that of married women, due to accepted approaches in their community, and for this reason many women marry at a very young age. Several women said their ability to be examined by a gynecologist was limited since the gynecologist available is male, and their families or the relatives of their spouses sometimes forbid their physical examination by a male doctor. Some of the interviewees said they feel discriminated and humiliated as women, and stated that this has affected their mental state and, as a result, their health. According to some of the interviewees, single women in the village are treated disrespectfully and suffer from depression as a consequence, despite the fact that their single status enables them to acquire an education or a profession. Interviewees stated that in their community a marriage was judged according to fertility, for which reason the families of couples sometimes compel the men to marry a second wife, even against the wishes of the couple.
D. A further factor affecting health was, according to interviewees, a lack of education and ignorance of health issues among women.
E. One of the interviewees stated that poor sanitary conditions in the village badly affected health, and commented that many residents suffer from asthma as a result of the dusty air. She recommended organizing disposal of cattle's waste from the streets of the village.
F. Some of the married women mentioned problems with pregnancy, fertility and childbirth as factors negatively affecting women's health.
2. Isolation of women and deterioration in their conditions
Most of the women interviewed reported a feeling that their condition has worsened over the past two years, especially in the financial realm. Moreover, most women stated that they exit the village very rarely, and only for medical purposes.
3. Organisations responsible for change
When the women were asked who is responsible for changing the situation or preserving it, most answered that the village council is responsible but does not do enough. One woman stated that the occupation is responsible for the situation, and one woman said that the women themselves are responsible for their situation and are capable of changing it. When the women were asked who they turn to when in need of advice or assistance, most answered that they turn to their mothers, sisters, or other family members.
4. Recommendations for change
- When asked for suggestions, almost all those interviewed expressed a wish to extend their education or to continue their studies. Some expressed a wish to work in order to contribute to the financial situation of their families and in order to acquire independence.
- Other suggestions included establishment of support services for women, a women's organization, a women's association, a club or other meeting place for women, initiation of joint action for change by women, a women's clinic, a female gynecologist in the village, an emergency medical center, open 24 hours a day, a mother-and-child healthcare center, permanent doctors, promotion of schools and a public park for the village.
Conclusions
The testimonies of the women paint a grim picture of a double or even triple occupation, comprising military restrictions on movement, financial distress and gender-based social restrictions. All these affect the health of women both directly and indirectly. In the Israeli-Palestinian patriarchy, as in any other patriarchal society, women are the first to be injured by general oppressive measures taken against the community. This general oppression is added to oppression that is directed specifically against women.
Physicians for Human Rights-Israel believes that social change is best effected from within the community. As an Israeli organization we see ourselves primarily responsible for change within our own society. For this reason our role is to call for an end to the occupation and to all other restrictions imposed by the Israeli government on the Palestinian community in the Occupied Territories, as a basic and necessary condition for the fulfillment of the right of Palestinian women to healthcare and to living conditions that enable a healthy life. This demand also stems from the Convention on the Elimination of All Forms of Discrimination against Women, according to which:
"… the eradication of apartheid, all forms of racism, racial discrimination, colonialism, neo-colonialism, aggression, foreign occupation and domination and interference in the internal affairs of States is essential to the full enjoyment of the rights of men and women."
"… the realization of the right of peoples under alien and colonial domination and foreign occupation to self-determination and independence, as well as respect for national sovereignty and territorial integrity, will promote social progress and development and as a consequence will contribute to the attainment of full equality between men and women."
(Paras 10 and 11)
PHR-Israel will continue its joint activities with Palestinian women activists and hold Mobile Clinics and other joint projects for the promotion of women's health and health rights.