Environmental and Public Health Crisis Emerging in The Western Ramallah Villages by Rita Giacaman and Anita Abdullah 5:03pm Tue Jun 4 '02 address: Institute of Community and Public Health, Birzeit University This rapid appraisal demonstrates that living conditions in the Western Ramallah communities are enormously difficult, and are likely to reach humanitarian and public health crisis proportions soon, unless a concerted effort is made to alleviate the difficulties of life there. print article June 3rd, 2002 This is a rapid appraisal of living conditions in 29 Ramallah District communities located west of the Ein Arik Israeli military roadblock, and separating these villages from their main town center, Ramallah, to the East. Already suffering the consequences of siege and closures, imposed since the beginning of this current uprising, the communities that were included in this study witnessed a severe deterioration in living conditions as a result of the tightening of the siege to unprecedented proportions following the February 19th 2000 Ein Arik incident when 6 Israeli soldiers were killed while manning the checkpoint. While the recent events heightened media and research interests in the conditions of towns and refugee camps during the period of invasion and curfew (beginning on the 29th of March, 2002, and lasting for up to 45 days in some areas), living conditions in villages are now emerging as a priority for documentation and action. Life in many villages is becoming extremely difficult, and even sometimes apparently impossible to cope with, requiring not only the attention of journalists and researchers, but also the concerted efforts of humanitarian organizations in dealing with an almost certain upcoming life and health crisis, should the current state of affairs continue. Villages in general have suffered the serious consequences of siege and closures in ways that have not adequately been reported. Many villages have been subjected to military attacks, curfew and strict siege even before the invasion of March 29th, 2002. How these conditions are affecting daily life and the ability of people to cope with serious constraints to normal life is the subject of this report. Methodology This rapid appraisal focuses on living, health and environmental conditions of communities located to the West of Ramallah town and the Ein Arik Israeli army checkpoint. This checkpoint has brought much of life to a halt since February 19th, 2002. The information contained in this report was obtained from the heads of Village Councils (Mukhtars, in Arabic) in addition to one other person with village responsibility and authority (mostly teachers or headmasters of village schools), and double-checked for accuracy with other informants. The interviews were conducted during the second and third weeks of May, 2002, by phone, as it is not currently possible to reach these communities because of the very strict siege and closure, except perhaps sometimes through dangerous tracks running up and down fields, hills and wadis, where soldiers trap and detain people on their way, or send them back at random. The following is a list of communities that were included in this appraisal : Aboud, al-Janieh, al-Midia, al-Tireh, Beit Liqia, Beit Sira, Beit Ur al- Foqa, Beit Ur al-Tahta, Bilin, Budrus, Deir Abu Mash'al, Deir Ammar, Deir Ammar refugee camp, Deir Ibzi', Deir Qiddis, Ein Arik (where the military checkpoint is located), Ein Qinia, Jammala, Kharbathat Bani Harith, Kharbathat Misbah, Kufr Ni'meh, Libban al- Gharbieh, Nilin, Qibia, Rantis, Ras Karkar, Saffa, Shibtin, and Shuqba . The total population of these communities was estimated to be 70170 in 2002 by PCBS. Of this population, around 37% are children under the age of 15 years, 20% are women of childbearing age, and around 5% are people over 65 years old . The results Curfew, siege, arrest and injury We began by asking informants about the length of curfew conditions in the village, beginning on the March 29th, 2002 invasion of towns. Of the 29 locales, only about one sixth (4) reported no curfew imposed at all, with the rest reporting curfew conditions ranging from a few hours, off and on, and up to 15 consecutive days. That is, during the period when towns were affected by the latest onslaught and curfew, villages were suffering similar, although perhaps not as acute, conditions. One particular village (Deir Ibzi') reported having been placed under curfew for 40 consecutive days before and up till the invasion, after which curfew conditions continued in a partial and off and on manner. When asked whether curfew was still being imposed or not 6 villages reported the continuation of curfew conditions sometimes for short periods. In one particular village, we were told that curfew conditions were a de facto operation, not announced, but instead, imposed abruptly with the IDF coming into the village on a day and night basis. A very tight situation of siege and closure, blocking passage not only to Ramallah, the main town center where the population shops, seeks services, especially health care and high school and University studies, but also to the nearby villages, appears to have been imposed since February 19th, as all of the communities except one reported facing this difficulty for 84 consecutive days up till the time of the interview. Only one village (Ein Qinia) provided reports indicating that the strict siege is imposed only sometimes, on and off, as the road East of the IDF checkpoint going towards Ramallah continues to be somewhat accessible. All indicated that siege conditions have continued and have in fact become worse at the time of interview, compared to before the invasion period. When asked whether they had knowledge of any new (since March 29th) fencing off of parts of the village land, 2 communities reported the erection of new fences in areas belonging to these villages. An additional community reported that a new fence has recently been erected around previously confiscated land, and another