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To what extent is the Israeli-Palestinian COVID-19 Vaccination Gap a Result of Medical and Structural Racism Generated by the Israeli Occupation?

Coursework essay completed in the course of a degree for University College London

Published onAug 28, 2022
To what extent is the Israeli-Palestinian COVID-19 Vaccination Gap a Result of Medical and Structural Racism Generated by the Israeli Occupation?

Abstract

As nations around the globe sped to vaccinate their populations against COVID-19, Israel led the race with its highly advanced vaccination programme. However, Palestinians living in the occupied Palestinian territories (OPTs) were not included in Israel’s vaccination plan, and the Israeli occupation came under scrutiny by the international community for not fulfilling its public health duties to Palestinians as the occupying power in Palestine. The data highlighted the notable disparity between the number of vaccinated Israelis and Palestinians, raising questions about the wider health inequalities that exist across the region. This essay places the vaccination gap in its political, socio-economic and historical context, attributing the disparity to medical and structural racism. Firstly, this involves highlighting Israel’s fragmentation of Palestinians across the region through artificial borders that strengthen the racial divide, and considering the occupation’s deliberate targeting of health and welfare in Gaza. This is followed by an assessment of Israel’s healthcare obligations under international law to protect the health of Palestinians in the occupied territories, and a critique of the Israeli institutional barriers that restrict Palestinians’ access to vaccines, leaving them unprotected against COVID-19. Furthermore, the vaccination gap is situated in the Palestinian healthcare landscape, investigating the discriminatory Israeli policies that suffocate the Palestinian healthcare system, deeming it unable to tend to the vaccination needs of the Palestinian population. This is exhibited by comparing the Israeli and Palestinian healthcare systems, and considering how these healthcare disparities have contributed to the COVID-19 vaccination gap. The essay also explores a number of case studies that exhibit the multiple ways through which Israel restricts Palestinian access to vaccines, thus widening the COVID-19 vaccination disparity. Finally, the essay concludes that the vaccination disparity is the combined result of Israel’s deliberate exclusion of Palestinians from its own vaccination plan, and of the political and institutional factors that inhibit the Palestinian healthcare system’s ability to function adequately.


Key words: apartheid, Middle Eastern studies, COVID-19, vaccines, racism, medical equality


Introduction

Since the coronavirus vaccines have become available, COVID-19 vaccination campaigns have accelerated around the globe, with nations competing to achieve the highest levels of immunisation amongst their communities. During this period, Israel was hailed for its highly advanced vaccination programme, leading the global race to immunise its population against COVID-19. However, as the occupying power in Palestine, questions were raised about the exclusion of Palestinians in the occupied Palestinian territories (OPTs) from its vaccination programme. A closer look at the data highlighted a stark disparity between the number of vaccinated Israelis and Palestinians in the region (Dahdal et al., 2021), leading to accusations that Israel was not fulfilling its public health duties under international law to the Palestinians. This raises concerns not only about the outcome, but also the root causes of the vaccination gap in Israel and the OPTs. Can this example of COVID-19 vaccine inequity be attributed to medical and structural racism generated by the Israeli Occupation?

In order to address this question, I will explore the relationship and power dynamics between Israel and Palestine, both historically and in the present day, and investigate how this has impacted Palestinian public health, with a particular focus on the COVID-19 vaccination gap. The aims of this essay are to highlight the health inequalities that exist between Israelis and Palestinians, to explore the socioeconomic factors and discriminatory policies that have shaped these inequalities, and to extrapolate this to the vaccination gap.

A Brief History

The formation of the Israeli State in 1948 resulted in the forcible displacement of hundreds of thousands of Palestinians and the destruction of hundreds of Palestinian villages (Lentin, 2013). For this reason, this period is often referred to as the Nakba, meaning catastrophe. However, for the purpose of this essay, I will focus on the time period from the 1967 war onwards. In 1967, the West Bank and Gaza Strip came under Israeli occupation, where land was confiscated for the expansion of Israeli settlements and military installation under a settler-colonial model (Feldman, 2019). Even though Israel withdrew troops and settlers from Gaza in 2005, this did not mark the end of occupation, but instead later led to a land, sea and air blockade of the Gaza Strip in 2007 (Moss and Majadle, 2020). The blockade is ongoing, and Gaza is often called “the world’s largest open air prison” (Procter, 2021).

