Rohan Radhakrishna’s study on Uganda’s “night commuters” was one of the winners of the first annual The Lancet-GHEC 2008 prize. An abstract of Rohan’s study - which will be presented at the 2008 GHEC conference - is provided below.

Context: An ongoing 22 year civil war has devastated Northern Uganda’s health infrastructure and caused the displacement of 1.8 million civilians. The displaced itinerant children in war-affected Northern Uganda known as the “night commuters” are a group who flee their villages and IDP (internally displaced person) camps at night for fear of rebel abduction and come into the town center for shelter and security. However, they have never been studied using randomized sampling, control groups, or mixed methods yet numerous policies have been implementing to improve their wellbeing. I arrived in Northern Uganda as a medical and public health student in 2006 working as a consultant for UNICEF and Caritas to conduct a needs assessment of the “night commuters” however the governor of Kitgum Province decided to abruptly close the 13 shelters were 4,500 children were finding sanctuary.

Objectives: To reveal the demographics of the “night commuters,” to understand their motivations for secondary displacement, and to promote evidence-based decision making by government, non-government organizations (NGOs), and humanitarian organizations through including the views of the populations they serve. My goal was also to use our research findings to convince the governor to not abruptly close the shelters and instead to slowly phase out the shelters using a case management approach for the extremely vulnerable children who weren’t able to return home immediately (AIDS orphans, disabled, child-headed households, formerly abducted children, children in congested homes etc.).

Design, Setting, and Participants: A retrospective cohort study of 720 “night commuter” children (aged 7-17) in 13 shelters in 1 district using stratified random sampling and a control group of 410 non-night commuting children (aged 7-17) in villages and camps for IDPS in the same district selected through random cluster sampling during July and August of 2006. Follow-up through an evaluation and prospective cohort study of 120 former “night commuters” in villages and camps in August of 2007. Quantitative surveys were administered in addition to qualitative methodologies using grounded theory: direct observation, key informant interviews (n=45), focus groups in 2006 (n=20) and focus groups in 2007 (n=8).

Main Outcome Measures: Sociodemographic information, housing situation, self-reported health indicators, sense of security, and motivations for displacement.

Results*: Night commuters were more likely to be partial or total orphans than non-night commuters. Lack of accommodation (44% p <.01) was found to be a greater reason for secondary displacement than lack of security (41% p<.01). Respondents cited other causes of insecurity after the rebels had left (thugs and local defense units). Over a dozen push and pull factors influencing their displacement were elucidated.

Conclusions: Respondents cited lack of accommodation and insecurity from non-rebel sources (e.g. thugs and local defense units) as major contributors to their secondary displacement which was not adequately considered by the government or humanitarian groups. Results helped construct a 10 Point Plan for responsible shelter closure adopted in consensus by stakeholders which led the governor to change his policy. I wrote 3 reports from my research leading to increased funding for health centers, schools, and shelter. This study revealed the need for developing minimum standards in population based research for displaced populations during complex humanitarian emergencies to promote more robust research, more representative sampling, and more locally informed decision-making.

*Full results available upon request. Some statistical tests are pending and a manuscript is being submitted.

The situation in Gaza is forever changing. Anand Bhat interviews, Dorothea Krimitsas, the International Committee of Red Cross’s Media Relations Director for the Middle East and North Africa to find out more about the situation on the ground.

From kidnapped soldiers and BBC correspondents to travel blockades, the Gaza Strip in the occupied territories earns its reputation as a conflict hotspot. This article spotlights the siege of Gaza, the history behind it, and includes an account from the ground from those who work there.

The Gaza Strip is home to 1.4 million people in an area of only 360 square kilometers.  This densely populated land (3 888 people per square kilometer) is envisioned to be part of a future Palestinian nation along with the West Bank.

Gaza and the West Bank have been illegally occupied by Israel after the Six Day War in 1967. (1) (2)  Gaza was run by Egypt between 1948 and 1967 after the partition of the British Mandate of Palestine and the declaration of Independence of Israel.  Afterwards, the state of Israel built illegal settlements on the occupied land. (2)

Three years ago, however, Prime Minister Ariel Sharon controversially and unilaterally “disengaged” from the Gaza Strip by evicting Jewish settlers and withdrawing the Israeli Defense Forces (IDF). (3)  In 2006, the Islamic fundamentalist group Hamas entered electoral politics and won a majority in the Palestinian Authority National Assembly against the secular Fatah Party.  Also in 2006, Palestinian militants kidnapped the Israeli soldier Gilad Shalit which led to Israeli incursions into Gaza.