village reported the fencing of 5-10 dunums of land that may have been confiscated recently, but apparently without warning. Looking at the communities' responses in relation to the arrest and injury of community members, we find two thirds reporting no temporary arrests during the period of invasion, and the rest reporting one and up to 11 persons that were arrested and then released. Arrest without release up till the date of the interview was reported by over half of the communities, with a range of 1 and up to 6 community members having been taken away then, and not having come back home since that time. Those arrested were either policemen serving in the national security forces or men on their way to work outside the village, and one health worker. About one fourth of the communities reported the martyrdom of one or two community members, mostly outside the community, in Ramallah or in other towns. The level of injury among community members is higher than that of arrests, with two thirds reporting the injury of one and up to 8 community members in the village, on the roads, when settlers attack and during imposed curfew episodes. Problems with settlers Of the total communities, four tenth (12) reported facing no problems with settlers nearby, as settlers use separate roads and villagers are kept away from lands surrounding the settlements. For the rest, a range of problems was reported. Seven communities maintained that they have serious problems with settlers, mainly dealing with the settlers stationing themselves on the main road and blocking access anywhere, sometimes, or much of the time, apparently taking the law into their hands. A particular village reported several problems faced with settlers, including problems in accessing the water supply, reaching roads that lead to other locales, reaching the land that the farmers need to till to live and also vandalism, deliberate electricity and water cuts. Of the total, at least two communities reported their inability to reach their agricultural land. Other reports pertain to uprooting trees, damaging communal cars, shooting at homes, attacking boys playing in the field, attacking commuting teachers who are trying to get into the village. In two cases, settlers and/or army tanks attacked even the community school and created such fears that some students decided to drop out of school altogether. Food and cash shortages, but unemployment ultimately determinant Since March 29th, food shortages have made life difficult to live in the majority of these communities. Of the total, over a quarter (8) reported severe food shortages in the village, emphasizing the serious shortage of baby milk powder, flour (a staple), sugar, vegetables, fruits, and meat; 5 other communities reported mild shortages and the rest reported moderate food shortages. However, it is not merely availability of food items that is the problem resulting from siege and closure conditions; it is the unavailability of employment and cash that is apparently the most acute problem at the moment, making the issue of food unavailability secondary to the main problem of loss of work and income. The lack of income has been felt increasingly intensely over the last few months of internal closure and since the 29th of March invasion of Ramallah. In these communities, the problem of unemployment was already serious before the invasion, as a large proportion of the male workers who used to work in Israel prior to September 29, 2000, the beginning of this current Uprising, had already been out of work for nearly 19 months. The way these communities have adjusted entails a remarkable mutual support among family and community, which includes taking food from village stores on account up till such time when the crisis eases, a pattern observed for the towns we have studied as well. However, given the length of the siege, three impediments to the continuation of this system of coping are evident at this time: an increasing reluctance on the part of shop owners to use the 'on account' system given no end in sight for siege and unemployment, and thus raising fears of no returns on their investment in people; the depletion without replenishment of foods stored before the conditions became severe; and finally the spiraling costs of the new stock that can sometimes reach the communities, but now at highly added costs because road closures necessitate using longer and alternative and more dangerous tracks to reach communities with basic supplies. We have also heard reports of truck drivers now refusing to reach the more remote villages because their vehicles have been repeatedly attacked and damaged (slashed tires, sand in motor) by army patrols, or because they were forced to go back before they could reach their destination. Sometimes, the goods are confiscated or simply destroyed, even those carried by pedestrians. For example, Israeli soldiers recently caught a man on the mountain returning from Ramallah with his donkey load of sugar sacks. The soldiers then ripped the sacks with knives, spilled the sugar on the ground, and the man was sent back to his village empty handed! Indeed, reports pertaining to prolonged un-employment re-enforce the opinion that forced joblessness because of road closures and siege is perhaps one of the most important indicators of an upcoming life crisis, and the need for immediate humanitarian action. All of the 29 communities reported that the large majority of their labor force is not able to reach their work, either in nearby Ramallah, or other villages, or across the green line in Israel, or even in their fields. The reports also indicate that it is not merely the strict siege that is the problem, but harassment by the IDF and settlers as well, making it impossible to reach the land that needs to be tilled, or the markets to sell their products. Medical and health care The medical and health conditions in these communities also appear to be critical. These are villages that rely on Ramallah for secondary care