Life and Health During the Israeli Invasion of the West Bank: The City of Nablus by Rita Giacaman and Abdullatif Husseini 4:28pm Wed May 22 '02 address: Institute of Community and Public Health, Birzeit University This is the second in a series of brief statistical reports elaborating some of the details and difficulties of daily life for Palestinian families during the April 2002 Israeli invasion of the West Bank. print article Life and Health During the Israeli Invasion of the West Bank The City of Nablus May 16, 2002 The first report pertained to conditions in Ramallah/al-Bireh. Here, we will focus on the city of Nablus; reports written by journalists, researchers and institutions pertaining to what happened during the period of re-invasion complement the findings of this house to house survey. The statistical reports that will follow include the towns of Jenin, Tulkarm and Bethlehem. A final report will sum up the individual town reports and will provide summary results for all the towns combined. As with Ramallah/Bireh, this is a house-to-house survey which identifies households as its main unit of analysis, offering quantitative indicators that are generalizable to all of the households and population of the city, estimated by PCBS to be 18003 households and a population of 100, 231 in 1997. The re-invasion of Nablus began on the 4th of April 2002 and ended on the 22nd. However, periodic re-invasions of the towns have continued up till the time of writing this report, where the Israeli army comes in, destroys homes and infrastructure, arrests or kills selected individuals then leaves. It should also be pointed out here that the World Bank has recently estimated the damage incurred during the re-invasion of the West Bank at 361 million US dollars, with the Nablus area having been identified as the hardest hit, and with repair costs there estimated at 114 million US Dollars. Survey Methodology This house-to-house survey was conducted during the first 10 days of May, 2002, just after the lifting of the curfew and the partial withdrawal of the Israeli army to the outskirts of town. A stratified random sample of households was chosen, primarily based on locale, and representative of all of the households in the city. Data Collection A sample of 154 households was selected utilizing stratified cluster sampling techniques. The city was divided into 5 strata, whereby 2-3 random starting points were selected. From each starting point a systematic sample of every 10th household was selected. In this survey, the expected maximum margin of error at the city level is: E= 1.96*DE*sqrt((P)*(Q)/(n)). P= The percentage of a certain attribute. Q=1-P. DE=Design Effect due to clustering. The estimated value of DE=1.1. E= 1.96*sqrt((0.5)(0.5)(1.1)/(150))=8.8%. Data Entry Data entry was completed using the ACCESS database. Proper control structure was defined on closed questions. Data was transferred to SPSS using "StatTransfer" software. Double entry was conducted for a sample of the questionnaire to check for errors that could not be detected by the control structure defined in ACCESS. One out of 50 questionnaires experienced swapping values like 1 entered instead of 2 or visa versa. The Results: One hundred and fifty four household heads or adult members were interviewed. The mean age of respondents was 42 years. Fifty one percent were women and the rest men. Fifteen percent were illiterate, 27% with elementary schooling, 18% with preparatory, 25% with secondary, 8% with higher diplomas, 6% with bachelors degree (considerably less than the 20% found in Ramallah/Bireh) and 2% master’s degree or more. While caution should be made when comparing with PCBS figures, as those pertain to the population 10 years or over, PCBS reports for 1997 Nablus a 6% rate of illiteracy, 15% as being able to read and write, 63% with secondary schooling or below, 6% with post high school education, 9% with bachelors degrees, and 9% with more than bachelors. The average household size was 6.22 persons per household, lower than the 6.8 found for Ramallah, but higher than the 5.4 reported by PCBS for Nablus in 1977, again perhaps indicating a shift in household composition as a result of the re-invasion.. The smallest household in this survey was composed of three persons and the largest 21. Of the total 15% only were composed of extended family (with three or more generations living together) again lower than the 28% found for Ramallah, and also lower than what has been reported for Nablus by PCBS in 1977, at 23%. Family Composition Change during Exceptional Circumstances Examining the data in relation to shifting household composition during the re-invasion, with families housing other families during the curfew and siege in protection against danger, and as families moved out of dangerous areas into perceived less dangerous ones, we find results similar to those found for Ramallah /Bireh. Here 29% of the respondents reported housing other families and or friends during the reinvasion, almost the same rate (30%) as in Ramallah/Bireh. Of those reporting housing people other than household members, two thirds (as in Ramallah/Bireh) reported that they were members of their extended family, one tenth housed neighbors (probably