Life and Health During the Israeli Invasion of the West Bank
The City of Nablus

May 16, 2002


The first report pertained to conditions in Ramallah/al-Bireh. Here, we will
focus on the city of Nablus; reports written by journalists, researchers and institutions pertaining to what happened during the period of re-invasion complement the findings of this house to house survey. The
statistical reports that will follow include the towns of Jenin, Tulkarm and Bethlehem. A final report will sum up the individual town reports and will provide summary results for all the towns combined.

As with Ramallah/Bireh, this is a house-to-house survey which
identifies households as its main unit of analysis, offering quantitative
indicators that are generalizable to all of the households and
population of the city, estimated by PCBS to be 18003 households
and a population of 100, 231 in 1997.  The re-invasion of Nablus
began on the 4th of April 2002 and ended on the 22nd. However,
periodic re-invasions of the towns have continued up till the time of
writing this report, where the Israeli army comes in, destroys homes
and infrastructure, arrests or kills selected individuals then leaves. It
should also be pointed out here that the World Bank has recently
estimated the damage incurred during the re-invasion of the West
Bank at 361 million US dollars, with the Nablus area having been
identified as the hardest hit, and with repair costs there estimated at
114 million US Dollars.
 
Survey Methodology

This house-to-house survey was conducted during the first 10 days of
May, 2002, just after the lifting of the curfew and the partial
withdrawal of the Israeli army to the outskirts of town. A stratified
random sample of households was chosen, primarily based on locale,
and representative of all of the households in the city.

Data Collection

A sample of 154 households was selected utilizing stratified cluster
sampling techniques.  The city was divided into 5 strata, whereby 2-3
random starting points were selected.  From each starting point a
systematic sample of every 10th household was selected. In this
survey, the expected maximum margin of error at the city level is:

E= 1.96*DE*sqrt((P)*(Q)/(n)).
P= The percentage of a certain attribute.
Q=1-P.
DE=Design Effect due to clustering.
The estimated value of DE=1.1.
E= 1.96*sqrt((0.5)(0.5)(1.1)/(150))=8.8%.

Data Entry

                   
Data entry was completed using the ACCESS database. Proper
control structure was defined on closed questions.  Data was
transferred to SPSS using \"StatTransfer\" software.  Double entry was
conducted for a sample of the questionnaire to check for errors that
could not be detected by the control structure defined in ACCESS.
One out of 50 questionnaires experienced swapping values like 1
entered instead of 2 or visa versa.

The Results:

One hundred and fifty four household heads or adult members were
interviewed. The mean age of respondents was 42 years. Fifty one
percent were women and the rest men. Fifteen percent were illiterate,
27% with elementary schooling, 18% with preparatory, 25% with
secondary, 8% with higher diplomas, 6% with bachelors degree
(considerably less than the 20% found in Ramallah/Bireh) and 2%
master’s degree or more. While caution should be made when
comparing with PCBS figures, as those pertain to the population 10
years or over, PCBS reports for 1997 Nablus a 6% rate of illiteracy,
15% as being able to read and write, 63% with secondary schooling
or below, 6% with post high school education, 9% with bachelors
degrees, and 9% with more than bachelors.

The average household size was 6.22 persons per household, lower
than the 6.8 found for Ramallah, but higher than the 5.4 reported by
PCBS for Nablus in 1977, again perhaps indicating a shift in
household composition as a result of the re-invasion.. The smallest
household in this survey was composed of three persons and the
largest 21. Of the total 15% only were composed of extended family
(with three or more generations living together) again lower than the
28% found for Ramallah, and also lower than what has been reported
for Nablus by PCBS in 1977, at 23%.

Family Composition Change during Exceptional Circumstances

Examining the data in relation to shifting household composition during
the re-invasion, with families housing other families during the curfew
and siege in protection against danger, and as families moved out of
dangerous areas into perceived less dangerous ones, we find results
similar to those found for Ramallah /Bireh. Here 29% of the
respondents reported housing other families and or friends during the
reinvasion, almost the same rate (30%) as in Ramallah/Bireh. Of those
reporting housing people other than household members, two thirds
(as in Ramallah/Bireh) reported that they were members of their
extended family, one tenth housed neighbors (probably because the
army took over their homes) one tenth friends (as opposed to a higher
quarter in Ramallah/Bireh), and the rest a mix, even members of the
national security, or strangers who do not live in town who were
stranded. 

