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Life and Health During the Israeli Invasion of the West Bank: Bethlehem Latin
by Rita Giacaman and Abdullatif Husseini 12:49pm Sat Jun 1 '02
address: Institute of Community and Public Health, Birzeit University

This is the fifth and final brief statistical report focusing on the daily life and environmental conditions of families living under curfew and in fear and danger, during the latest Israeli invasion of the West Bank.
print article

May 29th, 2002

This is the fifth and final brief statistical report focusing on the daily life and environmental conditions of families living under curfew and in fear and danger, during the latest Israeli invasion of the West Bank. The towns included in these series are Ramallah/Bireh, Nablus, Jenin, Tulkarm and the subject of this report, Bethlehem. Dispatched separately, these reports should ideally be considered together. A final report will follow the individual town reports and will focus on the summary results for all the towns combined. In this report, we will review the responses obtained from the Bethlehem households. The surveyed households include Bethlehem town and its three refugee camps (Dheisheh, lying at the outskirts of town, Aida, joining Bethlehem with Beit Jala town and Azza, inside Bethlehem proper) The responses obtained in this survey are generalizable to the entire population of Bethlehem and its refugee camps, estimated by PCBS in 1997 to be around 32,510 persons and 6,157 households.

Bethlehem was invaded more than once during the recent period. The first invasion took place on the 8th of March, 2002 and continued till the 15th of the same month. The second invasion, the subject of this report, began on March 29th, and continued until the 11th of May, 2002, placing Bethlehem in first place, compared to the other towns that we have studied, in relation to the number of days it has suffered under curfew and occupation (44 continuous days). The third invasion began on May 27th of 2002, with curfew, arrests, and destruction taking place as usual, and continues as we write this report. The impact of long periods of occupation and curfew, as well as repeated experiences of such events for shorter periods of time, can only translate into a heavy toll paid the people of Bethlehem in social and humanitarian terms, perhaps heavier than the other towns that we have reviewed so far.

Survey Methodology

This house to house survey was conducted during the third week of May, 2002. A stratified random sample of households was chosen, primarily based on locale, and representative of all of the households in the town. 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 forty eight adult household heads or family members were interviewed. The mean age of respondents was 38 years, comparable to the mean age of respondents for Tulkarm, but slightly less than for the four other surveyed towns. Forty seven percent of the respondents were females and the rest were males. Of the total, 8% were illiterate, 10% with elementary schooling, 16% primary, 27% secondary schooling; 10% reported having post high school diplomas, a high of 25% Bachelors degrees and 3% Masters degrees or above. The educational picture for the town as a whole and for those above the age of 10 years produced by PCBS for 1997 include: include 8 % illiterates, 14% able to read and write, 67% with secondary schooling or below, 4% with associate diplomas, and 8% with Bachelors or above.

The average family size in this survey was found to be high at 6.81 persons per family, higher than that reported by PCBS for 1997 (5.3 for town and camps combined) but close to the family size reported in this survey for Ramallah (6.84) and lower than that of Tulkarm (6.94). In Bethlehem, we found that the smallest household was composed of 1 person, and the largest a very high of 40 persons/household, the highest family size of all the towns included in this survey. Of the total 77% were composed of nuclear families and the rest were extended one, results that are comparable to those obtained by PCBS for Bethlehem (1997).

Family composition: change during exceptional circumstances

The higher than expected average household size found in this survey seems to be related to families housing other families during the siege, results that have been noted for all the towns included in this survey without exception. In Bethlehem, we found that 28% of respondents reported housing others during the period of re-invasion and curfew, a rate that is comparable to those obtained for Ramallah and Nablus, but higher than in Tulkarm (23%) but lower than in Jenin (37%). These results are indicative of population movements away from dangerous areas into perceived less dangerous ones, probably pertaining to severity of onslaught directed at homes, as opposed to infrastructure, and leading to the internal migration of families within the town during the invasion period. Over two thirds reported that the live-in guests were relatives, and the rest a mix of neighbors, friends or even stranded people who could not reach their homes either because of the curfew, or because they were used as human shields then dropped away from home, necessitating seeking shelter elsewhere.

