Humanitarian Bulletin Occupied Palestinian Territory MARCH 2018

Humanitarian Bulletin occupied Palestinian territory MARCH 2018

In this issue

22,000 people in the Gaza Strip still internally displaced HIGHLIGHTS from the 2014 hostilities ...... 3 ● 18 Palestinians killed and 1,400 injured by Israeli forces in the Gaza Strip, the majority Gaza fisheries: fishing catch Increases amid ongoing during demonstrations at the perimeter protection concerns ...... 7 fence; concern over possible excessive use of force by Israeli soldiers. Funding shortages undermine continuity of mobile health ● Some 22,000 people in Gaza are still clinics in vulnerable West Bank communities...... 12 displaced from the 2014 hostilities, primarily due to the lack of funding for reconstruction, © Photo by Ahmad Nofal and are living in precarious conditions and Clashes near the Gaza perimeter fence, east of Al Bureij camp, 30 constant uncertainty. March 2018. ● Seasonal expansions of the permitted fishing areas in Gaza have significantly increased the total catch, but this remains limited to low- OVERVIEW value sardines; concern over the methods used to enforce access restrictions remain. In what amounted to the highest number of casualties in a single day in the Gaza ● The operation of mobile health clinics in 35 vulnerable communities in the West Bank Strip since the 2014 hostilities, on 30 March, 18 Palestinians were killed by Israeli forces has been halted, and is at risk in another 154 (or died of wounds sustained that day), and another 1,400 were injured, including communities, due to severe funding gaps. over half of them by live ammunition, according to the Palestinian Ministry of Health (MoH). The Israeli authorities accused the MoH of inflating the number of wounded MARCH FIGURES by live ammunition. No Israeli casualties were reported. The majority of the casualties Palestinians occurred in the context of the first in a series of mass demonstrations, organized as part killed (direct conflict) 21 of the ‘Great March of Return’ and scheduled to take place near the perimeter fence Palestinians * injured (direct conflict) 1,168 with Israel, between 30 March (‘Land Day’) and 15 May, the 70th anniversary of what Palestinians refer to as the 1948 ‘Nakba’.1 Israelis killed (direct conflict) 3 Israelis injured (direct conflict) 5* Although demonstrations were largely non-violent, in line with the call of the Structures demolished organizers, some Palestinians approached the fence, threw rocks and, according to in the West Bank 23 Israeli sources, fire bombs at Israeli forces. In anticipation of the protests, the Israeli People displaced in the West Bank 24 army significantly increased its presence in the area, erecting earthen embankments to *Includes injuries from 1-26 March only overlook the fence and deploying more than a hundred snipers.

HUMANITARIAN RESPONSE Palestinian, Israeli and international human rights groups have expressed concerns PLAN 2018 over possible excessive use of force by Israeli forces, citing the high number of casualties among unarmed demonstrators. The Israeli military said it responded only 540 million (US$) requested to violent attacks aimed at troops and at breaching the border fence, and stated that ten of the fatalities were members of Hamas and other armed groups. The UN Secretary- General expressed his deep concern about the clashes and casualties, and called for an 6.2% funded independent and transparent investigation into the incident.2

6.2% Funded Medical facilities in Gaza, which are already overstrained by the longstanding shortages of medical supplies, electricity and fuel, are struggling to cope with the overwhelming 540 number of casualties. The Health Cluster, led by the World Health Organization, is monitoring the situation and providing support, in coordination with all million (US$) requested health partners. 74% 93.8% Unmet requirement 2 | oPt Humanitarian Bulletin

These events come in the context of a deteriorating humanitarian situation in Gaza, following more than a decade of an Israeli blockade, recurrent escalations of hostilities and stalled attempts to resolve the internal political divide. As detailed in one of the items in this month’s Humanitarian Bulletin, as of the end of February, over 20,000 people are still displaced from the 2014 hostilities, the most devastating in Gaza since the start of the Israeli occupation in 1967, and are living in precarious conditions and constant uncertainty.

Another item in this month’s bulletin highlights the situation of the fishery sector in Gaza and related concerns. Within a context of high unemployment and food insecurity, the sector is one of the few remaining sources of employment in Gaza, outside of the public service. Citing security concerns, the Israeli navy restricts access of fishers to sea areas only within six nautical miles (NM) from the coast, with an extension to nine NM along the southern coast, twice a year during the sardine season. Although the latter expansions have significantly increased the total catch over the past two years, this remains mainly The UN Secretary-General limited to low-value sardines, making it difficult for fishers to earn a liveable income. expressed his deep concern Additionally, practices used by the Israeli navy, and to a lesser extent by the Egyptian about the clashes and navy, to enforce the access restrictions, including the firing of live ammunition, have casualties in the Gaza raised a range of protection concerns. Strip and called for an Finally, this Bulletin also highlights the situation of 189 vulnerable communities across independent and transparent the West Bank, with over 220,000 residents, which face challenges in accessing basic investigation into the health services, and are therefore served by mobile clinics operated by humanitarian incident. partners. However, due to severe funding shortages, since the beginning of 2018, the services to 35 of these communities has been halted, and, unless additional funding is found immediately, another 11 communities will suffer the same fate.

www.ochaopt.org | [email protected] | facebook.com/ochaopt © Photo by OCHA FishingThis reportboats at was Gaza prepared city’s port, byMarch the 2018 United Nations Office for the Coordination of Humanitarian Affairs in collaboration with humanitarian partners. oPt Humanitarian Bulletin | 3

22,000 PEOPLE IN THE GAZA STRIP STILL INTERNALLY DISPLACED FROM THE 2014 HOSTILITIES

The hostilities between Israel and Palestinian armed groups from 7 July to 26 August 2014 were the most devastating in the Gaza Strip since the start of the Israeli occupation in 1967. In addition to the 1,460 Palestinian civilians killed, including 556 children,3 some 17,800 housing units were destroyed or severely damaged, causing approximately 100,000 internally displaced persons (IDPs). Three and a half years after the ceasefire, more than 22,000 people (4,162 families) are still displaced (as of the end of February 2018).4 As highlighted below, many of them continue to live in precarious conditions with uncertainty regarding their immediate future.