When asked why guests sought shelter in their homes,  about half
reported guests moved in because of shelling, the presence of the
army close by and fear for their lives, as their areas were deemed too
dangerous;  about one tenth thought that being with family gives the
feeling of safety; another one tenth reported the presence of a
pregnant woman at home, due to deliver soon, and thought it better to
move out  of their area presumably because health services are easier
to reach where they moved; another one tenth  moved out of their
homes because the army took the home over, occupied it and used it
for its own purposes,  and the rest a mix of reasons such as having
been used as a human shield, and ending up somewhere else other
than home, living in a place outside and inside Nablus and stranded
there during the re-invasion, and home destroyed by shelling.

The results from Nablus seem to be comparable to those of
Ramallah/Bireh, perhaps indicating a pattern of generalized response
to emergency combined with similar conditions that led people to act
in similar ways. Again, these results are important in that they
demonstrate this temporary shift in household composition and internal
migration in search of some safety as an important feature of
conditions during the period and also as an important method of
coping with war. Strong family and communal ties become more
important than usual during exceptional circumstances, and prompt
active cooperation of families, neighbors and friends with each other.

Loss of Work

Of the female respondents, 76% were housewives, and the rest, or
14% were working women: this is almost exactly the same level of
women’s paid work as in Ramallah/ Bireh, and almost identical to the
14.5% reported by PCBS in 1997.  Women are mostly employed in
white-collar occupations.

For men, 15% were employers or owner-operators in the private
sector, owning a shop or running a private operation, a low of 5%
were professionals (teachers, nurses, doctors lawyers), 24% were
white collar workers, lower than the 32% for Ramallah al-Bireh, and
a high of 38% were semi-skilled or unskilled workers. Fourteen
percent reported themselves as having been unemployed prior to the
invasion, compared to the 7% rate of unemployment reported by
PCBS for 1997 for those ages 10 or above, but  close to the 12%
reported for Ramallah/Bireh in our survey. The rest were students. Of
those reporting that they were working prior to the invasion, 27%
reported job loss since that time. Of those, more than three quarters
explained this new unemployment because of the collapse of the
economy and the market since the invasion, and the rest blamed the
closures and siege. These results are very similar to those obtained for
Ramallah/Bireh and point to perhaps a generalized as opposed to
locale specific increase in poverty levels, even beyond what was
estimated by PCBS for the first six months of the Uprising.

Unavailability of basic services

Nablus suffered serious electrical current cuts during the re-invasion
and curfew that had a negative impact not only on family life, but on
commercial enterprises as well, with reports of substantial loss of food
items that required refrigeration. In this survey, a high of 47% of
respondents reported living without electricity for most or all of the
period of re-invasion, a rate that is higher than Ramallah/Bireh (20%),
and confirming in part the observation that Nablus was perhaps most
hardly hit of all the towns. Being without electricity certainly
complicates family life to a considerable extent, especially given
children and additional guests as well. About 45% reported the loss of
electricity for some of the time, and 8% reported no electrical
shortages at. Just to note, electrical current interruptions also affected
an estimated population of 14,000 people in nearby villages, as the
Nablus Electric Company serves not only the City, but also selected
nearby locales.

Thirty nine percent of households reported tubed water shortages
most or all of the time, a rate similar to that of Ramallah, again due to
shelling, bombing, shooting and vandalism affecting the different levels
of the water system. Thirty nine percent reported water shortages for
part of the time, and 22% no water shortages at all. During such a
period, people usually rely on water wells. Of the total who have
phones, 44% had their telephone lines cut all of the time, 7% most of
the time, 15% some of the time and the rest did not face problems
with phones. 

The majority of households, on the other hand (84%) reported no
problems with sewage disposal, with the rest reporting blown up
sewage pipes mostly and cesspools not being emptied. As in
Ramallah, the garbage problem was major, affecting 98% of families
who said that they had serious problems getting rid of their garbage.,
mostly reporting the problem of un-emptied garbage containers, as
municipal services came to a halt during the period.  Several families
reported not being able to get the garbage out of the house, with
garbage piling up inside their home. On the whole, given that the areas
that were mostly affected by the violence were hardest hit in terms of
loss of electricity, water and phones combined, family lives must have
been very difficult indeed, especially among families with young
children and elderly and disabled members.