When asked about why these guests moved out of their homes and sought shelter in the surveyed household, almost a third reported fear of danger as the main reason for people seeking shelter in their home, four tenth reported that the home of the guests was located in very dangerous areas, surrounded by soldiers and shelling, and the rest reported the usual ‘ home was taken over by soldiers’, ‘fear of being arrested’, and the unusual ‘the guests were internationals who were in Bethlehem during the period to assist in our protection and in solidarity with our family’. On the whole, the observed major temporary shift in household composition through in-town migration during invasion appears to be an important phenomenon that affected all the towns during this period. These results once again call for future investigations of possible changes in family dynamics, perhaps focusing on power relations and the division of labor between men and women during these trying times, especially as anecdotal evidence indicates an increase in the burdens of women as caretakers to even higher proportions that what is observed normally. Likewise a closer look at the impact of seeming incapacitation, loss of work, inability to protect or provide for family and practical imprisonment at home on men’s perceptions of themselves and their self esteem is also an important question to raise for future research.

Loss of work

Of the female respondents, only 53% reported that they were housewives, with the rest reporting themselves as working, again denoting a strong bias in our survey in favor of the working women at home, and contrasting to the PCBS reports on the labor force participation of women for 1977, placed at a low of14%. The PCBS reports, however, pertain to all women over the age of ten, while our sample is composed of adults, making it difficult to ascertain the cause and level of bias here and precludes the possibility of further comparison.

Of the male respondents, one sixth engaged in private work, either owning a shop, or running a private operation, a high of a third reported working in white collar jobs, such as officer workers, technicians, and Palestinian Authority functionaries, another third reported that they were working as semi skilled and unskilled worked, while others reported themselves as professionals and farmers. Of the total males, one tenth reported themselves as having been unemployed immediately preceding the invasion.

When asked if they were still holding their jobs after the invasion, of respondents who were working prior to the invasion, a high of 29% reported that they no longer work, results that are comparable to those of Tulkarm (28%) and Nablus (27%), and higher than those of Jenin (24%) and Ramallah (23%). Of those reporting job loss, almost half pointed to the closures and siege as a main cause of their unemployment, about one fifth reported problems pertaining to the collapse of the market and the rest provided varying types of reports, such as ‘conditions are still abnormal’, or ‘ place of work destroyed during the invasion’, or even ‘laid off from work because of the conditions’. These results, combined with the results for the other town reports point to the need to investigate the problem of unemployment especially in relation to the siege and the collapse of the market. Furthermore, these results also point to the need for household assistance through the generation of employment in their area of domicile as perhaps one of main priorities for action at the economic, social and humanitarian levels.

Unavailability of basic services

While Bethlehem seems to have suffered the longest period of invasion and curfew of all the towns included in this survey, reports from households indicate that electrical cuts were perhaps not as severe as elsewhere. In this survey, we found that only 3% of respondents reported living without electricity all of the time, an additional 10% most of the time, and 45% only some of the time and a high of 42% not facing this problem at all. This contrasts with experiences of households in the other towns, with 20% for Ramallah households, 44% for Tulkarm, 47% for Nablus and a very high of 96% for Jenin reporting electrical shortages most or all of the time. Why Bethlehem’s electricity network was possibly spared is beyond the scope of this rapid survey. However, it may be that the substantial difference in the length of curfew and invasion between Bethlehem and the other towns does not allow for an appropriate comparison in relation to severity of service interruptions, and that, ultimately, the length of curfew and invasion may be determinant.

The water shortage during the invasion and curfew appears to have been more serious that the electricity shortage, with 6% reporting no tubed water most or all of the time, 17% reporting no tubed water some of the time and 77% no problem with running water at all. Again these results contrast with those obtained for the other towns, with 23% for Tulkarm with no water supply most of the time, 37% for Ramallah, 39% for Nablus and a very high of 96% for Jenin. The length of curfew and invasion as well as the neighborhood where the household is located may explain these apparently lower rates in Bethlehem. According to the Water Supply and Sewerage Authority of Bethlehem, the water shortage was severest in the Nativity Church area and around the Old City, with water cuts ranging from 5 and up to 20 days, including a period of 40 days in the areas within the immediate vicinity of the Church. Telephone line cuts were also found to be a problem, with 15% of those having phones reporting that the lines were cut most or all of the time, and 21% some of the time.