because the army took over their homes) one tenth friends (as opposed to a higher quarter in Ramallah/Bireh), and the rest a mix, even members of the national security, or strangers who do not live in town who were stranded. When asked why guests sought shelter in their homes, about half reported guests moved in because of shelling, the presence of the army close by and fear for their lives, as their areas were deemed too dangerous; about one tenth thought that being with family gives the feeling of safety; another one tenth reported the presence of a pregnant woman at home, due to deliver soon, and thought it better to move out of their area presumably because health services are easier to reach where they moved; another one tenth moved out of their homes because the army took the home over, occupied it and used it for its own purposes, and the rest a mix of reasons such as having been used as a human shield, and ending up somewhere else other than home, living in a place outside and inside Nablus and stranded there during the re-invasion, and home destroyed by shelling. The results from Nablus seem to be comparable to those of Ramallah/Bireh, perhaps indicating a pattern of generalized response to emergency combined with similar conditions that led people to act in similar ways. Again, these results are important in that they demonstrate this temporary shift in household composition and internal migration in search of some safety as an important feature of conditions during the period and also as an important method of coping with war. Strong family and communal ties become more important than usual during exceptional circumstances, and prompt active cooperation of families, neighbors and friends with each other. Loss of Work Of the female respondents, 76% were housewives, and the rest, or 14% were working women: this is almost exactly the same level of women’s paid work as in Ramallah/ Bireh, and almost identical to the 14.5% reported by PCBS in 1997. Women are mostly employed in white-collar occupations. For men, 15% were employers or owner-operators in the private sector, owning a shop or running a private operation, a low of 5% were professionals (teachers, nurses, doctors lawyers), 24% were white collar workers, lower than the 32% for Ramallah al-Bireh, and a high of 38% were semi-skilled or unskilled workers. Fourteen percent reported themselves as having been unemployed prior to the invasion, compared to the 7% rate of unemployment reported by PCBS for 1997 for those ages 10 or above, but close to the 12% reported for Ramallah/Bireh in our survey. The rest were students. Of those reporting that they were working prior to the invasion, 27% reported job loss since that time. Of those, more than three quarters explained this new unemployment because of the collapse of the economy and the market since the invasion, and the rest blamed the closures and siege. These results are very similar to those obtained for Ramallah/Bireh and point to perhaps a generalized as opposed to locale specific increase in poverty levels, even beyond what was estimated by PCBS for the first six months of the Uprising. Unavailability of basic services Nablus suffered serious electrical current cuts during the re-invasion and curfew that had a negative impact not only on family life, but on commercial enterprises as well, with reports of substantial loss of food items that required refrigeration. In this survey, a high of 47% of respondents reported living without electricity for most or all of the period of re-invasion, a rate that is higher than Ramallah/Bireh (20%), and confirming in part the observation that Nablus was perhaps most hardly hit of all the towns. Being without electricity certainly complicates family life to a considerable extent, especially given children and additional guests as well. About 45% reported the loss of electricity for some of the time, and 8% reported no electrical shortages at. Just to note, electrical current interruptions also affected an estimated population of 14,000 people in nearby villages, as the Nablus Electric Company serves not only the City, but also selected nearby locales. Thirty nine percent of households reported tubed water shortages most or all of the time, a rate similar to that of Ramallah, again due to shelling, bombing, shooting and vandalism affecting the different levels of the water system. Thirty nine percent reported water shortages for part of the time, and 22% no water shortages at all. During such a period, people usually rely on water wells. Of the total who have phones, 44% had their telephone lines cut all of the time, 7% most of the time, 15% some of the time and the rest did not face problems with phones. The majority of households, on the other hand (84%) reported no problems with sewage disposal, with the rest reporting blown up sewage pipes mostly and cesspools not being emptied. As in Ramallah, the garbage problem was major, affecting 98% of families who said that they had serious problems getting rid of their garbage., mostly reporting the problem of un-emptied garbage containers, as municipal services came to a halt during the period. Several families reported not being able to get the garbage out of the house, with garbage