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Policy Brief - Call to protection and response to COVID-19 in East Jerusalem
26 April 2020

Ramallah-Nisaa FM- CARE Palestine West Bank / Gaza (WBG) is extremely concerned about the lack of protection, risk mitigation and response measures to residents of East Jerusalem in the occupied Palestinian territory (oPt), who are facing the prospect of a major COVID-19 outbreak. In a politically charged environment, East Jerusalemites are caught in a precarious limbo. They cannot receive protection from the Palestinian Ministry of Health (MoH) because all activity by the Palestinian Authority (PA) in Jerusalem  is prohibited, and at the same time, they are not prioritized by the Israeli authorities, who bear legal responsibility, anchored in Article 56 of the Fourth Geneva Convention, to ensure that all the necessary preventive means available are utilized to 'combat the spread of contagious diseases and epidemics’ and to provide essential health services and apply public health measures throughout this pandemic in a non-discriminatory manner.  

Epidemiological investigations are limited for residents of East Jerusalem, and no accurate data on COVID-19 cases is captured or represented by Israeli Health Ministry statistics. Residents of East Jerusalem, live in densely populated neighborhoods, with poor infrastructure, posing significant risks of the virus rapidly spreading. Those without Jerusalem ID numbers, over 10,000 Palestinians, and those who live outside the separation barrier and in refugee camps, as well as the Palestinian hospitals in Jerusalem and their staff who have very little resources, are at particular risk. Finally, the impact of COVID-19 has deeply furthered economic and food insecurities of East Jerusalemites. Those who work in Israel can get allowances from Israeli National Insurance institute, however, the minimal monetary compensation, if received, is insufficient to cover debt, high taxes, utility usage expenses and basic needs. Over 70% of the residents in East Jerusalem live under the poverty line.  
Since the outbreak of the crisis in Palestine, on March 5th, there have been 449 cases, out of whom 329 have been identified in the West Bank (212 male and 117 female)1, 120 in East Jerusalem, 13 in Gaza, 70 have recovered and 3 persons died related to the disease. While the current number of people detected positive for COVID-19 in the oPt remains somewhat low relative to other countries, this reflects the limited testing capacity, particularly in the case of residents in East Jerusalem, where undocumented COVID-19 cases and the lack of accurate data present an increasing worry. Israeli Ministry of Health has deferred a responsibility towards Palestinians’ health to medical centers, a departure from the unified response approach in West Jerusalem and Israel. The initial awareness raising messages about the spread of COVID-19, issued by the Israeli Ministry of Health, were posted almost exclusively in Hebrew, with virtually no information posted in Arabic. This imbalance has been somewhat addressed, but it highlights the importance of ensuring equality of treatment for all residents of Jerusalem.  
To help prevent the spread of Corona Virus, Palestinian civil society in East Jerusalem has coalesced around increasing awareness about the Virus. In response to a petition to the Israeli Supreme Court, as of 14 April, the Israeli authorities have committed to opening health clinics and coronavirus testing centers for the estimated 150,000 Palestinians living in East Jerusalem neighborhoods beyond the separation barrier2.  However, thus far, only a few testing clinics have started to operate in the area and are accessible to members of private insurance companies. 
Residents of East Jerusalem are able to visit hospitals, however, each neighborhood has a designated clinic. Not only are the testing clinics few in number and limited in resources, local hospitals in East Jerusalem suffer from chronic underfunding, which hinders the provision of medical drugs and treatment3 and have a serious shortage of medical, testing and protective equipment. The access of patients from the West Bank referred to hospitals in East Jerusalem and Israel remains limited to emergency cases and cancer patients. The East Jerusalem Hospital Network has announced that all of their six facilities are preparing to deal with cases of COVID-19 that require clinical care, with 50 beds assigned for COVID-19 patients, and the other hospitals are getting ready to support the network with medical and nursing staff. At present, out of six hospitals, only two are equipped with COVID-19 units; Al Makased and St. Joseph Hospitals.  
Recently, local activists attempted to run a clinic that would provide vital testing to residents in neighborhood of Silwan, where doctors say there are 40 cases and where overcrowded living conditions could lead to a rapid spread of the virus. However, the Israeli authorities closed the clinic and arrested its organizers because medical equipment had been supplied by the Palestinian Authority Health Ministry and the tests carried out were to have been transferred to the PA for assessment.4 Rather than coordinating and sharing the responsibility to provide people with vital and potentially life-saving services, such efforts were perceived to be in collaboration with the PA, and, therefore, politicized. A lack of and hindered access to testing and relevant medical services is a breach of Israel’s international obligations with regards to the right to healthcare of Palestinians. 
Due to the prolonged nature of the crisis, the majority of East Jerusalemites are out of work and at risk of food insecurity. There are no clear criteria for the social security compensation, and anecdotal evidence suggests that the priority is given to Israeli residents, excluding Palestinians with Jerusalem IDs. Those who continue to work in Israel risk becoming infected and further spreading the virus. Lockdown restrictions make it particularly difficult to access and provide services in refugee camps, particularly in the Shuafat camp, located in the eastern part of the city. Also, movement restrictions on patients and health workers compromise Palestinians’ access to healthcare services, which may result in fatalities. In the midst of the COVID-19 crisis, Israeli security forces (ISF) continue to enact search and arrest operations in East Jerusalem, as well as in the West Bank, and the withdrawal of most international actors from sensitive areas has lessened the sense of protection, whereby exacerbating the vulnerability of Palestinians to settler violence.  
Due to the increasing vulnerabilities of community members residing in East Jerusalem, which have been further exacerbated in the wake of the COVID-19, CARE urges actors to take the following Actions:
1. Palestinian Authority a. To ensure coordination with Israel in dealing with the coronavirus crisis, necessary for an effective protection and response to the spread of the virus in East Jerusalem; b. To enable coordination among all relevant stakeholders to allow and help facilitate the distribution of the needed materials, including medicine, medical supplies and equipment, including lab testing kits, personal protective equipment, etc., as well as food and non-food items (NFIs), to reach the vulnerable population residing in East Jerusalem. 
2. Israeli authorities to take immediate action, in accordance with international law that safeguards people’s right to life, survival and health5, by the following: a. Enable movement and access of personnel involved in the COVID-19 response to and from the West Bank, including East Jerusalem, Area C, and Gaza; b. Facilitate the work of humanitarian agencies continuing to provide for essential humanitarian services, including health, shelter, water and sanitation, food, education, and protection. c. Establish testing clinics in East Jerusalem neighborhoods that could accommodate the number and needs of community members; d. Conduct epidemiological tests, capture and report accurate, up-to-date and sex and age disaggregated statistical data on COVID-19 cases in East Jerusalem; e. Provide and make easily accessible vital awareness-raising information about COVID19 in Arabic to resident in East Jerusalem.  
3. Donors to address the existing gaps in access to and provision of health care services to residents of East Jerusalemites by the following: a. Ensure that the necessary funding is available to deal with a potential spread of COVID-19 in East Jerusalem, as well as for life-saving and life-sustaining action not directly caused by the epidemic. b. Support the coordination of political actors, and call on Israel and Palestinian authorities to provide an unimpeded access to humanitarian aid and services, ensuring that the response to this epidemic adheres to the highest attainable standards of physical and mental health, and upholding the rules of the International Humanitarian Law and International Human Rights Law. c. Facilitate humanitarian action in response to COVID-19 by supporting humanitarian partners to overcome access, procurement, risk aversion, and program delivery challenges. d. Ensure that funding is available to support multi-sectoral comprehensive response including Health, Water and Sanitation, Education, Livelihood and Food Security, and Protection