Comment on Rytter, et al: “Effects of armed conflict on access to emergency health care in Palestinian West Bank:” - BMJ online April 3 2006
Rytter et al’s report attributes a risk for added hospitalizations to
delays from checkpoints, detours, curfews imposed by the Israeli Defence
Forces, (IDF) during January 2005-- described as “a relatively calm period
in the West Bank.” However, a review of their data raises some questions
about the internal consistency and coherence of the findings and their
interpretation. Of all 2228 contacts, 394 (17.7%) were delayed, and of
these, 125 (32%) required hospitalization, resulting in an overall risk of
5.6%. But, 51 of the 125 would have been hospitalized anyway based on
expected risks of hospitalizations in those not delayed for military
reasons.
Therefore, 74 hospitalizations –or 3.3% of all contacts--were
specifically attributable to delays, which were self-reported. Using the
authors’ data on travel times, (18 kph and 15.5 kph in non-delayed and
delayed groups), and estimated average trip length of 15 km, we estimated
median travel times to be 50 minutes and 58 minutes respectively. Although
these estimates omit ranges, it seems a bit odd that a 16% increase in
median travel time---an additional 8 minutes within the golden hour--
should account for 59.2% of the 125 delays. These findings do not make a
persuasive case for the role of IDF checkpoints, detours and curfews in
producing major delays in access to emergency health care.
The period leading up to January 2005 was anything but calm in our
region. From Sept 2004 through Feb 2005, terror attacks, originating
mostly from Palestinian regions, killed 76 and wounded another 234
persons, mostly Israeli civilians, Jewish and Arab, and foreigners. (1)
The checkpoints--themselves not very safe areas-- foiled other attacks and
smuggling of arms. Now they are fewer, having been replaced by the
barrier, an even more effective deterrent. (2)
Since 2000, --and for that matter, 1993, following the Oslo Accords,
the age-sex distributions of the dead among Israelis and Palestinians
suggest that the latter has been engaged in genocidal terror aimed at the
Israeli population, while the former has used force aimed against its
perpetrators, although many innocent bystanders have been caught in the
crossfire. (2,3)
What is striking is the asymmetry between the deaths and injuries
from genocidal terror and the admittedly stressful, but hopefully
inconsequential delays necessitated by the need to protect everyone---
Jews, Arabs, tourists, foreign workers, and others from terror’s lethal
reach, which has included the misuse of Red Crescent ambulances to smuggle
terrorists and weapons past checkpoints.
No one should be denied access to health care anywhere. Israeli
hospitals have done their maximum to ensure that this care was provided to
all during the last 5 years of what the authors call armed conflict. The
authors’ data, if anything, suggest that the IDF is doing what it can to
honor its commitments to clear ambulances within 30 minutes, despite the
dangers.
We suggest that the authors work to persuade the new Palestinian
Hamas government to renounce genocidal terror. Then there would be no
need for checkpoints, curfews, barriers, or soldiers.
Elihu D Richter,* Rony Blum,* Avraham Rivkind**
*Center for Injury Prevention and **Department of General Surgery and
Shock Trauma Unit, Hebrew University-Hadassah Medical Center Jerusalem
Israel
References:
1. Ministry of Foreign Affairs. Victims of Palestinian Violence and
Terrorism since September 2000 Accessed April 6 2006 http://www.mfa.gov.il/MFA-Terrorism
2. Richter ED The Barrier: Protection of the right to life from incitement
and terror in the Israeli-Palestinian Conflict: An Epidemiologic Working
Paper 30 pp (unpublished available on request) Feb 28 2004 Submitted to
International Court of Justice in The Hague
3. Human Rights Watch, Erased in a Moment, Suicide Bombing Attacks Against
Israeli Civilians (Oct 2002) http://www.hrw.org/reports/2002/isrl-pa/
Note for BMJ: Below may be included if possible, but is not
essential.
* Over the past 25 years, EDR has participated in investigations by
human rights groups on the use of tear gas, the health conditions of
Palestinian prisoner detainees, and initiated, supervised and particpated
in joint Israeli-Palestinian projects to investigate and prevent epidemics
of lead poising, asthma in refugee camps, and to assess the distribution
and determinants of lead exposures of children in Israel, Jordan and the
Palestinian Authority. RB is a researcher in trauma and bereavement an
interethnic conflict around the world. AR has overseen Hadassah’s trauma
care during the past 15 years, which has provided care for all injured and
provided training for Palestinian health care workers.