Of the total households, 11% reported that sewage pipes were blown off, with households facing a problem in disposing of sewage, while 1% reported difficulties in dealing with emptying cesspools. In contrast, a high of 95% reported difficulties in getting rid of household garbage, attesting to the severity of the curfew. Of those reporting this difficulty, 57% stated that municipal services came to a halt during the curfew, 25% reported that the curfew was so severe they were unable to transport the garbage outside the house, resorting to storing it at home, and the rest reported varied answers such as ‘ the tank was right next to the garbage container’, ‘ the army destroyed the container’, and ‘ the army was stationed right in front of the house’.

Low on food and cash

The results pertaining to difficulties faced because of the shortages of food and cash demonstrate a pattern that is different from the pattern observed for the previous findings: Bethlehem households seem to have suffered food and cash shortages to a larger extent than in the other towns, presumably the effect of the longer period of invasion and curfew. Here, we find that 54% of households reported problems with food availability at home, compared to 50% in Tulkarm, 43% in Ramallah, 37% for Nablus, and a higher 64% for Jenin. That is, it seems that Jenin may have been the hardest hit in relation to such problems, followed by Bethlehem, then Tulkarm, Ramallah and Nablus respectively.

Of those who reported food shortages at home in Bethlehem, a high of about one third reported that they tried to east less, rationing what they had to manage the extended curfew situation, almost one fifth reported that they got by with what they had and managed that way, another fifth reported cooperating with neighbors and relatives to feed their families, and the rest resorted to home production, relied on food aid, or managed with food substitution, with a reliance on canned foods. Likewise, shortages of food items in the market were noted when the curfew was lifted, with a high of 50% of respondents reporting problems with these shortages, compared to a high of 74% for Tulkarm, 69% for Ramallah, 43% for Nablus, and a very high 89% for Jenin.

Unavailability of cash was also a problem in Bethlehem, with a high of 65% reporting difficulties in this area, compared to 54% for Ramallah, 39% for Tulkarm, 34% for Jenin and 33% for Nablus. It is not clear why Bethlehem and secondarily Ramallah households suffered especially from this problem, but this may have to do with a possible greater reliance of Bethlehem households on Banks, or the fact that the invasion first began in both Ramallah and Bethlehem, providing other towns with advance warning and prompting families to prepare for the onslaught, as well as the length of the curfew and siege which created the conditions of more serious shortages of both essential items as well as cash. Clearly, these results call for further field investigation of this particular question. As with the other towns, these results also call for the need to examine in more detail the impact of these events on the health and nutritional status of the population, especially younger children.

Shooting, explosions and destruction of property and institutions

Thirty five percent of respondents reported having heard a lot of shooting and explosions throughout all the period of invasion and curfew, 51% most of the time, 14% a little and only 1% did not hear anything at all. When asked how they coped, A high of 65% reported that the family hiding in fear, lack of sleep and mental distress as a result, 18% reported that they went on with their life normally, as the family was by now accustomed to the situation or that there was nothing that anyone could do. Only 5% focused on dealing with the children’s physical and mental health, and the rest gave a range of reports, such as’ leaving our house and seeking shelter elsewhere’, ‘quite bothered by the army next door’, ‘sleeping in the safest place at home and hoping that God can protect’, and ‘family gathered in one room waiting for the army to come in’.

Of the total respondents, 31% reported considerable destruction in the neighborhood where they live, in contrast to a very high 87% for Tulkarm, 78% for Jenin, 67% for Nablus and 52% for Ramallah. Evidently, and judging by these responses alone, the level of destruction around the residents of Bethlehem was considerably less than elsewhere, perhaps denoting a generally lesser level of physical destruction overall, or perhaps a concentration of destruction only in specific areas, such as the Church of Nativity area and Old City. Of those reporting witnessing destruction, almost half reported considerable destruction of retaining walls, telephone and electrical poles, sewerage, pavements, cars and even traffic signs, almost one third reported the destruction of homes, doors, the breaking of furniture and windows and the rest reported destruction of public buildings, commercial enterprises, and the detonation of closed homes. It is interesting to note that none reported the destruction of institutions that took place in Ramallah, or the rampant destruction of homes that took place in Jenin and also Nablus’s Old City area.

Twenty one percent of respondents reported that their homes were directly exposed to shooting, bombing and/or destruction, compared to 28% for Tulkarm and Ramallah each, and a higher level of home destruction noted for Nablus (34%), and Jenin (59%). Of the total 15% reported that their cars were directly exposed to shooting, bombing or destruction, while 18% reported the exposure of their workplace to shooting, bombing and or destruction, slightly higher that in Tulkarm (13%) and Nablus(12%), but lower than in Jenin (29%) and Ramallah (41%).