Lack of funding is the primary reason for the slow pace of reconstruction: approximately two-thirds of remaining IDPs have not received any housing support and see no end in sight to their displacement. The homes of the other third Almost half of the surveyed are either still under construction or waiting for work to start. Reconstruction households indicated that has also been hampered, to a lesser extent, by Israeli restrictions on imports displacement had led to of essential construction materials into Gaza. Despite these delays, restricted an increase in the level of construction materials have been entering regularly via the Gaza Reconstruction gender-based violence in Mechanism (GRM) agreed in 2014 by the UN, the Palestinian Authority and their families, and 42 per Israel. cent reported an increase in violence against children at New vulnerability survey home. During November and December 2017, the Norwegian Refugee Council (NRC) carried out a vulnerability survey to inform humanitarian interventions to support IDPs.5 A total of 1,179 IDP households were surveyed, of which nearly 30 per cent were pre-identified as vulnerable, while the remaining 70 per cent were selected at random.6

Nearly half of the households surveyed reported living in rented accommodation, followed by 18 per cent living in damaged or partially reconstructed (without funding) homes, and 12 per cent were staying with extended or host families.

The level of overcrowding is particularly high: almost 30 per cent of surveyed Based on a survey carried families reside in a one-bedroom shelter and another 36 per cent in a two- bedroom shelter. Overcrowding is likely to be a significant factor behind the out by the Norwegian high levels of gender-based violence (GBV) reported: 49 per cent of surveyed Refugee Council households indicated that displacement had led to an increase in the level of GBV in their families, and 42 per cent reported an increase in violence against children at home.

Temporary shelter cash assistance (TSCA) of US$200-$250 per month per family has been the primary form of assistance provided by the humanitarian community to eligible families, enabling them to rent accommodation until their

homes are reconstructed or rehabilitated. However, the distribution of TSCA has been constantly disrupted due to funding shortages.

This is reflected in the survey’s findings, in which only 41 per cent of surveyed families reported receiving TSCA on regular basis; 13 per cent were uncertain about their current eligibility; and the rest had had their payment stopped or had never received any. Of concern, most families reporting that their TSCA had been discontinued indicated that they did not know the reason.

Inability to pay rent is one of the main drivers of the constant relocation of IDP families. Among the households surveyed, 65 per cent reported that they had relocated between three and ten times since their initial displacement in 2014. Additionally, 35 per cent reported that they are currently not living in their original neighbourhood or area. Many of these families indicated that displacement has had a negative impact on their access to livelihood opportunities, schools and 65 per cent of surveyed IDP health services. households reported that they had relocated between 5,440 three and ten times since CURRENT IDPs BY GOVERNORATE their initial displacement in 2014, negatively impacting ,210 on their access to livelihood 1,05 opportunities, schools and TOTAL health services. Fs Is 4,1 22,00 , 1,210 E

N G ,51 O 5 G

G M 2,4

Is 4 K Ys

E R

CURRENT ACCOMODATION PERCENTAGES

Rented accommodation 48

Host family 12

Other 12

Partially damage house 9

Self-reconstructed House 9

Pre-fabricated unit makeshift shelter 6

Tent 4

“We submitted the application for financial “ALL I WISH IS TO HAVE IFTAR WITH ALL MY CHILDREN AT assistance to rebuild our ONE TABLE.” home in March of 2016 and so far have received no The house of Marwan Kishko, a 62-year-old with hearing difficulties, in the Az Zeitun area of Gaza city, was almost totally destroyed during the 2014 answer.” hostilities. “I have lived with my wife and children in this house for 32 years. After the war we settled in a tent near the rubble of my house for two months, and after receiving cash assistance we moved to a rented apartment. However, the rental cash assistance was cut almost a year ago, I believe because lack of funds.”

Marwan’s wife, Umm Wael, added: “I prepared all the documents in the hopes that we would receive financial assistance to rebuild our home quickly. We submitted the request in March of 2016 and so far have received no answer. We keep waiting but could not afford the rent for the apartment and moved back to our damaged house. But you cannot call this a house. The walls cannot be repaired. The roof is made of corrugated steel sheets supported by iron bars. One evening, a wild dog entered the house and threatened me. I was terrified. All I wish is to have a house before the holy month of Ramadan so I can have iftar with all my children at one table.” © Photo by OCHA Damaged house of Kishko’s family, Gaza city, March 2018.

NUMBER OF RELOCATIONS SINCE 2014

6 72 1 115 11

1 4 225

3 0

In addition, 64 per cent of heads of households were not working at the time of the survey, well above the unemployment rate of 43.6 percent for the Gaza Strip as a whole during the fourth quarter of 2017.7 Coping mechanisms include selling assets, purchasing food on credit and reducing dietary diversity. This is The disbursement of funds of a particular concern for pregnant and lactating women, of whom nearly 20 per pledged by donors for the cent indicated that they were consuming food that was inappropriate for their reconstruction of Gaza needs. following the 2014 hostilities is the main step required The disbursement of funds pledged by donors for the reconstruction of Gaza to move towards ending following the 2014 hostilities is the main step required to move towards ending prolonged displacement and prolonged displacement and reducing the vulnerability of IDPs. In the meantime, reducing the vulnerability of it is essential that UNRWA and other agencies are adequately funded to maintain IDPs. the TSCA programme and provide IDPs with the minimal means necessary to maintain their current accommodation. Keeping IDP households better informed about their entitlements and the ongoing challenges to provision of assistance is also essential to reduce vulnerability.