Competing interests:
None declared
Competing interests:
No competing interests
15 April 2006
Elihu D Richter
Head Center for Injury Prevention
Rony Blum, Avraham Rivkind
Hebrew University-Hadassah School of Public Health and Community Medicine POB 12272 Jerusalem 91120
Rapid Response:
Comment on Rytter, et al: “Effects of armed conflict on access to emergency health care in Palestinian West Bank:” - BMJ online April 3 2006
Rytter et al’s report attributes a risk for added hospitalizations to
delays from checkpoints, detours, curfews imposed by the Israeli Defence
Forces, (IDF) during January 2005-- described as “a relatively calm period
in the West Bank.” However, a review of their data raises some questions
about the internal consistency and coherence of the findings and their
interpretation. Of all 2228 contacts, 394 (17.7%) were delayed, and of
these, 125 (32%) required hospitalization, resulting in an overall risk of
5.6%. But, 51 of the 125 would have been hospitalized anyway based on
expected risks of hospitalizations in those not delayed for military
reasons.
Therefore, 74 hospitalizations –or 3.3% of all contacts--were
specifically attributable to delays, which were self-reported. Using the
authors’ data on travel times, (18 kph and 15.5 kph in non-delayed and
delayed groups), and estimated average trip length of 15 km, we estimated
median travel times to be 50 minutes and 58 minutes respectively. Although
these estimates omit ranges, it seems a bit odd that a 16% increase in
median travel time---an additional 8 minutes within the golden hour--
should account for 59.2% of the 125 delays. These findings do not make a
persuasive case for the role of IDF checkpoints, detours and curfews in
producing major delays in access to emergency health care.
The period leading up to January 2005 was anything but calm in our
region. From Sept 2004 through Feb 2005, terror attacks, originating
mostly from Palestinian regions, killed 76 and wounded another 234
persons, mostly Israeli civilians, Jewish and Arab, and foreigners. (1)
The checkpoints--themselves not very safe areas-- foiled other attacks and
smuggling of arms. Now they are fewer, having been replaced by the
barrier, an even more effective deterrent. (2)
Since 2000, --and for that matter, 1993, following the Oslo Accords,
the age-sex distributions of the dead among Israelis and Palestinians
suggest that the latter has been engaged in genocidal terror aimed at the
Israeli population, while the former has used force aimed against its
perpetrators, although many innocent bystanders have been caught in the
crossfire. (2,3)
What is striking is the asymmetry between the deaths and injuries
from genocidal terror and the admittedly stressful, but hopefully
inconsequential delays necessitated by the need to protect everyone---
Jews, Arabs, tourists, foreign workers, and others from terror’s lethal
reach, which has included the misuse of Red Crescent ambulances to smuggle
terrorists and weapons past checkpoints.
No one should be denied access to health care anywhere. Israeli
hospitals have done their maximum to ensure that this care was provided to
all during the last 5 years of what the authors call armed conflict. The
authors’ data, if anything, suggest that the IDF is doing what it can to
honor its commitments to clear ambulances within 30 minutes, despite the
dangers.
We suggest that the authors work to persuade the new Palestinian
Hamas government to renounce genocidal terror. Then there would be no
need for checkpoints, curfews, barriers, or soldiers.
Elihu D Richter,* Rony Blum,* Avraham Rivkind**
*Center for Injury Prevention and **Department of General Surgery and
Shock Trauma Unit, Hebrew University-Hadassah Medical Center Jerusalem
Israel
References:
1. Ministry of Foreign Affairs. Victims of Palestinian Violence and
Terrorism since September 2000 Accessed April 6 2006
http://www.mfa.gov.il/MFA-Terrorism
2. Richter ED The Barrier: Protection of the right to life from incitement
and terror in the Israeli-Palestinian Conflict: An Epidemiologic Working
Paper 30 pp (unpublished available on request) Feb 28 2004 Submitted to
International Court of Justice in The Hague
3. Human Rights Watch, Erased in a Moment, Suicide Bombing Attacks Against
Israeli Civilians (Oct 2002) http://www.hrw.org/reports/2002/isrl-pa/
Note for BMJ: Below may be included if possible, but is not
essential.
* Over the past 25 years, EDR has participated in investigations by
human rights groups on the use of tear gas, the health conditions of
Palestinian prisoner detainees, and initiated, supervised and particpated
in joint Israeli-Palestinian projects to investigate and prevent epidemics
of lead poising, asthma in refugee camps, and to assess the distribution
and determinants of lead exposures of children in Israel, Jordan and the
Palestinian Authority. RB is a researcher in trauma and bereavement an
interethnic conflict around the world. AR has overseen Hadassah’s trauma
care during the past 15 years, which has provided care for all injured and
provided training for Palestinian health care workers.
Competing interests:
None declared
Competing interests: No competing interests