When the Foundation of Care Begins to Crumble
West Bank Healthcare
When the Foundation of Care Begins to Crumble
HATD’s community health work depends on a functioning health system underneath it. Across the West Bank, that foundation is being pushed closer to collapse.
Healing Across the Divides (HATD) currently partners with ten grantees across the West Bank. Their programs address some of the most pressing health challenges facing Palestinian communities: chronic disease self-management, domestic violence, and psychological first aid for children traumatized by attacks from Jewish settlers.
Each of these programs shares a critical dependency: they only work if a functioning health system exists underneath them. When someone’s chronic condition becomes acute, when a survivor of violence needs hospitalization, when a child’s trauma escalates beyond what community-based care can manage, there must be a hospital that can respond.
That foundation is crumbling.
For years, HATD has described the West Bank’s healthcare infrastructure as resembling a developing world health system: already under-resourced, already strained, but carrying an additional burden that almost no developing nation faces: military occupation.
That framing was never meant to be dramatic. It was a straightforward description of what our teams have seen on the ground. What recent reporting now tells us is that even that baseline is deteriorating.
A Health System Being Dismantled Piece by Piece
Two articles recently published in Haaretz lay out the structural causes in stark detail. Together, they describe a health system being dismantled piece by piece.
The financial collapse begins with two interlocking pressures. The Israeli Finance Ministry has seized Palestinian Authority customs revenues on imports, deducting PA payments for water and electricity before passing on what remains. At the same time, approximately 170,000 Palestinians have been barred from returning to their jobs in Israel, a significant blow to both household income and the broader Palestinian economy.
The result: public sector workers, including doctors and nurses, have gone without full salaries for years. Since early May, medical staff in Palestinian public hospitals in the West Bank have been on strike. Even before the strike, many were working only part-time.
The care being delivered today reflects those constraints. Government hospitals are limiting themselves to life-saving treatments only. But even that threshold is compromised. Reduced staffing, shortages of medications and disposable medical equipment, and an inability to fund routine maintenance and repair of existing equipment all mean that “life-saving” care is being delivered under conditions that make it harder to save lives.
Movement is its own crisis. More than 1,000 permanent checkpoints and roadblocks now line West Bank roads. For patients and medical teams alike, this means that reaching a hospital is rarely straightforward. Ambulances must travel circuitous routes. In some cases, medical teams are forced to use the “back-to-back” method: transferring a patient by vehicle or stretcher to a locked gate or roadblock, then moving them to a second ambulance waiting on the other side.
The human cost of those delays is difficult to quantify and impossible to ignore.
What Our Team Is Experiencing
Reporting and statistics tell part of the story. What our team experiences tells another.
Israeli settlers have recently established a presence on a hilltop directly adjacent to where HATD’s Palestinian representative lives. The daily reality of settler attacks across the West Bank makes this more than unsettling. It is a genuine physical threat to her and her family.
The settlement has also brought new checkpoints. Many of them are locked for much of the day, forcing her to take significantly longer routes to reach the nearest town, and the nearest hospital. A medical emergency, for her or for anyone in her community, now means navigating obstacles that did not exist months ago.
This is not an abstraction. It is the daily context in which our partners and the communities they serve are trying to maintain their health.
Why This Matters for HATD’s Work
Community-level health interventions, the kind HATD funds, are built on the assumption that a broader system can catch what they cannot. A self-management program for chronic disease can help someone better control their condition. It cannot replace the hospital that handles a cardiovascular emergency. A domestic violence intervention can provide safety planning and support. It cannot substitute for the acute psychiatric or medical care a survivor may need.
When the system underneath collapses, the effectiveness of every program above it is placed at risk.
HATD will continue to support our grantees and stand alongside the communities they serve. We will keep sharing what we learn, including what the evidence shows about the forces shaping health outcomes in this region.
The situation demands clear eyes and sustained attention. We are committed to providing both.