piling up inside their home. On the whole, given that the areas that were mostly affected by the violence were hardest hit in terms of loss of electricity, water and phones combined, family lives must have been very difficult indeed, especially among families with young children and elderly and disabled members. Low on Food and Cash Of the total respondents 37% reported food availability problems during the reinvasion and curfew period, and 43% reported food unavailability in the market, once the curfew was lifting periodically for people to shop for essentials. Of the total, 33% also reported a problem of cash availability, less than the reports from Ramallah (54%), perhaps because either because Nablus is a strong commercial center or because it has more extended family support networks than Ramallah, where a first impressions that one gets of Ramallah might lead one to think that household cash is more abundant there, given Ramallah’s function as a center of institutions and government. In Nablus, the pattern was similar to Ramallah, with an initial period where there was no curfew lifting at all and families could not get out to buy food, followed by a period where the curfew was lifted but selected fresh food items were not available, followed by an easing up of the problem of food availability and the uncovering of the problem of cash availability. The difference here is that throughout the re- invasion, banks did not re-open, even for the minimal services offered in Ramallah. When asked about how the families coped when faced with low food supply, 7% began to bake their own bread at home (in contrast to a higher 18% in Ramallah), a high of 38% relied on families and friends, a significantly higher rate than in Ramallah (5%), 20% reported substituting one type of food with another, and the rest gave mixed answers, with austerity measures of eating less frequently reported rather less than in Ramallah, and raising questions as to why this was one important method of coping in Ramallah, when in Nablus, it appears not to have been otherwise. Again the higher rate of family reliance may be an answer. However, and unlike Ramallah, a surprisingly high rate (about 20%) reported substituting milk for children with tea, not only losing an important source of protein and calcium, but contributing to the problem of loss of food iron from the body as tea chelates iron and blocks its absorption. These results raise the question of the need to conduct a specific nutritional status of children survey that includes clinical exams focusing on anemia in childhood during exceptional circumstances. As for cash availability problems, Nablus residents managed in slightly different ways than in Ramallah: 36% reported spending less in contrast to a higher 50% in Ramallah, ( yet eating less was hardly reported in Nablus, perhaps because Nabulsis store larger quantities of food at home), 30% borrowed money from families and friends, 28% relied on food shops loaning them food on account ( as in Ramallah) 8% delved into savings intended for use for purposes other than eating, and 7% resorted to living with what was at home(more than 100% as multiple reports were allowed). Overall, while families emerged out of the crisis, difficulties are not over yet, with the continuation of siege, collapse of the market and problems of unemployment forming serious family life problems in this community. Shooting, Explosion and Destruction of Property and Institutions When asked about shooting, explosions and destruction in their areas, a high of 57% reported that they endured much of that during the period , almost continuously (Ramallah: a lower 29%), 29% a lot of the time, and 13% only a little, again confirming the observation that Nablus was harder hit than Ramallah. Again the results seem to be related to the area where households are located, locations in and near the old City suffering more damage, such as Ras al-Ein. and Krum Ashour, as well as al-Quds and Nablus street in the nearby vicinity. That is, the main assault seems to have been on the Old City and its surrounding areas, as this survey seems to indicate. In response to how households managed, 57% reported hiding in fear, lack of sleep and mental distress; 14% reported the family hiding in one room, speaking quietly so as not to draw the army’s attention to their presence, 9% reported having to pay attention to children who were in great fear, again crying and urinating uncontrollably on themselves, and the rest responded in a variety of ways, including depression, learning the lessons and withstanding in resistance, waiting till the army came inside the house, or even behaving normally, at 5%, as fear has become ordinary or a way of life. Again, consistent with the above findings, a high of 67% ( Ramallah: 52%) reported considerable destruction in their neighborhoods. Of those, a high of 44% ( Ramallah 39%) reported pervasive destruction of retaining walls, telephones, electrical poles, shops, pavements, cars and even traffic signs; 22%, as in Ramallah, reported the destruction of homes, doors, the breaking of furniture and windows as well as water pipes while 13% reported the destruction of nearby homes as well, which combined (35%) point to a higher