services including delivery services, and either have primary health care centers operating in their locales, or in nearby communities that rely on central services (either governmental or non-governmental) to reach them with physicians, nurses and medications, including child and mother immunization teams. The strict siege and road closure of 84 days so far has produced havoc with no end in sight. Here we find that of the total communities, only one tenth (3) report that medical teams can reach the village without a problem, two thirds ( 8) state that medical teams are not able to reach their community at all, one fifth (6) report that medical teams reach them only sometimes, and 2 communities report that medical mobile teams reach them, but rarely. All communities without exception (including Ein Arik during the invasion of Ramallah) complained about the extreme difficulties and/or inability - especially during afternoons and at night - to reach a hospital or even a doctor in case of emergency. Occasional accidents and acute illness with children, heart attacks, renal failure, and scorpion bites have been mentioned as the most common emergency cases, where medical help could not be obtained, or obtained too late. While many deliveries have been completed on locale, with the help of a nurse or relatives and sometimes with professional assistance through the telephone, the community health worker of Aboud reported the death of a newborn baby delivered at home in the afternoon because no doctor or hospital could be reached for help. No ambulance or private car can reach the nearest hospital in Jerusalem or Ramallah in one stretch due to the multiple disruptions of connecting roads, in addition to harassment by army patrols between the villages, and only very few villages have an ambulance. Therefore complex arrangements are necessary for a very inadequate transportation of a patient. To think that immunization services, care of chronic patients, the elderly as well as care of acute and communicable diseases has almost halted altogether in such a large number of villages can only lead one to think of an emerging health crisis if not soon, very soon. For medications, the problem appears to be similar, with over two thirds of communities (20) reporting severe shortages of medications, especially those for the management of chronic diseases such as diabetes and hypertension, one fifth (6) report a moderate shortage, and the rest either mild or no shortages. The principal problem here is the unavailability of medications that are usually taken either free of charge or at low costs from the governmental or NGO health services, as closures and siege have greatly diminished if not halted altogether the arrival of these supplies as well as health personnel to their regular duties in these communities. That is, even though some drugs may be available through private practitioners or private pharmacies located in some of the villages, there is no cash to buy these essential medications, such as the very expensive Insulin that is required for the survival of diabetic patients. Other basic services Since the invasion of towns, these communities have also felt the impact of tight closures and siege in inhibiting the delivery of other services. Of the total communities, less than two thirds (17) reported no problems faced when getting rid of communal garbage, presumably because the garbage dump is close enough to village land not to be affected by the road blocks, and the rest (12) reported serious problems disposing of their garbage, either because they are unable to get to the dump outside the village, or because they used to dump their garbage in the Ramallah dump which is now inaccessible. The alternative sued was to dump and burn garbage close to domiciles, increasing the problem of air and soil pollution. An additional problem relevant to some villages was caused by the waste of scores of dead chicken from numerous chicken farms, previously a prospering business in some of these villages, because they could no longer import chicken feed or even sell their remaining life stocks due to the siege. A similar pattern is observed for sewage disposal, where over two thirds (21) reported no problems in getting rid of the community's sewage, with the rest reporting severe difficulties, including the problem of sewage spilling onto streets and between houses. Moreover, municipal disinfection services can no longer reach these communities from Ramallah. The events taking place during the invasion of Ramallah seem to have affected the supply of basic services to the villages as well. Of all communities, only one reported no interruption of electrical supplies during the period of invasion, with the rest reporting cuts of a few hours and up to 10 days duration. Respondents reported the spoilage of foodstuff that was stored in refrigerators during that period, adding insult to injury by destroying some of the precious remaining food items in communal stores. The water situation appears to have been less of a problem with about two thirds of the communities (19) reporting no water problems, probably related to the fact that many village communities still use rain water stored in cisterns (water wells). This of course raises the question of the adequacy of this water for drinking in terms of both bacterial and chemical water quality. The rest of the villages reported water cuts ranging from 2 and up to 60 whole days! In one particular village, it took two weeks to fix the water pump that broke one day because of the Israeli army blockade. In another village, tubed water supplies were suddenly cut because of vigilante settlers closing off the water source towards the village, and maintaining it this way as per their whims. Surprisingly, about one quarter of these communities (8) reported that they were not linked to the national earth telephone network at all, about half reported no problems with telephone line cuts and the rest reported difficulties in this area during the