GAZA FISHERIES: FISHING CATCH INCREASES AMID ONGOING PROTECTION CONCERNS

In 1994, a permitted fishing range of 20 nautical miles (NM) was agreed between Israel and the Palestinian Liberation Organization (PLO).8 In practice, Israel only allowed fishing up to 12 NM until 2006, when the fishing zone was reduced to six and later to three NM. According to the Israeli authorities, “Hamas has established naval forces with significant military capabilities, as seen during operation “Protective Edge” when Hamas naval commando infiltrated Israel and were detected near an Israeli village. This situation required Israel to tighten its security restrictions at sea to prevent similar future attacks.”9

Since the ceasefire agreement concluded in the wake of the August 2014 hostilities, the fishing limit has been fixed at six NM, with an extension to nine NM along the southern coast (between Khan Yunis and Rafah) twice a year during the sardine season, from April to June and from September to November. Such The seasonal extensions extensions in 2016 and 2017 have significantly increased the total catch, which of the fishing zone in 2016 reached their highest levels for the past 13 years. However, the catch remains and 2017 brought the total mainly limited to low-value sardines, making it difficult for fishermen to earn a catches to their highest livable income. Additionally, practices used by the Israeli navy, and to a lesser levels for the past 13 years. extent by the Egyptian navy, to enforce the fishing limits, including the firing of However, the catch remains live ammunition, have raised a range of protection concerns. mainly limited to low-value sardines, making it difficult for fishermen to earn a FISHING CATCH IN TONS AND FISHING LIMITS IN NM livable income.

Expanding fishing 20 NM under the 1994 Oslo Agreement but NM 6 zone first to Seasonal fishing only allowed up to 12 NM. conflict 2014 after NM 9 extension to Limited between 1.5 to Nautical miles Fishing zone decreased to 6 3 n.m. after ast Lead. NM in une 2006.

3,788 3,618 3,650 3,251 3,306 3,117 3,206 2,951 2,858 2,623 2,702 2,378 2,323 2,421 1,950 2,036 1,814 1,856 1,699 1,507 1,468 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Source: FAO analysis of data from Department of Fisheries, Ministry of Agriculture.

The fishing sector in the socio-economic context of Gaza Within a context of high unemployment and food insecurity, the fishery sector remains a significant source of employment. Fish, particularly sardines, is also a major source of protein, micronutrients and essential Omega 3 This section was contributed fatty acids for Palestinians in Gaza and contributes to nutritional diversity. by the Food and Agricultural In 2017, 40 per cent of households in Gaza were estimated to be severely or Organization (FAO) moderately food insecure10 and unemployment stood at 43.6 per cent,11 particularly among vulnerable groups such as women and youth.

According to the Ministry of Agriculture’s Department of Fisheries, there are currently 3,700 registered fishers in Gaza who rely on the sector for their livelihood. It is estimated that Gazan fishers currently support 18,250 other people (based on an average household size of 5.7 people in Gaza).12 It is also estimated that a significant number of people rely on fishing-associated industries, including repairs and retailing. According to the Ministry of Agriculture (MoA), only 2,000 of those registered fish on a daily basis while the remaining 1,700 work sporadically, around once a month, because the income Only 2,000 of the 3,700 they generate does not cover their operating costs. registered fishers fish on a daily basis, while the rest Fish catches and revenues have varied considerably over the years. While the work sporadically, around fishing limit impacts both catch and revenue, revenues also vary according once a month, because the to the type and quantity of fish available in the given zone. The restriction of income they generate does fishing to a small area near the coast leads to overfishing and has a negative not cover their operating impact on breeding grounds. According to the Department of Fisheries, the costs. impact of the restrictions on the fishing zone to three NM in 2006 and 2007 only became evident in 2009 when fish breeding grounds in the permitted three NM zone were severely depleted. Expansion of the fishing zone after 2012 led to a significant increase inboth catch and revenue, particularly in 2016 following the seasonal expansion of the fishing zone to nine NM on the southern Gaza coast. In 2016, revenues increased TYPE OF FISH CAUGHT BY SEA DEPTH AND NM

N High value bottom Pelagic ﬁsh,Bottom ﬁsh sardines Fish, Shrimps Tuna, S Mackerel, Sardines NM Sardines Small Sardine

100m 200m 300m 400m 500m GAZA STRIP 600m 700m Source: FAO of the United Nations.

www.ochaopt.org | [email protected] | facebook.com/ochaopt This report was prepared by the United Nations Office for the Coordination of Humanitarian Affairs in collaboration with humanitarian partners. oPt Humanitarian Bulletin | 9 proportionally more than the quantity of the catch due to the availability of other types of fish beyond the six NM limit that are more profitable than the fish available in shallow water. The same extension in 2017 resulted in a much lower increase in catch and revenue due to the unusually low fish supply that year. This could be addressed by the continued extension of fishing limits to nine NM or beyond, where fish supplies are less vulnerable to fluctuating conditions.

The Gazan fisheries sector lacks access to essential imports, including fibreglass, boat engines and spare parts, which are restricted by Israel as “dual use” items. Fishing nets and other items are often too expensive for fishermen on their limited income.

Gazan fishers were informally allowed to fish in Egyptian waters between 2011 and 2013, when access within Gazan waters was limited to six NM. During this period, fishermen were able to catch high-value fish more commonly found at 12 NM. According to the Department of Fisheries, a total of 180 tons of mullet was caught in Egyptian waters at 12 NM compared with 21 tons of mullet caught in Gazan waters at six NM during the same period. The extension of the fishing According to the Department of Fisheries, a revival of the fishery sector would zone to 12 NM all year round require the current fishing zones to be extended. A permanent extension of the could increase the fishing fishing zone to nine NM throughout the year would likely result in an increase catch by some 50 per cent, of approximately 20 per cent in both revenue and jobs. According to MoA, the resulting in a 60-65 per extension of the fishing zone to 12 NM all year round could raise the fish catch to cent increase in revenue, 5,000-6,000 tons, an increase of nearly 50 per cent. This could result in a 60-65 per if coupled with export cent increase in income if coupled with export facilitation, and could also ensure facilitation. full employment of all current fishermen in Gaza.