Low on Food and Cash

Of the total respondents 37% reported food availability problems
during the reinvasion and curfew period, and 43% reported food
unavailability in the market, once the curfew was lifting periodically for
people to shop for essentials.  Of the total, 33% also reported a
problem of cash availability, less than the reports from Ramallah
(54%), perhaps because either because Nablus is a strong
commercial center or because it has more extended family support
networks than Ramallah, where  a first impressions that one gets of
Ramallah might  lead one to think that household cash is more
abundant there, given Ramallah’s function as a  center of institutions
and government.   

In Nablus, the pattern was similar to Ramallah, with an initial period
where there was no curfew lifting at all and families could not get out
to buy food, followed by a period where the curfew was lifted but
selected fresh food items were not available, followed by an easing up
of the problem of food availability and the uncovering of the problem
of cash availability. The difference here is that throughout the re-
invasion, banks did not re-open, even for the minimal services offered
in Ramallah.

When asked about how the families coped when faced with low food
supply, 7% began to bake their own bread at home (in contrast to a
higher 18% in Ramallah), a high of 38% relied on families and friends,
a significantly higher rate than in Ramallah (5%),  20% reported
substituting one type of food with another,  and the rest gave mixed
answers, with austerity measures of eating less frequently reported
rather less than in Ramallah, and raising questions as to why this was
one important method of coping in Ramallah, when in Nablus, it
appears not to have been otherwise. Again the higher rate of family
reliance may be an answer.  However, and unlike Ramallah, a
surprisingly high rate (about 20%) reported substituting milk for
children with tea, not only losing an important source of protein and
calcium, but contributing to the problem of loss of food iron from the
body as tea chelates iron and blocks its absorption. These results
raise the question of the need to conduct a specific nutritional status of
children survey that includes clinical exams focusing on anemia in
childhood during exceptional circumstances.

As for cash availability problems, Nablus residents   managed in
slightly different ways than in Ramallah:  36% reported spending less
in contrast to a higher 50% in Ramallah, ( yet eating less was hardly
reported in Nablus, perhaps because Nabulsis store larger quantities
of food at home),  30% borrowed money from families and friends,
28% relied on food shops loaning them food on account ( as in
Ramallah)  8% delved into savings intended for use for purposes other
than eating, and 7% resorted to living with what was at home(more
than 100% as multiple reports were allowed). Overall, while families
emerged out of the crisis, difficulties are not over yet, with the
continuation of siege, collapse of the market and problems of
unemployment forming serious family life problems in this community.

Shooting, Explosion and Destruction of Property and
Institutions

When asked about shooting, explosions and destruction in their areas,
 a high of 57% reported that they endured much of that during the
period , almost continuously (Ramallah: a lower 29%), 29% a lot of
the time, and 13% only a little, again confirming the observation that
Nablus was harder hit than Ramallah. Again the results seem to be
related to the area where households are located, locations in and
near the old City suffering more damage, such as  Ras al-Ein. and
Krum Ashour, as well as al-Quds and Nablus street in the nearby
vicinity. That is, the main assault seems to have been on the Old City
and its surrounding areas, as this survey seems to indicate.

In response to how households managed,  57% reported hiding in
fear, lack of  sleep and mental distress; 14% reported the family
hiding in one room, speaking quietly so as not to draw the army’s
attention to their presence,  9% reported having to pay attention to
children who were in great fear, again crying and urinating
uncontrollably on themselves, and the rest responded in a variety of
ways, including depression, learning the lessons and withstanding in
resistance, waiting till the army came inside the house, or even
behaving normally, at 5%, as fear has become ordinary or a way of
life.

Again, consistent with the above findings, a high of 67% ( Ramallah:
52%) reported considerable destruction in their neighborhoods. Of
those, a high of 44% ( Ramallah 39%) reported pervasive destruction
of retaining walls, telephones, electrical poles, shops, pavements, cars
and even traffic signs;  22%, as in Ramallah, reported the destruction
of homes, doors, the breaking of furniture and windows as well as
water pipes while 13% reported the destruction of nearby homes as
well, which combined (35%) point to a higher level of home
destruction than in Ramallah; and with scattered answers such as: I
cannot describe what I saw, or,  bullets shot into the house.

