The number of infections and deaths from COVID-19 continues to increase worldwide, putting to test the immunity of nation-states, societies, communities and healthcare systems. While pandemics target the well-being of all, preparedness and responses to pandemics occur within the social and historical context of preexisting health disparities and, in some populations, underlying mistrust in government.
Lessons from the 2009 H1N1 pandemic were stark. Indigenous populations in the Americas and the Pacific had a three to six fold higher risk of developing the disease and dying compared to the rest of the population. This was explained by population risk factors such as higher prevalence of diabetes, obesity, asthma and respiratory diseases, as well as living conditions, including larger family sizes, crowding, poverty and deficient access to health care.
Both a population’s health status and its environment are not given natural variables. They are shaped by a variety of political visions and policies. The latest report on health disparities from the Israeli Ministry of Health (released in February 2020) reveals an unsurprising landscape: Palestinian citizens of Israel (PCI) have a poverty rate of 44.2%; nine out of the ten towns with the highest overall mortality rate and all ten towns with the highest death rate from heart diseases are Palestinian. The Palestinian death rate is 2.96 higher for motor vehicle accidents, 2.69 for respiratory diseases, 2.25 for diabetes and 1.85 for hypertension compared to the Jewish population. The living conditions of the PCI predispose them to higher morbidity and mortality rates compared to Jewish Israelis.
After closely observing the struggle between native Indians and their European colonizers in North America, the German geographer and zoologist Friedrich Ratzel in 1901 found that the struggle for space and sustenance is one of “annihilation.” Annihilation, in this context, does not necessarily mean the physical extermination of people: displacement from their homes, herding them together, and limiting their access to food and water are sufficient for them to die in far greater numbers than if overt violence were used against them.
The Palestinians were dispossessed in 1948, most but not all driven out of their homeland. During the 1950s and 60s, in order for the Zionist project to expand, successive Israeli governments enforced massive land confiscation, leaving those Palestinians who remained in Israel – the PCI, who currently make up over 20% of the country’s population – with approximately 3% of the land, while the Israel holds 93% of the land as state land.
The same tactics of displacement, massive land confiscation and home demolitions that have mutilated the West Bank and the Gaza Strip have also been practiced against the Palestinians inside Israel, resulting in the existence of two parallel systems living on top of each other. Jewish Israelis are free to cross between vibrant cities, small towns and agricultural communities. They enjoy vast public spaces, good public school systems, excellent access to healthcare and an efficient transportation system. Israel has the highest number of museums per capita in the world and a thriving technology sector that works hand in hand with its military and armaments industry.
In contrast, the Palestinian community lives in small geographical enclaves that are often stigmatized zones of racial exclusion and economic marginalization; rather than villages and cities, by and large the PCI reside in something akin to "townships."
For Palestinians, the shrinking of living space has been coupled with the demographic growth and the absorption of internally displaced communities. After the destruction of Palestinian urban life in cities like Jaffa, Akka, Safad and Haifa, along with the annihilation of a viable rural life, the reality for the PCI is that of being landless peasants or urban dwellers living in slums: dense concrete residential areas where houses are packed chaotically on top of each other, trying to contain the 11-fold increase of the population over three generations, in structures that not only defy permits, safety rules and aesthetics, but tear away at the entire social fabric of the community. A feeling of suffocation dominates, as Mahmoud Darwish has expressed:
The Earth is closing on us,
pushing us through the last passage,
The Earth is squeezing us,
Where should we go after the last frontiers?
Where should the birds fly after the last sky?
Where should the plants sleep after the last breath of air?
Infectious diseases are a major problem among urban populations, particularly those living in slums. The overcrowding of an impoverished and marginalized population in harsh physical and social conditions heightens their vulnerability to diseases like tuberculosis, acute respiratory infections, meningitis and multiple influenza outbreaks.
Structural violence has become "as natural as the air around us." During the COVID-19 outbreak, it has unfolded in contradictory fashions. Since the overall health status of the PCI is worse than that of the Jewish population, the average life expectancy is lower. Segregation and a relatively young population have paradoxically protected the PCI from a high mortality rate during the current pandemic. Nevertheless, Palestinian towns remain densely populated, poorer and more prone to disease, making them ripe for a deadly spread of the virus. These predesigned living conditions will continue to create greater suffering, disability and death. Until power structures change, these conditions are why COVID-19 might more heavily affect the Palestinians in Israel.
A version of this article appeared on the Arabic blog.