An expansion would also release pressure on fish populations within the three to six NM zone, with a positive impact on the carrying capacity of fish stock. The fisheries sector would also benefit significantly from the easing of restrictions © FAO/Marco Longari © FAO/Marco

www.ochaopt.org | [email protected] | facebook.com/ochaopt This report was prepared by the United Nations Office for the Coordination of HumanitarianA Gazan Affairs fisherman in removes collaboration the catch from with his humanitarianfishing net. partners. 10 | oPt Humanitarian Bulletin

on imports of equipment to meet repair needs (both regular and increased demand resulting from damage during conflict and the confiscation of boats by the Israeli navy).

FISH CULTURE TO ENHANCE PRODUCTION AND SUSTAIN FISHERIES LIVELIHOOD Fish culture (both land and marine-based) has been introduced to Gaza to supplement traditional methods of fishing and generate sustainable livelihoods. Fish production generated from land-based fish culture has been increasing steadily from five tons in 2010 to 435 tons in 2017, according to the Department of Fisheries. The FAO of the UN is piloting a marine cage farm as a social business13 owned and managed by fishery member institutions in the sea off Gaza to promote development of a marine aquaculture sector that will benefit Live ammunition continues to the fishery community. The cage farm has the potential to promote greater be widely employed by the productivity and incomes, and ensure the succession of a sustainable and Israeli navy to enforce the resilient livelihood to younger fishing generations. Supported by the Government maritime limits: in 2017 there of Italy, this initiative delivers marine aquaculture technologies and capacity were 213 shooting incidents development to fishermen and the Gaza Fisheries Syndicate to enable operation of the marine cage farm as a social business. It also promotes access and links registered, resulting in one to markets. The pilot marine cage farm is expected to produce approximately fisherman killed and 14 150 tons of sea bream per year, contributing an additional 4.5 to 5 per cent to the injured, including one child. local fish market. The increased availability of fish is expected to make fish more affordable for consumers, improve consumption levels and dietary diversity, and contribute to the growth of exports and income.

Continuing protection concerns and lack of accountability Live ammunition continues to be widely employed by the Israeli navy to enforce the maritime limits. Overall, 213 shooting incidents were registered in 2017, resulting in one fisherman killed and 14 injured, including one child. Another fisherman died in unclear circumstances and 39 more were arrested, of whom three were children. During the first two months of 2018, 64 shooting incidents were recorded: one fisherman was killed and eight were injured. The fatality, Ismail Saleh Abu Riyalah, aged 18, died when the Israeli navy fired at his boat without a verbal warning or warning shots, reportedly at close range and in the absence of a threat to life or serious injury. This section was contributed by the Office of the United If arrested, fishermen report being interrogated about Palestinian armed groups Nations High Commissioner for Human Rights and subjected to ill-treatment and verbal abuse prior to their release. This raises serious human rights concerns, including the right to life and respect for due process guarantees enshrined in international law.14 In 2017, the Israeli navy confiscated 13 boats and another seven incidents of damage, confiscation and loss of fishing equipment were registered. In January and February 2018, four boats were confiscated and not returned, and one more was damaged.15

Under international law, the use of firearms should be strictly limited to situations of last resort, i.e. in response to an imminent threat to life. Otherwise, the use of

www.ochaopt.org | [email protected] | facebook.com/ochaopt This report was prepared by the United Nations Office for the Coordination of Humanitarian Affairs in collaboration with humanitarian partners. oPt Humanitarian Bulletin | 11 firearms constitutes excessive and unlawful use of17 force. Violations of these standards that result in casualties must be duly investigated by the authorities and accountability ensured promptly through independent, objective and impartial investigations. Civil remedies, including financial compensation, are also clearly established under international law.18

TWO CASES OF FISHERMEN FATALITIES AND LACK OF LEGAL REMEDIES

On 15 May 2017, Mohammad Mjid Fadil Bakr, aged 25, was killed while working on his fishing boat approximately three NM off the coast. Reportedly, the Israeli navy instructed the boat to stop by loudspeaker, while simultaneously opening fire. The boat disregarded the warnings and continued to move until a bullet In the cases of the two hit the engine: Mohammad was shot in the back as he was trying to protect the fatalities, a Palestinian NGO engine. The victim was immediately taken by the navy to a hospital in Israel requested the opening of (Ashkelon), where he was pronounced dead. criminal investigations and also filed civil complaints On 4 January 2017, another fisherman, Mohammad Ahmad Jameel al Hisi, for compensation, with little aged 33, went missing about five NM off the Beit Lahia coast in unclear response from the Israeli circumstances. An Israeli navy vessel reportedly crashed into the victim’s authorities in either instance. boat which “was not visible due to the conditions out at sea”.16 He was later pronounced dead.

In the cases of the two fatalities, the Palestinian Centre for Human Rights (PCHR) requested the opening of criminal investigations by the Israeli Military Attorney General (MAG) and also filed civil complaints for compensation before the Israeli Ministry of Defense (MoD). There has been little response from the Israeli authorities in either instance. PCHR has received no response to criminal complaints filed regarding four other cases of injuries. Of 11 civil cases filed in 2017, only three responses acknowledging receipt have been received from the MoD. © Photo by OCHA Fishing boat equipped with a lightening system to attract fish. Gaza city’s port, March 2018

FUNDING SHORTAGES UNDERMINE CONTINUITY OF MOBILE MOBILE HEALTH CLINICS IN THE WEST BANK FEBRUARY 2018 OCCUPIED PALESTINIAN TERRITORY HEALTH CLINICS IN VULNERABLE WEST BANK COMMUNITIES

