Beyond the humanitarian: Palestinian health from a liberation perspective

First published in French at Contretemps. Translation by Samirah Jarrar and Gwenael Velge for Academics for Palestine WA. Introduction by Academics for Palestine WA. 

Since October 2023, the situation in Gaza has been overwhelmingly described in terms of a “humanitarian catastrophe.” The dominant discourses, whether from the media, international organisations, or humanitarian institutions, primarily mobilise the language of emergency, crisis, and the right to survival. While this approach may seem legitimate given the scale of the destruction, it risks normalising the violence and erasing its structural causes and those responsible. Reducing Gaza to a disaster zone often serves to obscure the political logic that produces this crisis: that of Israeli settler colonialism.

Without a critical analysis of this colonial reality, any response — including medical, humanitarian, or academic — risks reproducing the power relations that made it possible. This article thus proposes to re-situate health in Palestine within a long history of colonial domination, by analysing its concrete effects on infrastructure, medical practices, bodies, and subjectivities. As Samirah Jarrar demonstrates in this article, the goal is to move beyond the humanitarian framework to envision a politics of care rooted in justice, sovereignty, and self-determination.

The impasse of the humanitarian response

Since 1948, the health of Palestinians has been caught in the violent reconfigurations of Zionist colonialism. The expulsion of nearly 800,000 Palestinians — about 70% of the population of Mandatory Palestine — during the Nakba led to the collapse of existing social and institutional structures. Deprived of their land, their institutions, and their sovereignty, Palestinian refugees found themselves relegated to often unsanitary camps, dependent on international humanitarian aid. In response to this catastrophe, UNRWA (United Nations Relief and Works Agency for Palestine Refugees), created in 1949, took charge of a portion of the public health of Palestinian refugees — a mission it continues to fulfill today, particularly in Gaza, the West Bank, Jordan, Lebanon, and Syria.

Since 1967, Palestinian health has been under the yoke of the Israeli occupation. After the Six-Day War, the healthcare systems in the West Bank and Gaza came under military administration. For more than two decades, they were marked by chronic underfunding, staff and equipment shortages, and a forced dependence on the Israeli hospital system. In 1975, the entire health budget for the West Bank was less than that of a single Israeli hospital. This structural asymmetry reflects a colonial logic that marginalises Palestinians while making them dependent.

In response to this systemic neglect, grassroots health initiatives, the popular health committees — often led by women — emerged in the 1970s and grew in scale during the first Intifada (1987–1993). This new wave of community health activism was characterised by decentralisation, volunteerism, and a refusal to comply with Israeli regulations.

Young urban professionals, often heavily involved in local popular committees, were at the forefront of a movement focused on access to care in rural areas, health education, and primary care. The goal was to establish mobile and permanent clinics, not limited to curative medicine but also including prevention, first aid, and medical education. These local committees were largely part of a broader movement of popular and anti-colonial resistance, structured around autonomy, sumud (perseverance on the land), sovereignty, and self-organisation.1

In parallel, the Israeli civil administration sought to integrate a Palestinian elite into its own structures, while suppressing autonomous forms of organisation from civil society. In the 1980s, it criminalised several municipal councils deemed dissident and tried unsuccessfully to replace them with figures considered more conciliatory, ready to cooperate with the occupier in exchange for resources and financial support. This was an early Israeli attempt to establish a form of so-called Palestinian self-administration under its control.

A new phase began after the Oslo Accords (1993), which were officially supposed to lead to an independent Palestinian state but, in fact, deepened the occupation and outsourced the responsibilities of the occupying Israeli regime to the Palestinian Authority (PA). The partial transfer of health responsibilities to the PA marked the beginning of a process of institutionalisation, but also of depoliticisation: the language of resistance and liberation gave way to that of development, good governance, and short-term projects.