After political spats and two mini-civil wars with Fatah, Hamas engineered a violent takeover of the Gaza Strip in 2007 throwing out the Fatah-dominated security forces. (4)  The international community condemned and cut off aid to Hamas and looked to the West Bank government for any peace negotiations.  Ending foreign aid to the Hamas Gaza government has caused enormous economic hardship for a very foreign aid-dependent society.  Militants began firing Qassam rockets into Israel from the Gaza Strip.

In response to rocket attacks and the kidnapped soldier, Israel declared Gaza to be a “hostile territory” at war with Israel. (5)   The Strip is now under siege and sealed off from the outside world.  Recently, Israel also announced it would stop fuel from entering the Gaza Strip.

Between such violence on both sides, I found the 2007 report by the Red Cross, “Dignity Denied,” interesting. (6) The International Committee of the Red Cross (ICRC) declared that humanitarian aid is insufficient for the situation in Gaza and urged a political solution, an intriguing break with its neutrality in such conflicts.  From the report it reads:

“Throughout the occupied Palestinian territories, in the Gaza Strip as well as in the West Bank, Palestinians continuously face hardship in simply going about their lives; they are prevented from doing what makes up the daily fabric of most people’s existence. The Palestinian territories face a deep human crisis, where millions of people are denied their human dignity. Not once in a while, but every day…

“The dignity of the Palestinians is being trampled underfoot day after day, both in the West Bank and in Gaza.  Israel’s harsh security measures come at an enormous humanitarian cost, leaving those living under occupation with just enough to survive, but not enough to live normal and dignified lives.”

To find out more about the situation on the ground, I interviewed the person in charge of the International Committee of Red Cross’s Media Relations for the Middle East and North Africa, Dorothea Krimitsas, on the siege in Gaza and its medical and humanitarian implications as opposed to the media’s usual focus on the political, ethnic, and religious implications.

Q:  What is the situation right now in the Gaza Strip and why should young medical professionals care?
“The Israeli blockade, although not fully hermetic, remains quite tight. With the decision taken by the Israeli Supreme Court allowing cuts to fuel deliveries to Gaza, no improvement can be expected. In other words, supplies reaching Gaza are still strictly limited to essential humanitarian shipments. The number of trucks currently entering the Strip is down to a trickle compared with the situation before June 2007 [when Hamas took over]. As a result, the needs of the population are far from being met. The amount of goods currently entering Gaza has fallen down dramatically and the downward spiral of conditions for Gazans will continue until all parties concerned reach a solution to the current impasse.

“Hospitals facilities are directly hit by these shortages. They are still operating on the emergency mode only, as their fuel reserves do not allow them to run all services, which would be needed for a population of 1.5 million inhabitants. Chronic diseases and non-urgent interventions are no longer dealt with. Drugs and disposables are on short supply, although the ICRC is keeping a constant watch on their needs and is re-supplying their stocks as quickly as possible. It is hard to say when the situation will get any better for the medical profession and their patients in Gaza.”

Q: How does the siege affect doctors, hospitals and patients?  Do you have any figures on patients harmed by the power cuts?
“Doctors, nurses and patients are all affected by the present situation. The shortage of fuel and electricity is the major problem they are facing. Patients in Gaza used to benefit from a better level of medical care until the restrictions became fully effective in June 2007. Since then, and in a more acute way with the additional electricity cuts, the medical profession is experiencing severe lacks affecting the treatment of ordinary surgical or medical cases, and the follow-up of chronic diseases. This is a major concern for a population already weakened by all sorts of deprivations.

“We know of one ventilated patient who died at Ahli Arab hospital during the process of switching over from the main power plant to the generator. The ICRC does not have statistics on how the restrictions are affecting health.”

Q: What are the casualties on either side of this conflict?  What is the status of the kidnapped Israeli soldier?
“There are ongoing hostilities between Palestinian fighters and Israeli soldiers, with almost daily casualties. In Gaza, most cases can be treated on the spot. People wounded by rockets in nearby villages in Israel such as Sderot are also treated on the spot or evacuated to better equipped Israeli hospitals if needed.

“So far, ICRC delegates did not get access to the Israeli soldier in Palestinian hands. The priority for the ICRC is to get at least a sign of life. Despite all efforts this has not yet materialised.”

