Sunday, May 31, 2009


Steven M. Albert • Elihu D. Richter, MD MPH Ted H Tulchinsky, Elliot M Berry
Published in: Vol 373 May 30, 2009 May 30, 2009

Rita Giacaman and colleagues (March 7, p 837)[1] misrepresent trends in public health and health services for Palestinians in the West Bank and Gaza in 1967-94, before the Palestinian National Authority assumed leadership. Population health improved sub stantially under the Israeli Civil Administration.
Major sanitation and disease-control projects included eff orts to bring chlorinated running water to homes, which increased from 24% (1972-74) to 79% (1992) in the West Bank, and from 14% to 93% in Gaza. In the 1970s, oral rehydration campaigns reduced morbidity, hospital admission, and mortality from diarrhoeal diseases. Israeli Civil Administration health priorities included the full spectrum of primary prevention, screening, and workforce development.[2] Vaccine coverage was more than 95% and reached the smallest villages; polio and measles were eradicated.[3],[4] Routine vitamin K for neonates was introduced, along with screening for phenylketonuria and congenital hypothyroidism, and routine vitamin A, D, and iron supplements were provided for infants and pregnant women.

The gains from this period persist. UNICEF data (2009)[5] show that immunisation coverage in the “occupied Palestinian territories” is 99%, above Israeli and Jordanian rates; the proportion of Palestinian infants with low birthweight is 7%, compared with 6% in Lebanon, 7% in Kuwait, 12% in Jordan, and 11% in Saudi Arabia. The Palestinian mortality rate among children younger than 5 years fell from 38 per 1000 livebirths in 1990 to 27 in 2007. Life expectancy at birth rose from 54 years in 1970 to 68 years in 1990 and 73 years in 2007.

The commitment of the Hamas government in Gaza to the destruction of the State of Israel has made cooperation between health establishments very diffi cult. Yet past successes in public health offer a model of the potential of cooperation, mutual benefit, and hope for the future.


THT served with the Israeli Ministry of Health as Coordinator for Health in the West Bank and Gaza from 1980 until 1994 and continues cooperative projects with Palestinian academics in public health to the present time. SMA chairs the Public Health and Medicine Task Force for Scholars for Peace in the Middle East. The other authors declare that they have no confl icts of interest.

Ted H Tulchinsky, Elihu D Richter, Braun School of Public Health (THT, EDR)
Steven M Albert, (Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15232, USA
Elliot M Berry Faculty of Medicine (EMB), Hebrew University-Hadassah, Ein Karem, Jerusalem, Israel;


[1] Giacaman R, Khatib R, Shabanay L, et al. Health status and health services in the occupied Palestinian territory. Lancet 2009; 373: 837-47.

[2] Ministry of Health. Health in Judaea and Samaria and Gaza 1967-1994. Jerusalem: Israel Ministry of Health, 1994.

[3] Tulchinsky TH, Abed A, Shaheen S, et al. A ten year experience in control of poliomyelitis through a combination of live and killed vaccines in two developing areas. Am J Public Health 1989; 79: 1648-55.

[4] Tulchinsky TH, Ginsberg GM, Abed Y, Angeles MT, Akukwe C, Bonn J. Measles control in developing and developed countries: the case for a two-dose policy. Bull World Health Organ 1993; 71: 93-103.

[5] UNICEF. State of the World’s Children 2009. html (accessed March 20, 2009).

Comment: Although a most unfortunate title, it plays inadvertently into our enemies hands, the atricle is well written and designed to counter incorrect charges. I have written the authors suggesting concern with their title.

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