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The Gaza Strip has recently witnessed a growing trend of doctors’ immigration a result of many complications including the Palestinian political division. In addition to being forced to think about migration due to the clashes of Hamas and Fatah, countless doctors migrate because of the blockade and their experiences every time Israel attacks Gaza.
The repercussions of the Palestinians’ internal division have not been purely political; the medical sector has also been affected greatly.
Dr Saeed al-Zinati exemplifies the situation. For nine years, he only received part of his monthly salary for his work in a Hamas-run hospital in the Strip.
Al-Zinati, a urologist, refused to stay at home after the administration split in 2007. At the time, the Palestinian Authority called on workers in Gaza’s medical sector to boycott the Hamas government and its institutions. The Authority regarded Hamas’ government as dismissed after it took over the Strip. While the Authority promised to pay the wages of those who refrained from working at Hamas-affiliated hospitals, it denied payment to those who did work at these hospitals.
On the other hand, Hamas paid those who were denied salaries by the Authority. However, since the fall of the Muslim Brotherhood in Egypt, Hamas’ greatest supporter at the time, the movement experienced a financial crisis, which left it unable to pay wages to workers in the medical sector.
Al-Zinati resigned after financial hardship left him unable to provide for his two sons studying medicine in Jordan. He resigned to open a private clinic, which he had been unable to do while working at a public hospital. The General Department of Internal Control at the Ministry of Health in Gaza puts restrictive measures on doctors working in Gaza’s hospitals to ensure they do not open private clinics to treat public hospital patients for extra income. Doctors’ low income naturally forces them to either resign to open a private clinic or migrate in search of a better life.
Describing the current situation in Gaza, al-Zinati told Fanack, “Doctors no longer have value in Gaza. They are the victim of the Palestinian division. Doctors are asked to commit to working under pressure in wars and crises. In return, they get neither financial security nor appreciation from authorities. I did not forfeit my humanitarian duty for nine years, but now I struggle to secure a good future for my sons.”
Because of their poor financial conditions, Gaza’s residents are forced to seek free medical care. Waiting times for treatment in outpatient clinics of public hospitals can be months.
Aa’ed al-Najjar is one of these patients. He is 54 years old, poor and has been unemployed for years. He suffered a herniated disc in his back and needs regular follow-ups with a neurosurgeon.
He told Fanack, “I need regular follow-ups, but I can’t pay for a medical check that’s 100 shekels ($28.5) because I am poor. When the medical check is due after waiting as many as two months, I wait four hours to get to the doctor because of the overcrowded clinic. Even the medicine, I get most of it from the government free of charge, and I cannot buy the medicines they don’t have.”
Gaza has had a very high unemployment rate since Hamas took over. Figures by the Palestinian Central Bureau of Statistics show a considerable difference in unemployment between Gaza and the West Bank. When it was 47 per cent in Gaza in 2021, it was only 16 per cent in the West Bank. While unemployment among fresh graduates in Gaza reached 74 per cent, it only amounted to 36 per cent in the West Bank.
The number of unemployed people over 15 years of age reached 372,000 in 2021, 230,000 of whom live in Gaza and 142,000 in the West Bank.
The Palestinian division drove young minds out of Palestine, especially those studying abroad aided by scholarships. According to Majed Taha, a doctor from Gaza working in Canada, not many Gazan graduates return to the Strip because of occupational insecurity.
Taha, a 31-year-old doctor, studied medicine at the University of Sousse in Tunisia in 2010. Taha returned to Gaza in 2016 only to face troubles and problems due to unemployment. He had no choice but to volunteer at the well-known al-Shefaa’ hospital by the end of 2016. He then worked six months on a supposedly annual contract that, however, only covered 11 months.
He decided to migrate in mid-2018 when he applied to several European and American universities to resume his studies. Applying to one of Montreal’s hospitals, on his seventh attempt, he landed a job. Since then, Taha has been working at this Canadian hospital and preparing to specialise in neurology.
He says, “I studied medicine in Tunisia alongside 18 other Palestinians from Gaza. Most of them practise medicine outside the Strip, and others continue their specialised studies outside Palestine. Only one of us was hired under an annually renewable contract at one of Gaza’s hospitals.”
He adds, “I suffered quite a lot when I worked as a doctor in Gaza, as the political and financial conditions constantly damage the medical sector. Doctors are like any other citizen; they live without hope for the future and have no access to basic needs. As young doctors, we don’t have the capabilities to open private clinics or practise a different profession. Because of this, many graduates find emigration an opportunity for a better future.”
Outpatient clinics are always overcrowded, with patients waiting in line for a medical check-up by a specialist. This includes orthopaedics, otolaryngology, urology, cardiology, neurology, and nephrology clinics, according to the director general of hospitals in the Ministry of Health in Gaza, Muhammad Zaqout.
On the other hand, the total number of hospitals and clinics is 30 at most. In early 2016, the capacity of these hospitals and clinics stood at 1.3 beds per 1000 residents of Gaza, according to World Bank statistics. This count includes 13 public hospitals in the Strip, which have a capacity of 2.824 beds, representing 79 per cent of hospital beds in the Strip.
There is only one mental health hospital in the Gaza Strip, which means that this hospital provides services to more than 2.3 million Gazans. A UN report published in September 2022 noted that a third of Gaza’s residents need mental and social support after more than 15 years of blockade.
Patients visiting hospitals and outpatient clinics have increased noticeably in recent years. According to a report published in September 2021 by the Ministry of Health in Gaza, 45% to 59% of patients visit specialised doctors’ outpatient clinics.
Scarce Medical Professionals
In 2020, a statistic by Hamas’ Ministry of Health indicated that every 1000 Gazan gets treated by 1.3 physicians. Specialists believe this is an insufficient number for a society living in such harsh conditions with multiple crises, such as infections and diseases, caused by constant wars.
Half of the Strip’s doctors receive salaries from the Palestinian Authority. From time to time, these doctors fall victim to the political rift between Fatah and Hamas. A recent example occurred in July 2022, when 42 doctors with different specialisations quit working at Kamal Adwan hospital in the northern region of the Strip. They did so per the instructions of concerned parties in the Palestinian Authority, from which these doctors receive their salaries.
For years, workers in Gaza’s government have received 60 per cent of their monthly salaries. Recently, Hamas had to cut wages to 40 per cent due to the escalating financial crisis.
On the other hand, Dr Fadl Na’eem, Dean of the Faculty of Medicine at the Islamic University of Gaza, labelled the emigration of doctors as “an exaggeration.” He based his view on the fact that over 100 doctors graduate from accredited medical colleges in the Gaza Strip every year.
Dr Fadl told Fanack, “The emigration of doctors is probable in any society facing such harsh economic conditions. When medical graduates fail to find a job, they migrate to find a better opportunity abroad. Thus, I believe that the medical sector’s dilemma won’t be solved with more medical professionals. Rather it needs medical institutions, equipment and advanced technologies.”
Gaza’s medical sector has been unstable during the past 15 years, which has led to a continuous dependence on the referral of patients to hospitals in Israel, the West Bank and Egypt. According to a report issued by the Ministry of Health in 2021 concerning specialised treatment in the Strip, the number of referrals reached 18,000.
Doctors will likely continue their flights abroad as Gaza’s medical sector remains on this path. As a result, Palestinian patients will suffer even more since they have no option but to wait months for treatment in clinics or referrals to specialised hospitals outside Palestine.