Visualizing health disparities in war and peace: Israel vs Palestine

Palestinian women sit on the rubble of their home in Beit Hanoun, Gaza Strip, Friday, Aug. 1, 2014. AP

Conflict between Israel and Palestine has resumed, with Israeli airstrikes killing top Hamas leaders and Hamas executing Palestinians they suspected of collaborating with Israel. The deadly cycle begins again, with civilian casualties mounting in Gaza as leaders on both sides blame each other for the breakdown in negotiations.

To date, more than 2,000 Palestinians and more than 60 Israelis have been killed, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). The UN says that most of the Palestinians killed, 1,444, were civilians, including 475 children and 246 women. On the Israel side, most of those killed, 64, were soldiers.

But when it comes to the health situation in Israel and Palestine, the lopsided death tolls during periods of conflict are only the tip of the iceberg.

Take, for example, child mortality. The following graphic (using IHME’s online visualization tool) shows child deaths per 1,000 live births in Palestine compared to those in Israel between 1990 and 2013. The gap between the two has diminished over time, but child mortality in Palestine was still nearly five times larger than it was in Israel in 2013.

Child deaths per 1,000 live births in Israel and Palestine, 1990-2013

Israel Palestine IHME

For maternal mortality, levels in Palestine are more than double the levels in Israel (see illustration below).

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Maternal deaths per 100,000 live births in Israel and Palestine, 1990-2013

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Diseases primarily affecting children and child-bearing women (communicable, maternal, newborn, and nutritional disorders) account for 28% of all the years lost to early death and disability in Palestine. Non-communicable diseases are to blame for the majority of healthy years lost (62%) in Palestine.

Compared to Israel, Palestine has higher rates of early death and disability from certain non-communicable diseases, as illustrated in the next screen grab.

Certain causes stand out: cardio and circulatory diseases; mental and behavioral disorders, diabetes, urogenital, blood, and endocrine disorders; and other non-communicable diseases. Rates of early death and disability from diseases associated with poverty, such as nutritional deficiencies; neonatal disorders; and diarrhea, lower respiratory infections, and other infectious diseases, were also higher in Palestine than in Israel.

Rates of premature death and disability by cause in Israel and Palestine, 2010

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Israel’s health outcomes are more similar to those seen in Western European countries.

The graphic below shows how rates of premature death and disability in Israel, adjusted for differences in ages, are more similar to rates seen in Italy and Spain. Although its outcomes compare favorably to Western European countries, the US, Canada, and Australia, one area where Israel stands out is its high rates of diabetes, urogenital, blood, and endocrine disorders. Overall, the health of the Israeli people is among the best in the world, based on the Global Burden of Disease study.

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Rates of premature death and disability by cause in the US, Australia, Western European countries, and Israel, 2010

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These data show how, despite being embedded within Israel’s borders, health outcomes among the Palestinian people are starkly different. Israel also has more advanced medical facilities than Palestine. For Palestinians, seeking medical treatment in more advanced facilities within Palestine or in Israel or Jordan can be a challenge.

A study published in The Lancet found that permission for 19% of patients and their companions applying for Israeli permits for hospital access in 2011 was denied or delayed. Israel restricts the movement of Palestinians between the West Bank and the Gaza Strip and to areas outside Palestine.

In addition to more widely publicized sources of tension between Israel and Palestine, extreme health disparities between the two areas are likely to add to the conflict for years to come.

Katie Leach-Kemon, a weekly contributor of global health visual information posts for Humanosphere, is a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

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About Author

Katie Leach-Kemon

Katherine (Katie) Leach-Kemon is a policy translation specialist at the Institute for Health Metrics and Evaluation (IHME). Katie specializes in two of IHME's research areas, the Global Burden of Disease and health financing. Katie has helped produce IHME's Financing Global Health report since it was first published in 2009. She received an MPH from the University of Washington and served as a Peace Corps volunteer in Niger. Her work has been published in The Lancet, Health Affairs, and the Journal of the American Medical Association. You can follow her on Twitter @kleachkemon.

  • Little Betty

    Don’t forget that Israel’s Iron Dome protected it’s citizens from more casualties. Had there not been such protection, there would not have been such lopsided casualty numbers. Such health disparity would not exist if the Palestinians had agreed to a 2 state solution when Israel’s left wing government was in power years ago. They would have greatly benefited from Israeli innovations in medicine and technology and, hence, enjoyed much better health outcomes. But the Palestinians have to come to that conclusion on their own.

  • Where the Hell is “Palestine?”

    When Israel captured the West Bank and Gaza Strip in 1967, officials took measures to improve the conditions that Palestinians had lived under during Jordan’s 19-year occupation of the West Bank, and Egypt’s occupation of Gaza. Universities were opened, Israeli agricultural innovations were shared, modern conveniences were introduced, and health care was significantly upgraded. More than 100,000 Palestinians were employed in Israel, and were paid the same wages as Israeli workers, which stimulated economic growth.

    The rise in violence during the 1990s, and then the war instigated by Palestinian terrorists beginning in 2000, took a heavy toll on the Palestinian economy. To
    protect its citizens from suicide bombers and other terrorists, Israel was forced to take measures that had a deleterious impact on the economy in the Palestinian Authority.

    The most serious step was to limit the number of Palestinian laborers entering Israel to reduce the risk of terrorists pretending to beworkers slipping into the country. This raised the level of unemployment, which, in turn, had a negative spillover effect on the rest of the Palestinian economy.

    Despite the global economic downturn, the West Bank economy grew by more than 7percent, representing the 26th best growth rate in 2009 out of 212 countries and territories in the world, second in the Middle East, and double the rate of Israel. This remarkable growth was attributable to continued aid from the West, the implementation of economic reforms, and the easing of security restrictions on movement by Israel.

    Even when the economy was at a lowpoint, Palestinian Arabs were better off than many of their neighbors. The most recent Human Development Report from the United Nations ranks the PA 110 in terms of life expectancy, educational attainment and adjusted real income out of the 182 countries and territories in the world, placing it in the “medium human development” category along with most
    of the other Middle Eastern states (only the Gulf sheikdoms are ranked “high”).

    The PA is ranked just below Egypt (#101) and ahead of Syria (#111) and Morocco (#114). Few Palestinians would trade places with Arabs in neighboring countries. Well, perhaps, with one exception. They might aspire to the standard of living in the country ranked 15th by the UN:

    ISRAEL, NOT “Palestine!”