As a result of occupation, some Palestinians are refugees in the diaspora, others are living in the OPTs, and some have become Israeli citizens living within the borders of the Green Line, the boundary between the State of Israel and the OPTs (Feldman, 2019). Moreover, there is a further distinction to be made between Palestinians in the OPTs. Palestinians living in the West Bank and those living under blockade in Gaza have different experiences as an occupied people. In ‘Reframing Palestine’, anthropologist Ilana Feldman explains the “fragmentation” of Palestine and categorises the Israeli governance of Palestinians based on geography, whilst simultaneously underlining the shared struggles between them. Palestinians with Israeli citizenship living within the borders of the Green Line are treated as “second-class citizens”, those in the West Bank as a native people living under occupation, and those in Gaza as dangerous enemies, subject to collective punishment (Feldman, 2019). This essay exhibits how this discriminatory categorisation of Palestinians by Israel is a defining feature of its governmental policies with regard to healthcare access in the OPTs. Despite the fluctuations in Israeli governance of the Palestinian people across the region, the underlying theme is the treatment of Palestinians as other, not governed by the same set of regulations and not entitled to the same privileges as Israelis. So how does this political discrimination extend to matters of public health, and subsequently to the vaccination programme?

Civilian Harm in The Gaza Strip

The approximately 14-year blockade on the Gaza Strip has produced conditions that have destroyed the lives and health of the Gazan population. Ilana Feldman describes the Israeli strategy of targeting Gaza’s “liveability” as a means of political control, outlining how the blockade affects all aspects of life including access to water, shelter and electricity (Feldman, 2019). This is an attack on Palestinians’ quality of life through their health and economy, creating an environment where living circumstances are barely liveable. In ‘The Siege of Gaza’, Yves Winter describes the Israeli “biopolitical mode of warfare” in Gaza, where the aim of the Israeli blockade is to punish Palestinian civilians, not by killing them, but by targeting welfare and health to create circumstances that impoverish the population (Winter, 2015). This is further explained using the example of the nutritional limits imposed on Gaza’s citizens from 2006-2010, where Israel severely restricted the import of a vast variety of food items in a plan to limit Gazans to a calorie intake that would not starve them, but would provide them with minimal nutritional sustenance (Winter, 2015). I argue that these deliberate forms of violence are institutional, and emphasise the disturbing nature of the policies employed by the Israeli government in Gaza.

In briefly describing the nature of the Israeli blockade on Gaza, I hope to contextualise why the vaccination gap should be attributed to medical racism, especially considering Israel’s deliberate targeting of health and welfare in Gaza. The health situation in Gaza has only further deteriorated as a result of the pandemic, and the importance of lifting the blockade on Gaza to allow its health system to recover and respond to COVID-19 has been explored by Moss and Majadle (2020). Furthermore, it is important to note that collective punishment policies that target civilians are discriminatory by definition, and this form of institutional violence, one that attacks the Palestinian healthcare system through economic restrictions, has undoubtedly vastly contributed to the conditions that have led to the COVID-19 vaccination gap.

In the following sections, I will explore how Israel’s discriminatory policies and apartheid regime impact Palestinian health more broadly across the region, and the ways in which this has contributed the COVID-19 vaccination gap.

Healthcare Obligations of the Occupation

Article 56 of the Fourth Geneva Convention states that:

“The occupying Power has the duty of ensuring and maintaining, with the cooperation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory, with particular reference to the adoption and application of the prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics”.