Q: Are any international laws or treaties being broken on either side?
“In its recent publication “Dignity Denied”, ICRC emphasized the immense suffering caused by decades of occupation in the West Bank and Gaza Strip. Non-respect of international humanitarian law applicable in occupied territories (the Fourth Geneva Convention) is a constant concern for ICRC delegates who are monitoring the situation of the Palestinian population.

“Likewise, ongoing hostilities putting at risk the life of Israeli civilians have to be considered. Legitimate security concerns, on one side, and the right to live a normal and dignified life, on the other side, are the minimal requirements.”

Q: It is alleged that Palestinians use ambulances to smuggle weapons to attack Israelis.  Israel has bombed ambulances in the past.  Are these charges true?  Is attacking medical personnel against international law?  “Attacking medical personnel is forbidden under international humanitarian law.  Medical  personnel, facilities and vehicles, must be protected at all times, thus the importance to respect red cross and red crescent emblems, and the ‘magen david adom’, which is the emblem of the Israeli national society. The ICRC regrets that, in many conflict situations, misuse of emblems or lack of protection of the medical mission are reported.

“To improve the situation, its delegates around the world keep disseminating the most important rules to be respected in times of conflict. For instance, throughout 2008, the ICRC is running a campaign to raise awareness on the specific rules which are linked to this obligation of respect. It will address the Palestinian Territories and also Israel Defense Forces.

“As a matter of policy, the ICRC does not comment publicly on specific events or violations of international humanitarian law, but discusses its findings and recommendations directly with the parties concerned. Whenever the ICRC is aware of attacks on medical personnel or facilities, it intervenes with the parties concerned.”

Q: What is Egypt’s role in the sealing off of Gaza?
“Egypt is a sovereign country which is sharing part of its border with the Gaza Strip. After the recent events, it has imposed a close control of this border. It is not up to the ICRC to comment any further.”

Q: Did Israel truly disengage from Gaza in 2005?  Do Gazans have the right to use their coast, airport, and borders?
“As a matter of fact, in spite of the departure of Israeli occupying forces from Gaza, Israel still imposes a very strict control of all access roads to the Strip, be it by air, sea or ground. As a result, no trade can be operated by Gazans. Only essential humanitarian goods are allowed, and even this vital aid is sometimes subject to further restrictions.”

Q: What are you asking from the international community?  Why has the Red Cross made such a statement?  Is there something fundamentally different that warranted the need for a “political solution?”   

“The ICRC has been continuously present in Israel and the Occupied and Autonomous Territories for the last 40 years. The situation on the ground is further deteriorating. To prevent more hardship for the population, it is necessary to go back to the same levels of access for humanitarian goods and personnel, which existed before June 2007, and the delivery of essential humanitarian goods must be secured in the long run. But it is high time that those responsible within the international community and among the direct actors realise that humanitarian action is no substitute for political action. As the ICRC’s head of operations for the Middle East and North Africa said in a statement on 13 December 2007, “In the current situation, humanitarian assistance alone is insufficient. It cannot and should not be a substitute for political action.

“The ICRC firmly believes that only prompt, innovative and courageous political action can change the harsh reality of this long-standing occupation, restore normal social and economic life to the Palestinian people, and allow them to live their lives in dignity.”

Conclusion
Will the situation improve any time soon?  Will there be a political solution?  A recent poll of Israelis by the newspaper Ha’aretz finds that 64% of Israelis now favor direct negotiations with Hamas with only 28% are opposed, (7) a faint sign of hope for the region.  It is only too logical to ask for peace and dignity for both sides.

Anand Bhat
Second year Medical Student
University of Texas Medical Branch
Texas, US
akbhat@utmb.edu

(1)  U.N. Security Council Resolution 242

(2)   “Forty years on.“  The Economist : March 24, 2007

(3) Oliver, Mark.  “Soldiers evict Gaza settlers.“   Guardian : August 17, 2005.

(4)  Shult, Christoph.  “Hamastan” vs. “Fatahstan“  Der Spiegel : June 19, 2007.

(5)  Ravid, Barak and Shlomo Shamir.  “Cabinet declares Gaza ‘hostile territory.”   Ha’aretz: September 20, 2007.

(6) Dignity Denied. ICRC 2007

(7)  Verter, Yossi.  “Poll: Most Israelis back direct talks with Hamas on Shalit.” Ha’aretz:  February 27, 2008.

