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Social determinants and mental health needs of Palestine refugees and UNRWA responses in Gaza during the COVID-19 pandemic: a qualitative assessment
Background
Due to pre-existing difficulties, refugees are especially susceptible to the negative effects of the pandemic; nonetheless, the pandemic’s effect on this group is still unclear. The purpose of this study was to determine the effects of the COVID-19 pandemic on the mental health of Palestine refugees in Gaza by identifying the role of social determinants. During the pandemic, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) enacted a number of policies and measures. The purpose of this research was to assess their efficacy and acceptability.
Methods
This qualitative study took place between August and November 2020. Twenty-nine key-informant interviews were conducted remotely with UNRWA Headquarters, field and clinical staff in Gaza and with community members, aged ≥18 years and residing in Rafah and Jabalia camps. We sought informed consent verbally or via email. Data was coded based on the framework for social determinants of mental health.
Results
Interview results indicated that the relationship might be unidirectional, with COVID-19 causing the degradation of living conditions and vice versa, with living conditions exacerbating the COVID-19 situation by facilitating virus transmission. In other instances, the association between mental health determinants and COVID-19 might be bidirectional. In terms of experiencing violence and anxieties, women, children, and daily-paid employees were significantly more disadvantaged than other groups in the community. UNRWA modified its service delivery techniques in order to continue providing essential services. In general, UNRWA’s strategies throughout the pandemic were deemed beneficial, but insufficient to meet the needs of Gazans.
Conclusion
The pandemic highlights the need to go beyond disease treatment and prevention to address social determinants to improve refugees’ health and reduce their susceptibility to future shocks. UNRWA has rapidly implemented telemedicine and mental telehealth services, making it imperative to assess the efficacy of these novel approaches to provide care at a distance. A long-term option may be to employ a hybrid strategy, which combines online and in-person therapy.
Journal Article
Arafat and the dream of Palestine : an insider's account
Bassam Abu Sharif was one of the most notorious and dangerous terrorists in the sixties and seventies, acting as \"minister of propaganda\" for the Popular Front for the Liberation of Palestine (PFLP) and as a recruiter for terrorists (including Carlos the Jackal). In 1972, a bomb was placed in a book (the memoirs of Che Guevara) and sent to him, leaving him half-blind, deaf in one ear, and almost fingerless. He later became one of Arafat's closest advisers and one of the minds behind the Oslo Peace Treaty between Israel and the PLO. This is his first-hand account of the inner-working of Arafat's regime, the PLO, Fatah and the relationship that allowed Abu Sharif to encourage important strides toward peace. In taking readers behind the scenes of all the major events in thirty years of Middle East politics, Abu Sharif delivers a unique living history of Palestine.--Publisher description.
BOOK
Responding to the covid-19 in West Bank Palestine refugee camps: lessons and role of community engagement
Background
Global unpreparedness was noted, where even high-income countries with their established healthcare systems could not cope with the Covid-19 pandemic. In the Occupied Palestinian Territory (OPT), especially in the Palestinian refugee camps, Covid-19 was an additional burden on multiple levels.
Objective
The aim of this study is to understand the notion of Covid-19 responses in the West Bank refugee camps and the health system’s ability to meet the needs of the refugees as well as the role of local community actors in the response.
Methods
Qualitative data were collected through semi-structured interviews. In total, 27 interviews were conducted with popular committees in camps, professionals working at the Palestinian Ministry of Health in addition to local and international health-related non-governmental organizations (NGOs). Participants were contacted via phone calls, Zoom meetings and in-person, for one to one and a half hours maximum. Questions were about the impact of Covid-19 and the way the participants and their organizations responded to this pandemic.
Results
Our findings state that wide-scale multilevel Covid-19 responses were conducted from different committees and institutions in the OPT. For example, the popular committees took part in distributing medicines, food parcels and hygiene kits, and the NGOs provided refugees with educational materials and psychosocial support. However, the overstretched Palestinian health system, the limited resources in addition to the poor coordination between health providers and poor follow up of the imposed restrictions, hindered the fast and effective response. Community engagement was a remarkable element which contributed to the successful deployment of response plans. This was demonstrated by the collaboration of the camps’ local bodies in addition to the initiatives of the local community in camps.
Conclusion
Covid-19 impacts were particularly pronounced for refugees where response efforts did not fulfil their needs. The study highlights the importance of preparedness, working with community organisations and designing interventions in a human-centred/community-centred way to increase the effectiveness of health interventions and responses.
Journal Article
The biggest prison on earth : a history of the occupied territories
A powerful, groundbreaking history of the Occupied Territories from one of the most influential Israeli historians. From daily life under occupation to analyzing political positions and abortive peace attempts in the present day, this book seeks to redress the harm done by the occupation.
Book
Healthcare workers preparedness for COVID-19 pandemic in the occupied Palestinian territory: a cross-sectional survey
Background
The COVID-19 pandemic threatens to overwhelm the capacity of a vulnerable healthcare system in the occupied Palestinian territory (oPt). We aimed to evaluate the availability of personal protective equipment (PPE) and the level of preparedness among HCWs in the oPt.
Methods
A cross-sectional study was conducted using a validated online questionnaire distributed through convenient sampling between March 30, 2020 and April 12, 2020. Outcomes were availability of PPE, healthcare workers (HCWs) preparedness in oPt for COVID-19 pandemic, and regional and hospital differences in oPt in terms of availability of PPE and HCWs preparedness. Descriptive statistics and univariate analysis were used in this study.
