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 Jabel 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 Jabel Mukaber, on April 2, 2020. (Yonatan Sindel/Flash90)
'Things are absolutely out of control here'

East Jerusalem buckles under virus’s 2nd wave, while largely ignored by Israel

Figures show Jerusalem Palestinians disproportionately struck by COVID-19; health officials lament lack of coordination with municipality and massive budget deficit in hospitals

East Jerusalem Palestinians made it through the first wave of the coronavirus pandemic relatively unscathed. By early May, only about 150 cases had been reported in Palestinian areas of the city. Jerusalem breathed a sigh of relief and began to reopen.

But, like everywhere else, that was when things started to go wrong.

The city now has 3,891 active cases, the highest count in Israel. While there is some dispute about the number of active cases among Palestinians – Clalit official Ali Jabrini told The Times of Israel that 1,888 were currently infected, while the Palestinian Authority Health Ministry sets the number at 2,523 – all see a disproportionate impact in East Jerusalem.

The number of active coronavirus cases among East Jerusalem Palestinians surpassed West Jerusalem two weeks ago, even though Palestinians constitute only 38 percent of the capital’s population.

Some 375 cases were recorded in the city’s east over the Eid al-Adha holiday last weekend, even as the number of active cases among West Bank Palestinians began to fall.

“Things are absolutely out of control here,” Fouad Abu Hamid, director of a clinic in East Jerusalem’s Beit Safafa neighborhood, warned in an interview last week.

The number of new cases is increasing even as the total number of tests is going down. Augusta Victoria Hospital director Walid Nammour said this could mean that large numbers of cases are going undetected.

Walid Nammour, the chief executive officer of the Augusta Victoria Hospital in East Jerusalem. (Screenshot: Canadian Lutheran World Relief)

Most East Jerusalem Palestinians are permanent residents of Israel but not citizens. Their blue residency cards entitle them to membership in one of Israel’s four health maintenance organizations and to National Insurance, although government accountability reports have found that a complex and opaque system sometimes blocks them from actually accessing state benefits.

Still, by the end of the first wave of coronavirus in the Palestinian territories, East Jerusalem seemed largely untouched, thanks to an exceptional degree of coordination between the Jerusalem municipality and local Palestinian groups to fight the virus.

The municipality opened an East Jerusalem command center in City Hall, directed by the IDF Home Front Command, while local coronavirus committees were formed to track the situation in each of East Jerusalem’s Palestinian neighborhoods. The city, in coordination with local councils, distributed hundreds of meals to families during Ramadan.

Jerusalem Mayor Moshe Lion “takes coronavirus in East Jerusalem very seriously,” former municipality official Ben Avrahami told The Times of Israel. A fluent Arabic speaker, Avrahami advised Jerusalem’s last mayor, Nir Barkat, on East Jerusalem and continues to consult with the municipality.

“He meets weekly with East Jerusalem leaders, including the directors of East Jerusalem hospitals and community councils, for updates on the coronavirus situation in the city’s east,” Avrahami said.

East Jerusalem Palestinians have long had a fraught relationship with city authorities. But even many who have long criticized the municipality hailed its response to the first wave.

“During the first wave, the municipal institutions worked to provide tests, to provide isolation centers, aid for the unemployed, food for the elderly. We felt like we were really able to fulfill residents’ needs,” said Hani Ghaith, who directs a community center in the Silwan neighborhood, as well as the local community council.

Ghaith, a former member of Tanzim, the armed wing of the Palestinian Fatah movement, is the cousin of the Palestinian Authority’s Jerusalem governor Adnan Ghaith, who has been repeatedly arrested by Israeli authorities seeking to curb the PA’s presence in the contested city.

Some of that city assistance has carried over through East Jerusalem’s spiraling second wave. The municipality reopened the IDF Home Front Command center as the second wave began. Last week, the Jerusalem municipality announced that it would open a coronavirus hotel in East Jerusalem specifically to serve Palestinians. Lion also opened a coronavirus testing center in the Palestinian neighborhood of Sheikh Jarrah.

But the second wave has seen far less coordination with local Palestinian authorities, according to Nammour. Lion’s weekly meetings with East Jerusalem health officials ceased with the end of the first wave and have yet to resume — even as the situation grows more dire by the day.

“It’s a shame. It was apolitical, a real attempt by the municipality to listen to the needs of East Jerusalem residents. That’s stopped,” Nammour said.

