“While the COVID-19 pandemic might produce a concerned audience watching theatrical and televised deaths counted by the day and entered into charts and real time updated maps, long lasting, well-engineered, slow, non-theatrical and sometimes ungrievable deaths of a larger scale remain stacked in health disparity reports and colourful human rights organisations’ newsletters. These deaths have become a part of daily normal life, a daily non-dramatic butchers’ bill,” says Osama Tanous, a paediatrician in Haifa explaining the situation for Palestinians to GRIP’s miniseries on the COVID-19 outbreak.
We are already seeing how the impacts of the COVID-19 are unevenly distributed depending on where you live, your job situation, age, class position, gender, ethnicity, the availability of health services, and a range of other factors. In this series, we provide short interviews with scholars and relevant organisations that share their insights and views on how the pandemic might exacerbate or alter existing inequalities across six key dimensions: social, economic, cultural, knowledge, environmental and political inequalities.
In this interview we speak with Osama Tanous, a paediatrician based in Haifa who is also currently pursuing a Master’s in Public Health. Not only explaining how the current COVID-19 outbreak is affecting Palestinians, he also traces the long history of settler colonialism and racial capitalism and how this informs the ongoing responses to the pandemic.
To what extent could we now see health and other inequalities both between and within countries becoming accentuated as a result of the COVID-19 outbreak?
Rudolph Virchow, one of the founding fathers of public health, wrote in 1848 that “Medicine is a social science and politics is nothing but medicine on a grand scale.” He wrote these words after examining the Typhus outbreak in Upper Silesia and having been shocked with the poverty, lack of culture and the wretched conditions of the peasants that allowed such an epidemic to happen. He was certain that if these conditions were removed, the epidemic would not recur. He saw that the interests of the human race are not served by an absurd concentration of capital, land and property in the hands of single individuals. His suggested solution was sharp and clear: the demolition of the old edifice of the state and full and unlimited democracy. Public health research took a long path since then in a mainly liberal direction. Many researchers discuss inequality and injustice, without discussing its origins, its architects and engineers.
Within countries of the global North this inequality in the distribution of the “shared pool of wealth,” with its capital, land, resources, services and infrastructure is a result of different modes of capitalism, unequal citizenship status and marginalization of migrants, even second and third generations, working class and other disenfranchised groups. In the global South capitalist market relations are in many cases much more violent and unrestrained, without effective labour unions and state regulations on food and medicine prices, health services and so on. This overall “collective pool of wealth”, has suffered endless looting in the colonial times, by the exploitation of labour, natural resources and wealth. It continues to shrink in post-colonial times due to the predatory policies of the IMF, The World Bank, WTO and various trade deals between governments in the South and multi-national corporations and governments in the North. This makes inequalities much larger and more destructive.
For indigenous populations in settler colonial states; the USA, Canada, Israel, New Zealand and Australia, have been subjected to all of the mentioned polices of colonial and neoliberal violences and impoverishment. Their collective pool of wealth was entirely confiscated by the settler projects, leaving such populations as surplus populations on various “dumping grounds” in shredded geographies of dispossession fighting for crumbs, leftovers and sometimes donations. Pandemics put this entire system of ongoing injustices that produce unequal distribution of health and diseases on a stress test. So, while Palestinians have lower life expectancy than Israelis and on a regular basis die more frequently of diabetes, heart and lung diseases, these same diseases expose them to a higher mortality risk from COVID-19, as well as being under-screened and having worse access to healthcare.
How are the responses to the COVID-19 outbreak showing the echos of colonial and postcolonial histories in terms of how pandemics are seen?
Panic and anxieties from epidemic diseases was a repetitive theme in colonial history. The control of pathogens and the people carrying them was a main source of concern in British India and Dutch Indonesia. Another repetitive theme in responses to epidemics is the desire to assign responsibility. This discourse of blame exploits existing racist ideas based on religion, race, or class.
