The billions of aid dollars poured into the Palestinian territories in the past 15 years have failed to bring about development because donors have overlooked everyday insecurity, health researchers say.

Some $9.4 billion in aid disbursed since 1994 has not met its goals, with evidence in recent years pointing to a reversal in development in the Gaza Strip and West Bank, according to a study in a special issue of the Lancet medical journal focusing on Palestinian health.

Rajaie Batniji of Oxford University, one of the study's authors, said the international community had done little to stop threats to the basic security of the territories' 3.8 million inhabitants, targeting the effects of the violence rather than its causes.

"Ensuring that every person has the security to survive, to function normally is a requirement for development efforts to work," he said. "Giving aid without doing things to open the economy, giving aid without taking measures to ensure people are safe might not achieve the effects we're all hoping for."

Batniji's team analysed direct threats to Palestinians' security, including aerial bombings, the use of guns by the Israeli military, demolition of homes and land confiscation.

Since 2000, some 6,100 Palestinians have been killed by Israeli military action, and another 600 by fighting between Palestinian factions, according to the study. Over the same period, more than 35,000 have been wounded in the conflict.

INSECURITY HARMS HEALTH

The study also explores indirect threats to human security, which spring from "an interlocking web of checkpoints, barriers, border closures, curfews and the permit system imposed by Israel". Symbolic of these is the towering security barrier Israel began building in 2002, a 720 km (447 mile) construction separating Israeli settlements from Palestinian communities in the West Bank.

"While the causes of social exclusion, unemployment and hunger need uncovering in other parts of the world, in the Occupied Palestinian Territory (OPT) some social determinants of health are eight metres tall and others turn homes to rubble," Batniji told reporters in London.

Between 2000 and 2006, the Ministry of Health reported 69 cases of Palestinian women giving birth at Israeli checkpoints, while 10 percent of women in labour were delayed for two to four hours on their way to medical facilities, according to the Lancet.

Another paper on health status and health services points out how improvements in infant and child mortality have stalled since 2000, and stunting in children rose from 7.2 percent in 1996 to 10.2 percent in 2006, reaching 30 percent in some parts of Gaza. Rates of tuberculosis and mental disorders have also increased amid an upsurge in poverty, hunger and unemployment.

The Palestinian health system is fragmented and inadequate due to a lack of development under Israeli military rule and mismanagement by the Palestinian Authority, the paper says, meaning many patients have to be referred to countries like Egypt and Jordan for treatment.

"Hope for improving the health and quality of life of Palestinians will exist only once people recognise that the structural and political conditions that they endure ... are the key determinants of prevailing health conditions," concluded the authors.

PSYCHOLOGICAL TRAUMA

Researchers say it is too early to know the full consequences of the 22-day Israeli offensive launched in December. Besides the immediate effects of serious injuries, damage to health facilities, and food and water shortages, they expect longer-term impacts from mental trauma, displacement and rising unemployment following the destruction of farms and factories.

"It is very clear that initially everybody is saying this is the scale of an earthquake, this is a disaster," said Rita Giacaman of the West Bank's Birzeit University. "Those who are living are severely traumatised."

Giacaman said the conflict had compounded the distress experienced by Palestinians over the past six decades, as they have lived with the threat of violence, expulsion and land seizure.

"The bulk of people have mental health problems," she said. "We need to recognise that in the OPT, the home front is the battle front ... The battle front is at your doorstep, where people endure the social suffering of war daily."

Giacaman said that, in most cases, mental stress had not yet manifested itself in sickness. But Tony Laurance, head of the World Health Organisation office for the West Bank and Gaza, said health professionals were particularly worried about the effects of the latest offensive on children.

"Families are reporting a lot of primary symptoms of distress, anxiety, bed-wetting that will need urgent attention to which there has been a very partial response so far," he told journalists.

This week, international donors pledged $4.5 billion of new aid to help the Palestinian economy and rebuild Gaza after Israel's offensive, although they insisted their funds should bypass the territory's Hamas rulers.

Awad Mataria of Birzeit University said the money could help alleviate medical suffering but would be most effective if used to tackle the political factors behind the conflict. "If we want to improve health, we have to deal with the causes of the occupation," he said.

Giacaman urged donors to go beyond meeting the immediate needs of the crisis-hit population. "Humanitarian aid is not enough," she said. "We need to address the Israeli military occupation of Palestinian land and the severe violation of human rights, including health rights."

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