Of the total, 34% reported that their home was directly exposed to
shooting, bombing and destruction, compared to 28% in Ramallah.
More than half reported that the shooting was directed to their home’s
walls, glass, entrances and retaining walls;  a quarter ( Ramallah = one
fifth) reported that the army occupied their homes, destroyed and
broke windows, cupboards, furniture, threw food out of cupboards
and all over the place and dirtied their homes,  again pointing to the
higher severity of incidents in Nablus;   2% reported theft by the IDF;
and the rest reported destruction of water pipes and sewerage.

Of the total households, 50% reported that their homes were
searched by the Israeli army (41% for Ramallah).  Respondents also
reported the arrest of at least one of their family members in 24% of
the cases, probably during home searches, but not solely.  These are
likely to have been temporary arrests of course, but certainly add to
the weight of fear and terror in the family. Among those with searched
homes, over half reported that IDF broke the belongings in their
homes in the process, with a high of a fifth reporting theft of
belongings adding weight  to the  reports on the IDF stealing people’s
belongings  but  casting doubt on the assumption that theft was more
prevalent in  Ramallah. This impression may be due to the fact that
documentation of theft took place earlier and more precisely than in
other towns, rather than Ramallah being  an exclusive venue where
Israeli soldiers engaged in widespread theft.  These results indicate
once again the appearance of a picture of systematic theft, and not
only destruction and vandalism.

Asking about the workplace of household members who were
working prior to the invasion, 12% reported direct damage there,
very low in contrast to the high of 41% in Ramallah, perhaps the effect
of the higher level of indiscriminate violence against homes that took
place in Nablus  and the assault on institutions, particularly ministries,
in Ramallah. Again, cars were directly affected by the violence in 9%
of the cases in Nablus, compared to a high 19% for Ramallah. On the
whole, though, these results demonstrate that, a consistent pattern of
vandalism is beginning to appear, that may be re-enforced or negated
once we analyze the results from the other towns. However, as it
stands now,  the results at hand cannot be justified by the claims of
‘incidental occurences’ of such awful destruction nor ‘ security’
considerations. What appears to be the case instead is a systematic
attempt and destruction, violence and the construction of fear in a very
large number of the population.

Medications

A lower than expected 22% of households (Ramallah: 49%) reported
a medication availability problem during the period. It is not clear why
this large discrepancy between households in these two communities,
but may perhaps pertain to differing household routines and ways of
life, with Ramallah residents being more ‘urbane’, and less inclined to
storage of things at home, and even perhaps more inclined to be
dependent on medications as a way of life. In addition, Nablus
residents may have learned from the experience of the earlier
Ramallah invasion and stocked up with needed medications.

 Of those with this problem almost half (a quarter for Ramallah) just
waited until the siege was over, one quarter got help from neighbors
and friends ( substitute medications probably),one tenth called the
Red Crescent,, one twentieth called the UPMRC,  and the rest used
indigenous medical practices, or managed to reach hospital. Negative
ramifications or complications because of the absence of medications
was reported by almost half of those who reported problems with
medication unavailability, with 1/6th specifically reporting out of
control diabetes mellitus – increasing in this way the risk of future
complication on the heart, kidney and eye, among other organs.
Again, the long term effects of the sudden interruption of needed
medications, especially in the case of difficult to control chronic
diseases – such as hypertension and diabetes, can only be speculative,
yet the reports do indicate the need for a study of the consequences
of the lack of medications, and perhaps more importantly the lack of
primary and secondary care among selected groups within the
population as an important priority research in the near future.

Mental Health

Again in contrast to Ramallah, with the rate of mental health problems
reported in households as high as 93%, a lower 70% of responded
stated that they faced a variety of problems with various members of
their family. Given the higher severity of the onslaught in Nablus
compared to Ramallah, perhaps these results are indicative of the
‘awareness’ of the symptoms of the problem, or perhaps willingness
of respondents to spell out mental health problems without worrying
about ‘taboo and image’, that is, if our assumption of a more ‘urbane’
and exposed Ramallah is correct. Surely, these differences call for
further investigation. Of all of the respondents here, a high of 53%
reported the problem in terms of fear, screaming, crying, inability to
eat or sleep and psychological disturbances generally, and 12%
focused on these symptoms in children especially. When asked about
how they managed these symptoms and coped with these trying times,
 a high of 22% singled out praying as a method of coping
(Ramallah:6%), followed by a focus on relieving children’s fear,
sleeping with them and taking care of them at 20%, 17% drew on self
control and ability to withstand and only 7% reported watching
television (probably because the electrical cuts were more severe and
longer) playing cards etc., and then a range of answers such as’ dealt
with the situation as normally’,  drinking indigenous herbs to feel
better, seeking the help of a counselor, sleeping at the neighbor’s and
calling friends and family to see if they are all right.