After the Nakba – the forced expulsion of the majority of Palestinians from their land in 1948 –Dr. Avraham Katzinilson declared in the Israeli newspaper Haaretz that the complete segregation between the Jewish and Arab populations during wartime was responsible for the absence of infectious diseases like typhus and dysentery. Between 1948 and 1966 – Palestinians that became citizens of Israel were put under military curfew with severe restriction on the freedom of movement. Right after the displacement of Palestinians from villages around Nazareth, especially Eilot and Mjedil, their crowding and concentration in churches and monasteries in Nazareth caused several infections. In a letter to the Minister of Health in 1948, Minster Shitrit described a deteriorating situation with diseases like typhus, malaria and chickenpox erupting. A chickenpox outbreak in the city in November 1948 lead to a month of closure of Nazareth and the surrounding villages and a special field hospital was established to take care of the 55 patients.
In early March, when the Palestinian Ministry of Health (MoH) announced it had confirmed the first seven cases of the coronavirus (COVID-19) in the city of Bethlehem, the Israeli Defence Minister Naftali Bennett was quick to shut down the city. Bennet also declared that if the coronavirus outbreak reaches massive proportions in Israel, “the Defence Ministry will take action”. Of course, the concern was not the health and safety of Palestinians in the city, but rather the threat of them infecting Israelis. Previous announcements of Bennet, like “I’ve killed lots of Arabs in my life, and there’s no problem with that” are well engraved in our memory. Palestinians consequently do not believe that Bennet has a newfound concern for Palestinian lives, whether they die from Israeli bullets or COVID-19.
The nearby settlement of Efrat that had 20 confirmed patients by March 20th, or other Israeli cities with confirmed infections, of course, were not put on lockdown at that time. Later on Israeli Prime Minister Netanyahu asked the “Arabic-speaking public” to follow the instructions of the Ministry of Health, though these were only published in Arabic after a huge delay and in an incomplete form, Netanyahu saying that there is a compliance problem among the Palestinians. No such concerns were expressed about some sections of the Jewish population of Israel, who outright refused to shut down religious schools and businesses. Again, a notion of ungrateful otherness can be noted.
In what ways is the global outbreak of the virus also revealing the underlying political and economic drivers of heightening inequalities within a capitalist system?
In Palestine we need to think beyond classical capital and class analysis and into racial capitalism and settler economy. The accumulation of land and thus capital by the settler state has been at the expense of the dispossession of the native Palestinian. This is true for all Palestinians. Palestinian citizens of Israel, 20% of the population who lives on 3% of the land, had to integrate in the Israeli market as landless peasants living in enclaves of racialized poverty, similar to ghettos. With time these places became more crowded and are not a healthy habitat, lacking safety, green parks or even walkable sidewalks. This population, like many other impoverished and marginalized groups, suffers from higher rates of heart diseases, hypertension and diabetes, all of which significantly increase the risk of mortality from COVID-19. For comparison following the H1N1 pandemic in 2009, indigenous populations in the Americas and the Pacific had three to six fold higher risk of developing severe disease and of dying compared to the rest of the population.
In the West Bank, the situation is much worse and more complicated, a large percentage of the population are refugees, who lost land and capital in the Nakba. Poverty is a natural product of colonization, lack of sovereignty, denied access to water, land and other natural resources and debilitating economic policies and restrictions on imports and exports. A significant percent of the population is a cheap exploitable labour force inside Israel and much of the market is a captive market for Israeli products, so capital circulates back into the Israeli economy. Lately, when some of the laborers had fever and were suspected of having COVID-19, they were thrown back into the Palestinian side of the checkpoint without any tests or coordination. Israeli military occupation, the geographical division by checkpoints and walls and the lack of sovereignty produced a chaotic healthcare infrastructure that is a mishmash of several providers, including the Palestinian Ministry of Health, the UNRWA, the private sector, NGOs and Israeli hospitals based on a permit regime. Such arrangements result in health services that are inaccessible, delayed, unequal and mediocre at best, and that produce premature, unnecessary and avoidable suffering, disabilities and deaths. These fragile services are put to the test with each Israeli cycle of warfare and are now being pushed to the limit with COVID-19.
All of the above mentioned on the West Bank is true in the Gaza strip and stretched to the extreme. Gaza is practically an open-air prison where almost 2 million Palestinians live in one of the most crowded areas on the planet in condensed poverty and under siege, in almost unlivable conditions with an even more vulnerable medical system and situation in terms of medical staff. A COVID-19 outbreak can be dystopic in an already ongoing catastrophe.
