East Jerusalem scrambles to prevent COVID-19 outbreak before Ramadan

Israel had weeks to help prevent the spread of coronavirus in East Jerusalem. Instead, it dragged its feet in helping Palestinian hospitals, closed down testing sites, and blocked the PA from stepping in.

Health workers are warning of a potential COVID-19 upsurge in occupied East Jerusalem with the Muslim holy month of Ramadan set to begin on Friday. Israel is doing too little, too late to stem the virus in the city’s Palestinian neighborhoods, critics say, while the government simultaneously prevents the Palestinian Authority from taking actions to prevent a possible outbreak.

While the Israeli Health Ministry says it has officially recorded only “dozens” of cases of the COVID-19 virus in East Jerusalem, health workers on the ground say the number is likely far larger. According to the workers, the unofficial count stands at 140 known cases as of April 19, with half of them in the densely populated neighborhood of Silwan. They warn of hundreds more of unreported infected people that could unwittingly be spreading the disease.

Without a concerted awareness campaign and sufficient prevention guidelines in Arabic to inform the community, a virus outbreak could be imminent during Ramadan, say Palestinian health experts.

After writing to the Health Ministry last month, Adalah – The Legal Center for Arab Minority Rights in Israel noted that the ministry had increased its efforts to retroactively supply Arabic-language information on the novel coronavirus. However, the information is not being transmitted in real time and is still missing essential details, Adalah said in a statement.

“Clearly the Arabic side of the Israeli Ministry of Health is underdeveloped. There is a lack of information being produced [in Arabic],” concurred Walid Nammour, chief executive officer of Augusta Victoria Hospital, one of the three East Jerusalem hospitals tasked with establishing coronavirus units. “I know there are testing sites [in East Jerusalem] but there is a lack of information about them. People need to know about these things.”

Magen David Adom medical workers seen at a drive-through site to collect samples for coronavirus testing, at the entrance to the East Jerusalem neighborhood of Jabal Mukaber, on April 2, 2020. (Yonatan Sindel/Flash90)
Magen David Adom medical workers seen at a drive-through site to collect samples for coronavirus testing, at the entrance to the East Jerusalem neighborhood of Jabal Mukaber, on April 2, 2020. (Yonatan Sindel/Flash90)

Nammour added that many people in East Jerusalem have yet to self-quarantine, and that until now, there has been little enforcement of government regulations by the Israeli authorities.

Eight mobile coronavirus testing centers have been set up in East Jerusalem — six of them through Israel’s national health providers, stationed in five locations including the neighborhoods of Silwan, Shuafat, Sheikh Jarrah, and Kufr Aqab. Two drive-through centers run by the municipality have been erected at the entrance of Jabal Mukaber, and the other near the checkpoint at the entrance to Shuafat Refugee Camp.

According to Ben Avrahami, advisor to the mayor for East Jerusalem affairs, so far some 7,000-8,000 Palestinians in the city have been tested. The goal, he said, is to reach 10,000.

A crackdown on the Palestinian Authority

Although Israel does not report on the number of COVID-19 cases in East Jerusalem separately, as of April 22 the Palestinian Authority’s Health Ministry, which has attempted to step in and conduct its own testing in the eastern part of the city, has reported 139 cases there.

That the PA is attempting to run a parallel operation in what Israel deems its “united capital” has angered Israeli authorities, leading to drastic steps such as arresting Palestinian officials and journalists, and shutting down PA-sponsored testing sites.

Israel prohibits the PA from carrying out uncoordinated activities in Israeli territory, including East Jerusalem, which it has controlled since the 1967 war (Israel officially annexed the area in 1980, a declaration that has been rejected by most of the international community).

The crackdown began in early April, when police arrested both the PA Jerusalem Affairs Minister, Fadi al-Hadami, and PA Governor of Jerusalem, Adnan Ghaith, for what it claimed was illegal political activity in the city. Palestinians say the two men were engaging in coronavirus preventive activities such as disseminating safety information. On April 15, Israeli police shut down a small testing center it said was operating under the auspices of the PA in Silwan.

Palestinian health officials, in turn, are warning that the Israeli authorities are not taking serious measures to alleviate the COVID-19 crisis, and that Palestinian Jerusalemites have mostly been left to their own devices with very little support or resources. This is compounded by the fact that most international aid groups are prioritizing their aid to meet the critical needs of the blockaded Gaza Strip, which has so far reported 13 cases of the virus.