Anne Aspler and Greg Queyranne take an indepth look at the atrocities currently being committed again women and girls in this troubles country

More lives have been lost in the conflict in the Democratic Republic of the Congo (DRC) than in any other conflict since World War II (1); surprisingly, it has not generated significant media attention. (2)  The little media coverage it does receive too often fails to address issues unique to women and girls, perhaps the greatest victims of the war in the Congo, to whom large-scale rapes and sexual slavery are almost exclusively reserved.  When the international community analyzes the human effects of wars, they tend to focus either on the combatants, comprised nearly entirely of men, or on the victims as a whole; seldom do they take into consideration the specific victimization of women.

In this article, we discuss how women have been affected by the war in the Congo in a qualitatively different manner, with a focus on the extent and consequences of sexual violence.  While there is no internationally agreed upon definition of sexual violence, we will focus on one of the most extreme forms - rape - which the WHO defines as “physically forced or otherwise coerced penetration…of the vulva or anus, using a penis, other body parts or an object.” (3)  We include both a practical guideline for the acute management of rape victims, and conclude with a few suggestions for an appropriate response from the international community.

Overview of the Conflict
Before discussing the impact of sexual violence on women, it is helpful to provide an overview of the conflict itself.  The origins date back to 1996, when Rwanda and Uganda backed a rebellion to overthrow Mobutu Sese Seko, then dictator of Zaire, as DRC was known until that time.  In 1998, Rwanda and Uganda then invaded and occupied large parts in the east and north of the Congo, (4) a country roughly the size of Western Europe. (2) The ensuing war, which Angola, Burundi, Namibia and Zimbabwe soon joined, (4) has led to the deaths of approximately 4 million people, mostly from disease and malnutrition, as insecurity has restricted access to basic healthcare services and sanitation. (5)

Much of the war has been fought over access to minerals, including gold, diamonds, and coltan, (1) a mineral essential for the high tech-industry; coltan is found in every cell phone, computer, iPod, DVD player and jet engine. (6) At least 85 multinational corporations have benefited from the war: a UN Panel of Experts has concluded that “[c]ompanies trading minerals…[are] considered to be ‘the engine of the conflict in the Democratic Republic of the Congo.’” (7)

Sexual Violence in the Conflict
Although peace accords and recent democratic elections have given the impression that the conflict is abating, violence in the eastern provinces continues. It has been determined that approximately 38,000 people die every month. (5)

Sexual violence against women and girls has been found to be “the most common form of violence” and “the most widespread form of criminality” in the war in the DRC. (5)  In a 2002 report on the subject, Human Rights Watch described sexual violence as nothing less than “a weapon of war [used] by most of the forces involved” in the conflict. (8) It is so widespread that the UN estimates that in the province of South Kivu alone, approximately 27,000 women were raped in 2006 (9) and 45,000 women in 2005, (1) though these may only be fractions of the total number in the Congo. (9)

Consequences of Sexual Violence
The consequences of sexual violence are many - not only medical, but also long-term psychological, emotional, and socioeconomic effects. (10,11,12)  Health consequences may include physical trauma to the reproductive tract, such as ecchymosis, tears, and fistulas; increased risk of sexually transmitted infections, including HIV; and increased incidence of unwanted pregnancy with subsequent unsafe abortion - which can result in pelvic inflammatory disease, infertility, and even death. (10,11) Manifestations of psychosocial problems range from post-traumatic stress disorder, depression, and attempted suicide, to more subtle signs of fear, anxiety, intrusive memories, difficulty sleeping, withdrawal, and flashbacks. (9,10)

Perhaps the most devastating consequence of rape, however, is the subsequent experience of stigma and discrimination.  Those that undergo the process of medical and psychosocial healing may return to their communities only to face total rejection from their partner, family, and community. (10) Practitioners must, unsurprisingly, be prepared to take on several roles in responding to patients who have experienced sexual violence.  The Box (below the references at the end of this article) provides basic guidelines for the acute care and management of victims. (13,14,15)

Extent of Sexual Violence
Médecins sans Frontières (MSF) has responded to the crisis in the DRC by providing treatment to victims of sexual violence in several regions affected by the conflict.  From August 2003 to January 2004, over a period of just 6 months, they reported more than 550 victims of sexual violence attending an emergency clinic in Baraka. (10) The age of victims attending the clinic ranged from 12-70 with over 75% of attendees reporting multiple aggressors, from 2 to 5 men, at a time. (10) In 2007, MSF reported treating 7,400 rape victims over four years at the Bon Marché hospital in Bunia - with an average of 50-300 women arriving every month for treatment. (16) With emergency missions in over 70 countries worldwide (17), an overwhelming majority - 75% - of rape cases dealt with by MSF are currently in eastern Congo. (18)