The Palestinian refugees in neighbouring countries are stateless, live in excluded refugee camps and are subjected to many economic sanctions and racist xenophobic policies of host countries that might turn harsher under pandemic fuelled racism.
A larger image of Palestinians living in several “dumping grounds,” artificially created and charted by colonial frontier expansion can be seen. These broken geographies host a population largely considered surplus to the settler project and the new world order. The usual disposability politics of citizen-consumer, with low consumption abilities and much unneeded labour in a post-industrial society intersects with racial settler colonial, neoliberal and military tactics to produce unwanted, unnecessary and ungrievable others left to be surveilled, ignored and to disappear.
What might a global and equitable response to the outbreak look like, and are there experiences from the Palestinian, Israeli or Middle Eastern context that global stakeholders or researchers concerned with inequality should be mindful of?
These are tricky questions. While the COVID-19 pandemic might produce a concerned audience watching theatrical and televised deaths counted by the day and entered into charts and real time updated maps, long lasting, well-engineered, slow, non-theatrical and sometimes ungrievable deaths of a larger scale remains stacked in health disparity reports and colourful human rights organisations’ newsletters. These deaths have become a part of daily normal life, a daily non-dramatic butchers’ bill and came to be accepted “as natural as the air around us,” following the phrasing of the Norwegian sociologist Johan Galtung.
While it is of course important to use this momentum of global concern with health care systems, infrastructures, number of hospital beds and ventilators per capita in different parts of the world and especially the global South or in places lacking universal healthcare, it is important to also draw attention to states that are racializing and militarizing their interventions. Israel for example had a blind spot for its Palestinian citizens in terms of publications of instructions, testing, screening and mapping. Palestinian communities became problematic blind spots while Jewish orthodox towns became a target for heavy screening and intervention. Such racialized policies are potentially deadly and those responsible should be held accountable.
Another troubling yet expected phenomena, was the militarization of the medical discourse. The Israeli health, military and intelligence systems fused together in response to the pandemic. Mossad, the Israeli intelligence/spy agency, purchased over 100,000 coronavirus test kits in a complex mission from two countries with whom Israel has no diplomatic relations. The army launched “Operation Save Grandma” to convert hotels into quarantine facilities and the Shin Bet, the domestic intelligence agency charged with surveilling Palestinian citizens, was authorized to use a technology developed primarily for counterterrorism purposes in order to identify people that may have come into contact with infected patients. Rafael, the weapons development and manufacture company, offered to provide the state with an even more developed system able to invade audio, video, texts and location in phones to map and predict the pandemic spread. A normalization of the fusion of these systems together will be a slippery path to further increasing racialized state surveillance and possibly increasing violence.
Other points for the global community to tackle might include:
- What is preventing Palestinians, or any other group subjected to different forms of colonization, marginalization, ghettoization and racism, from developing and accessing viable healthcare systems?
- Exposing the hypocrisy of the actions of the same bodies and policy makers that engineer oppression, misery and injustice via tactics ranging from actual bombardments and shootings to sieging, collective punishment, sanctions, exploitation and blocking access to healthcare. The same policies that produce avoidable and unnecessary deaths pre- COVID-19 times and even more so in COVID-19 times, gain international legitimacy and are sometimes even awarded for humanitarian aid and viewed as partners in the aid process of their victims and of other victims.
- At times of emergency, considering all lives as equal and worthy of screening and caring. Making sure enough test kits are sent to communities not able to or prevented from purchasing them and making sure food and medicine supplies are not interrupted.
- Focusing media attention on how quarantine and emergency laws are being used to intensify police and military brutality in some communities like Palestinians in Jaffa, Jerusalem, the West Bank and the Naqab.
As for local experiences, big loose networks built on social cohesion exist in different parts of Palestine. From a shoemaker changing his production line to make masks, to local community networks mapping vulnerable families and supplying them with food, financial support and medications, to women organizations offering solutions for children. Palestinians have long learned not to rely on their occupiers and donors for help.