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Israeli immunity hinges on Palestinians getting COVID shots too, doctors say

Epidemiological interest is clear, say officials, warning that herd immunity cannot be reached otherwise, but legal experts conflicted over whether Israel is ultimately responsible

Palestinians sit as PA Prime Minister Mohammed Shtayyeh opens a hospital for COVID-19 patients in the West Bank city of Nablus, on January 16, 2021. (Nasser Ishtayeh/ Flash90)
Palestinians sit as PA Prime Minister Mohammed Shtayyeh opens a hospital for COVID-19 patients in the West Bank city of Nablus, on January 16, 2021. (Nasser Ishtayeh/ Flash90)

Ahmad Sheib, a Palestinian resident of Tulkarem, has followed news of the stunningly successful Israeli vaccination drive against coronavirus with envy.

“We’ll get it much later, and we’ll get Chinese or Russian or who knows what,” said Sheib, who works for an Israeli agricultural firm. “For now, I’m not holding my breath.”

While Israel has sprinted ahead in immunizing its population against the coronavirus — 21% of Israelis have received at least one dose of the Pfizer vaccine — Palestinians have yet to receive any doses and likely won’t for several months, sparking a blistering debate over whether Israel should work to ensure Palestinians in the West Bank and Gaza are included in its vaccination drive.

Critics say Israel has a moral and legal obligation to ensure Palestinians in the West Bank and Gaza are afforded vaccinations along with Israeli citizens, while Israeli officials maintain that vaccinations for Palestinians are not its primary responsibility and will only be considered once all Israelis are inoculated.

Israeli epidemiologists told The Times of Israel that it is in Israel’s overall interest to ensure Palestinians are vaccinated as quickly as possible, as the populations are too intertwined to have one gain herd immunity without the other, despite some claims to the contrary by Israeli leaders.

“The message is very simple: We are one epidemiological unit. As much as we can, we have to help them address this matter,” recently departed Health Ministry Director-General Moshe Bar Siman-Tov told The Times of Israel.

With the vaccine unsuitable for children until testing is carried out and only 95% effective, most experts see herd immunity, the idea that the virus will fade away without enough hosts to latch onto, as the only real way to return to normal life.

A Palestinian medical team works in the coronavirus department at the Dura hospital near the West Bank city of Hebron, January 13, 2021. (Wisam Hashlamoun/Flash90)

It’s not known at what point collective protection kicks in, but is often estimated at 60 percent to 80% depending on various factors including the transmissibility of the virus.

Israel anticipates having 5.2 million citizens vaccinated by March, which, together with the estimated number of people who have already gotten the virus, will be around 65 percent of the population of 9.25 million. But add in another 3 million West Bank residents and the ratio of those immunized drops to just below 50 percent. Include Gaza, as some epidemiologists do, and the percentage drops even lower.

“They have to be part of the picture. We ignore them at our peril. We are really endangering our population if we do so,” said Dr. Manfred Green, an expert in vaccines who was the founding director of the Health Ministry’s Israel Center for Disease Control.

Separated by checkpoints and conflict, the daily lives of many Israelis and Palestinians are in other ways very much intertwined. Over 100,000 Palestinians regularly cross into Israel or Israeli settlements for work, often moving back and forth, according to workers’ rights group Kav LaOved.

“There are Palestinians who come to work in Israel and movement of Israel Arabs who go to Palestinian areas, something that is a lot more common than realized — for shopping, to hold weddings, and … to see family. Plus there are many Palestinians working in settlements,” said Amnon Lahad, chairman of the National Council for Community Health.

Illustrative: Palestinian laborers line up to cross a checkpoint at the entrance to the West Bank settlement of Maale Adumim, near Jerusalem, June 30, 2020. (AP Photo/Oded Balilty, File)

Both Israeli and Palestinian health officials have occasionally blamed the other side for “exporting” coronavirus cases to their areas.

“The rule is very clear with coronavirus — if the virus is anywhere, it’s everywhere. We’ve seen how easily the virus jumps across the Green Line, to Kafr Qasim, Netanya, Haifa,” agreed former Israeli Health Ministry Director-General Gabi Barbash.

