COVID-19 threatens the vision of thousands in the Palestinian territories

ALICANTE, Spain — Almost 18,000 people in the Palestinian territories have been unable to access eye health services since April as a result of COVID-19, according to eye health charity The Fred Hollows Foundation and St John of Jerusalem Eye Hospital Group, the only charitable provider of expert eye care in Gaza, the West Bank, and east Jerusalem.

The pandemic’s lockdowns, general closures, and curfews have meant access to eye health services has been seriously disrupted. Many have missed vital follow-up consultations, diagnoses, and treatments while 1,200 sight-saving surgical procedures have been canceled, some of which would have been time-sensitive, said Jon Crail, programs executive director at The Fred Hollows Foundation.

For example, if a person who has diabetic retinopathy — a complication of diabetes that affects the eyes — is not receiving regular treatment via injections or laser therapy, they risk losing their vision completely, Crail said.

St John of Jerusalem Eye Hospital would usually admit at least 7,000 patients on a monthly basis but saw its number of surgeries drop by 50% in April as it shifted to only treat urgent cases. Meanwhile, the Palestinan authorities, as the second main provider of eye care, have stopped almost all eye care services from functioning, said Ahmad Ma’ali, CEO of St John of Jerusalem Eye Hospital Group. “All of this has put pressure on the hospital to meet the increasing demand for eye health services in Palestine,” Ma’ali said.

Globally, at least 1 billion people — out of the 2.2 billion with a vision impairment or blindness — have a vision impairment that could have been prevented or is unaddressed. “The Palestinian population has a rate of blindness which is ten times as high as in the West,” according to the International Agency for the Prevention of Blindness. Untreated cataracts account for 38% of blindness in the territories, while diabetic retinopathy accounts for 24%.

While reduced access to health care during the pandemic has been the case in most places, those living in the Palestinian territories were already at a disadvantage because of the ongoing violence in the region and limitations on movement. According to the United Nations Relief and Works Agency for Palestine Refugees, health facilities in the Gaza Strip were already lacking in adequate physical infrastructure and overstretched prior to the outbreak.

“Even on the best day, it’s very difficult in Palestine, [particularly] in Gaza, to get anything. There’s an embargo. It’s basically a jail,” Crail said, adding that eye health is often not seen as essential.

As of the end of September, there had been over 54,000 confirmed cases of COVID-19 in the Palestinian territories and over 400 reported deaths. Meanwhile, Israel finds itself amid a second countrywide lockdown and state of emergency as its death toll rises to almost 1,800.

The U.S. presidential administration’s funding cut in 2018 to hospitals in east Jerusalem offering care to Palestinians has also created additional pressures by leaving “a big hole in budgets,” Crail said. With the extra funding needed for personal protective equipment and the rerouting of aid budgets to address COVID-19, the backlog of people who need care is growing, he added.

“It’s a political situation, a COVID situation, a funding situation, and a repurposing situation all hitting at once,” Crail said, calling it a perfect storm in a place that is difficult to operate in even without a pandemic.

He called for others to step up and support St John’s through increased funding. “Israel is not really living up to their responsibilities and meeting the eye health needs of the Palestinians, and neither are the two Palestinian governments. So it’s really fallen to NGOs, particularly St John’s, to pick up the slack,” Crail said.

In July, St John of Jerusalem Eye Hospital Group launched a one-year emergency campaign in partnership with the Palestinian Ministry of Health and UNRWA. The aim is to treat the backlog of patients needing eye care services caused by the health crisis. “We will mobilize financial and human resources in order to provide more than 25,500 eye operations and treatments, including 2,500 complicated surgeries,” said David Dahdal, St John Eye Hospital Group’s head of development and grants.

Crail said the big lesson from COVID-19 should be the need to increase investment in global health and national health systems. “A better health service will be better for eye health as well,” he added.

Devex, with financial support from our partner Essilor, is exploring challenges, solutions, and innovations in eye care and vision. Visit the Focus on: Vision page for more.