Thirty eight percent of respondents reported that their homes were searched by the IDF, compared to a lower 30% for Jenin, higher 41% for Ramallah, Tulkarm (45%) and Nablus (50%). Of the total respondents, 27% reported the arrest of at least one family member during the period of re-invasion and curfew, a rate that is lower than reports from Ramallah (36%) higher than the 12% reported for Tulkarm or Jenin (21%), but comparable to those of Nablus(24%).

Taken together, these results demonstrate that while the curfew and invasion continued for a longer period in Bethlehem, the physical damage there may have been less severe than in Jenin, at least in relation to the home destruction that took place during the period, and less in severity as well than the institutional damage reported for Ramallah. These results combined with other results noted above, such as electrical and water supply interruptions leads one to suggest that Bethlehem households were affected largely, but not solely, by the special problem of the long curfew and consequent inability to move around, buy what is needed, reach services and work, to a larger extent than in terms of the physical damage that took place in the town during the invasion.

Medications

In Bethlehem reports of medication shortages stood at 34%, the same level of shortage reported for Tulkarm and Jenin, leaving Ramallah with the highest level of medication shortages (49%) and Nablus with the lowest (22%). Given that the invasion in both Bethlehem and Ramallah took place at the same time, an understanding of why Ramallah residents reported a higher level of medication shortages than in Bethlehem, even though Bethlehem’s curfew conditions continued for much longer than in Ramallah is beyond the scope of this quick survey, and may well be an interesting question to investigate in the future. However, given that Bethlehem residents were already exposed to the experience of invasions of long durations, it may also be that this experience is important as a conditioning factor determining patterns of shopping and the stocking up of homes with essentials, especially medications.

When asked about how they coped with medication shortages at home, a quarter contacted relief and humanitarian organizations for help, another fifth took the medication or its equivalent from the neighbors; one sixth resorted back to indigenous medical practices; another sixth did nothing and waited, and the rest either got help from friends, contacted ambulances for help, used sedatives instead of the medication that they needed, or relied on the ‘Godly immune system’.

Of those reporting medication shortages during the period, over two thirds reported the deterioration of the conditions of the patient, while others provided responses that included ‘ lived with strong pain’, ‘medical condition took longer to resolve’, ‘disease was self limiting anyway’, and ‘ bodily disruptions ensued’.

Mental Health

As is the case with the other towns, a high of 87% of respondents reported facing problems related to the mental health of one or more family members, results that are comparable to those obtained for the other towns, and demonstrating considerable household psychological distress. A variety of conditions were reported, including great fear among children, uncontrolled shivering, lack of sleep, crying, lost appetites, exhaustion mixed with fear and worry, disagreements between the family and the neighbors (apparently seen as evidence of mental distress), and the feeling of insecurity and the inability to protect one’s family.

When asked about how the family responded to such problems, the range of answers was quite wide, with one sixth reporting focusing on relieving children of their fears, another fifth watching television, playing cards, computer games and entertaining themselves with others, a quarter reporting that they did nothing as nothing could be done, another sixth resorted to praying, and the rest reporting just being bored and nervous, keeping the family in one room, seeking the counselor’s help, seeking the help of the ambulance services in town, taking medications to sleep, eating garlic (presumably because it is good for the nerves and calms people down) and screaming at the children in reaction to the stress that the family is living.

If one takes into consideration the reports from Bethlehem in combination with the reports from the four other towns, one can be led to the conclusion that the impact of the invasion and curfew periods was felt by households not merely in physical terms, but also in mental health terms as well. The fact that mental health problems were also recognized by respondents, who were willing to report on such household problems, is also significant in that these reports indicate the presence of a generalized awareness of the importance of psychological distress for the general well being of households, and perhaps the need to work to manage and resolve such problems. While these reports are proxy reports that cannot be analyzed further, especially at the individual level, the information we obtained here suggests that the impact of the invasion and curfew may have manifested themselves through symptoms of psychological distress, both somatic and behavioral, perhaps exacerbating pre-existing disease conditions, both physical and mental.