Over 220,000 Palestinians living in 189 communities across the THE IMPACT OF FUNDING ON MOBILE HEALTH CLINICS WHAT IS A MOBILE HEALTH CLINIC CLINICS POPULATION PARTNERS COMMUNITIES West Bank lack a permanent clinic and face critical challenges SERVED This article was contributed F A September by the Health Cluster in accessing basic health services. These communities The mobile health clinics serve communities in Area , H2 and seam include, primarily, those located in Area C, in the Israeli- K FEBRUARYHI 2018 MOBILE HEALTHzones that have no CLINICS access to primary healthcareIN THE services. WEST BANK OCCUPIED PALESTINIAN TERRITORY controlled parts of Hebron city (H2), and in the closed areas UNRWA The mobilebehind health the clinics Barrier include (the aSeam doctor, Zone). nurse In andmany midwife. of these They areas, DV THE IMPACT OF FUNDING ON MOBILE HEALTH CLINICS WHAT IS A MOBILEprovide primarythe HEALTH journey health careCLINICto the services nearest for aclinic community has lengthened and also provide CLINICSbecause POPULATION PARTNERS COMMUNITIES CARE I PMRS curative treatmentof the needand some to travel laboratory circuitous tests on ways a daily around basis. settlements COMMUNITIESSERVED SERVED BY MOBILE HEALTH CLINICS MH F A September and barriers. Access to healthcare can be hampered by the The mobile healthThe clinics clinic isserve registered communities and licensed in Area to practice, H2 and by theseam MOH. K At risk HI CARE I HWC unavailability or high costs of transportation, and in some Functioning FEBRUARYClosed 2018 MOBILE HEALTHzones that have noCLINICS access to primary INhealthcare THE services. WEST BANK OCCUPIED PALESTINIAN TERRITORY The clinic visitscommunities, each community access at to least emergency 4 times perservices month. is challenging as UNRWA PMRS MEDICO I The mobile health clinics eveninclude ambulances a doctor, nurseface delays. and midwife. They DV MAPUK There is an established referral mechanism with basic rehabilitation THE IMPACT OF FUNDING ON MOBILE HEALTH CLINICS provide primary carehealth providers. care services for a community and also provideCLINICS POPULATION PARTNERSPrimary HealthCOMMUNITIES Care Level 2(PHC L2)+ Lab Emergency Medical & TrainingCARE (EMT) I PRCS PMRS WHAT IS A MOBILE HEALTH CLINIC COMMUNITIES SERVED BY MOBILE HEALTH CLINICS Ended The Humanitariancurative treatment Fund for and someThe laboratory most vulnerable tests on a dailyin these basis. communities includeSERVED women Primary Health Care L2 Basic Rehabilitation Services (BRS) MH F A September the oPt provided UNRWA during pregnancy and childbirth; sick children and infants; *Some communities received complementary health services from more than one mobile team (Partner). The mobile healthThe clinics clinic serve is registered communities and licensed in Area to , practice H2 and by seam the MOH. CARE I HWC with $612,000 to secure the the elderly; and the chronically ill or disabled. The knowledgeFunctioningK At risk FEBRUARYHI 2018Closed MOBILE HEALTHzones that have CLINICSno access to primary IN healthcare THE services. WEST BANK OCCUPIED PALESTINIAN TERRITORY operationThe of clinic mobileMOBILE visits clinics each communityCLINIC that BY healthat least STATUS, access4 times mayper PARTNER month. be difficult AND and LOCATION risky also acts asa UNRWA PMRS MEDICO I "J The mobilein 39health communitiesThere clinics is aninclude untilestablished a doctor, referral psychologicalnurse mechanism and midwife. stressor with They thatbasic can rehabilitation directly affect health. DV MAPUK mid-2018. To secure the THE IMPACT OF FUNDING ON MOBILE HEALTH CLINICS provide primary healthcare providers. care services for a community and also provideCLINICS POPULATION PARTNERS Primary HealthCOMMUNITIES Care Level 2(PHC L2)+ Lab Emergency Medical & TrainingCARE (EMT) ICLOSED PRCSPMRS WHAT IS A MOBILE HEALTH CLINIC To mitigate this situation,FUNCTIONING ten COMMUNITIESorganizations in the SERVED Health BY MOBILEAT HEALTH RISK CLINICS Ended curative treatmentcontinuation and some of the laboratory mobile tests on a daily basis. SERVED Primary Health Care L2 Basic Rehabilitation Services (BRS) MH F A September Cluster have been operating mobile clinics in vulnerable T clinic service in all of the 189 PMRS 48 *Some communitiesHI received complementary health services from 36more than one mobileHW team (Partner). 15 T "J The mobile healthThe clinics clinic serve is registered communities and licensed in Area to, practice H2 andcommunities by seam the MOH. for the past few years.19 A mobileK health clinic At risk HI Closed CARE I HWC "J communities in need through UNRWA 6 Functioning zones that have noThe access clinic to MOBILE visitsprimary each healthcare community CLINIC services. atBY least STATUS, 4 timesteam per PARTNER commonly month. includes AND LOCATION a doctor, a nurse and a midwife UNRWA PMRS MEDICO I the end of 2018, additional MAP-UIS 6 PMRS 13 N "J UNRWA 35 "J The mobile health clinics include$900,000 a doctor, are required. nurse and midwife.who They visit each community at least once a week. The clinics DV MAPUK There is an established referral mechanism with basic rehabilitationPRS 4 "J often operate in structures not intended for this purpose but PRS 5 provide primary health care services for a community and also provide Primary Health Care Level 2(PHC L2)+ Lab PRCS care providers. MAP-U 2 Emergency Medical & TrainingCARE (EMT) ICLOSED PMRS FUNCTIONINGCOMMUNITIES SERVED BY MOBILE ATHEALTH RISK CLINICS Ended curative treatment and some laboratory tests on a daily basis. provide primary health care services, curativePrimary Health treatment Care L2is-i and some7 Basiclaboratory Rehabilitation Services (BRS) HW 2 MH T "J tests. MoH 1 "J Salfit River ordan PMRS 48 *Some communitiesHI received complementary health services from m36ore than one mobile HWteam (Partner). 15 T Salfit The clinic is registered and licensed to practice by the MOH. MoH 1 At risk Closed CARE I HWC "J UNRWA 6 Functioning Severe funding shortagesMAP-U since the beginning of 2018 PMRShave halted2 the work of The clinic visitsMOBILE each community CLINIC at BY least STATUS, 4 times per PARTNER month. AND LOCATION UNRWA 1 PMRS MEDICO Iis-i 1 MAP-UIS 6 PMRS 13 N UNRWA "J these clinics serving nearly 13,000 people in 40 of the 189 communities. 35Unless "J HI 1 MAPUK There is an established referral mechanism with basic rehabilitationPRS 4 "J additional funding is-i is found1 immediately, mobile clinicsMoH serving2 another 11 PRS 5 R Primary Health Care Level 2(PHC L2)+ Lab PRCS "J care providers. FUNCTIONINGMAP-U 2 AT RISK Emergency Medical & Training (EMT) CLOSED communities in the Hebron area with ais-i population of over 9,500 will also have Ended Primary Health Care L2 7 Basic Rehabilitation Services (BRS) E "J HW 2 to cease work. T "J MoH 1 "J Salfit River ordan PMRS 48*Some communitiesHI received complementary health services from more36 than one mobile teamHW (Partner). 15 T Salfit MoH 1 "J MOBILEUNRWA CLINIC6 BY STATUS AND LOCATION OnMAP-U 20 February, the Humanitarian FundPMRS for2 the oPt, managed by OCHA on MOBILE CLINIC BY STATUS, PARTNER AND LOCATION UNRWA 1 is-i 1 MAP-UIS 6 At risk PMRS 13 N behalf of the HumanitarianUNRWA Coordiator, released $612,000 to UNRWA to "J FunctioningHI 1 losed 35 "J "J B PRS 4 "J guarantee the continued operation of six medical teams serving 35 communities, HEALTH SERVICES PROVIDED is-i 1 20 MoH 2 PRS 5 R 20 17 "J MAP-U 2 16 20 15 CLOSED BRS PH L2 FUNCTIONING mainly in Area C, until mid-2018.AT13 RISK To secure the resumption and continuation 12 is-i 7 E EMTs PH L2 Lab 10 9 9 "J HW 2 of the mobile clinic service in all of the 189 communities8 through the end of 8 Barrier M 7 8 T "J 5 MoH 1 5 5 River ordan PMRS 48 HI 36 HW T "J Salfit Israeli unilaterally declared 1 2 2 15 2 "J by statusMoH 1 2018, additional $900,000 are required. While the Palestinian Ministry of Health 1 H East erusalem municipal MOBILEUNRWA CLINIC6 BY STATUS AND LOCATION "J boundary MAP-U is willing to cover the currentPMRS 2 and expected gaps, their capacity is estimated to 1 is-i 1 UNRWA At risk PMRS N Palestinian community MAP-UIS 6 UNRWA 13 "J FunctioningHI 1 losed 35 "J Settlement built-up, outer-limit B PRS 4 "J and municipal area HEALTH SERVICES PROVIDED is-i 1 20 MoH 2 PRS 5 R 20 17 "J Oslo Areas A and B MAP-U 2 Population served 16 15 BRS PH L2 13 12 is-i 7 E EMTs PH L2 Lab per governorate www.ochaopt.org | [email protected] | facebook.com/ochaopt9 9 "J Oslo Area HW 2 H 8 T Bethlehem 8R Salfit T Barrier M 7 8 "J This report was prepared by5 the United Nations Office for the Coordination of Humanitarian Affairs inMoH collaboration1 5 with humanitarian5 partners. Salfit River ordan 1 2 2 2 Israeli unilaterally declared by statusMoH 1 1 H East erusalem municipal MOBILE CLINIC BY STATUS AND LOCATION "J PMRS 2 boundary MAP-U 1 HI: Humanity & Inclusion, UNRWA: The United Nations Relief and Works Agency, Dis-Vi: Italian NGO, CARE International, PMRS: Palestinian Medical Relief Society, MoH: Ministry of Health, HWC: Health Work Committees, MEDICO International, MAP-UK: Medical Aid for UNRWA Palestinians,At risk PRCS: Palestine Red Crescent Society. is-i 1 Palestinian community HIFunctioning1 losed "J Settlement built-up, outer-limit B and municipal area HEALTH SERVICES PROVIDED is-i 1 20 MoH 2 R 20 17 "J Oslo Areas A and B Population served 16 15 BRS PH L2 13 12 E EMTs PH L2 Lab per governorate H 10 8 9 T Bethlehem 8 R 9 Salfit T "J Oslo Area M 5 7 8 5 5 Barrier 1 2 2 2 Israeli unilaterally declared by status 1 H East erusalem municipal MOBILE CLINIC BY STATUS AND LOCATION "J HI: Humanity & Inclusion, UNRWA: The United Nations Relief and Works Agency, Dis-Vi: Italian NGO, CARE International, PMRS: Palestinian Medical Relief Society, MoH: Ministry of Health, HWC: Health Work Committees, MEDICO International, MAP-UK: Medicalboundary Aid for Palestinians,At risk PRCS: Palestine Red Crescent Society. Palestinian community Functioning losed "J Settlement built-up, outer-limit B and municipal area HEALTH SERVICES PROVIDED 20 20 Oslo Areas A and B Population served 17 BRS PH L2 16 13 15 12 EMTs PH L2 Lab per governorate H 10 8 9 T Bethlehem8 R 9 Salfit T Oslo Area M 5 7 8 5 5 Barrier 1 2 2 2 Israeli unilaterally declared by status 1 H East erusalem municipal HI: Humanity & Inclusion, UNRWA: The United Nations Relief and Works Agency, Dis-Vi: Italian NGO, CARE International, PMRS: Palestinian Medical Relief Society, MoH: Ministry of Health, HWC: Health Work Committees, MEDICO"J International, MAP-UK:boundary Medical Aid for Palestinians, PRCS: Palestine Red Crescent Society. Palestinian community Settlement built-up, outer-limit and municipal area Population served Oslo Areas A and B per governorate H T Bethlehem R Salfit T Oslo Area

