Israel, the Palestinians, and the COVID-19 vaccination rollout: The legal and moral obligations

• Israel is the world leader in vaccinating its population against COVID-19. About 19% of the population has already received a dose of the vaccine.
• Israeli citizens and Palestinian residents of East Jerusalem are eligible to be vaccinated. Those in the West Bank and Gaza are not — unless they are Israeli settlers.
•  Some people argue that the Oslo Accords mean that it’s not the Israeli government’s responsibility to vaccinate those in the Palestinian territories. Others cite the Geneva Convention to insist that it is.
• Human rights activists argue that Israel holds a moral obligation to vaccinate vulnerable Palestinians.
• It is unclear, at this point, whether the Palestinian Authority has actually asked Israel to secure vaccines on their behalf. There are conflicting reports.
• Visit Business Insider’s homepage for more stories.

As Israel leads the world in vaccinating its population against the coronavirus, critics have questioned whether the country is fulfilling its supposed legal and moral obligations to help millions of Palestinians living in the West Bank and Gaza.

While some argue that certain peace treaties’ nature point towards Israel being absolved of responsibility, others have cited certain international laws to illustrate that Isreal holds a duty of care.

The debate as to who Israel is duty-bound to vaccinate is, ultimately, a complicated one.

Israel’s record-breaking vaccination rollout

“I am continuing to work around the clock to bring millions of vaccines to Israel and at the same time, the health system is continuing to vaccinate the citizens of Israel at a pace that is awe-inspiring to the entire world,” wrote Israel’s Prime Minister Benjamin Netanyahu on Twitter.

Since Israel administered its first dose of the Pfizer-BioNTech vaccine last month, the country has gone into overdrive to vaccinate its population against COVID-19 quickly.

As Netanyahu declared, it has gone at a pace that has been "awe-inspiring" to the entire world.

About 19% of Israel's 8.9 million population has received a dose of the vaccine, according to Bloomberg's Vaccine Tracker.

This marks Israel out as the clear world leader in the global vaccination rollout, as seen in Our World in Data data.

Israel's total number of vaccinations administered per 100 people in the total population far exceeds comparative vaccination rates in the US, UK, and other Western nations.

The US has vaccinated 2.4% of its population against COVID-19, according to the Bloomberg Vaccine Tracker. The tracker also shows that the UK has a vaccination rate of 2.2%.

Israel's vaccination rollout is going so well that it expects to have administered the second dose to the entirety of the high-risk population by the end of January, according to Forbes.

The country also expects to have a "fully vaccinated population" by the end of March, a former Israeli presidential aide - Yonatan Adiri - told Insider.

But while Israel has been applauded for implementing a world-beating vaccination strategy, critics have claimed millions of Palestinians in the West Bank and Gaza have been overlooked.

It has sparked debate about Israel's legal and moral obligations and how this affects those situated in the Palestinian Authority.

The answer is not clear-cut, with both sides of the debate citing international treaties to prove their points.

Every citizen of Israel, Jew or Arab, is eligible for the vaccine

Healthcare in Israel is universal and, by law, all citizens and permanent residents must participate in it.

People who are over 60, work in healthcare, or are especially vulnerable are currently prioritized in the Israeli vaccine rollout. 

The vaccination drive includes all Palestinian citizens of Israel and Arab Israelis, who make up around 21% of Israel's population.

Palestinian residents of East Jerusalem are also eligible even though they do not possess Israeli citizenship. The majority are covered by Israel's health network, according to The Times of Israel.

While those in East Jerusalem are entitled to a vaccine, the takeup rate has been shallow.

Only about 20 percent of Palestinian East Jerusalem residents aged 60 and older have received the coronavirus vaccine, according to Israeli newspaper Haaretz. This compares to the 75% of Jerusalem's Jewish population from the same age group, Israel's Home Front Command told the paper.

The reluctance of Palestinians has been attributed to the propensity of fake news about vaccinations in East Jerusalem, according to Reuters.

An article about excluded Palestinians sparked controversy

Almost five million Palestinians living in the West Bank and Gaza are not eligible for Israel's vaccination program. 