Dr. Mustafa Barghouti, director of the Palestine Medical Relief Society in Ramallah, said he is especially concerned about the situation of Palestinians whose Jerusalem residency cards have been revoked by Israel — a policy carried out when the authorities claim that a Palestinian’s so-called “center of life” is no longer in their stated neighborhood — and therefore are no longer entitled to Israeli health insurance.

Barghouti is also troubled by the situation of Palestinian laborers in Israel who are being infected by the coronavirus but do not have Israeli insurance. Many of these laborers, he says, work in Area C of the occupied West Bank, which is under full Israeli military control and where the PA is barred from operating.

Palestinians walk past a section of the separation wall in the East Jerusalem village of Abu Dis, February 2, 2020. (Olivier Fitoussi/Flash90)
Palestinians walk past a section of the separation wall in the East Jerusalem village of Abu Dis, February 2, 2020. (Olivier Fitoussi/Flash90)

From health to infrastructure to education, East Jerusalem Palestinians have faced a litany of discriminatory policies since the beginning of Israel’s occupation.

Israel has revoked the permanent residency status of more than 14,000 Palestinian Jerusalemites since 1967, part of Israel’s political goal of preserving a “demographic balance” — namely, a Jewish majority — in the city. Over 70 percent of all Palestinian families in Jerusalem live below the poverty line, compared to 26 percent of Jewish families, and only 44 percent of East Jerusalem residents are connected to the water network in a regulated and formal manner.

“No matter what we do, there will be people who say that we’re not doing enough,” said Avrahami of the Jerusalem municipality. He said that the city has invested in an Arabic information campaign, including videos with local medical and religious leaders, phone texts, printed flyers, and social media. “From the beginning of the outbreak, the mayor took the situation in East Jerusalem seriously and put it at the top of his priority list. We have a situation room and we meet with representatives of the health clinics and hospitals every other day.”

While acknowledging that the meetings with the municipality are taking place, some Palestinian health workers say there is still a lack of coordination which leads to very little substantive action.

Although Palestinian patients in the city are also sent for treatment in Israeli hospitals, between the three hospitals located in East Jerusalem, there are only 22 ventilators and 62 beds prepared for coronavirus patients. Twelve of those ventilators are reserved for patients of Augusta Victoria Hospital with extremely compromised immune systems. Makassed Hospital has a coronavirus unit with 22 beds, while St. Joseph Hospital in Sheikh Jarrah has a wing prepared with 28 beds.

“We need not less than 200 beds, [but] we have less than 10 percent of what we need in case there is a serious outbreak,” said Nammour.

As of April 19, Makassed and St. Joseph received only half of the NIS 2 million promised each of them by the Israeli Health Ministry to fight the coronavirus, added Nammour. Makassed also received some personal protective equipment from the ministry some time earlier, but were then charged NIS 70,000 for the supplies.

An Israeli firefighter disinfects the entrance to St Joseph Hospital in East Jerusalem as a preventive measure against the spread of the coronavirus, April 16, 2020, (Yonatan Sindel/Flash90)
An Israeli firefighter disinfects the entrance to St Joseph Hospital in East Jerusalem as a preventive measure against the spread of the coronavirus, April 16, 2020, (Yonatan Sindel/Flash90)

East Jerusalem hospitals have been struggling financially since 2018, after Trump cut $25 million worth of financial aid, which covered the bills of Palestinian patients referred by the PA. The hospitals now owe $75 million in debt to medical suppliers, said Nammour.

“This represented a very serious challenge even prior to the coronavirus,” he continued. “We are in a very difficult financial situation, and on top of that now comes the coronavirus. We have to serve our population.”

The Israeli Health Ministry did not respond to several emails and phone calls for comment.

‘Our aim is to save lives’

Facing what they say is a lack of official preparation against the coronavirus, a group of 81 local Palestinian NGOs last month formed the ad-hoc “Jerusalem Alliance” to confront the threats of the disease in the city’s Palestinian communities.

The alliance has started an awareness campaign with videos and online information in Arabic, as well as anti-bacterial cleaning in East Jerusalem neighborhoods, which the group said was not carried out by the municipality. It has also established counseling and telephone hotlines for people to call in with questions and concerns.

