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Overcoming barriers to health care access in the West Bank with mobile clinics

27 May 2019 - A small room in an improvised school in Zakariah village, the West Bank, occupied Palestinian territory, used to serve as a patient consultation space for a mobile clinic providing primary healthcare services in the area. Last year, the clinic stopped operating due to a lack of funding, leaving a community of 650 without access to essential health care.

Since then, to get even basic health services, Zakariah residents have to travel to a health clinic in Bethlehem – about 12 kilometres from the village. The distance, however, is not the biggest barrier for the community to access the health care they need. A journey to the town is costly, time-consuming and frequently stressful. The villagers need to pass through a number of checkpoints which makes access often unpredictable and at times heavily restricted. Zakariah is surrounded by settlements that hamper free movement for the community. It is not safe for residents to leave the village on foot, meaning that they need a car to reach Bethlehem. The majority does not have a car and there is no public transport, so many in the community rely on the only taxi driver in the village to reach health facilities for appointments.

“It’s very hard for the villagers to see a doctor,” says Zakariah’s community leader. He is the first person people come to in cases of emergency. “When there is a case that requires urgent medical attention, I am looking for ways to either reach the hospital in Bethlehem or bring an ambulance to the village, but these trips can sometimes take hours.” But in emergency situations, any delay in care can have serious adverse consequences on patient outcomes. A woman from the community took first aid training from the mobile team to ensure immediate assistance is available. She can also provide non-prescription medication to reduce fever and pain as a temporary measure.

Zakariah village is among 100 communities with about 114,000 residents in Area C* that have limited or no access to primary healthcare services. The geographical, legal and administrative fragmentation of the West Bank creates barriers for them to access health, but these obstacles are particularly severe for those in Area C. Like in Zakariah, many communities rely on mobile health clinics to get primary health care.

A team of two general practitioners, a women’s health specialist and a nurse used to visit Zakariah village twice a month offering free consultations, medication and providing basic health services such as screening for noncommunicable diseases, immunization, women health services, lab analysis and health education.

Now, people from the village only go to the hospital when there is an urgent need, such as for childbirth or in the case of injury. This situation can be particularly worrisome for the elderly, who make up much of Zakariah’s community, with hypertension, diabetes and other chronic diseases that require regular checkups, medical attention and daily medication. 

“My husband died from kidney failure, and I have diabetes and blood pressure,” says Hajra, a 65-year-old woman from the community. “I have to pay for medicine from my pocket, and it’s often half of my monthly income.”Many of Hajra’s neighbours cannot afford medicine at all.

Mobile clinics offer viable options to improve access to primary health care for such vulnerable and remote populations. Currently, the Palestinian Ministry of Health and health partners are reaching around 140,000 people in Area C, the West Bank. To deliver health care to underserved areas, the World Health Organization with its partner CARE International supports the provision of quality primary healthcare services through mobile clinics to about a further 12,000 people in 19 vulnerable communities in Hebron, Bethlehem and the North Jordan Valley areas. In addition to essential health services, the teams will also be providing psychosocial support to the populations. This project is possible thanks to the contribution from the UN Central Emergency Response Fund.

A director of Zakariah’s school said the mobile clinic services went beyond health care and had an overall positive impact on the community: “They were bringing a feeling of safety and normality to our people devastated by a lack of security, movement restriction, constant pressure and stress.”

*Over 60% of the West Bank is considered Area C, where Israel retains near exclusive control, including over law enforcement, planning and construction.

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