THE IMPACT OF FUNDING ON MOBILE HEALTH CLINICSTHE IMPACT OF FUNDING ON MOBILE HEALTH CLINICS WHAT IS A MOBILE HEALTH CLINIC WHATCLINICS IS A MOBILE POPULATION HEALTHPARTNERS CLINIC COMMUNITIES CLINICS POPULATION PARTNERS COMMUNITIES SERVED SERVED F A September F A September The mobile health clinics serve communities in Area , H2 and seam The mobile health clinics serve communities in Area , H2 and seam K HI K HI zones that have no access to primary healthcare services. oPt Humanitarian Bulletin | 13 zones that have no access to primary healthcare services. UNRWA UNRWA The mobile health clinics include a doctor, nurse and midwife. They The mobile health clinics include a doctor, nurse and midwife. They DV DV provide primary health care services for a community and also provide provide primary health care services for a community and also provide CARECOMMUNITIES I PMRS SERVED BY MOBILE HEALTH CLINICS CARE I PMRS curative treatment and some laboratory tests on a daily basis. COMMUNITIEScurative treatment and SERVED some laboratory BY MOBILE tests on a HEALTH daily basis. CLINICS MH MH The clinic is registered and licensed to practice by the MOH. The clinic is registered and licensed to practice by the MOH. CARE I HWC Functioning At risk Closed CARE IFunctioning HWC At risk Closed The clinic visits each community at least 4 times per month. The clinic visits each community at least 4 times per month. PMRS MEDICO I PMRS MEDICO I MAPUK There is an established referral mechanism with basic rehabilitation There is an established referral mechanism with basic rehabilitation MAPUK PRCS care providers.Primary Health Care Level 2(PHC L2)+ Lab Emergency Medical & Training (EMT) PRCS Primary Health Care Level 2(PHC L2)+ Lab Emergency Medical & Training (EMT) care providers. Ended Basic RehabilitationEnded Services (BRS) Primary Health Care L2 Basic Rehabilitation Services (BRS) Primary Health Care L2 *Some communities received complementary health services from more than one mobile team (Partner). *Some communities received complementary health services from more than one mobile team (Partner). MOBILE CLINIC BY STATUS, PARTNER AND LOCATION MOBILE CLINIC BY STATUS, PARTNER AND LOCATION "J "J CLOSED FUNCTIONING AT RISK FUNCTIONINGCLOSED AT RISK