Pfizer/BioNTech vaccines are being distributed to hundreds of thousands of Jewish settlers in settlements in the West Bank, according to the Los Angeles Times. These settlements are considered by many in the international community to be illegal.

Last week, in the UK, the Observer published an article about Israel's vaccination rollout.

It was titled: 'Palestinians excluded from Israeli Covid vaccine rollout as jabs go to settlers.'

The headline and choice of image - an Orthodox Jewish man being vaccinated - outraged some members of the Jewish community.

The Board of Deputies of British Jews said in a statement: "We are extremely troubled by the Observer's blatantly false headline claiming that Israel has 'excluded' Palestinians from its Covid-19 vaccination program."

The organization added: "[It] has provided grist to the mill of far-right and far-left antisemites alike, who seek to take anything positive Israel does and twist it beyond recognition."

Dr. Shany Mor, a researcher at the Israel Democracy Institute, agreed. He told Insider: "People seem to be obsessed with this notion of an unbelievably diabolical Israeli evil."

People took issue with the idea that the headline did not take into account the Palestinians who are included in Israel's vaccine rollout. Others were angered by the headline's implication that Israel should be responsible for the Palestinian Authority's vaccination rollout.

—Seth Frantzman (@sfrantzman) January 3, 2021

—Patty Serl (@SerlTheGirl) January 4, 2021

While the headline was criticized, the article did refer to Palestinian autonomy and the Oslo Accords in the body of the text.

Israel's legal responsibility and the Oslo Accords

This is where things get complicated.

It is argued that Israel does not hold a legal responsibility to vaccinate those under the Palestinian Authority's control.

They cite the Oslo Accords - a historic agreement signed by Israel and the Palestinian Liberation Organization in 1993 and 1995.

The Oslo Accords granted the Palestinian people the right to self-determination and, consequently, created a Palestinian Authority (PA) tasked with partial self-governance in parts of Gaza and the West Bank.

The accords transferred jurisdiction - including primary healthcare responsibility - to the PA

Shortly after the signing of the accords, the PA set up their own Ministry of Health.

Dr. Mor believes that this is a clear indication that the duty to vaccinate its population falls upon the Palestinian Authority.

He told Insider: "The Oslo Accords spell out exactly what the various parties' obligations are and what their responsibilities are in terms of healthcare and even vaccination."

Article 17 of the 1995 Oslo agreement reads: "Powers and responsibilities in the sphere of Health in the West Bank and the Gaza Strip will be transferred to the Palestinian side, including the health insurance system."

Seth Frantzman, the senior Middle East affairs correspondent for The Jerusalem Post, said: "It can't suddenly be Israel's health insurance providers' responsibility to absorb millions of people."

Frantzman continued: "It also can't possibly be true that, in December, Israel suddenly became responsible for vaccinating all these populations whereas some two weeks beforehand, Israel held no responsibility for the same populations."

However, others dispute the idea that Israel holds no legal responsibility to vaccinate those in the Palestinian territories.

Dana Moss, an international advocacy coordinator for Physicians for Human Rights Israel, told Insider: "The Oslo Accords technically transferred responsibility for the healthcare system to the Palestinian Authority. That part is true. But the extent of Israeli control over the West Bank and Gaza has essentially denuded this responsibility of any meaning."

Moss continued: "Israeli control over the movement of people and goods means that patients can't cross from the West bank to East Jerusalem without Israeli permits. Medication and equipment can't pass either."

She added: "Whatever was theoretically enshrined in the Oslo Accords is actually just a facade." 

Those who believe that the Oslo Accords are insufficient grounds to take responsibility for vaccinating people in the West Bank and Gaza point to a different set of international agreements - the Geneva Conventions.

Israel's legal responsibility and the Geneva Conventions

The Geneva Conventions compromise four treaties and three additional protocols that provide the basis in international law for how countries should act humanely during wars.

Human rights activists highlight Article 56 of the Fourth Geneva Convention to argue that Israel is obligated to provide COVID-19 vaccines to those in the Palestinian territories.

Article 56 reads: "The Occupying Power has the duty of ensuring and maintaining, with the cooperation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory, with particular reference to the adoption and application of the prophylactic and preventative measures necessary to combat the spread of contagious diseases and epidemics."