Results
Of 138 respondents, only 38 HCWs (27.5%) always had access to facemasks and 15 (10.9%) always had access to isolation gowns. Most HCWs did not find eye protection (
n
= 128, 92.8%), N95 respirators (
n
= 132, 95.7%), and face shields (
n
= 127, 92%) always available. Compared to HCWs in West Bank, those in the Gaza Strip were significantly less likely to have access to alcohol sanitizers (
p
= 0.03) and gloves (
p
< 0.001). On average, governmental hospitals were significantly less likely to have all appropriate PPE than non-governmental institutions (
p
= 0.001). Only 16 (11.6%) surveyed felt confident in dealing with a potential COVID-19 case, 57 (41.3%) having received any COVID-19-related training, and 57 (41.3%) not having a local hospital protocol.
Conclusion
HCWs in oPt appear to be underprepared and severely lacking adequate PPE provision. The lack of PPE provision will exacerbate spread of COVID-19 and deepen the crisis, whilst putting HCWs at risk.
Journal Article
Options and Strategies for Planning Water and Climate Security in the Occupied Palestinian Territories
(1) Background: Water security is at the front and center of climate change, human security, and sustainable development in regions and communities with competing water usage contexts, climate change effects, and cross-border water-sharing agreements, resulting in conflicts arising. Shared water agreements are affected by geopolitics, segregation, water availability, and access rights. Climate change can worsen water problems by changing precipitation trends or causing droughts. (2) Methods: Document and content analysis and primary and secondary data assessment were used to develop spatio-temporal patterns. In establishing a water security narrative for the region, the selection of SDG 6 (water) and SDG 13 (climate action) targets and indicators was also evaluated. UN-Water’s 2013 water security conceptual framework was used to examine water and climate security concerns and give a set of principles to assess gaps and fulfill needs toward a ‘water security future’ for communities and states in the region. Also, hydro-political perspectives in the region or state were evaluated using discourse analysis and guiding notes from emerging scholarship to support suggestions and prospective solutions toward mitigating water insecurity and risks from climate change and disasters, including resource (water) related conflicts. (3) Results: Hydro-hegemony keeps the water sector in one state under massive stress, and the lack of consensus-building for the regional water agenda continues to breed conflicts between communities and states. (4) Conclusions: We reiterate that the escalating water and climate crises will deepen, and at the national and local scale for OPT, the restrictions and geopolitical tensions about shared waters can render coping and adaptation mechanisms for people and stakeholders challenging.
Journal Article
Pathways to food insecurity in the context of conflict: the case of the occupied Palestinian territory
Background
Conflict reduces availability of production input and income, increases the number of days households had to rely on less preferred foods, and limits the variety of foods eaten and the portion size of meals consumed. While existing studies examine the impact of conflict on different food security measures (e.g., Food Consumption Score, Food Insecurity Experience Scale), the relationship between these measures as well as their relationship with political, economic, and agricultural factors remain under explored. Food insecurity may not only be an externality of conflict but also food deprivation may be utilized as a weapon to discourage residency in contested territories or to incentivize rebellions.
Methodology
This paper examines the association between political factors (e.g., violence, policies that require permit for passage in one’s own hometown), economic factors (e.g., loss of assets, unemployment), agricultural factors (e.g., shortage of water, poor weather conditions), and food insecurity experience and dietary diversity in a conflict setting—that of the occupied Palestinian territory (oPt). The study employs generalized structural equation models to analyze the ‘Survey on socio-economic conditions for Palestinian households 2014’ dataset compiled by the Palestinian Central Bureau of Statistics—which contains a representative sample of the population in the oPt at governorate and locality levels.
Results
We find that in the West Bank, residence in Area C—administered by Israel in both civil and security issues and contains illegal Israeli settlements and outposts—is associated with a higher level of agricultural hardship (
p
< 0.01) but lower economic hardship (
p
< 0.01) and a higher dietary diversity (
p
< 0.001), as compared to those living outside of Area C. In the Gaza Strip, living within one kilometer to a buffer zone is associated with lower dietary diversity (
p
< 0.01), higher level of political hardship (
p
< 0.01), and higher level food insecurity experience (
p
< 0.01) compared to not living in close proximity to a buffer zone. Concomitantly, in the Gaza Strip, food insecurity experience is associated with approximately a one-point reduction in dietary diversity as measured by the food consumption score (
p
< 0.01).
Conclusions
The results suggest that broader socio-political conditions in the oPt impact different aspects of food security through augmenting the economic and agricultural hardships that are experienced by the residents. As such, it is important to address these broader political and economic structures in order to have more sustainable interventions in reducing food insecurity.
Journal Article
Tax morale and prosocial behaviour: evidence from a Palestinian survey
The first empirical investigation is conducted into the relationship between prosocial behaviour and tax morale in the context of state capacity building as in the Palestinian Territories. We consider 'public spirit' (a positive attitude adopted by citizens for the benefit of the community) and associational activity (individuals' engagement in voluntary activities) two major expressions of prosocial behaviour and estimate their impact on Palestinians' 'tax morale' (intrinsic motivation to pay taxes). The empirical analysis employs a unique Palestinian public opinion survey conducted in 2007 in the West Bank and the Gaza Strip. By using a bivariate probit model, we find that tax morale increases with public spirit but it is lower among Palestinians involved in associational activities. Predicted conditional probabilities indicate that public spirit has more impact when the respondent has low confidence in the institutions and in the rule of law. Finally, more public spirit is required for a self-employed person in order to deal with tax compliance than for a worker in the public sector, unless the worker in the public sector has lower confidence in the institutions and in the rule of law than the self-employed person.
Journal Article