At the advent of my career in Jerusalem, I met a scholar, who was interested in the city’s history. He stated that most Palestinian cities and communities had either economic or military significance, however, Jerusalem had neither! Its only significance was religious i.e. its value to the three monotheistic religions. I mention this to stress the dependence of Jerusalem on the rest of the country for its viability, in all aspects of life, the health industry being no exception!

There are five major hospitals in East Jerusalem; three general hospitals, one maternity and an eye hospital. These institutions depend largely on referrals from other Palestinian cities. Furthermore, the vast majority of the staff comes from what is known now as the Palestinian Territories.

The Israeli occupation of the city in 1967, has greatly affected health care in East Jerusalem. After occupation, most of the work force in Jerusalem, largely employed by Israelis, became insured at the Israeli sick funds, which did not deal with the Arab Hospitals, thus depriving East Jerusalem hospitals from a major cohort of patients. Maternity services were supported by the Israeli National Insurance Institute according to Israeli law. This has increased the dependence of East Jerusalem hospitals on referrals from the West Bank and Gaza. Furthermore, the slow and weak development of hospitals in Jerusalem and the need for security clearance for employment at Israeli hospitals, has led many doctors, who have cost their families their life savings in tuition fees, to leave the country to seek employment and make their careers abroad. This has contributed to further impoverish the hospitals as well as the community as a whole; people sought help at Israeli hospital for advanced sub-specialized services against hefty bills.

After the passage of the National Health Law of 1994, that provided universal compulsory health coverage for all citizens and residents of Israel, the hospitals were increasingly assimilated under the laws governing the medical profession in Israel. The great majority of Jerusalem residents became directed towards the Israeli health system. This, coinciding with closures, checkpoints and, eventually, the Separation Wall, led East Jerusalem hospitals to seek agreements with the Israeli Sick funds leading to signing agreements at rates much lower than those granted to Israeli hospitals; rates that are barely enough to cover the expenses of each case’s care. The Palestinian Authority, eventually, became the biggest client of the East Jerusalem hospitals, meaning that reimbursement became under the mercy of fluctuations in Palestinian – Israeli relations.

Currently, all patients and staff coming from the West Bank and Gaza are required to obtain permits from the security forces. Many patients, with history of resisting the occupation, are denied access to health care in Jerusalem. It is only fair, however, to mention that some special cases are still allowed to come in through negotiation between the hospitals and the Civil Administrations in the West Bank and the Gaza Strip. This permit issue has directed a lot of staff time and hospital resources towards processing and filing the necessary documents. The hospitals are still struggling to provide funds for running costs and development, which is still going at a very slow pace. A lot of projects are being stalled and even called off while waiting for the necessary permits required by the licensing authorities. Failure of Jerusalem’s hospitals to offer good salaries and to utilize the expertise of highly qualified and trained doctors has led new graduates from the city to train in Israeli hospitals. Many of these doctors prove to be brilliant and aregladlyemployed at Israeli hospitals, further depleting the city’s vital resources. Obviously, medical research, in such an environment, is almost nonexistent.

Another important issue is the refusal of the Israeli Ministry of Health to recognize the qualifications of East Jerusalem residents graduating from Al Quds University. The US, Canada and European countries recognize Al Quds University so many of these graduates seek immigration, further contributing to the evacuation of the city of Jerusalem from its educated and skilled Arab population.