Views on current conditions

Lastly, when prompted to express their views regarding the conditions in which they live, once again, a high of 76% reported views pointing to despair and misery over what is happening to their lives, results that are consistent with the results obtained from the other four towns; 8% focused on worries pertaining to the financial condition of the family, and the rest gave a range of answers, such as: ‘this is a normal consequence of the Oslo Accords’, ‘ a wise leadership for the Palestinian people does not exist’, ‘ the play is being exposed’, ‘ the fear is over what will happen in the future’, and ‘ a political game, betrayal and agreement’. The cause of this deterioration in daily life was placed on the Palestinian leadership in not assessing the situation well, because of favoritism, corruption and other factors in 20% of the responses; the blame was placed on occupation and its force, Sharon and his political failure in 34% of the cases; the blame fell on both Israel and the Arab World leaders in 10% of the cases, and on occupation combined with the failure of the Palestinian authority in another 10%. The rest were mixed answers, including the standard Arab betrayal and American support responses that one hears commonly here, the absence of national unity, the presence of collaborators with Israel, and Arab silence.

Conclusion

This initial statistical report focusing on Bethlehem town during the re- invasion of March 29th, 2002, shares findings and observations made in the four other town reports that have been completed. In Bethlehem, however, the length of curfew and siege manifested themselves with more difficulties dealing with food shortages and cash, compared to the other towns. However, reports of electrical, water and telephone shortages indicate that those were less severe than elsewhere, although the duration of curfew and siege differences between Bethlehem and the other towns makes it difficult to come up with definitive results.

As with the other towns, the households of Bethlehem were subjected to much violence and violation of basic human rights, including the right to move around, to access health services, to work and adequate nutrition. Yet, although Bethlehem may have taken a larger share of media attention because of the specific events that took place around the Nativity Church, and despite the fact that the curfew and invasion were the longest of all five towns, our data suggests that Bethlehem may have suffered less than other towns in terms of physical destruction and damage. Perhaps the presence of media coverage and international volunteers, combined with the spiritual status of the town in the Christian civilization may have caused the Israelis to use a softer hand and may have deterred some of the brutality demonstrated elsewhere, especially in Jenin Camp. However, as is the case with the other towns, despair in Bethlehem seems to be rampant and part of a generalized consciousness that began to appear among the Palestinian population even before that last invasion began. This despair is now being consolidated by not only grave violations of human rights and the destruction of the infrastructure needed for survival, but also the continuation of the episodes of re-invasion and curfew as well as closures and siege so strict that preclude possibilities for rehabilitation and reconstruction. Without the removal of closures and the state of siege, without putting a stop to Israeli army invasions and re-invasions, indeed, without the end of occupation, the people of Bethlehem as well as the other towns and villages of Palestine are likely to be facing even worse conditions than what they have already witnessed.

In estimating 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, and based on PCBS estimates, we find the following:

1- Family Composition Change during Exceptional Circumstances a- 28% of respondents reported housing others during the period of re-invasion and curfew that is 9,103 individuals or 1,724 households.

2- Unavailability of Basic services a- 3% of respondents reported living without electricity all of the time that is 975 individuals or 185 households. b- 6% reporting no tubed water most or all of the time that is 1,951 individuals or 369 households. c- 95% reported difficulties in getting rid of household garbage that is 30,885 individuals or 5,849 households.

3- Low on Food and Cash a- 54% of households reported problems with food availability at home that is ,17,555 individuals or 3,325 households. b- A high of 65% reported suffering from unavailability of cash, that is 21,132 individuals or 4,002 households.

4- Shooting, Explosion and Destruction of Property and Institutions a- Thirty five percent of respondents reported having heard a lot of shooting and explosions throughout all the period of invasion and curfew that is 11,379 individuals or 2,155 households. b- 31% reported considerable destruction in the neighborhood where they live that is 10,078 individuals or 1,909 households..

5- Medications a- In Bethlehem reports of medication shortages stood at 34% that is 11,053 individuals or 2,093 households. .

6- Mental Health a- 87% of respondents reported facing problems related to the mental health of one or more family members that is 28,280 individuals or 5,356 households.

References:

1. Bennet, James, Bethlehem Invaded Again, as Israelis Extend Control, New York Times, May 27 th , 2002.
2. Palestinian Central Bureau of Statistic, PCBS, 1999 . Population of Palestinian Communities, 1997-2010 . Ramallah-Palestine.
3. Palestinian Central Bureau of Statistics, 2000. Population, Housing and Establishment Census -1997, City Reports Series. Final Results- Bethlehem City.


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