Prof. Tomer Hertz (courtesy of Tomer Hertz)

Prof. Tomer Hertz of Ben-Gurion University contended that the mixing of the populations was limited enough that Israel could reach herd immunity without the Palestinians, but said Israel would still need to be prepared for a significant flow of infection from Palestinian areas.

“If Palestinians are working in Israel and inter-mixing with us, it can lead to serious issues regarding the introduction of the virus,” Hertz said.

Palestinian health officials have said that they anticipate receiving the first shipments of vaccines by March. But previous deadlines have fallen through, and a large chunk of them may not arrive until mid-year.

The official PA position has emphasized that in the absence of Israeli support, they plan on immunizing their citizens on their own, though they have yet to submit an official request to vaccinate large parts of their population.

Former senior Israeli defense official Michael Milshtein added that Israel had a security interest in ensuring that Palestinians — especially in the West Bank — are vaccinated regardless.

“Israel has an interest in maintaining strategic stability in the area, economic stability, and so on. Israel does not have to purchase the vaccines in and of themselves, but we should support them however we can, including by helping to pay,” Milshtein argued.

So far, the Palestinians say they have struck deals with four different companies to access coronavirus vaccines, including the British AstraZeneca vaccine and the controversial Russian Sputnik V, as well as two others that have not been publicly named.

The logistical challenges are enormous. Israel has built enormous storage centers in the Negev to hold the Pfizer and Moderna vaccines, while the PA has only a single, relatively small cold-storage unit in Jericho.

Pfizer-BioNTech COVID-19 vaccine doses arrive at a vaccination center in Jerusalem, January 4, 2021. (Olivier Fitoussi/Flash90)

In the Gaza Strip, which is ruled by the Hamas terror group, the obstacles will be greater still. The coastal enclave’s infrastructure has been battered by three wars between Israel and terror group Hamas, as well as a 13-year blockade by Israel and Egypt. Israel says the blockade is necessary to prevent Hamas, which controls Gaza, from importing weapons. Gaza suffers from chronic power cuts, making cold storage extremely difficult.

Milshtein, the former defense official, said he believed that Hamas was likely to escalate tensions in the south in an attempt to pressure Israel to allow the vaccine to enter.

“Hamas will try all sorts of tricks — more flaming kites, and attacks [on] the [border] fence — in an attempt to push Israel to allow the vaccine. Israel needs to be a tough player here, not to give things away for nothing,” Milshtein said.

Illustrative: Then-Ichilov hospital director Gabi Barbash announces the death of singer Arik Einstein, in 2013. (photo credit: Gideon Markowicz/Flash90)

Barbash declined to suggest who would fund Palestinian vaccines or what level of priority vaccinating Palestinians should be given. But the former official was clear that achieving immunity among the Palestinians was a “key epidemiological interest” for Israel.

“Israel is nine million people. Not everyone will be vaccinated, certainly not for some time. Children are not being vaccinated, and while they will not get as sick, you don’t want that,” said Barbash.

“Of course, I want to ensure that the Israeli population is vaccinated. But at the same time, this also needs to go forward, to help them receive vaccines — because Israel and the Palestinians are connected. It’s in our interest,” Barbash said.

‘A duty to cooperate’

The question of vaccinating Palestinians has ignited a small firestorm in the press and online, exacerbated by the stark contrast between Israel’s speedy vaccination drive and the lack of any inoculations for Palestinians.

“Palestinians excluded from Israeli Covid vaccine rollout as jabs go to settlers,” read a headline in the Guardian earlier this month.

Israeli officials have framed the debate as whether or not Israel ought to care for its neighbors, while human rights groups allege that Israel is as responsible for the Palestinians as it is for its own citizens.

The Oslo Accords, a series of bilateral agreements between Israel and the Palestinians signed in the 1990s, specifically designate the Palestinian Authority as responsible for Palestinian health care.

But the treaty is vague on what obligations it imposes on Israel and the Palestinians in the event of a raging pandemic.