Discussion
Sexual violence in the conflict regions of the DRC must be confronted both on a local and international scale.  Locally, extension of health care and support services addressing both the medical and psychosocial effects of sexual violence is needed. (19) Healthcare workers may need special training in order to be prepared to respond with appropriate prophylaxis, counseling and referral for psychological and social support. (11,13) Medical intervention should be part of an integrated approach advocating for peace and security in the region and an end to sexual violence by supporting victims, documenting the extent of sexual assault, and advocating specifically for those affected by sexual violence. (11)

Beyond acute intervention at the medical level, we also have to consider the roots of the underlying conflict itself.  The links between the desire to control areas of mineral wealth and the continuing acts of sexual violence in the eastern regions calls into question how the international community should be responding to help resolve the conflict.  As poignantly expressed by journalist Jan Goodwin: “The commerce in these “blood” minerals, such as coltan, used in cell phones and laptops…drives the conflict. The brutality of the militias - the sexual slavery, transmission of HIV/AIDS through rape, cannibalism, slaughter and starvation, forced recruitment of child soldiers - has routinely been employed to secure access to mining sites or insure a supply of captive labor. “(20)

The more we ignore the victims of this brutal tragedy, and the more rapidly we consume high-electronics without demanding that components do not come from war-afflicted regions of the Congo, the less likely these horrors will end. (21)

Anne Aspler
second year medical student
and
Greg Queyranne
first year political science student

University of Alberta
Edmonton
Alberta
Canada
aaspler@ualberta.ca and queyrann@ualberta.ca

[1] Hari, J. “A Journey into the Most Savage War in the World: My Travels in the Democratic Vacuum of Congo.” The Independent 6 May, 2006. Available from: http://johannhari.com/archive/article.php?id=863

[2] Hawkins, V. Stealth Conflicts: Africa’s World War in the DRC and International Consciousness.  Journal of Humanitarian Assistance. Jan 2004. Available from: http://www.jha.ac/articles/a126.htm

[3] World Health Organization. World Report on Violence and Health. World Health Organization. October 2002:  p. 149. Available from: http://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap6.pdf

[4] Turner, T. The Congo Wars: Conflict, Myth, and Reality.  New York:  Zed Books, 2007.

[5] International Crisis Group, “Beyond Victimhood: Women’s Peacebuilding in Sudan, Congo and Uganda,” Africa Report No. 112, (28 June 2006): p.8-11.

[6] Dena Monatgue. “Stolen Goods: Coltan and Conflict in the Democratic Republic of Congo.” SAIS Review. Vol. XXII no. 1 (Winter-Spring 2002).

[7] United Nations, Security Council. “Report on the Panel of Experts on the Illegal Exploitation of Natural Resources and Other Forms of Wealth of the Democratic Republic of the Congo.” United Nations. 16 April 2001. Available from: http://www.un.org/News/dh/latest/drcongo.htm

[8] Human Rights Watch. “The War Within the War: Sexual Violence Against Women and Girls in Eastern Congo.” Human Rights Watch June, 2002: p. 1.  Available from:  http://www.hrw.org/reports/2002/drc/Congo0602.pdf

[9] Gettleman, J. “Rape Epidemic Raises Trauma of Congo War.” The New York Times. October 7, 2007. Available from: http://www.nytimes.com/2007/10/07/world/africa/07congo.html?ref=opinion

[10] Médecins Sans Frontières.  “Medical, Psychosocial, and Socioeconomic Consequences of Sexual Violence in Eastern DRC.”  Médecins sans Frontières. 2004. Available from:  http://www.msf.org/source/countries/africa/drc/2004/drcreport-nojoy.pdf

[11] Shanks, L. and Schull, MJ.  “Rape in war: the humanitarian response.” Canadian Medical Association Journal. 2000 October 31; 163 (9): p. 1152-1156.

[12] World Health Organization. Violence against women. World Health Organization. July 1997. Available from: http://www.who.int/gender/violence/v7.pdf

[13] Mein, JK, Palmer, CM, Shand, MC, Templeton, DJ, Parekh, V, Mobbs, M, Haig, K, Huffam, SE, and Young,L.  Management of acute adult sexual assault. Medical Journal of Australia. 2003 178 (5): p. 226-230.

