Structural violence and health in the OPT: towards exposing Israeli occupation as the main determinant of the health of Palestinians

In a paper of the Lancet Series on ‘‘Health in the Occupied Palestinian Territory’’ (OPT) Batniji et al.1 convincingly argue that the health of Palestinians is compromised by threats to the security of Palestinians. People living in the OPT, the argument goes, lack the basic security for them to be healthy and flourish as a society, and for development aid to result in real autonomous develop-ment. Direct physical aggression through bombs, gunfire, home demolitions, land expropriation, torture and daily humiliation at checkpoints adds to the indirect, less visible, creeping violence forced on people by lack of access to water, electricity, fuel, sanitation and adequate health services. This deprives Palestinian people of the basic determinants of health, i.e. the preconditions to be healthy, and makes their life miserable. This paper takes the discourse of human, as opposed to international and national, security further by linking it with the concept of structural violence as a root cause of insecurity and thus as the most upstream determinant of the health of populations. Structural violence and the way in which it undermines Palestinians’ health is more than elsewhere conspicuously apparent in the OPT where it takes the various forms of economic, political, cultural, religious and environmental violence. By examining empirical examples of how structural violence and its links with Israeli occupation undermine the health and human rights of Palestinians, we point at practical ways for the international community to move from theory to practice and to promote non violent approaches (education, awareness raising, advocacy, etc.) to conflict resolution. Public health practitioners, in their different working contexts, are bound to play a central role in exposing the impact of structural violence in undermining human security and health, in the footsteps of the 19th-Century German doctor Rudolf Virchow who fought for recognition of medicine as a social science and called upon physicians to be the ‘‘apostles of peace and reconciliation’’.