T T "J PMRS 48 HI 36 HW "J T PMRS 48 HI 36 HW T 15 "J 15 "J UNRWA 6 UNRWA 6 PMRS N MAP-UIS 6PMRS N 13 "J MAP-UIS 6 UNRWA 13 UNRWA 35 "J 35 PRS 4 "J PRS 4 "J PRS 5 PRS 5 MAP-U 2 MAP-U 2 is-i is-i 7 7 HW 2 "J

HW 2 River ordan "J MoH 1 Salfit MoH 1 Salfit River ordan MoH 1 MoH 1 PMRS MAP-U PMRS 2 MAP-U 2 1 is-i 1 UNRWA 1 UNRWA is-i 1 HI 1 HI 1 is-i 1 MoH 2 R is-i 1 MoH 2 R "J "J E "J E "J MOBILE CLINIC BY STATUS AND LOCATION MOBILE CLINIC BY STATUS AND LOCATION At risk At risk Functioning losed "J Functioning losed "J B B HEALTH SERVICES PROVIDED 20 20 17 HEALTH SERVICES PROVIDED 20 20 17 16 15 BRS PH L2 16 15 13 BRS PH L2 13 12 EMTs PH L2 Lab 12 10 9 EMTs PH L2 9Lab 10 9 7 98 8 8 Barrier 7 8 M 8 5 8 5 5 Barrier M 5 5 5 Israeli unilaterally declared 1 2 2 2 1 Israeli unilaterally declared 1by status2 2 2 1 H East erusalem municipal by status H East erusalem municipal "J boundary "J boundary Palestinian community Palestinian community Settlement built-up, outer-limit Settlement built-up, outer-limit and municipal area and municipal area Oslo Areas A and B Population served Population served Oslo Areas A and B per governorate Oslo Area per governorate H T Bethlehem RH Salfit T T Bethlehem R Salfit Oslo Area T

HI: Humanity & Inclusion, UNRWA: The United Nations Relief and Works Agency, Dis-Vi: Italian NGO, CARE International, PMRS: Palestinian Medical Relief Society, MoH: Ministry of Health, HWC: Health Work Committees, MEDICO International, MAP-UK: Medical Aid for HI: Humanity & Inclusion, UNRWA: The United Nations Relief and Works Agency, Dis-Vi: Italian NGO, CARE International, PMRS: Palestinian Medical Relief Society, MoH: Ministry of Health, HWC: Health Work Committees, MEDICO International, MAP-UK: Medical Aid for Palestinians, PRCS: Palestine Red Crescent Society. Palestinians, PRCS: Palestine Red Crescent Society. www.ochaopt.org | [email protected] | facebook.com/ochaopt This report was prepared by the United Nations Office for the Coordination of Humanitarian Affairs in collaboration with humanitarian partners. 14 | oPt Humanitarian Bulletin

THE MOBILE CLINIC IN KHAN AL AHMAR The only health service available since the beginning of 2018 in a cluster of five Palestinian Bedouin communities in the Jerusalem governorate known as Khan al Ahmar, is a mobile clinic run by the Palestinian Medical Relief Society (PMRS). Access by Khan al Ahmar’s residents to health facilities in East Photo by: Health Cluster.