[14] Sommers, MS. Defining patterns of genital injury from sexual assault: a review. Trauma Violence Abuse. July 2007 8 (3): p. 270-80.

[15] Brode, S. and Schofield, L.  Emergency Medicine. Toronto Notes: Comprehensive Medical Reference. 23^rd ed. Toronto: University of Toronto. 2007.  p. 34-35

[16]  Médecins Sans Frontières.  Ituri, “Civilians still the first victims”  Permanence of sexual violence and impact on military operations.  Médecins sans Frontières. 2007.   Available from: http://www.msf.org/source/countries/africa/drc/2007/Ituri_report/Ituri_report.pdf

[17] Médecins Sans Frontières. “About MSF: The MSF role in emergency medical aid.” Available from: http://www.msf.org/msfinternational/aboutmsf/

[18] McGreal, C. Hundreds of thousands of women raped for being on the wrong side. The Guardian. November 12, 2007.  Available from: http://www.guardian.co.uk/international/story/0,,2209383,00.html

[19] World Health Organization. Sexual violence: strengthening the health sector response. World Health Organization. 2007. Available from: http://www.who.int/violence_injury_prevention/violence/activities/sexual_violence/en/print.html

[20] Goodwin, J.  Silence = Rape.  The Nation.  March 8, 2004. Available from: http://www.thenation.com/doc/20040308/goodwin

[21] Queyranne, G.  “War for Minerals in the Democratic Republic of Congo.” Antidote. 2007. 4 (1): p. 6.

Feroze Sidhwa recently spent his elective in the occupied Palestinian territories. Here he discusses the food insecurity issues there

The Israel Defense Forces (the army of the State of Israel) invaded and occupied the West Bank, Gaza Strip and East Jerusalem (the occupied Palestinian territories; oPt) in June 1967. Since then Israel has maintained a military occupation in those territories, with policies that have led to “de-development”, the “structural[] and institutional[] dismantl[ing of] the Palestinian economy…”(1) This has led to the recent sharp rise in food insecurity in the oPt. Please note that in the article, “Palestinian”, “Palestinians”, etc. refers only to the Palestinians in the occupied Palestinian territories.

Current food security status

The World Food Program (WFP) reported in January 2007 that 34% of Palestinian households are food secure, 20% are marginally secure, 12% are vulnerable to food insecurity, and 34% are food insecure.(2) As of November 2006, 40.2% of Palestinian households lived in “deep poverty” (daily per capita consumption of less than $2.10); in Gaza the figure is 79.8%. The first half of 2006 saw a 38.3% increase in the number of Palestinian households in deep poverty. (3)

In 2004 the World Bank estimated that per capita food consumption declined some 25% in real terms compared to 1999. (4) The decline in food consumption continued, with a further decline of 8% in the first half of 2006 alone. (2)

The consequences have been severe and will likely have long-term effects on Palestinian children’s development. In 2004 wasting reached 1.9%; stunting 9.9%; and vitamin A deficiency in children 12-59 months reached 22%. (2) 50.5% of West Bank children under 24 months and 71.9% of Gazan children 9-12 months are anaemic. (5) According to UNICEF, “one in ten children is stunted, one in two is anemic, and 75 per cent of children under the age of five suffer from vitamin A deficiency and low birth weight rates are as high as 8.2%…” (6)

The observed vitamin A deficiency and anemia “are considered by WHO international standards as a severe public health situation…”  The observed rise in malnutrition status is due to decreased food consumption and decreased quality of consumed food over at least the past eight years. (2)

Food insecurity as a consequence of economic de-development

Palestinian food insecurity is highly correlated with the long-term intensity of Israel’s closure regime (severe restriction on freedom of movement within the oPt; see http://www.ochaopt.org/documents/InsertMap_Fragmentation_May07-withCheckpoint.pdf ), the extent of land confiscation, the attendant destruction of assets and infrastructure, and loss of income. (2) Closure and physical destruction of Palestinian economic infrastructure are both core policies of the occupation and lead directly to de-development.(1)

In December 2002 Palestinian gross national income (GNI) losses “reached some US$5.2 billion in 27 months - when one considers that GNI was estimated at US$5.4 billion in 1999, the opportunity cost of the crisis represents almost one entire year of Palestinian wealth creation. Cumulated raw physical damage [from September 2000 to December 2002] has jumped in the last year to some US$930 million, and lost investment to US$3.2 billion.” (7) The UN Conference on Trade and Development reports the loss “of up to one third of the existing physical capital and productive capacity” of the oPt. (8) Real per capita GDP declined another 10 percent in the first half of 2006 alone. (3)

The Word Food Program (WFP) lists nine major risk factors predisposing Palestinian households to food insecurity. (2) Similarly, a joint European Union and UN Food and Agriculture Organization report lists eight reasons for the increasing cost of food. (9) In each risk model, all but one risk factor is due to occupation policies.