Hence, as an occupying power, the Israeli government is obliged to maintain and sustain the healthcare systems of the Palestinians. More specifically, the government has a legal responsibility to include Palestinians living in the OPTs in its vaccination plan, in order to combat the spread of COVID-19. Despite this, the approximately five million Palestinians living in the OPTs were not accounted for in the Israeli vaccination drive that began at the end of 2020 (Amnesty International, 2021). As a result, Israel was consequently accused of institutionalised discrimination by Amnesty International and numerous other human rights organisations.

Additionally, as emphasised by the International Commission of Jurists (ICJ), denying Palestinians the right to be included in Israel’s vaccination plan is a violation of their right to life. The United Nations (UN) Human Rights Committee has confirmed that the right to life requires governments to provide access to healthcare and protect the health “of all individuals within their territory”, meaning the Israeli government is obligated to provide vaccines in the OPTs (Todeschini, 2021). Thus, the exclusion of Palestinians from the vaccination plan is not only unethical, but it is also a basic human rights violation. The Israeli government’s blatant disregard of Palestinians’ right to life, evident in its denial of their right to be protected against COVID-19 by the same means as Israeli citizens, is an example of the medical racism inflicted on Palestinians by the Israeli State.

In response to these accusations, Israel highlighted the Oslo Accords, a pair of agreements signed in 1993 and 1995 as part of a peace process, claiming the agreements meant the Palestinian Authority (PA) was responsible for any public health matters relating to Palestinians living in the OPTs (BBC News, 2021). The PA is a governmental body that was granted restricted governance of some areas of the West Bank and the Gaza Strip as part of the Oslo Accords, in an attempt to give Palestinians the right to self-determination (Feldman, 2019). Despite the conflicting nature of the Geneva Convention and the Oslo Accords, UN Experts have argued that the Convention takes precedence over the Accords, and condemned Israel for its human rights violation (UN Human Rights, 2021). This is relevant here because an important feature of the Oslo Accords is a restriction imposed on Palestinians from receiving any medical supplies that have not first been authorised by the Israeli government, naturally resulting in further delays of COVID-19 vaccines from reaching the Palestinian population (Dahdal et al., 2021). Such a limitation opposes the Palestinians’ right to self-determination, and only further aggravates the COVID-19 crisis in the OPTs by delaying the arrival of vaccines. The global threat posed by COVID-19 has resulted in nations around the world speeding up administrative processes in an attempt to accelerate vaccination campaigns and stifle the spread of the disease. Hence, Israel delaying vaccines from reaching the OPTs for bureaucratic purposes during a global health crisis further emphasises the structural nature of the vaccination gap; the result of discriminatory policies being embedded into the Palestinian health system. Furthermore, the presence of these institutional barriers to vaccination that cause delays for Palestinians, but not for Israelis, points to the vaccination gap being the result of structural racism. Access to vaccines across the region is governed by the colonial borders described earlier, resulting in health disparities that deny Palestinians of their rights to be vaccinated against COVID-19.

Health System Inequalities and Vaccination Privileges

COVID-19 infections have ripped through communities around the globe, claiming lives and overwhelming even the most economically stable countries. The pandemic has been a true test of the resilience of health workers and national health system capacities. However, as is the case with most global crises, the magnitude of the threat was not the same for everyone, and the pandemic only further exacerbated pre-existing inequalities. Affluent nations with access to funds, and later vaccines, were able to protect their communities much more quickly and efficiently than countries that were not well equipped to deal with the rapid spread of the virus and the subsequent economic turmoil, highlighting inter-country inequalities on a global scale. However, the COVID-19 crisis has also amplified socioeconomic and racial inequalities within national contexts, and Palestinian access to vaccines lies at the intersections of these two ‘axes’ of inequality.