Ghaith’s assessment of the municipality during the second wave is also far less rosy.

“There’s no coordination anymore, nothing. I keep asking myself why no one’s working with us…I feel like East Jerusalem residents have nowhere left to turn,” he said.

A Muslim woman wears a mask and gloves in East Jerusalem’s Mount of Olives, overlooking the Dome of the Rock and al-Aqsa mosque compound on the Temple Mount, which remains shut to prevent the spread of coronavirus during the holy month of Ramadan, Friday, May 1, 2020. (AP Photo/Ariel Schalit)

Other East Jerusalem activists disagreed.

Nadira Jabr, who runs a community council in Kafr Aqab, said she works regularly with the municipality on coronavirus in areas beyond the security fence. She works to ensure residents have access to testing and can go through checkpoints to receive medical care.

“We had a meeting with the mayor last week. Anyone who needs anything speaks to us and we work on an emergency footing with all parties to bring aid, to help people move to the coronavirus hotels, everything,” Jabr told The Times of Israel.

Officials offered different rationales for the stark rise in cases. Avrahami suggested that many East Jerusalem residents who had traveled to the West Bank for large weddings may have brought the coronavirus back them.

Multiple sources said that they had witnessed a rise in conspiratorial thinking, with many denying the severity of the crisis.

“The spread of denial about the coronavirus and its effects, even among educated people, is deeply concerning,” Nammour said.

Jerusalem’s complex geography also seems to be shaping the path of the disease. Neighborhoods inside the security fence, where the municipality has some limited presence, are doing better than those outside it.

“With some exceptions, the coronavirus situation in Beit Safafa, Jabel Mukaber, and the southern neighborhoods is better than North Jerusalem — Beit Hanina, Kafr Aqab, Shuafat Refugee Camp and so on,” Abu Hamid said last week. Since then, cases have also spiked in some areas within the fence, such as A-Tur and the Old City.

Beyond the wall

As of 2017, about 140,000 East Jerusalem Palestinians lived within the boundaries of the Jerusalem municipality but beyond the security barrier. It is there — in areas such as Kafr Aqab and Shuafat Refugee Camp — that the coronavirus may be taking its highest toll, local activists told The Times of Israel.

Kafr Aqab residents have long suffered from municipal neglect, saying that the city fails to provide even basic public services to residents beyond the wall. Visitors to Kafr Aqab are confronted by crowded, congested streets and piles of garbage. At an estimated 120,000 people, the “neighborhood” is larger than some cities, but receives relatively little funding from the municipality.

Avrahami said that city leaders were working with the local community council on the coronavirus response. But he also acknowledged that there were limits to what the municipality could accomplish in an area whose problems long precede the coronavirus crisis.

“When it comes to Kafr Aqab, it’s clear that the lived reality there is extremely difficult and challenging. No one is disputing that… It’s very hard for the municipality to be present there on the ground,” Avrahami said.

A massive building spree has taken off in the area in the last few years. East Jerusalem Palestinians looking for cheaper rents, while still being able to retain their Jerusalem permits, have flocked to Kafr Aqab.

Congestion and density in the neighborhoods was a significant factor in the virus’s spread, Nadira Jabr told The Times of Israel.

“People aren’t following the guidelines, there are lots of gatherings. There is a lot of stress on this area in terms of space,” Jabr said.

While in the first wave residents generally adhered to guidelines and stayed at home, the second wave has seen what local coronavirus committee director Samih Abu Rumeila called “widespread denial of the existence of the virus.”

Abu Rumeila said he received constant reports of those testing positive or those ordered into quarantine flouting health restrictions. Many who suspected they had been exposed were not even bothering to get tested, he said, adding that he believes that the number of undetected cases in Kafr Aqab was enormous.

Even testing itself poses a problem. In the first wave, a testing point operated by Magen David Adom existed at Qalandiya checkpoint. But because HMOs are now in charge of testing, that testing point has not been reopened even as the number of cases has sharply increased. The Clalit HMO appears to be the only Israeli health care provider with a testing center beyond the security barrier.

According to Abu Hamid, 70% of East Jerusalem Palestinians are registered at Clalit, but the rest are in the other three HMOs.

“The only people who can get tests out here are those who belong to Clalit. Everyone else is stuck with long wait times, waiting three or four days before they can even get a test,” Abu Rumeila said.