Jerusalem is restricted by © the Barrier and the permit Nabila Mousa in the PMRS mobile health clinic in Khan al system, and the nearest Ahmar, March 2018. permanent clinic is in Jericho, 20 kilometres away. Transportation costs to Jericho are often prohibitive “In November 2011, for already impoverished families. Both residents and ambulance/health personnel PMRC had to halt servicing the community often report delays on the roads at flying checkpoints the mobile clinic deployed by Israeli forces. service in Khan al Nurse Nabila Mousa visits six Bedouin communities to the east of Jerusalem, Ahmar for six months including in Khan al Ahmar, every week: with disastrous consequences on “I am one of a small team of four comprising a general practitioner, two nurses and a midwife, who visit Khan al Ahmar every Wednesday. We operate in the local mosque, patients with chronic where we treat both acute and chronically ill patients. We also provide preventive diseases.” care and health education, especially for women, including awareness raising on breastfeeding, pregnancy follow-ups, and early stage breast cancer screening. We also provide limited pharmaceutical services with a range of medications, including antibiotics and drugs for chronic and skin diseases, as well as oral contraceptives and condoms. On average, we treat 50-70 patients per week, 86 per cent of whom are women and children. We rely on solar energy to run the basic medical equipment.”

“We feel responsible for the lives of the people residing in these communities. We often get calls from our patients if we are ten minutes late and they keep asking us to come more frequently. In November 2011, due to funding shortages, PMRC had to halt the mobile clinic service in this area for six months and that was disastrous. Some patients with chronic diseases stopped taking their medication and their condition deteriorated. We also detected many cases of children suffering from extreme skin and respiratory conditions that would have been easily treated if our services had not stopped. At that moment, I realized the critical importance of our work.”

Khan al Ahmar communities, inhabited by about 100 families, are located next to an area planned by the Israeli authorities for the expansion of the Ma’ale Adummim settlement (the E1 plan). They are among the 46 Palestinian Bedouin communities in the central West Bank at risk of forcible displacement due to the coercive environment generated by Israeli practices, including pressure to relocate the community.21 A hearing at the Israel Supreme Court, on a petition against the demolition of the largest of the five Khan al Ahmar communities (Abu al Helu) is expected by the end of April.

ENDNOTES 1. The ‘Land Day’ is an annual commemoration of mass protests by Palestinian citizens of Israel, which took place in 1976, in response to the Israeli government’s announcement of a plan to expropriate thousands of dunams of land. The ‘Nakba day’ commemorates the forcible displacement from areas that became part of Israel of more than 700,000 Palestinians, over the course of the first Arab-Israeli war in 1948. 2. Statement attributable to the Spokesman for the Secretary-General on the situation inGaza. https://www.un.org/sg/en/content/sg/statement/2018-03-30/statement-attributable-spokesman-secretary- general-situation-gaza 3. Five Israeli civilians, including a child, were also killed over the course of the 2014 hostilities. 4. Estimate from the IDPs Working Group led by OCHA and the Shelter Cluster. 5. This survey was intended to update a re-registration and vulnerability profiling survey carried out in the second half of 2015 by the IDP Working Group under OCHA’s coordination and which targeted 16,000 IDP households. For the main findings see: http://www.ochaopt.org/documents/idps_report_april_2016_english. pdf. 6. Households were considered particularly vulnerable if they were headed by a female, an elderly person or a child; if they had one or more member with a disability; or if they were residing in caravans or makeshift shelters. 7. Although these two figures are indicative of the high prevalence of unemployment among IDPs, they are not fully comparable: to be considered unemployed in labour statistics, a person must be actively seeking a job during the reporting period, which is not necessarily the case for all heads of household covered in the IDP survey. 8. Agreement on the Gaza Strip and Jericho, Cairo, 4 May 1994. A no-go zone one mile wide along Gaza’s boundaries with Egypt in the south, and another of one mile and half along Gaza’s boundaries with Israel in the north, were also established. 9. Letter from the Israeli Ministry of Foreign Affairs to OCHA, commenting on the draft 2017 Humanitarian Needs Overview, December 2016. 10. 2018 Humanitarian Needs Overview (HNO). Available at https://www.ochaopt.org/content/2018- humanitarian-needs-overview-hno 11. PCBS 2018, The Labour Force Survey Results 2017: Main Results. Available at http://pcbs.gov.ps/portals/_pcbs/ PressRelease/Press_En_13-2-2018-LFYear-en.pdf 12. PCBS 2015, Summary of Demographic Indicators in Palestine by Region. Available at http://pcbs.gov.ps/ Portals/_Rainbow/Documents/DEMO-2016-EEE.htm 13. A social business is created and designed to combine commercial and social goals with an emphasis on the latter. Investment in social business should lead to equivalent increase in social impact. Profits realized by the business are reinvested in the business itself. 14. International Covenant on Civil and Political Rights, Articles 6, 7, 9, 10. 15. Figures provided by al-Mezan Centre for Human Rights. 16. http://www.timesofisrael.com/gaza-fisherman-lost-at-sea-after-collision-with-idf-ship/ 17. Basic Principles on the Use of Force and Firearms by Law Enforcement Officials. 18. ICCPR, Articles 2,14,26, and Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Law and Serious Violations of International Humanitarian Law. 19. The organizations are: HI: Humanity & Inclusion; UNRWA: The United Nations Relief and Works Agency; Dis-Vi: Italian NGO; CARE International; PMRS: Palestinian Medical Relief Society; MoH: Ministry of Health; HWC: Health Work Committees; MEDICO International; MAP-UK: Medical Aid for Palestinians; and PRCS: Palestine Red Crescent Society. 20. An additional $288,000 were allocated by the HF to UNRWA to maintain food distribution to Bedouin and herding communities in Area C for a period of six months. See Statement by the Acting Humanitarian Coordinator: https://www.ochaopt.org/content/opt-humanitarian-fund-fills-critical-gap-140000-most- vulnerable-palestinians-left-cut-unrwa. 21. The findings of a needs assessment carried out by OCHA in 2017 among the 46 affected communities is available on an interactive database at: https://www.ochaopt.org/page/46-bedouin-communities-risk-forcible- transfer-central-west-bank-vulnerability-profile.