203134 Effects of war and occupation on access to health care: A study of women in the West Bank, Palestine

Tuesday, November 10, 2009: 12:30 PM

Cindy Sousa, MSW/MPH , School of Social Welfare, University of Washington, Seattle, WA
Mustafa Barghouthi, MD, MSc , Palestinian Medical Relief Society, Ramallah, Palestine, Palestine
Mona el-Zuhairi , Palestinian Medical Relief Society, Ramallah, Palestine, Palestine
Marah Hriesh , Palestinian Medical Relief Society, Ramallah, Palestine, Palestine
Bahia Amra , Palestinian Medical Relief Society, Ramallah, Palestine, Palestine
This study examines the impact of ongoing military interventions on healthcare delivery in the West Bank, Palestine, where a system of border closures severely restricts movement for the population and health care providers.

We conducted qualitative and quantitative research in the form of participant observation, key informant interviews with health care providers and surveys to women over 16 weeks with the Palestinian Medical Relief Society (PMRS).

Respondents reported their ability to access health care had suffered due to military occupation, including two incidents where women in labor were prevented from passing through a checkpoint. Impairment in accessing health care was significantly correlated with mental distress, r(35) = + .3 (p < .05).

Health care workers reported regular delays in reaching worksites and patients, difficulties transporting patients and harassment in the course of duty, resulting in impaired provision of primary and acute care. Results include one case where the ambulance driver was beaten at a checkpoint and one where a patient died in an ambulance delayed at a checkpoint. Healthcare providers reported an increase in chronic disease as sequelae of interruptions in care.

Results demonstrate significant indirect impacts of conflict on public health, thus expanding the understanding of the relationship between war and public health. Furthermore, findings underscore the importance and potential of health care professionals to respond quickly and creatively with community based and mobile programming. While results illustrate the challenges of healthcare under military occupation, they also show potential for organizational resilience that can be fostered through international cooperation.

Learning Objectives:
- Identify effects of military occupation on the status of health and health care delivery. - Evaluate the role of creative, community-based health care under extreme stress and violence. - Discuss the ethical imperatives of public health practice in the context of ongoing conflicts and war.

Keywords: Access to Health Care, War

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: It is original research conducted by myself.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.