Can action on health achieve political and social reform?BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38980.664074.94 (Published 19 October 2006) Cite this as: BMJ 2006;333:837
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2 November 2006
Jabbour et al (BMJ 21 Oct 2006) discuss health in the Arab world and
assert that "in the late 1970s, Israeli neglect of health in the Occupied
Palestinian Territory…". I was the supervisor in the Israeli Ministry of
Health of health in the Territories during the 1980s to 1994, and I beg to
During this period, the Israeli authorities, working with senior
Palestinian professionals, adopted health programs which made a major
improvement in health of the Palestinian population, with a focus on
infants, children and women. A study by UNICEF reported a decrease in
infant mortality from 75/1,000 and child mortality from over 100/1,000
live births in 1978 to 35 and 38, respectively, in 1991.
The immunization program in the West Bank and Gaza for the
Palestinian population prior to 1967 was poor, and was given top priority
during the 1970s reaching equivalence to, and in some cases better than,
the Israeli immunization program. Control was established of epidemics of
poliomyelitis and measles as well as a massive reduction of tetanus (1-6)
and diarrhoeal disease hospitalizations and mortality.
The Israeli governmental health service provided visiting
immunization teams to all villages in the West Bank without onsite
clinics. The Gaza population was served by government or UNRWA clinics
with vaccines provided by the Israeli Ministry of Health. Rural primary
care was provided in the 10 cities and over 450 villages in the West Bank
in 1992 with 147 government clinics, 51 village health rooms, 20 UNRWA
clinics, 131 NGO clinics and 152 private clinics. In the 1980s an
innovative Village Health Guide program was developed by the Israeli
Ministry of Health with UNICEF help under the local management of
Palestinian health personnel. By 1994 this program had brought primary
care to some 90 small villages previously served only by visiting
immunization teams (7).
The Israeli administration arranged massive training programs for
medical personnel and nurses from hospitals and community based services
that were carried out in Israeli hospitals with parallel development of
dialysis centers in all government hospitals in the West Bank and Gaza. As
an example, anesthesiologists were trained for 3 years in Israeli
hospitals and returned to upgrade this vital service in all government
hospitals in the WB and Gaza (8). From 1985, infants attending
governmental clinics received vitamins A, D and iron supplements,
resulting in improved growth patterns (9).
Many developments from that period were carried on after 1994
turnover of health services to the Palestinian Authority. Some programs
such as the village health rooms were expanded by the Palestinian
Authority. Sadly some of the important innovations of that period were
dropped by the PA such as routine vitamin A, D and iron supplements for
infants, possibly explaining findings of stunting in children in recent
years. Some of the successful developments, such as the immunization
program in the Palestinian health program in the 1970s to 1990s (e.g.
combined OPV and IPV for polio control) were emulated in neighboring Arab
countries, as well as in Israel.
TH Tulchinsky MD MPH,
Hebrew University-Hadassah School of Public Health and Community
Medicine, Ein Kerem, Jerusalem, Israel email@example.com
1. A ten year experience in control of poliomyelitis through a
combination of live and killed vaccines in two developing areas. Am J
Public Health, 1989;79:1648-1655.
2. Tulchinsky TH, Abed Y, Ginsberg G, Shaheen S, Friedman JB,
Schoenbaum M, Slater PE. Measles in Israel, the West Bank and Gaza:
continuing incidence and new strategies for eradication. Rev Infect Dis,
3. Tulchinsky T H, Friedman JB, Acker C, Ben David A, Slater PE.
Tetanus in Israel, the West Bank, and Gaza, 1968-1988: progress and
challenge. Isr J Med Sci, 1990;26: 438-441.
4. Tulchinsky, TH, Ginsberg GM, Abed Y, Angeles MT, Akukwe C, Bonn J.
Measles control in developing and developed countries: the case for a two-
dose policy. Bull WHO, 1993; 71:93-103.
5. Tulchinsky TH, Abed Y, Handsher R, Toubassi N, Acker C, Melnick J.
Successful control of poliomyelitis by a combined OPV/IPV polio vaccine
program in the West Bank and Gaza, 1978-1993. Isr J Med Sci, 1994;30:489-
6. Goldblum N, Gerichter ChB, Tulchinsky TH, Melnick JL.
Poliomyelitis control in Israel, 1948-1993: changing strategies with the
goal of eradication in an endemic area. Bull WHO, 1994;72:783-796.
7. Tulchinsky TH, Al Zir AM, Abu Munshar J, Subeih T, Schoenbaum M,
Roth M, Gamulka B, Acker C. A successful, preventive-oriented village
health worker program in Hebron, the West Bank, 1985-1996. J Public Health
Man Practice, 1997;3:57-67.
8. Tulchinsky TH, Shemer J. Health services in Gaza under the
autonomy plan. Lancet. Letter to Ed. 1994;344:478.
9. Tulchinsky TH, el Ebweini S, Ginsberg GM, Abed Y, Montano-Cuellar
D, Schoenbaum M, Zansky S, Jacob S, El Tibbi AJ, Abu Sha'aban, Koch J,
Melnick Y. Growth and nutrition patterns of infants in association with a
nutrition education/supplementation program in Gaza. Bull WHO,
I was Coordinator of Health for the West Bamk and Gaza fro the Isreali Ministry of Health during 1980 to 1994
Competing interests: No competing interests