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Research Highlights “Hidden Crisis” Of High Levels Of Chronic And Acute Illnesses In Palestinian Refugees

New research draws attention to the continuing and urgent health emergency facing Palestinians living under occupation, especially the health and wellbeing issues surrounding refugees from the . Abstracts of the research, which were presented at the fourth meeting of in March 2012, are published online today [Monday, October 8] in The Lancet.

A survey of 356 living in refugee camps and other gatherings in Lebanon revealed that an estimated 31% of individuals living in these camps have chronic illnesses, and nearly a quarter (24%) had experienced acute illness in the six months before the survey was taken. The researchers, led by Dr Rima Habib at The American University of Beirut, found that 42% of survey respondents had water leaking from their walls or roofs, and 8% of dwellings were composed of dangerous building materials such as asbestos. The researchers identified a significant positive correlation between chronic illness and water leakage in the homes surveyed, as well as finding other correlations which together indicate that there is a strong link between poverty and ill health in these communities.

According to Dr Hala Ghattas at The American University of Beirut, and colleagues, food insecurity presents another pressing issue for displaced Palestinians, with a survey of 2501 households revealing that 63% had experienced some food insecurity, and 13% reported being severely food insecure. Severely food insecure households were more likely than those that were not to have a household member with chronic disease, disability or mental illness.

In an appraisal of Palestinian refugees’ health needs, based on focus group discussions and one-to-one interviews, Dr Yoga Nathan Velupillai, at the University of Limerick, notes that in a similar assessment undertaken in 1996, lack of coordination between service providers was leading to refugees’ health needs not being met. Dr Velupillai found that in 2012, the health status of Palestinian refugees in Lebanon had remained unchanged after 16 years.

Rouham Yamout, at the American University of Beirut, and colleagues undertook a pilot study measuring indicators of insecurity among 356 Palestinian refugees living in Lebanon, six months after the Israeli war of 2008-09. The researchers found high levels of insecurity and distress among this population, with more than a third of respondents reporting moderate to high levels of individual distress (38% / 134 respondents) and / or a high intensity of insecurity (34% / 121 respondents).

There is an increasing burden of non-communicable diseases in Palestinian refugees, with research led by Dr Yousef Shahin, at the in Jordan, showing that diabetes is presenting an increasing problem, with rising levels in the population. However, Dr Shahin and colleagues suggest that good monitoring, capacity building of staff and drug availability can reduce the rising problem of high prevalence of risk factors and late complications.

Salwa Massad, also at the UN Relief and Works Agency for Palestine Refugees in , and colleagues describe the prevalence of stunting, undernutrition, and obesity among refugee schoolchildren, demonstrating a need to target food insecurity and a need for better monitoring of nutritional status among children, together with a need for improved ways of disseminating information about healthy lifestyles.

According to Richard Horton, Editor-in-Chief of The Lancet, “The aim of The Lancet Palestine Health Alliance is to use international collaboration to strengthen and expand the capacity of Palestinian scientists to study, report and advocate for the health of their own people. These abstracts outline an extraordinary picture of Palestinian life, and when taken together, these data expose the hidden crisis facing Palestinian refugees, whose health needs have been sorely neglected.”

In addition to highlighting the health issues faced by Palestinian refugees, research presented at the meeting also examined health issues inside the West Bank and Gaza, as well as providing an overview of selected health issues in the region.

Anita Vitullo and colleagues at the World Health Organisation office in the occupied Palestinian territory examined barriers to accessing health services faced by many Palestinians, the majority in East Jerusalem, as a result of Israel’s permit regime. In 2011, 175 228 patients and patient-companions in the West Bank applied for permits to access health care, but 19% of these requests were denied or delayed; of 10,560 Gaza patients who applied for permits, 10% were denied or delayed. Israeli travel restrictions also affect hospital workers in East Jerusalem, with permits restricting the mode and route of entrance to the city, and permission for Palestinian Red Crescent ambulances to enter East Jerusalem being severely constrained; the researchers report permission being granted on just 49 (5%) of 1074 occasions.

Another study, by Randa May Wahbe at Colombia University, USA, highlights concerns over the physical and mental health of long-term Palestinian political prisoners. A survey of ten former prisoners – who had been imprisoned for an average of more than twenty years each – revealed that the prison environment had exacerbated the health problems of detainees, with overcrowding, humidity, pest infestation, and poor hygiene being described as widespread in Israeli security facilities. Respondents reported that prison facilities used prison clinics to coerce them into giving political information in exchange for treatment, with insufficient nutrition thought to be the main contributor to the various ailments reported by the former prisoners.

Other abstracts include an exposition of the shortcomings in the provision of care for diabetes mellitus in the Occupied Palestinian Territories, and a study which associates maternal psychosocial, economic and political stress with low birth weight.

According to , “We hope that the publication of this research, and the ongoing annual meetings of The Lancet Palestine Health Alliance, can act as an mechanism to hold all those who share responsibility for the state of Palestinian health – the Government of Israel, the Palestinian Authority, regional Arab nations, and the international community – accountable for their legal obligations and sometimes also their illegal acts and policies.”


Health and living conditions of Palestinian refugees residing in camps and gatherings in Lebanon: a cross-sectional survey