Israeli police are said to rarely venture beyond the barrier. Abu Rumeila blamed the lack of police presence for the widespread disregard for social distancing regulations during the second wave.

“It should be the case that if there’s a wedding or funeral or high school graduation celebration, the police should come and break it up and say it’s illegal for more than 50 people to gather in a hall. Well, at these events more than 1,000 people gather in one hall, and the police are nowhere in sight,” Abu Rumeila said.

During the first wave, Palestinian security forces conducted rare operations in Jerusalem beyond the security barrier, even though Israel has banned the Palestinian Authority from operating anywhere in the capital. PA police reportedly set up checkpoints and dispersed crowds in accordance with social distancing guidelines, while Israel turned a blind eye due to the state of emergency.

In the meantime, however, the fleeting coronavirus honeymoon has ended. Israel and the Palestinian Authority are at loggerheads over Israel’s declared intention –mired in delays — to annex parts of the West Bank, and security coordination between the two sides has ceased.

“If the PA and Israel could cooperate more in Jerusalem, especially in areas beyond the wall, that would be better for residents,” Abu Hamid said.

The potential for such cooperation has always been fragile and endangered. It now seems all but extinct.

Rising hospital deficits

In the midst of an enormous public health crisis, East Jerusalem hospitals suffered an unexpected second blow: the end of coordination between the Palestinian Authority and Israel.

East Jerusalem’s six hospitals treat the capital’s Palestinian residents. But they also depend financially on patients from across the West Bank and Gaza. Without coordination, it is far more difficult for Palestinians to receive permits and funding to enter Israel for medical treatment.

While Israeli authorities opened offices in the West Bank to allow Palestinians there to apply for permits directly, residents of the Hamas-controlled Gaza Strip have no such opportunity.

Before the end of coordination, around 2,500 Gazans entered Israel every month for medical care, with many of those treated in the East Jerusalem hospital network. By July that number had dropped to some 200, according to the human rights group Gisha.

Many patients chose to delay elective surgeries so as to avoid a two-week quarantine back in Gaza, Augusta Victoria’s Nammour said. But other patients with appointments in Israel saw their well-laid plans fall apart.

Omar Yaghi, an 8-month-old baby from Gaza, died in late June after his scheduled heart surgery in Israel was postponed for months due to the end of coordination. If Yaghi had lived, he would have been treated at Augusta Victoria.

According to Jamal Dakkak, the financial administrator at a-Tur neighborhood’s al-Makassed hospital, his institution has lost the majority of its funding since the crisis began. While al-Makassed receives funding from the four Israeli HMOs and Israel’s National Insurance Institute, around 70% of its budget comes from the Palestinian Authority Health Ministry, which offers financial support for Palestinians entering Israel for medical treatment.

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

“We depend on the Palestinian Health Ministry because we’re the referral hospital for critical cases. Most of the complex and difficult cases in the West Bank reach us,” Dakkak said.

But the PA in late May announced that the end of coordination included rejecting tax revenues Israel collects on its behalf. The PA normally receives around $200 million each month from Israel in tax revenues — more than two-thirds of its budget.

Battling a now massive budget deficit has left the PA unable to pay its own employees for months at a time, let alone subsidize thousands of expensive surgeries in East Jerusalem.

Running a hospital in East Jerusalem has never been easy, but the two crises have brought the six East Jerusalem hospitals to an unprecedented and dangerous point, according to Nammour.

“We’ve always experienced delays in payments from the Palestinian Authority. But there’s a new problem, which is a 40% decline in our revenues due to the crisis… This has become a real deficit, not merely a liquidity problem,” Nammour said.

In early April, Jerusalem Mayor Lion wrote a letter to the Israeli Health Ministry to ask for additional support for East Jerusalem’s hospital network. The ministry responded by supplying al-Makassed with ventilators and masks for an emergency response. The current fiscal hole, however, remains unresolved.

The hospital has cut all its staff’s salaries by 25% in recent weeks and delayed paying a significant number of its employees. Dakkak said he may have to cut still further if the financial situation does not improve.

Some hospitals with outside funding, such as those funded by the Red Crescent, may not face the same fiscal crisis. But as hospitals overflow their capacity across the country, every doctor and bed seems critical.

“We can’t furlough people. This is a hospital, we have to be prepared. We can’t afford to lose a single person, especially not medical personnel,” Dakkak said. “We need government support. Who else will save us all if not our hospitals?”

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