invasion ranging from one and up to 20 days, again corroborating previous reports of damage having been done not only to towns during the town invasions, but to nearby villages that receive services from the towns as well. For both electricity and telephone services, a hidden problem appeared as we completed our interviews, which was not directly solicited by our interview questions focusing on the interruption of services: inability to pay utility bills. Reports indicate that the bills for these services have become unaffordable for many families, with for instance, telephone connections now being considered a 'luxury', or because of difficulties in reaching Ramallah to make payments for the purchased services. Closed roads also lead to fuel shortages as well. Of the total 12 communities (four tenth) reported no fuel shortages so far, with the rest reporting a range of problems, from mild to severe. At least 6 communities (one fifth) reported that the fuel shortages are so severe that women are now obliged to cook using firewood instead of the bottled gas that they normally use. This is yet another added burden on the already over-burdened lives of women as closure and siege not only mean having to cope and make ends meet with the little food and cash that they have, but they now have to go out to the fields, collect firewood, and spend considerably longer hours cooking in this primitive and labor intensive manner! Education School problems and educating children were noted as especially serious concerns in these communities. All of the communities reported problems that are difficult or impossible to resolve without the removal of closures and the siege. Firstly, schools were closed during the 23-day period when Ramallah was occupied by the Israeli Army. Once the schools began operating again, the community began to realize what most parents and teachers in the towns noted as well, that this long period of interruption has led students, especially younger ones, to forget much of what they had learned, with the majority of these communities reporting this concern. Secondly, Tawjihi ( the national High School examination) students have fallen far behind their curriculum requirements and suffer especially from the loss of qualified teachers who can no longer reach the community's schools. Perhaps a combination of interruptions and stress has produced cumulative effects on the ability of students to concentrate on studying. Most of the communities reported problems that are similar in nature, such as needing to utilize the services of substitute teachers who do not always possess the right qualifications, students having difficulties concentrating, having lost interest because of psychological distress associated with the political and living conditions, the fact that the classes are overcrowded now, adding insult to injury, as the shortage of teachers has obliged schools to combine more than one grade in the same classroom, the problems faced with high school and university students, who must commute to town to continue their education, with some ending up living in town as a temporary but costly way out, and the fact that some students have dropped out of school altogether because the array of problems faced in dealing with the children's education was just too much to handle. When asked whether these problems were continuous up till the time of interview, all except 4 communities reported that the conditions were just as severe at the time of interview as they were when the invasion began. For the remaining 4 communities, reports indicate that the problems have not been resolved, but that 'it is getting better now'. Most pressing communal problems and priorities We asked our informants to tell us what in their view were the priority problems that the community faces these days. Without being prompted by specific question, the large majority (25) listed poverty and unemployment as a very serious problem requiring immediate relief, 24 communities listed the need for health care as a priority issue, and the rest denoted road conditions, the political problems, military attacks, the problems with settlers as issues of concern and worry. None listed the un-availability of food as a communal priority issue, clearly demonstrating what we already know, namely, that it is not food or 'charity' that these communities need, but employment instead. This rapid appraisal demonstrates that living conditions in the Western Ramallah communities are enormously difficult, and are likely to reach humanitarian and public health crisis proportions soon, unless a concerted effort is made to alleviate the difficulties of life there. Attention needs to be paid by humanitarian and other organizations to the problems and priorities expressed by our informants. To this end, employment and health care are by far the most important priorities listed by these communities, and not food aid and charity. The results of this survey demonstrate that humanitarian and aid organizations must address these pressing impediments to survival in ways that go beyond the incidental distribution services. Advocacy for the lifting of the closures and siege must be included as a crucial component of any actions that is taken. Food aid and other similar humanitarian emergency services in this context can only be a palliative treatment to a recurring disease, a disease called closures, siege and occupation. While in the short term, food aid may be of some help in alleviating the misery of these communities, the lifting of the closures and siege and the end of occupation is the only ultimate solution to this crisis of survival. References: UN Office for the Coordination of Humanitarian Affairs (OCHA), Occupied Palestinian Territory crisis update, 18-20 February, 2002 PCBS, 1999. Population, Housing and Establishment Census, 1997: Final Results, Population Report, Palestinian Territory, First Part - PCBS, 1999. Small Area Population, 1997-2010. Ramallah - Palestine - add your comments Source file