The UN Office for the Coordination of Humanitarian Affairs reports closure and fragmentation by Israeli settlements and settlement-related infrastructure “is at the root of the West Bank’s declining economy…. Unless the problems caused by the existence and expansion of the settlements are addressed, the dismal humanitarian outlook for Palestinians will intensify.” (10) Several World Bank reports affirm this judgment. (4, 7, 11)

Roy describes the core policies of de-development as “measures designed…[to] fragment Palestinian society…to render it unviable…include[ing]:…introduction of advanced agricultural technologies concomitant with the steady confiscation of land and water; the introduction of refugee rehousing programs together with the establishment of Jewish settlements on Arab land; [and] improved access to employment in the Israeli economy in conjunction with prohibitions on the development of the domestic Palestinian economy (e.g. restricted access to international markets, control over all forms of indigenous production and over the flow of information, and consistently low levels of government investment in key economic sectors)…”(1)

Possibilities for improvement

Short of an end to the occupation, food security can perhaps be improved with food aid from the international community, but this will require Israeli cooperation on movement of food aid, especially into and out of Gaza, as well as sustained international financial and political support for such aid. Israel’s recent designation of Gaza as a “hostile entity” and US Secretary of State Rice’s agreement with the declaration does not indicate that either international support or Israeli assistance will be forthcoming. (12) Sustainable food security can only grow out of Palestinian economic stability and recovery, which are likely impossible under continued Israeli occupation and de-development. (13)

Feroze Sidhwa
2nd year medical student
University of Texas Health Science Center
San Antonio
USA
Sidhwa@uthscsa.edu

(1) Roy S. The Gaza Strip: The Political Economy of De-Development, 2^nd ed., Washington, DC: Institute for Palestine Studies; 2001.

(2) World Food Programme. West Bank and Gaza Strip: Comprehensive Food Security and Vulnerability Analysis, Jan 2007.

(3) United Nations Relief and Works Agency for Palestine Refugees in the Near East. Prolonged Crisis in the Occupied Palestinian Territory: Recent Socio-economic Impacts on Refugees and Non-Refugees, Nov 2006.

(4) World Bank. Four Years - Intifada, Closures and Palestinian Economic Crisis, Oct 2004.

(5) United Nations Office for the Coordination of Humanitarian Affairs. The Humanitarian Monitor: occupied Palestinian territory, No. 15, July 2007.

(6) United Nations Children’s Fund. UNICEF Humanitarian Action Report 2007, 2007.

(7) World Bank. Twenty-Seven Months - Intifada, Closures and Palestinian Economic Crisis, May 2003.

(8) United Nations Conference on Trade and Development. Report on UNCTAD assistance to the Palestinian people, July 2007.

(9) EC-FAO Food Security Information for Action Programme. Strengthening Resilience: Food Insecurity and Local Responses to Fragmentation of the West Bank, Apr 2007.

(10) United Nations Office for the Coordination of Humanitarian Affairs. The Humanitarian Impact on Palestinians of Israeli Settlements and Other Infrastructure in the West Bank, July 2007.

(11) World Bank. The Palestinian Economy and the Prospects for its Recovery: Economic Monitoring Report to the Ad Hoc Liaison Committee, Dec 2005.

(12) Israel brands Gaza “hostile entity” as Rice visits. AFP, Sept 20, 2007.

(13) Roy S. ‘A Dubai on the Mediterranean’. London Review of Books, Nov 3, 2005.

Aoife Singh
Intercalating Medical Student International Health BSc, Centre for Child & Adolescent Health, University of Bristol, Bristol BS6 6JL, UK

Throughout history, war has taken an unacceptable toll on children. They have been killed, injured, orphaned and employed as part of a country’s armed forces. However in today’s world a new and horrific phenomenon is the widespread use of child soldiers.

(more…)