Infant Mortality Rates in Gaza, West Bank, and Israel From 1975 to 2018
By: Laila Shadid/Arab America Contributing Writer
The Israeli-Palestinian conflict has caused loss, suffering, and a current refugee population of around five million, as well as disparities in infant mortality rates among the respective populations. This multifaceted, nuanced conflict largely began with the 1948 Arab-Israeli War, where Israel captured the area proposed by the 1947 United Nations Partition Plan, as well as sixty percent of the proposed Arab state. Since 1948, Palestinians have lost increasingly more land as a result of land wars and illegal Israeli settlements in the occupied West Bank (see Figure 1).
The two Palestinian areas which this article will focus on are the Gaza Strip (hereby referred to as “Gaza”) and the West Bank.
Gaza is a densely populated strip of land stretching 25 miles along the Mediterranean Sea, bound by Israel and Egypt, with a population of about two million. In 2007, Israel imposed a blockade on Gaza after Sunni-Islamic fundamentalist militant organization Hamas took power. Since then, Gaza has deteriorated socioeconomically and undergone numerous armed conflicts, affecting education, food supply, and, for the purposes of this article, healthcare.
Living conditions in Gaza are dismal because of Israeli sanctions, coupled with the dense and increasing population. The three main factors contributing to poor healthcare include power cuts and instability, deteriorating medical equipment due to the blockade, and shortages in essential drugs.
The West Bank
The second Palestinian territory is the West Bank. This area is the larger of the two (see Figure 1) which borders Jordan and the Jordan River. Since the 1967 War, Israel has occupied the land and pushed out hundreds of thousands of Palestinians who resided in the territory. The West Bank is the hotspot for the Israeli-Palestinian conflict, and despite the overwhelming occupation, is under partial control of the Palestinian Authority.
As WHO stated: “The situation in the occupied Palestinian territory is characterized by years of occupation, political stalemate, violence, restrictions on access and movement and persistent human rights violations.” The healthcare system in the West Bank is hugely affected by the “Separation Wall” (see Figure 2), which isolates the West Bank from Israel, and cuts off 3.3 million people from access to land, education, healthcare, and other necessities, as well as freedom of movement. The wall restricts Palestinians from accessing healthcare by restricting the movement of patients, doctors, ambulances, medication, and additional medical supplies and essential items.
Ultimately, the health of Palestinians in Gaza and the West Bank suffers from the Israeli-Palestinian conflict. This article will specifically review infant mortality rates (IMR) in these two territories in comparison to Israel between 1975 and 2018. Common factors that influenced infant mortality were preterm birth, congenital anomalies, and inadequate neonatal care in hospitals. This article is interested in comparing the IMR in Israel to that of the West Bank and Gaza to determine if Israeli occupation and blockade negatively affect the health of Palestinian populations.
Data and Methods
The data for this project was all retrieved from The World Bank, under the “World Development Indicators.” To ensure consistency and accuracy, the IMR estimates were developed through the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), which comprises the United Nations Children’s Fund (UNICEF), WHO, The World Bank, the United Nations Population Division, as well as other universities and research institutes.
According to IGME, the data originates from vital or sample registration systems, a survey or census collecting full birth histories, birth summary histories, or information on household deaths, as well as life tables. This article uses two sets of data: annual IMR estimates from the West Bank and Gaza—combined as one entity—and IMR estimates from Israel, both between 1975 and 2018.
The time range used is due to the availability of data. The earliest data point for Israel’s IMR was from 1974, while the West Bank and Gaza began in 1975. To compare the two sets of data, the article omitted Israel’s IMR in 1974 and began both data sets with their IMRs in 1975. Each data set provides an IMR for every year between 1975 and 2018. The data combines both female and male IMRs.
What is IMR?
IMR is an important indicator of health for populations, often reflecting other measures of development in a country or territory such as socioeconomic status, living conditions, social well-being, prevalence of illness, and quality of the environment. IMR is calculated as the number of deaths under the age of one year, per every 1,000 live births in the same year.
IMR in the Gaza Strip, West Bank, and Israel
In 1975, the IMR for both areas were at their highest; the IMR in Israel was 22.4 deaths per 1,000, and the IMR in Gaza and the West Bank was 76.7 deaths per 1,000 (see Figure 3). In 2018, both areas hit their lowest IMR; the IMR in Israel was 3.1 deaths per 1,000, and the IMR in Gaza and the West Bank was 17.3 deaths per 1,000. Israel’s IMR decreased by 86 percent between 1975 and 2018, while Gaza and the West Bank decreased by 71 percent. Israel’s IMR decreased by 15 percent more than Gaza and the West Bank.