The creation of the Palestinian Ministry of Health was accompanied by an influx of international aid, conditioned on security cooperation with Israel and increasingly aggressive neoliberal reforms. Many activist initiatives were absorbed by NGOs, the new Ministry of Health, or humanitarian programs, stripped of their political significance. Health became a sector structured around technical, managerial, and apolitical objectives, often dictated by international donors.

This approach is based on a paternalistic vision, founded on models of care that induce dependence, charity, and the individualisation of both health needs and responsibilities — in contrast to the politicised medicine advanced by the Palestinian popular committees, which aimed to build community autonomy, transmit critical medical knowledge, and put it at the service of collective care practices, anchored in justice, dignity, and solidarity.

This situation deteriorated after the 2007 political division between Hamas in Gaza and Fatah in the West Bank, following Hamas's democratic victory in the 2006 Palestinian legislative elections. Two parallel, poorly coordinated health systems developed. In the West Bank, care is undermined by checkpoints, settler violence, and territorial fragmentation. In Gaza, the Israeli blockade, reinforced by international sanctions, has led to an acute health crisis: shortages of medicine, equipment blocked at the border, and paralysed medical training. Patients often have to be transferred to the West Bank, East Jerusalem, or abroad — provided they can obtain an Israeli permit. Repeated military offensives on Gaza (2008-2009, 2012, 2014, 2021, and 2023-ongoing) have caused the destruction of hospitals, the killing of healthcare workers, and the collapse of the medical infrastructure.

Health and settler colonialism: A necessary analytical framework

For decades, international approaches to health in Palestine have adopted a depoliticised reading. Health is viewed through technical indicators, quantitative data, or humanitarian discourses focused on emergency, “crisis,” and human rights. This perspective, largely dominant in Global North institutions, has helped to mask the structural causes of Palestinian suffering. This “humanitarian health” produces epistemic violence by erasing Palestinian voices calling for justice and liberation, and by consolidating a neoliberal order where supposedly neutral experts perpetuate a colonial status quo.

In response, a critical Palestinian tradition emerged in the 1980s. Rita Giacaman, a pioneer of this thought, showed how occupation, restriction of movement, poverty, and violence shape bodies and diseases. She identifies three dominant discursive frameworks: a technocratic biomedical model; a nationalist framework focused on colonial occupation and sumud; and a third, more promising one in her view, rooted in popular, feminist, and community struggles. For Giacaman, health cannot be separated from internal and external power structures: one must fight colonialism, patriarchy, and class stratification simultaneously.

Since the Gaza war of October 2023, a turning point is occurring. A growing number of researchers are adopting the category of “settler colonialism” to analyse the determinants of health. This framework allows for understanding health not as a side effect of war or underdevelopment, but as a direct product of a colonial project aimed at the elimination of the indigenous people. The violence is not only military; it is also medical, territorial, environmental, and psychological. It affects the right to be cared for, but also the conditions of care production, solidarity networks, food, and the relationship with one's body.

From this perspective, health inequalities between Israeli Jews and Palestinians are not a matter of a “development gap” but of a structural logic of dispossession. The case of the Naqab Bedouins is striking: forced urbanisation, destruction of ecosystems, and industrialised food have caused an explosion of diabetes. Up to 70% of adult women in some villages are affected. These pathologies are neither random nor the result of “bad habits,” but of targeted colonial policies.

Finally, these analyses remind us that colonialism redraws the political body as much as biological bodies: by fragmenting territories, denying the right of return, and destroying social ties, it makes collective health impossible. The struggle for Palestinian health thus joins the struggle for liberation: it calls not for managing the crisis, but for dismantling the colonial order that is its cause.

Health, elimination, control and colonial exploitation

Health in Palestine alone embodies the intertwined logics of Israeli settler colonialism: control, exploitation, but above all elimination — the latter being the central characteristic of this regime, which is based on replacing the indigenous population with a settler society, implying its physical, social, and political erasure. In this hybrid model of domination — between direct military occupation and more diffuse colonial structures — health becomes a central instrument of power, but also of resistance.