Access to public health services are not the same for Palestinians and Israelis. Whilst Israel benefits from a robust healthcare system, the OPTs has very limited public health resources and considerably less capability to combat the spread of the disease (ASPHER, 2021). An example of the inadequacy of the capacity of the Palestinian healthcare system is the fact that there was only one appropriate freezer for storing COVID-19 vaccines present in the West Bank at the time of writing (Dahdal et al. 2021), an essential requirement for mRNA vaccines to be administered. Moss and Majadle have attributed the cause of this disparity to structural barriers, such as restrictions placed on the movement of medical staff and supplies in the OPTs by the Israeli government (Moss and Majadle, 2020). The socioeconomic conditions resulting from long-term restrictions and the ongoing blockade in Gaza means the PA has insufficient financial resources and infrastructure to fund and distribute COVID-19 vaccines in the OPTs (PHRI, 2020). This has meant that the Palestinian population has had to rely on organisations such as COVAX, a vaccine equity initiative, to gain access to the coronavirus vaccines (Amnesty International, 2021).

Meanwhile, Israel had secured 8 million doses of the Pfizer vaccine and 6 million doses of the Moderna vaccine for its population of around 9 million by December 2020 (Amnesty International 2021). This paints a particularly vivid picture of the health disparity that exists between Israelis and Palestinians. Whilst Palestinians had to rely on charitable donations with no guarantee of vaccination, Israel had secured almost enough vaccines to immunise its entire population with both doses before the end of 2020. As the world praised Israel for its extraordinary inoculation speed and efficiency, Palestinians remained unvaccinated against COVID-19.

In the spring of 2020, Israel and the PA initially reached a deal where the Israeli government would send the PA approximately 1.4 million vaccines that were near their expiration date. The condition to this was that the PA would have to send the same number of doses to Israel at a later stage in the year (Sawafta and Ayyub 2021). However, the PA cancelled the deal in June, claiming they had been told by the Israeli government that the vaccines’ expiration date was in July or August, only to discover that it was in June, meaning there would not be enough time to use the vaccines before they expired. Israel denied the allegations and claimed it had been transparent about the expiration date.

Regardless of whether or not the Israeli government disclosed the date, even its expectation that a health system that is already very fragile would be able to mobilise a vaccination effort with that speed is highly likely to have caused further delays and in turn, contributed to the vaccination inequity. The vaccines would have had to be received and utilised in the same month that they were due to expire, a task too difficult for the fractured Palestinian healthcare system. Furthermore, the vaccination swap within itself points to the medical divide that exists between Palestinians and Israelis, highlighting the apartheid policies of the Israeli state that systemically widen the gap in access to healthcare and strengthen racial seperation within the medical sphere (Amnesty International, 2022; Medical Aid for Palestinians (MAP), 2021).

A Different Set of Standards

In this section, I will explore the multi-faceted case of the Russian Sputnik V vaccine, a vaccine that is not approved for use in Israel, but batches of which were secured by the PA for distribution in the OPTs. I will expand on how this example highlights the violation of Palestinian rights on separate levels, with health inequalities interacting on different planes.

In a statement that was signed by thirty-one prominent Human Rights Organisations in early 2021, Israel was once again urged to include Palestinians in its vaccination plan. One of the concerns mentioned was the pending distribution of the Russian Sputnik V vaccine in the OPTs. The statement points to the Paris Protocol, which prohibits Israel from allowing the use of medication in the OPTs that does not meet the requirements of the Israeli Health System (PHRI 2020). Hence, the inoculation of Palestinians with a vaccine not approved for use on Israeli citizens would be a violation of the Protocol by Israel. More relevant here is that the use of this vaccine in the OPTs points to the Israeli government viewing the health of the Palestinians as secondary to that of the Israelis, where the safety of medical supplies being used in the OPTs is assessed using different standards to those being distributed in Israel. This brings to light a separate dimension of the medical racism that has impacted vaccination efforts in the OPTs, one that discriminates not just by affecting the quantity, but also the quality of healthcare resources available.