Infant deaths in Gaza and the West Bank per every one infant death in Israel
For every year between 1975 and 2018, Gaza and the West Bank had an IMR between 3 and 6 times that of Israel (see Figure 4). The largest disparity between the two was in 2013 when it was 5.76 times more likely for an infant to die in Gaza and the West Bank than Israel. The lowest disparity in IMRs occurred in 1975 when it was 3.42 times more likely for an infant to die in Gaza and the West Bank than Israel. The disparity in IMRs increased by 39 percent between 1975 and 2018. The average over 43 years was 4.54 infant deaths in Gaza and the West Bank per every one infant death in Israel.
The findings in the Results support the expected findings stated in the hypothesis: Israeli occupation and blockade negatively affect the health of Palestinian populations.
Although IMRs have steadily decreased in both Gaza and the West Bank and Israel, the disparity between the two has steadily increased. One explanation for this phenomenon is that, while Israel is advancing its medical technologies and healthcare system freely, Gaza and the West Bank’s healthcare is suffering under occupation, sanction, and restriction, and as a result, infants are dying.
As discussed in the introduction, causes of infant mortality in Gaza and the West Bank, such as preterm birth, congenital abnormalities, or poor neonatal care, could be partially caused, and most likely exacerbated, by Israeli control. The difference in IMR highlights the effect of this conflict on the Palestinian population and the poor health infrastructure that this demographic must operate in.
Moreover, Israel’s IMR is low on a global scale, beating the United States by 2.5 deaths per 1,000 in 2018, when the U.S. had an IMR of 5.6 deaths per 1,000. Little research has compared or acknowledged the striking disparity in IMRs between the Israeli and Palestinian populations living in Israel-Palestine, possibly due to the controversy of the conflict.
Regardless of race, religion, or sect, both Israeli and Palestinian infants are born in the same region and should have access to the same healthcare and be afforded the same chance of survival in their first year of life. It is beneficial to reframe this political issue as a health issue to save infant lives. These children have no say in the conditions, families, or regions they are born into—they are the voiceless people often forgotten in conflict. These are unnecessary deaths that deserve more attention, deaths which humanize the Palestinian population.
In the short term, action must be taken to reduce restrictions and sanctions on Gaza to allow for easier transportation of medical supplies and movement of Gazans to areas with more comprehensive healthcare. The same applies to the West Bank, which is more equipped than Gaza, but far from developed compared to Israel. In the long term, Israel and Palestine must reach a solution to this ongoing and gruesome conflict, where every infant and person living in the region has access to advanced healthcare.
Editors of Encyclopedia Britannica. “Gaza Strip: Definition, History, Facts, & Map.” Encyclopedia Britannica, inc. January 28, 2020. https://www.britannica.com/place/Gaza-Strip. Accessed May 5, 2020.
Editors of Encyclopedia Britannica. “West Bank: Definition, History, Facts, & Map.” Encyclopedia Britannica, inc. January 24, 2020. https://www.britannica.com/place/West-Bank. Accessed May 5, 2020.
“Israel-Palestinian conflict: Life in the Gaza Strip.” BBC World News. May 15, 2018. https://www.bbc.com/news/world-middle-east-20415675. Accessed May 4, 2020.
Keelan, Emma. “Medical Care in Palestine: Working in a Conflict Zone.” The Ulster Medical Society. January, 2016; 85(1):3-7. Accessed May 4, 2020.
“Mortality rate, infant (per 1,000 live births).” The World Bank. https://data.worldbank.org/indicator/SP.DYN.IMRT.IN. Accessed April 12, 2020.
“Palestine Refugees.” United Nations Relief and Works Agency for Palestine Refugees in the Near East. https://www.unrwa.org/palestine-refugees. Accessed May 4, 2020.
Reidpath DD, Allotey P. “Infant mortality rate as an indicator of population health.” Journal of Epidemiology & Community Health. May 1, 2003; 57:344-346. Accessed May 4, 2020.
“The occupied Palestinian territory: providing health care despite the lack of a stable environment.” World Health Organization. February, 2011. https://www-who-int.proxy.library.upenn.edu/hac/crises/international/wbgs/highlights/february2011/en/. Accessed May 3, 2020.
van den Berg MM, Madi HH, Khader A, Hababeh M, Zeidan W, Wesley H, et al. “Increasing Neonatal Mortality among Palestine Refugees in the Gaza Strip.” April 8, 2015. PLoSONE 10(8): e0135092. doi:10.1371/joumal.pone.0135092. Accessed April 25, 2020.
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