level of home destruction than in Ramallah; and with scattered answers such as: I cannot describe what I saw, or, bullets shot into the house. Of the total, 34% reported that their home was directly exposed to shooting, bombing and destruction, compared to 28% in Ramallah. More than half reported that the shooting was directed to their home’s walls, glass, entrances and retaining walls; a quarter ( Ramallah = one fifth) reported that the army occupied their homes, destroyed and broke windows, cupboards, furniture, threw food out of cupboards and all over the place and dirtied their homes, again pointing to the higher severity of incidents in Nablus; 2% reported theft by the IDF; and the rest reported destruction of water pipes and sewerage. Of the total households, 50% reported that their homes were searched by the Israeli army (41% for Ramallah). Respondents also reported the arrest of at least one of their family members in 24% of the cases, probably during home searches, but not solely. These are likely to have been temporary arrests of course, but certainly add to the weight of fear and terror in the family. Among those with searched homes, over half reported that IDF broke the belongings in their homes in the process, with a high of a fifth reporting theft of belongings adding weight to the reports on the IDF stealing people’s belongings but casting doubt on the assumption that theft was more prevalent in Ramallah. This impression may be due to the fact that documentation of theft took place earlier and more precisely than in other towns, rather than Ramallah being an exclusive venue where Israeli soldiers engaged in widespread theft. These results indicate once again the appearance of a picture of systematic theft, and not only destruction and vandalism. Asking about the workplace of household members who were working prior to the invasion, 12% reported direct damage there, very low in contrast to the high of 41% in Ramallah, perhaps the effect of the higher level of indiscriminate violence against homes that took place in Nablus and the assault on institutions, particularly ministries, in Ramallah. Again, cars were directly affected by the violence in 9% of the cases in Nablus, compared to a high 19% for Ramallah. On the whole, though, these results demonstrate that, a consistent pattern of vandalism is beginning to appear, that may be re-enforced or negated once we analyze the results from the other towns. However, as it stands now, the results at hand cannot be justified by the claims of ‘incidental occurences’ of such awful destruction nor ‘ security’ considerations. What appears to be the case instead is a systematic attempt and destruction, violence and the construction of fear in a very large number of the population. Medications A lower than expected 22% of households (Ramallah: 49%) reported a medication availability problem during the period. It is not clear why this large discrepancy between households in these two communities, but may perhaps pertain to differing household routines and ways of life, with Ramallah residents being more ‘urbane’, and less inclined to storage of things at home, and even perhaps more inclined to be dependent on medications as a way of life. In addition, Nablus residents may have learned from the experience of the earlier Ramallah invasion and stocked up with needed medications. Of those with this problem almost half (a quarter for Ramallah) just waited until the siege was over, one quarter got help from neighbors and friends ( substitute medications probably),one tenth called the Red Crescent,, one twentieth called the UPMRC, and the rest used indigenous medical practices, or managed to reach hospital. Negative ramifications or complications because of the absence of medications was reported by almost half of those who reported problems with medication unavailability, with 1/6th specifically reporting out of control diabetes mellitus – increasing in this way the risk of future complication on the heart, kidney and eye, among other organs. Again, the long term effects of the sudden interruption of needed medications, especially in the case of difficult to control chronic diseases – such as hypertension and diabetes, can only be speculative, yet the reports do indicate the need for a study of the consequences of the lack of medications, and perhaps more importantly the lack of primary and secondary care among selected groups within the population as an important priority research in the near future. Mental Health Again in contrast to Ramallah, with the rate of mental health problems reported in households as high as 93%, a lower 70% of responded stated that they faced a variety of problems with various members of their family. Given the higher severity of the onslaught in Nablus compared to Ramallah, perhaps these results are indicative of the ‘awareness’ of the symptoms of the problem, or perhaps willingness of respondents to spell out mental health problems without worrying about ‘taboo and image’, that is, if our assumption of a more ‘urbane’ and exposed Ramallah is correct. Surely, these differences call for further investigation. Of all of the respondents here, a high of 53% reported the problem in terms of fear, screaming, crying, inability