Nevertheless, despite the Paris Protocol, the vaccine was approved for use in the OPTs by Israel and the PA prepared 2,000 doses to be sent to Gaza for health workers on the frontline in February 2021 (Holmes, 2021). However, Israel initially blocked the shipment from entering Gaza, causing a delay for political reasons (Dahdal et al., 2021). It is essential to emphasise that the delay had nothing to do with health concerns about the vaccine’s safety or the legal implications of the Paris Protocol. Palestinians in the Gaza Strip have been living under blockade for well over a decade, and Israel continues to enforce the siege, partly as a means of punishing the Gazan population for being governed by Palestinian militant group Hamas, instead of targeting Hamas directly (Winter, 2015; Feldman, 2019). Using similar tactics, the reason for the delay was due to some Israeli officials wanting to use the vaccine shipment as a means of political negotiation with Hamas (Akram and Krauss, 2021), once again applying collective punishment to Gazan civilians because of political conflict, and leaving Palestinians unprotected against COVID-19 in the process. Palestinians have no control over the borders, and withholding the vaccines for political reasons further delayed inoculation in the OPTs, thus contributing to the vaccination gap.

At first glance, the two arguments may seem contradictory. However, on closer inspection, they go hand in hand to reinforce the idea that the health of the Palestinians is a secondary, if any, consideration for Israel. Whether considering the legal stance of the Paris Protocol or the tactic of withholding vaccines to push political agendas, the two arguments work in tandem to highlight the different means through which Israel’s ignorance of the Palestinians’ rights manifests within the vaccination sphere, further contributing to the disparity through institutional forms of violence.

The Result of the Palestinian Vaccination Struggle

As of early January 2022, Israel has fully vaccinated 64% of its population, whilst only 39% of the Palestinian populations in the OPTs have received both doses of the coronavirus vaccine (Our World in Data, 2022). Israel was also the first country in the world to begin offering its citizens a third booster vaccine in the summer of 2021, at a time when only 14% of Palestinians in the OPTs were vaccinated (Todeschini, 2021). For clarity, Israel’s vaccination statistic includes Israeli settlers in the West Bank, and also accounts for Palestinians living within the Green Line, and those with permission to work in the settlements (Todeschini, 2021).

Hence, the Israeli government has specifically excluded Palestinians that reside in the OPTs, despite its legal obligations and vastly superior public health capabilities. Palestinians in the OPTs are simply not entitled to the same privileges as Israeli citizens, where policies differ on the basis of where in the region they happen to be located (Feldman, 2019). With this in mind, it becomes evident that the vaccination gap is the result of a culmination of political, economic, and geographical factors rooted in Israel’s discriminatory policies in the OPTs, thus pointing to the health disparity being a result of structural racism.

Conclusion

As demonstrated by the examples outlined in this essay, the Israeli government has repeatedly employed tactics of discrimination through its unequal governance of Israelis and Palestinians with regard to healthcare. The decision to exclude Palestinians in the OPTs from its vaccination plan is no exception to this, and highlights a structural issue in the treatment of Palestinians as a population that is not entitled to the same health privileges as the Israelis. The exclusion from the Israeli vaccination plan, coupled with the political and economic factors that cripple the Palestinians’ own health system, has resulted in the COVID-19 vaccination inequity between Israelis and Palestinians. The wider health inequalities endured by Palestinians stem from a combination of general socioeconomic disadvantages and specific political barriers from Israeli blockage. When the vaccination gap is put into the context of the wider inequalities that exist between Palestinians and Israelis, it further points to the gap being a result of medical and structural racism.


BIBLIOGRAPHY

Akram, F., & Krauss, J. (2021). After Delay, Israel Allows Vaccines Into Hamas-Run Gaza. AP News. Retrieved 22 February 2022, from https://apnews.com/article/israel-health-coronavirus-pandemic-west-bank-gaza-strip-74da17fc337ce6e9812f05c9e0d0461f.