The logic of control is emblematically manifested in the health sector through the system of medical permits: to access vital care (radiotherapy, specialised surgery), one must obtain an Israeli pass, which is often rejected or expires before the appointment date. Some are conditioned on interrogations by Israeli intelligence services. A 2008 report documents cases of patients ordered to collaborate with Israeli intelligence services in exchange for a permit. Others are summoned and then arrested. The health system thus becomes an instrument of blackmail, surveillance, and political coercion.

The logic of exploitation, for its part, is expressed in the way the Israeli state monetises access to care for Palestinians in the occupied territories, billing them for its medical services while considering them “foreign patients” — instead of assuming its responsibilities as an occupying power. At the same time, many Palestinian health workers from the West Bank are employed in Israeli hospitals in temporary, specific, and precarious positions, contributing to the smooth functioning of the system without sharing its benefits. This is a veritable colonial economy of care, in which Palestinian bodies are both exploited as a labour force and transformed into sources of income.

Finally, the logic of elimination completes and crowns this colonial triptych, with access to care constituting a strategic site for its implementation: refusal of medical permits, blocking of essential equipment like radiotherapy machines, or tactics of mutilation during military operations. Chronic exposure to racist violence, trauma, and institutional humiliation generates lasting pathologies. The logic of elimination thus operates through insidious mechanisms: blockades, territorial fragmentation, destruction of collective lands, denial of access to care, and nutritional deprivation.

In Gaza, Israel's policy of “caloric restriction" explicitly aimed to keep the population “on the brink of collapse.” But these effects are not confined to the territories occupied in 1967: Palestinian citizens of Israel also experience systemic health inequality. Fewer clinics, under-equipped hospitals, longer distances, the language barrier: everything contributes to more difficult access to care, which translates into a shorter life expectancy.

Today, in Gaza, the logic of elimination reveals its genocidal nature in its most brutal form: systematic destruction of health infrastructure, assassinations, imprisonment and torture of healthcare personnel, and more broadly, the annihilation of all conditions for the maintenance and reproduction of life.

Reinventing care and solidarity: Resistance, justice and decolonisation

Through these three logics, health appears not as a neutral sector, but as a strategic space where colonial domination is played out. But this colonial medicalisation — or its denial — does not go unanswered. Despite the processes of elimination, control, and exploitation, Palestinians have always produced forms of medical resistance and counter-practices of care. In Gaza today, health professionals continue to embody sumud: they rebuild hospitals after repeated destructions, transform tents and shelters into clinics, and continue their work of care despite the collapse of the health system and the deadly and incessant attacks targeting them.

Today, in the face of the depoliticisation imposed by humanitarian and neoliberal frameworks, a decolonial and anti-colonial thought and praxis of health is re-emerging, carried by professionals, researchers, and communities — including Palestinians — who re-situate care within a political horizon of justice, international solidarity, autonomy, and liberation.

To listen to these voices is to refuse the naturalisation of violence, charity as the sole response, or compassionate victimisation. It is to recognise that Palestinians are not merely suffering bodies, but political subjects, bearers of knowledge, practices, and projects. It is to open paths towards a solidarity founded not on pity, but on co-resistance, health self-defence, dignity, and the invention of collective forms of life and care.

Samirah Jarrar is a PhD candidate at Aix-Marseille University. She would like to thank Taher Labadi, Osama Tanous, Layth Hanbali, and Larbi Benyounes for their proofreading and insightful comments.

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  Translator’s note: the Arabic term sumud (صمود( literally translates to "steadfastness." However, the term signifies much more than passive resilience. It is a core Palestinian cultural and political concept representing an active, strategic, and defiant perseverance. It involves the conscious act of remaining on one's land, maintaining cultural life, and asserting existence and identity in the face of occupation, displacement, and hardship. It is often symbolized by the deep-rooted olive tree.