The unhealthy aid provided for the health of Palestinians

Aid to Palestinians looks like an inappropriate political tool, provided to limit the damage created by a political problem that donor countries dare not address.3 By perpetuating the structural flaws of the health sector, aid has become an essential condition for its survival. Despite this reality, the trend is more of the same, exemplified by the ambiguous maintenance of a development discourse,4 alongside massive emergency funds, by a shift towards direct assistance to the Palestinian Authority, and by inattention to Gaza. While it is evident that aid without freedom of movement is largely squandered, donors seem to be refraining from pressuring Israel to protect the peace process, thus underestimating the effect of the Israeli occupation on aid effectiveness. Aid is not only ineffective but might also be harmful. The International Court of Justice6 has ruled that states are under obligation not to render aid that might maintain the situation created by the occupying power, to ensure Israel’s respect for international humanitarian law, and not to substitute for the responsibility of the occupying power. For example, financing highly localised health facilities to mitigate the delays created by Israeli closures7 effectively normalises an unacceptable situation. In view of the fact that 45% of aid goes to Israel and the remaining 55% is divided between waste on occupation measures and actual project benefits,8 aid subsidises the Israeli expansion in the occupied Palestinian territory. Normalisation is also made easier by sanitised language (eg, dropping the word occupation so that occupied Palestinian territory becomes Palestinian territory). Generous and un- conditional assistance to the health sector has led to punishing levels of donor dependency: 42% of the health expenditure is financed by donors. What can be done? In view of the broader political environment, avoiding mere technical solutions, which might be “missing the forest for the trees”, is paramount. Both technical and political aspects should be tackled