Israel’s vaccine rollout has been the envy of the world. As of Wednesday, 57.4 percent of Israelis have received at least one dose of a COVID-19 vaccine, and 53.3 percent had received both. In a year of pandemic-induced stagnation—of the economy and of personal lives—the swift rollout has been nothing short of life-changing. The New York Times said the country offered a vision of the future.
But only a few miles away, millions of people face a dramatically different reality. In Gaza and the West Bank, Palestinians, including those living under a blockade and occupation, will likely wait many months before securing their first doses—and both areas are now facing their worst COVID wave of the pandemic. This disparity has drawn intense social media criticism and Israeli pushback in recent months. But what’s really happening on the ground now? To understand more, I called Natalie Thurtle, an emergency physician and the medical coordinator for Médecins Sans Frontières (Doctors Without Borders) in the region, to explain what her team there sees in their daily work and why the situation has reached a crisis point.
Our conversation has been edited and condensed for clarity.
Madeline Ducharme: What has been the vaccine relationship between Israeli and Palestinians, in terms of who got vaccinated and when?
Natalie Thurtle: It’s quite complicated. In the early days of the rollout, my understanding is that Palestinians in East Jerusalem who have status in Israel could access the vaccine as any other Israeli citizens can, but there was no access for individuals living in Gaza. In the West Bank, there has been some limited rollout to Palestinian workers because the border between the West Bank and Israel is actually quite porous. You’ve got about 140,000 Palestinian workers who cross the border and work in Israel as a long-standing arrangement.
More recently, there have been some small offers from Israel to Palestine to cover other vulnerable workers, but overall, there’s no serious commitment from Israel, and they feel no obligation to vaccinate people living in Palestine, despite positioning from the U.N. and other bodies that they do have an obligation. I recently got a summary from the Ministry of Health in Palestine that they have a total of 173,000 doses secured. That is 3.4 percent of the population of Palestine, more or less. So, it’s not awesome.
What reasoning does Israel provide for its position?
Israel interprets the Oslo Accords as the Palestinian Authority having the responsibility for provision of health care to Palestinians. There is no precedent for Israel providing health care for the Palestinian population during a public health crisis. In fact, in Gaza, you’re always looking at 30 percent of essential medicines being unavailable. There were already multiple issues with access to health care in Palestine before COVID.
Can you describe how the pandemic has unfolded in Gaza and the West Bank from last March through now?
Both the West Bank and Gaza had very, very few cases until May, when the West Bank had an outbreak. Gaza didn’t have any cases from community transmission until Aug. 21. They did quite well, and that gave us time to prepare.
So the West Bank had a first wave around June; Gaza had a small wave in August and September. Then both regions had quite a big wave—it happened in October and November in the West Bank, and in November and December in Gaza.
Now they’re in a third wave, which started in mid-February in the West Bank. I’m hoping they’ll peak soon. Gaza only started its third wave around mid-March. The pattern has largely been the same as the rest of the world—their trajectory was just delayed.
How has the lack of vaccines affected what is happening on the ground in Gaza and the West Bank right now?
While I don’t expect the vaccines to impact this wave of infections, we’ll need them to prepare for the next one. We’re really struggling in the West Bank. We’re supporting the Ministry of Health at the Palestinian Red Crescent Society Hospital in Nablus, in the West Bank. It’s a 40-bed unit and it’s supposed to only have 11 ICU beds. Instead, we basically have 40 ICU patients and tons of other patients being managed at home on home oxygen. And these are young people. We’ve had surges before, but they haven’t been like this.
We only just discovered the U.K. variant, B.1.1.7, in Gaza in the last couple weeks. It’s not yet been widely publicized, but it really needs a bump, because it’s going to be a real mess. We need to up the ante on vaccine procurement for Gaza. The West Bank is a few steps ahead of Gaza socioeconomically, and it’s already really bad there. I’m quite concerned about how the variant will hit Gaza. I think it’s important to flag this news to help push the agenda of supporting vaccine flow in Palestine.
What does your organization’s day-to-day efforts there look like right now? What have you and your doctors seen on the ground?
We have a team of two doctors: an intensive care specialist and an emergency specialist, as well as one intensive care specialist nurse. We have a plan to bring quite a number of other members of the team back, but it’s quite difficult to get people in at the moment, and it’s challenging to find people to go because of the global demand for doctors and nurses.
On the ground, basically you’ve got a really junior staff who aren’t trained in critical care medicine, since there are limited residency programs for specializing in intensive care medicine in Palestine. They’re also struggling in terms of supply. They recently ran out of cleaning products in our hospital, and we can’t source more products that are hospital-grade given the supply chain problem in Palestine, and because of global strains on supply chains.
Does the Israeli government view Gaza and the West Bank’s COVID emergency—and lack of vaccinations—as a national health risk for Israel?
I can’t speak for them, but I think it’s fairly straightforward public health. From a public health perspective, it makes sense that Israel would include them in their vaccine plan, not because of some humanitarian provision of vaccines to Palestine but because there’s a lot of cross-population between the two. With new variants evolving all the time, it doesn’t make sense to have open borders with a country that has 2 percent vaccination coverage.
Israel has extra stockpile of vaccines it has shipped around the world, to countries like Guatemala. What do you make of that?
Vaccine politics are quite complicated, and I think there’s a lot of drivers to how countries approach their vaccine rollout. I wouldn’t know what all those pressures are in my position. But we are living in a globalized health dynamic, so it’s not surprising that this is going on.
How does the blockade affect health care in Gaza, both during the pandemic and in more “normal” times?
There are items that are not allowed to cross the border—anything that can be repurposed as “tools of conflict.” But more of the issue is that there’s a lot of bureaucracy in terms of permissions for items to be imported. Additionally, Gaza’s fragile economy means that it’s very donation-dependent, and the donor structure itself is fragmented.
There’s also a very high population density, not enough beds and doctors per capita, and there’s a brain drain where you lose a lot of your specialists. There are no fully qualified plastic surgeons in Gaza. Most oncological patients need to be transferred to the West Bank to be treated, but there’s a very extensive process for them to get permission to leave and seek that treatment. That’s also been highly disrupted by COVID.
How do you think viral tweets and reporting about the disparity between the Israeli and Palestinian COVID situations and vaccine rollouts affect the way the rest of the world responds to a crisis? Do they affect the amount of aid that Palestinians might get on an issue like this?
I think that’s a really hard question because it’s difficult to know the specific set of circumstances that can get traction in people’s minds, because we have access to so much information these days. There is a long-standing concern about health inequalities in the Middle East, and particularly between Palestine and Israel, and obviously it’s very polarizing and complicated. But let’s put it this way: My organization hasn’t really talked about COVID in Palestine before publicly. And I think we really do feel that this is an emergency situation. Our role as MSF is to say, “Look, this is a situation that is not controlled and is likely to lead to high morbidity and mortality.” And, of course, that’s happening all over the world at different times over the last year, and probably unfortunately, for the rest of this year, and therefore, it’s difficult to get traction talking about this issue—which is why we haven’t talked about it until it really has become an emergency. And we have a specific ask, which is: vaccines for Palestine from any source that is safe and willing to engage.