to eat or sleep and psychological disturbances generally, and 12% focused on these symptoms in children especially. When asked about how they managed these symptoms and coped with these trying times, a high of 22% singled out praying as a method of coping (Ramallah:6%), followed by a focus on relieving children’s fear, sleeping with them and taking care of them at 20%, 17% drew on self control and ability to withstand and only 7% reported watching television (probably because the electrical cuts were more severe and longer) playing cards etc., and then a range of answers such as’ dealt with the situation as normally’, drinking indigenous herbs to feel better, seeking the help of a counselor, sleeping at the neighbor’s and calling friends and family to see if they are all right. Views on Current Conditions The last question asked to respondents pertained to their views on the current conditions. Again a high of 74% reported views expressing despair and misery over what is happening to their lives (Ramallah:71%), an additional 30% showed great concern over the family’s financial situation, with the rest offering a range of answers such as ‘ Excellent because we deserve what happened to us’, and ‘ These are abnormal times, they will come again’, ‘God Almighty will make the conditions better’, ‘ What Israel and America want will happen’, ‘ This calls for our insistence on popular resistance’ and ‘This indicates a crisis in politics, in lack of clear vision and strategy and lack of unity’. These answers combined, and collated with the Ramallah results allows for a picture to emerge focusing on the issue of despair as key to understanding the current state of the population of Palestine, and perhaps not only the towns that were studied. Despair, combined with cumulative international and overall neglect, want and deprivation can have a marked influence on current behavior and future aspirations as well. Conclusion Other than quantifying the phenomena reported by others through qualitative methods and interviews, this study demonstrates both similarities and differences in the experiences of ordinary people living in Nablus and Ramallah during the Israeli Re-invasion of their areas. On the one hand, household reports indicate a uniformity of experiences that cannot be explained by accidental destruction in the pursuit of ‘security.’ On the other hand, responses to this terror in Nablus appear to be different from Ramallah in ways that social relations, setting and mode of life seem to dictate, and maybe an indication of the cultural differences noted between both cities. Nablus households report having been harder hit than Ramallah, confirming earlier reports pertaining to this matter. But the pattern of destruction and vandalism is clear: such rampant destruction and events witnessed by ordinary people cannot be simply accepted as accidental or haphazard as the IDF claims. This study demonstrates otherwise, given the consistency in reporting specific events, such as the destruction of homes and property, breaking household belongings, ruining food supplies, stealing people’s valuables, to name only a few clear indicators of an intended policy or an out of control army, or both. To estimate the number of households and people that were affected by specific serious difficulties in dealing with daily life as a consequence of this re-invasion, we are using PCBS’s census report of Nablus’ population of 100,231 and 18,003 Households: Some calculations that may be useful: 1- Family Composition Change during Exceptional Circumstances a- 29% of the respondents reported housing other families and or friends during the reinvasion that: is 29,067 individuals or 5,221 households. 2- Unavailability of Basic Services a- 47% of respondents reported living without electricity that is: 47,109 individuals or 8,461 households. b- 39% of households reported tubed water shortages most or all of the time that is 39,090 individuals or 7,021 households. 3- Low on Food and Cash a- 37% reported food availability problems during the reinvasion and curfew period that is 37,085 individuals or 6,661 households. b- 33% reported a problem of cash availability that is 33,076 individuals or 5,941 households. 4- Shooting, Explosion and Destruction of Property and Institutions a- 57% reported that they endured much of explosions and destruction in their areas during the period, almost continuously that is 57,132 individuals 10,262 households. b- 67% reported considerable destruction in their neighborhoods that is 67,155 individuals or12,062 households. 5- Medications a- 22% of households reported a medication availability problem that is 22,051 individuals or 3,961 households. 6- Mental Health a- 70% of responded stated that they faced a variety of mental health in various members of their family that is12,602 households. References: Greenberg, Joel, West Bank Damages put at $361 million, the New York Times, May, 16, 2002. Palestinian Central Bureau of Statistics, 2000. Population, Housing and Establishment Census -1997, City Reports Series. Final Results– Nablus City. Palestinian Central Bureau of Statistic, PCBS, 1999. Population of Palestinian Communities, 1997-2010. Ramallah-Palestine. add your comments Source file