Israel’s Medical Apartheid: An Insight

Israel has attracted international attention as the country leads the race to vaccinate the global population. With over 9 million inhabitants, the country reported on Saturday that they had managed to vaccinate 18% of its population, according to the Israeli Ministry of Health. Israeli Prime Minister Benjamin Netanyahu himself smiled at cameras as he was administered the vaccine – alongside members of his office staff who received doses irrespective of age or underlying health conditions. Ahead of a national election on 23 March, Netanyahu has been praised for securing 8 million doses of the Pfizer-BioNTech Covid vaccine at the price of $62 a dose compared to the US paying $19.50.

This has sparked controversy vis-a-vis Israel’s role in vaccinating the Palestinian population in the Occupied Palestinian Territories (OPT). Amnesty International was the latest NGO to condemn Israel’s vaccination roll-out and its lack of inclusion of the 5 million neighbouring Palestinians, saying it “highlights the institutionalized discrimination that defines the Israeli government’s policy towards Palestinians”. This comes as an increasing rate of infection soars in the West Bank and Gaza, standing at 36% as opposed to Israel’s 4.5%, with social distance virtually impossible in certain areas of the OPT.

While countries worldwide are prioritising health workers in their vaccine rollouts, Israel has refused a request made by the World Health Organization to vaccinate Palestinian health workers in the occupied territories. This request came following concerns over the distribution of vaccinations among inhabitants of Israel and the OPT. Within the OPT, the healthcare system and facilities were barely managing to provide the necessary services and amenities prior to the COVID-19 pandemic.

Israel’s roll-out plan applies to Israeli citizens – including communities living in settlements – and Palestinian residents of Jerusalem. On the other hand, the Palestinian Authority (PA)’s Health Minister, Mai Al-Kaila, has stated on Palestine TV that they would receive enough vaccines from the UN-led COVAX initiative to vaccinate 20% of its population. This push is still waiting for approval and health officials speculate it might not be approved until mid-February.

Israel has defended its roll-out plan by maintaining that the PA has not officially asked for help from the Israeli authorities and therefore bears no obligation to assist the PA, referencing the 1993 Oslo Accords that assign the responsibility of medical issues to the PA. The international community has condemned this argument, affirming that the PA looking elsewhere for help does not absolve them from international obligations.

Legal Obligations Under International Law

In light of recent COVID-19 vaccinations, states worldwide are under the obligation to provide the necessary healthcare services to help combat and curb the spread of the contagion. As an identified occupying power, they are also required to provide the adequate and necessary healthcare services to the population of the OPT. This duty is enshrined in international humanitarian law, as well as other international treaties imparting erga omnes obligations.

In matters concerning health, the Oslo Accords of 1993 dictate that the powers and responsibilities regarding health fall within the discretion of Palestinian Authorities (Article VI & Article VI(2)). Although there is a separation of responsibility between Israel and Palestinian authorities, Annex II of the 1995 Interim Agreement emphasizes the need for coordination between Israel and Palestine in health matters concerning epidemics and contagious diseases. This coordination is further supported by Article 55 of the Fourth Geneva Convention, which confers a due-diligence obligation on Israel to guarantee the necessary medical supplies “if the resources of the occupied territory are inadequate”.

Israeli authorities have pushed for the PA to provide sufficient healthcare services and amenities as codified in the Oslo Accords. The Palestinian Authority retains limited agency in less than 38% of the West Bank, with the remainder under Israeli military control. Critics argue that Israel has not been faithful to the Oslo Accords as exemplified by its continuation of settlement expansion.

The Geneva Convention relative to the Protection of Civilian Persons in Time of War (Fourth Geneva Convention) is one of the four principal international conventions dictating jus in bello (law in war). Jus in bello is often interchangeable with international humanitarian law, in that both terms address the “conduct of parties engaged in armed conflict” and aim at “minimizing the suffering of the conflict in question and by protecting and assisting all victims of the conflict to the greatest extent possible”. As regards Israel and the OPT, under the Fourth Geneva Convention, Israel is regarded as an occupying power, and the OPT is regarded as occupied territory, therefore, the former is under legal obligation to abide by jus in bello.

Under Article 56 of the Fourth Geneva Convention, Israel as a signatory, has the duty of “[…] ensuring and maintaining […]  the medical and hospital establishments and services, public health and hygiene […]” in the OPT. This provision imparts a general obligation onto Israel as an Occupying Power to protect the health rights of the OPT. In the context of the issuance of vaccines to the OPT, Israel, under the same provision is required to ensure “[…] the adoption and application of the prophylactic and preventative measures necessary to combat the spread of contagious diseases and epidemics.”  The duty of Israel as an occupying power stems from the aforementioned international humanitarian law and international human rights law, thus demanding strict observance of such obligations.

Medical Apartheid

In 2017, the UN published a report arguing that “Israel has established an apartheid regime that dominates the Palestinian people as a whole”. Originating from the former system of discrimination in South Africa, the report argued that there was a separate development in place by Israel which segregated and subjugated the Palestinian Arabs while favouring the Israeli communities. Israel has rejected this report, arguing that “the Declaration of Independence pledges to safeguard the equal rights of all citizens”, including the Palestinians. In this context, medical apartheid is a system in which one group is subjugated when it comes to receiving medical aid and resources.

In the West Bank, the roll-out includes only Israelis living in these settlements – offering vaccines to the 600,000 Jewish settlers living in the 256 settlements but surpassing its neighbouring Palestinian communities. This prioritisation of medical aid of one community over another in the same area is condemned by various NGOs as an act of discrimination. For example, Medical Aid for Palestinians reports how testing centres in East Jerusalem were only introduced following legal pressure by international NGOs, with free healthcare available only to those who hold a permanent residency status – a permit that has been revoked 14,000 times since 1967.

The pandemic has brought about a concern regarding the treatment of Palestinian prisoners detained on Israeli soil. The UN issued a statement urging Israel not to discriminate between Israeli prisoners and Palestinians. The statement reports how hundreds of Israeli prisoners with pre-existing conditions were released in April of 2020 for preventative measures while no such exception was made for Palestinians. In December, Public Security Minister Amir Ohana gave orders to vaccinate the guards of security prisons and not the security prisoners. Although the Minister does not distinguish between Palestinian and Israeli prisoners, there are no Israeli security prisoners in Israel.

The context of the pandemic is not the first time Israel has faced allegations of imposing a medical apartheid-like system in the OPT. Critics argue that Israel has not facilitated the development and self-determination of the Health Ministry in both the West Bank and Gaza in the past. The Israeli-Egyptian blockade severely hindered the entry of international aid into the Gaza strip by for example not allowing the entry of ventilators, according to the Ministry of Health. Both the West Bank and Gaza lack the logistical infrastructure required for a Pfizer-BioNTech vaccine, where the West Bank has only one refrigeration unit and where Gazans often go up to 12 hours without electricity. Herd immunity cannot be reached until a large portion of the OPT is vaccinated too, as Palestinian communities regularly travel into Israel. Netanyahu’s pledge to beat COVID by the end of March therefore cannot be achieved unless Israel abides by international humanitarian law.

Agnese Boffano

Agnese is a postgraduate journalism student living and working in London. Always moving countries, she has developed a passion for international affairs with a specific interest in MENA politics. Will most definitely find her with a cup of coffee in one hand and a paper map in the other.

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