Palestinian man sits in his wheelchair in front of his house in the Al Azza refugee camp in the West Bank town of Bethlehem March 30, 2006. (MaanImages/Magnus Johansson)

Life quality

Quality of Life measures are increasingly being used to assess health outcomes worldwide. These measures help to achieve a deeper understanding of the impact of protracted conflict on the health of the population. The World Health Organization (WHO) developed a Quality of Life tool and ran trials with it in 23 countries.1

Since the second intifada the Palestinian people in the occupied Palestinian territories have been confronted with increasingly brutal behaviour from the Israeli military forces. Until now emphasis has been placed on counting the dead and the injured, and on morbidity and access to health and other services problems. However, no attempt had been made to assess the consequences of the intensified conflict, the severe closures and siege, and spiraling unemployment, on life quality, nor to document the views, worries, needs, and the suffering of the Palestinians living in the West Bank and Gaza. This lack prompted the pilot Quality of Life study in the occupied Palestinian territories. A sample of 1,008 Palestinians was drawn from the general population and a set of context-relevant items was added to the Quality of Life tool without affecting its consistency and face validity.

Findings

Interviews were held with 1,008 Palestinians living in the West Bank and Gaza. Of the Palestinians interviewed, 25.6 per cent consider their life quality as ‘poor’ or ‘very poor’, and more than 21.2 per cent suffer ‘a lot’ or ‘extremely’ from physical/bodily health problems that negatively influences their ability to function, as well as their life quality. In relation to daily life, about 38.2 per cent do not enjoy ‘at all’ or enjoy ‘just a little’ daily life activities; roughly the same amount feel frustrated, anxious, fed up with life, and almost one in two feel bored.

Overall, about one in four Palestinians report suffering ‘a lot’ or ‘extremely’ from psychological strain. The reasons for this suffering are more than apparent: 28.5 per cent reported a close relative killed or imprisoned; 52.5 per cent have to cross Israeli army checkpoints to pursue daily life activities, such as getting to work, school, university or services; 26.5 per cent in the West Bank live close to an Israeli settlement, with 80.8 per cent reporting being negatively affected. Almost 19.8 per cent live close to the wall, with 87.2 per cent feeling negatively affected.

A very high proportion of those interviewed (72.6 per cent) do not have access ‘at all’ or ‘only a little’ to leisure activities and 42.8 per cent do not consider their physical environment healthy ‘at all’ or ‘a little’. Almost one in two Palestinians are dissatisfied ‘a lot’ or ‘extremely’ with their living environment.

One out of every three Palestinians suffer a lot or extremely from financial problems. The results show that 42.6 per cent do not have money ‘at all’ to meet their individual or family needs or ‘only a little’; two out of every ten need to borrow money to make ends meet; the same proportion are in severe debt; four out of ten postpone paying bills to manage. Further, 49.7 per cent are not able to bear sudden medical expenses.

Nearly half of the respondents seriously fear losing their home (45.5 per cent), their land (46.1 per cent), or to be displaced or uprooted (44.5 per cent).

Of the Palestinians interviewed, 68 per cent are very much worried about the future and 70.5 per cent fear chaos in Palestinian society. In addition, almost half are dissatisfied with the political leadership of their community.

More results conclude that 65.8 per cent feel ‘always’ or ‘very often’ angry over what Israeli military occupation is doing to them and 63.4 per cent ‘always’ or ‘very often’ experience humiliation by Israeli military action. Nearly eight in ten people are seriously negatively affected by the ongoing conflict and Israeli military occupation and 78.5 per cent by closures and siege, 62.7 per cent by the Wall.

How does Palestinian Quality Of Life compare with other countries in the world?

The findings of the pilot Field Trials of the World Health Organization’s WHO-QOL-Bref in 23 countries2 involving a sample from the general population made of sick and well respondents, as well as from hospitals and primary care centres, were compared with those in the West Bank and Gaza whose sample was drawn from the general population. The results of the research in the 23 countries will be referred to as the Pilot.

The Palestinian population reported significantly worse Quality of Life (QoL) with 18.7 per cent of the Palestinians reporting poor QoL compared to 9.1 per cent of the population of the Pilot, and with 6.9 per cent of the Palestinians reporting very poor QoL compared to 2.3 per cent of the Pilot population.

Despite the fact that the sample in the West Bank and Gaza did not specifically target sick persons and was randomly drawn from the population at large, the respondents reported significantly more pain and discomfort; energy and fatigue problems; sleep problems (31.7 per cent for the occupied Palestinian territories (oPt) compared to 21.4 percent for Pilot); activities of daily living problems, and reduced working capacity (66 per cent for oPt compared to 20.3 per cent for Pilot).

The Palestinian respondents report significantly less positive feelings, more negative feelings, less self esteem, less ability to think and concentrate, and less satisfaction with oneself compared to Pilot.

However, the Palestinian respondents reported significantly better satisfaction with personal relationships compared to the Pilot. Furthermore, this was the only domain where oPt respondents reported better QoL compared to the Pilot. These results are not surprising as Palestinian culture is collectively based, and social support and social cohesion are strong, and the political and economic history and realities that people have endured and continue to endure require high levels of community cohesion for communal survival.

Of the Palestinian respondents, 42.1 per cent reported poorly for satisfaction with financial resources compared to 27.2 per cent for the Pilot; 75.8 per cent do not have access ‘at all’ or ‘only a little’ to recreation and leisure for the oPt compared to 28.5 per cent for the Pilot; 45.4 per cent for poor satisfaction with physical safety and security for the oPt compared to 13.7 per cent for the pilot, and 42.8 per cent for poor satisfaction with the physical environment for the oPt compared to 13.5 per cent for the Pilot.

Sombre perspective

In March 2006, the World Bank wrote an Economic Update and Potential Outlook on the West Bank and Gaza.3 Several scenarios were modelled by World Bank staff. The most damaging scenario is unfolding with Israel refusing to transfer Palestinian tax income, and further trade and labour restrictions. Aid flows will be reduced due to the negative response of Europe and the United States to the vote for Hamas. According to the World Bank, the real GDP per capita will decline by 27 per cent in 2006, and personal incomes by 30 per cent. In 2008, the cumulative loss in real GDP per capita since 1999 will have reached 55 per cent. Unemployment rate will reach 47 per cent and poverty 74 per cent by 2008. If in 2008 a Quality of Life survey among the Palestinian people living in the West Bank and Gaza would be repeated, it is not difficult to predict that it will reflect the consequences of the strangulating measures of Israel and the European Union. Are we going to wait for this in silence?

Adri Nieuwhof is a psychologist and human rights advocate based in the Netherlands

Endnotes

[1] The WHO-QOL Bref is a list of indicators tested in the following countries: Argentina, Australia, Brazil, Bulgaria, China, Croatia, Germany, Greece, Hungary, Israel, Italy, India: Madras and New Delhi, Japan, Malaysia, Netherlands, Nigeria, Norway, Romania, Russia, Spain, Turkey, United Kingdom, and United States.

[2] See footnote 1.

[3] West Bank and Gaza - Economic Update and Potential Outlook, Worldbank (15 March 2006)

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