The alliance has also arranged lodging for doctors and nurses from the West Bank who work in the city but are unable to return home.

“After the outbreak of the coronavirus, we felt that the Israeli authorities will obviously neglect East Jerusalem as they have over the years, and the Palestinian Authority can’t operate here for obvious reasons,” said Ahmad Budeiri, who helps coordinate the Jerusalem Alliance. “We worry about our children and our elders and nothing is being done to help. Our aim is to save lives. We are not making any political statements — that is useless now.”

In addition, Palestinian businessman Bashar al-Masri has provided his St. George Hotel as a quarantine for Palestinians who have may have been exposed to the virus. Food for those in quarantine is being donated by the Jerusalem Fund, an American humanitarian organization.

Budeiri said that with 15 new suspected coronavirus cases from the neighborhood of Issawiyah requiring quarantine, the St. George Hotel is almost at full capacity. In addition, he said, several Palestinians who returned from abroad were not allowed to come to the St. George Hotel, but rather were directed by the Israeli Health Ministry to a quarantine hotel at the Dead Sea, which causes further hardship because families are unable to send packages to the patients. (The Health Ministry has opened a number of hotels for social quarantine).

What this crisis reveals

Though government assistance has been slow in coming to the East Jerusalem hospitals, Nammour noted that the Israeli Health Ministry has delivered NIS 25 million worth of personal protective equipment to the hospitals, including over 50,000 face masks and 10,000 gloves.

The supplies may have come as a response to a letter by Jerusalem Mayor Moshe Leon to the Health Ministry on April 6, which alerted the authorities of the “severe shortage of basic medical equipment in East Jerusalem,” despite the ministry’s repeated promises to provide such equipment including coronavirus testing kits. Leon warned that the city’s health system could be stretched to breaking point if the hospitals remained unable to carry out the needed medical care.

Jerusalem Mayor Moshe Leon visits a drive-through testing site in the East Jerusalem neighborhood of Jabal Mukaber, April 2, 2020. (Yonatan Sindel/Flash90)
Jerusalem Mayor Moshe Leon visits a drive-through testing site in the East Jerusalem neighborhood of Jabal Mukaber, April 2, 2020. (Yonatan Sindel/Flash90)

“The shortage of hospital equipment in the east of the city is severe and needs urgent attention in dealing with the coronavirus,” wrote the mayor. “I personally appeal to you… to allocate the resources needed to the East Jerusalem medical services so that they can bear the burden of treating coronavirus patients and prevent the state of the medical system from collapsing in Jerusalem.”

“This is something good, we need more of this,” Nammour said in response to the increased supplies. “I really hope we continue on this same path. It is creating and enabling an environment for effective and efficient performance.”

Stressing the excellent historic relations his hospital Augusta Victoria has had with Jerusalem’s Hadassah and Haifa’s Rambam hospitals, Nammour lamented the fact that the support offered by the Israeli government and the Jerusalem municipality had, until last week, been little more than lip service.

“Palestinians and Israelis have one enemy: the coronavirus. We have to put down the psychological wall and… consider all the strategies,” he said. “There should be more collaboration and more sharing of information… Gaza, the West Bank, and Israel is one epidemiological unit. Everything that goes on here must be closely coordinated. The Palestinians will fail without Israel, and Israel will fail without the Palestinians.”

Dr. Gerald Rockenschaub, the WHO’s Head of Office in the occupied Palestinian territory, said that the organization has been coordinating with the East Jerusalem Hospitals Network (EJHN) to address the health needs of Palestinians in the city.

“All network hospitals have scaled up risk communication and community mobilization efforts to raise awareness through social media and TV spots,” said Rockenschaub. “WHO continues to provide technical support, including sharing of COVID-19 guidelines and protocols with the EJHN and advocates with the international and donor community to provide direct support to the hospitals.”

Still, even with these gradual shifts in the coronavirus response, Inès Abdel Razek, advocacy director at the Palestine Institute for Public Diplomacy, argued that the health crisis has exposed the “apartheid reality that Palestinians live in,” and further illustrates the real effects of Israel’s annexation of the eastern part of the city.

“Israeli authorities have control over everybody, whether Jews or Palestinians,” said Abdel Razek, “but the Palestinians are collectively neglected, subject to institutional racism, and stripped of their basic socio-economic and political rights. This health crisis is a revealing factor.”