Amnesty International. (2021). Denying COVID-19 Vaccines To Palestinians Exposes Israel’s Institutionalized Discrimination. Retrieved from https://www.amnesty.org/en/latest/news/2021/01/denying-covid19-vaccines-to-palestinians-exposes-israels-institutionalized-discrimination/

​​Amnesty International. (2022). Israel’s apartheid against Palestinians: Cruel system of domination and crime against humanity. Retrieved from https://www.amnesty.org/en/documents/mde15/5141/2022/en/

BBC News. (2021). Covid: Israel To Transfer 5,000 Vaccine Doses To Palestinians. Retrieved 22 February 2022, from https://www.bbc.co.uk/news/world-middle-east-55879337.

Coronavirus Pandemic (COVID-19). Our World in Data. (2022). Retrieved 22 February 2022, from https://ourworldindata.org/covid-vaccinations.

Dahdal, Y., Davidovitch, N., Gilmont, M., Lezaun, J., Negev, M., Sandler, D., & Shaheen, M. (2021). Lessons of the Israeli-Palestinian Conflict for Public Health: The Case of the COVID-19 Vaccination Gap. International Journal Of Environmental Research And Public Health18(21), 11292. https://doi.org/10.3390/ijerph182111292

Feldman, I. (2019). Elimination Politics. Public Culture31(3), 563-580. https://doi.org/10.1215/08992363-7532655

Feldman, I. (2019). Reframing Palestine. Radical History Review2019(134), 193-202. https://doi.org/10.1215/01636545-7323685

Holmes, O. (2021). Israel blocked Covid vaccines from entering Gaza, say Palestinians. The Guardian. Retrieved 22 February 2022, from https://www.theguardian.com/world/2021/feb/16/israel-blocked-covid-vaccines-from-entering-gaza-say-palestinians.

Lenṭin, R. (2013). Co-Memory And Melancholia: Israelis Memorialising The Palestinian Nakba (1st ed.). Manchester University Press.

Medical Aid for Palestinians (MAP). (2021). Systematic Discrimination And Fragmentation As Key Barriers To Palestinian Health And Healthcare. Retrieved from https://www.map.org.uk/downloads/reports/map-health-inequalities-paper-final.pdf

Moss, D., & Majadle, G. (2020). Battling COVID-19 in the occupied Palestinian territory. The Lancet Global Health8(9), e1127-e1128. https://doi.org/10.1016/s2214-109x(20)30237-0

Physicians for Human Rights–Israel. (2020). 31 Organizations: Israel Must Provide Necessary Vaccines To Palestinian Health Care Systems. Retrieved from https://www.phr.org.il/en/israel-must-provide-necessary-vaccines-to-palestinian-health-care-systems/

Procter, C. (2021). Coordinated Mobility: Disrupting Narratives of Convergence in the Irregular Migration of Youth from the Gaza Strip. Public Anthropologist3(1), 93-110. https://doi.org/10.1163/25891715-03010005

Sawafta, A., & Ayyub, R. (2022). Palestinians Cancel Deal For Near-Expired COVID Vaccines From Israel. Retrieved 22 February 2022, from https://www.reuters.com/world/middle-east/israel-give-palestinians-1-million-covid-vaccine-doses-israeli-statement-2021-06-18/.

The Association of Schools of Public Health in the European Region (ASPHER). (2021). The Right To COVID-19 Vaccination Must Be Extended To Palestinians. Retrieved from https://www.aspher.org/download/639/aspher_statement_covid-19_vaccination_palestine.pdf

Todeschini, V. (2022). Under Occupation: Unprotected And Unvaccinated Israel’s Denial Of Equitable Access To COVID-19 Vaccines In The Occupied Palestinian Territory. International Commission of Jurists. Retrieved from https://www.icj.org/wp-content/uploads/2021/10/Israel-COVID-19-Vaccines-Briefing-Paper-2021-ENG.pdf

United Nations Human Rights. (2021). Israel/OPT: UN Experts Call On Israel To Ensure Equal Access To COVID-19 Vaccines For Palestinians. Retrieved from https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=26655

Winter, Y. (2015). The Siege of Gaza: Spatial Violence, Humanitarian Strategies, and the Biopolitics of Punishment. Constellations23(2), 308-319. https://doi.org/10.1111/1467-8675.12185

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