The Palestinian Economy. Theoretical and Practical Challenges

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Abu-Zaineh – Mataria
distribution of PHC facilities, where the number of population per PHC facility in the
GS is much higher than in the WB: 11,106 versus 4,692 individuals per PHC facility
(HPU 2008a).
While the above patterns indicate unequal distribution of secondary and tertiary
facilities in favour of the centre areas in both regions, and in favour of the WB in case of
PHC facilities, special-inequalities can, in fact, matter more – as a factor that contribute to
inequity in the health sector – in the context where the country’s area is rather large and
transportation are costly or unavailable (Fortney, Rost et al. 2000). Overall, the OPT is a
combined area of 6165 km², divided into two geographically distinct territorial regions:
the WB (5800 km²) and the GS (365 km²), separated throughout by areas of Israeli
jurisdiction (PASSIA 2005). In principle, therefore, since the country is rather small and
transportation is available, services are within rather easy access. For instance, most of
the population, especially in GS, live within a short distance of the health care services.
Yet, the problematic issue is the physical accessibility to the available services. Indeed,
when considering the current geopolitical realities, the special distribution of health care
can be a significant factor, given the imposed discontinuity between the “autonomous”
Palestinian agglomerations, which were attributed as a “mosaic of islands” (Pourgourides
1999), and today are further enclosed by the separating wall.
In effect, there is limited physical accessibility to health care due to mobility
restrictions imposed by multiple manned and non-manned military checkpoints and the
separation wall that prevent patients and medical staff, and sometimes ambulances,
travelling from rural to urban localities and between urban centres from accessing needed
care (Giacaman, Khatib et al. 2009; Mataria, Khatib et al. 2009). A national survey
(PCBS 2004) conducted at the end of 2003 reported that the number of people needing an
hour or more to reach the appropriate health facility was increased tenfold by Israeli
restrictions on travel (4.0% vs. 0.4%). The compromised access to health care has led to
the introduction of a network of mobile clinics to cater for the needs of people living in
remote and isolated localities, the adaptation of many PHC centres to provide more than
basic services, and the increase in the number of referrals for treatment abroad, with a
consequent additional cost burden for both the system and the patients (Mataria and
Khouri 2008). Despite that the unavailability and the limited physical accessibility to the
needed health care have been recently documented in several studies (Miranda 2004;
Qato 2004; Horton 2007; ICRC 2007), and in a series of reports prepared by the WHO’s
mission in the WB and GS (WHO 2007; WHO 2008b). All showing an emerging lack of
medications, medical supplies and functioning equipments, particularly, during 2006 and