Views on Current Conditions

The last question asked to respondents pertained to their views on the
    current conditions. Again a high of 74% reported views
    expressing despair and misery over what is happening to their
    lives (Ramallah:71%),  an additional  30% showed great
    concern over the family’s financial situation,  with the rest
    offering a range of answers such as ‘ Excellent because we
    deserve what happened to us’,  and ‘ These are abnormal
    times, they will come  again’,  ‘God Almighty will make the
    conditions better’, ‘ What Israel and America want will
    happen’,  ‘ This calls for our insistence on popular resistance’
    and ‘This indicates a crisis in politics, in lack of clear vision
    and strategy and lack of unity’.  These answers combined,
    and collated with the Ramallah results allows for a picture to
    emerge focusing on the issue of despair as key to
    understanding the  current state of the population of Palestine,
    and perhaps not only the towns that were studied. Despair,
    combined with cumulative international and overall neglect,
    want and deprivation can have a marked influence on current
    behavior and future aspirations as well.

Conclusion

Other than quantifying the phenomena reported by others through
qualitative methods and interviews, this study demonstrates both
similarities and differences in the experiences of ordinary people living
in Nablus and Ramallah during the Israeli Re-invasion of their areas.
On the one hand, household reports indicate a uniformity of
experiences that cannot be explained by accidental destruction in the
pursuit of ‘security.’ On the other hand, responses to this terror in
Nablus appear to be different from Ramallah in ways that social
relations, setting and mode of life seem to dictate, and maybe an
indication of the cultural differences noted between both cities. Nablus
households report having been harder hit than Ramallah, confirming
earlier reports pertaining to this matter. But the pattern of destruction
and vandalism is clear: such rampant destruction and events witnessed
by ordinary people cannot be simply accepted as accidental or
haphazard as the IDF claims. This study demonstrates otherwise,
given the consistency in reporting specific events, such as the
destruction of homes and property, breaking household belongings,
ruining food supplies, stealing people’s valuables, to name only a few
clear indicators of an intended policy or an out of control army, or
both.

To estimate the number of households and people that were affected
by specific serious difficulties in dealing with daily life as a
consequence of this re-invasion, we are using PCBS’s census report
of Nablus’ population of 100,231 and 18,003 Households:

Some calculations that may be useful:

1- Family Composition Change during Exceptional
Circumstances
a- 29% of the respondents reported housing other families and or
friends during the reinvasion that: is  29,067 individuals or 5,221
households.

2- Unavailability of Basic Services
a- 47% of respondents reported living without electricity that is:
47,109 individuals or 8,461 households.
b- 39% of households reported tubed water shortages most or all of
the time that is 39,090 individuals or 7,021 households.

3- Low on Food and Cash
a- 37% reported food availability problems during the reinvasion and
curfew period that is 37,085 individuals or 6,661 households.
b- 33% reported a problem of cash availability that is 33,076
individuals or 5,941 households.

4- Shooting, Explosion and Destruction of Property and
Institutions
a- 57% reported that they endured much of explosions and
destruction in their areas during the period, almost continuously that is
57,132 individuals 10,262 households.
b- 67% reported considerable destruction in their neighborhoods that
is 67,155 individuals or12,062 households.

5- Medications
a- 22% of households reported a medication availability problem that
is 22,051 individuals or 3,961 households.

6- Mental Health
a- 70% of responded stated that they faced a variety of mental health
in various members  of their family that is12,602 households.

References:

        Greenberg, Joel, West Bank Damages put at $361 million,
    the New York Times, May, 16, 2002.
    Palestinian Central Bureau of Statistics, 2000.  Population,
    Housing and Establishment Census -1997, City Reports
    Series. Final Results– Nablus City.
    Palestinian Central Bureau of Statistic, PCBS, 1999.
    Population of Palestinian Communities, 1997-2010.
    Ramallah-Palestine.