Human rights groups have cited provisions that obligate the Israelis and Palestinians to work together: “Regarding epidemics and contagious diseases, [the two sides] shall cooperate in combating them and shall develop methods for exchange of medical files and documents.”

“Any honest lawyer will tell you — a duty to cooperate is to talk to one another and get along. In international law, it’s referred to as ‘duties of good faith’ — make a genuine effort to coordinate, provide information. It does not mean one side gives the other side free stuff,” said Eugene Kontorovich, a conservative legal scholar who directs the Center for the Middle East and International Law at George Mason University.

Human rights groups, who argue that Israel occupies the West Bank and Gaza, also invoke the Fourth Geneva Convention — an international legal document that provides guidelines for occupying forces.

Israel rejects claims that it occupies the West Bank, saying the territories it has ruled since 1967 are “disputed,” rather than occupied. As such, Jerusalem has never accepted the applicability of the Fourth Geneva Convention to the territories.

Palestinian security forces block the main northern entrance to enforce curfew amid the COVID-19 pandemic in the West Bank town of Hebron, on December 11, 2020 (HAZEM BADER / AFP)

Israel also withdrew from the Gaza Strip in 2005; the coastal enclave is now ruled by the Hamas terror group, which avowedly seeks to destroy Israel.

The Convention obligates the Occupying Power to “import the necessary medical supplies, including medicaments, vaccines, and sera, when the resources of the occupied territory are inadequate.”

According to left-wing human rights lawyer Michael Sfard, the Convention entails that if the Palestinian Authority cannot provide immunizations for its own people, Israel is obligated to step in.

“The current situation is that a settler from Israeli Tekoa can receive a vaccine, while his neighbor in the Palestinian village of Tekoa cannot. This is a clear manifestation of apartheid,” added Sfard, who has written extensively on Israel’s military governance in the West Bank and Gaza.

Sfard cited an Israeli court case from the 1990s: When Iraqi chemical weapons threatened Israeli cities during the First Gulf War, the Israeli government distributed gas masks to Israeli settlers, but not Palestinians.

Lawyer Michael Sfard talks to media after a court hearing at Israel’s Supreme Court in Jerusalem, on Dec. 17, 2013 (photo credit: AP Photo/Dan Balilty)

The Israeli Supreme Court ordered Israel’s military government in the West Bank to hand out masks to Palestinians as well, citing inequality and discrimination, as well as a failure to fulfill its obligations to the Palestinian civilian population.

But the legal ground has shifted considerably since the 1990s. Israel signed the Oslo Accords, which specifically designate the PA as ultimately responsible for immunizing Palestinians.

“Even if the Fourth Geneva Convention might have been applicable before now — it’s a moot point. The Oslo agreement has overtaken any other obligations that might have pertained,” former Israeli diplomat Alan Baker said in a phone call.

While the Oslo Accords were intended as an interim agreement as Israeli and Palestinian negotiators hacked out a final deal, no comprehensive follow-up treaty was ever concluded. Israel still controls nearly every entrance and exit to Palestinian areas, and Israeli forces regularly enter territory administered by the Palestinian Authority to conduct arrests.

Palestinian Ministry of Health crews conduct random checks through blood samples in the town of Rafah, southern Gaza Strip, on January 14, 2021. (Abed Rahim Khatib/Flash90)

Still, even which law applies is up for debate, as the Fourth Geneva Convention specifies that those occupied cannot be deprived of any of their rights under the Convention by bilateral agreements like the Oslo Accords.

“Properly understood, Oslo was a change within the framework of an occupation. It did not ultimately end the Israeli occupation or absolve Israel of its responsibility for those living under its rule,” Sfard said.

Baker, the former diplomat, rejected that the idea of an Israeli obligation to provide vaccines. But he acknowledged that Israel could not avoid the question entirely, either.

“‘Cooperation’ doesn’t mean that Israel must provide 1.5 million vaccinations to the Palestinians,” he said. “On the other hand, it doesn’t mean that Israel can completely ignore the fact that the Palestinians are our neighbors.”

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