This, it is argued, is the legal basis for Israel's responsibility in helping those in occupied territory to combat the coronavirus.

Saleh Higazi, Amnesty's deputy regional director for the Middle East and North Africa, told Insider: "Although you do have the Palestinian Authority that has a very limited system of governance, it does not change Israel's responsibility - according to international law."

But, beyond the legal debate, some believe that moral obligation is the critical factor

Is Israel morally obligated to vaccinate Palestinians in Gaza and the West Bank?

Last month, 10 Israeli, Palestinian, and international human rights organizations implored Israeli authorities to provide doses of the Pfizer-BioNTech vaccine to those in the Palestinian territories.

In a joint statement, they wrote: "We call on relevant international stakeholders to urge Israel to fulfill its duties and moral responsibilities to assist the Palestinian health systems and the Palestinians in the Gaza Strip and the West Bank."

Dana Moss, whose organization Physicians for Human Rights Israel co-signed the statement, told Insider: "It's simply ethically unconscionable that a healthy 22-year-old living in a West Bank settlement will receive a vaccine, whereas an 80-year-old Palestinian with diabetes will not."

On Wednesday, Amnesty International published a letter that argues that denying COVID-19 vaccines to Palestinians is morally negligent.

The letter's author Saleh Higazi said: "The pandemic has exposed Israel's institutionalized discrimination and systematic abuses of human rights."

A group of 200 rabbis also signed a petition calling on the Israeli government to hasten the distribution of vaccines to the Palestinian population in the West Bank and Gaza.

One of those who signed it, Rabbi Laura Janner-Klausner from the UK, explained to Insider why the moral arguments matter. 

"When you start pulling out the Oslo Accords to justify something that's not moral, then that is very concerning," she said. "It is the right thing that Israel, who is the dominant military power, look after the most vulnerable in Palestinian society just like they do with the Jews there."

Even those who do not believe there is a responsibility enshrined in law recognize that there may be a moral obligation.

Seth Frantzman told Insider: "Insofar as Israel is an occupying power, there most likely are obligations to help facilitate the issuing of the vaccine. It just doesn't come down to Israel's health insurance providers to do that."

Does the Palestinian Authority have a plan for securing COVID-19 vaccines?

Up to this point, the Palestinian Authority had largely been counting on WHO's Covax initiative. This is a scheme that aims to provide vaccines to poorer countries.  

Covax had pledged to vaccinate at least 20% of Palestinians, according to The Guardian. Though the authorization and delivery of these vaccines could be months away, it also reported. March is the earliest vaccines would be delivered, reported The Wall Street Journal.

Palestinian health officials had also looked into shipping Russia's Sputnik V vaccine, according to the Financial Times. These could also take a month or so to arrive, a senior Palestinian official told The Guardian.

There are also reports that the Palestinian Authority is in talks to secure two million vaccines from AstraZeneca to arrive at the end of February, according to the Israeli state-owner broadcaster Kan and The Wall Street Journal.

Meanwhile, it is unclear whether the Palestinian Authority has directly asked Israel to support a vaccination campaign in the West Bank and Gaza.

On Tuesday, a Palestinian health official told The Jerusalem Post that they had not asked Israel to supply the Palestinians with a vaccine or to purchase vaccines on their behalf.

Later that day, the paper reported that the PA was now examining the possibility of obtaining vaccines from Israel.

On Wednesday, two Palestinian officials told The New York Times that the PA had asked Israel for up to 10,000 doses to inoculate healthcare workers. A PA minister told the paper that Israel had refused this request.

On Thursday, a senior Palestinian official told The Wall Street Journal that the PA had not actually asked Israel for vaccines.

Israel has, however, reportedly provided several dozen doses of the vaccines to the Palestinians. This was done in secret and for "special humanitarian reasons," according to Israeli broadcaster Kan.

Does Israel have enough vaccines to provide for those in the Palestinian Authority?

While Israelis have received widespread praise for the fast and efficient rollout of COVID-19 vaccines, the Pfizer-BioNTech vaccine supplies are reportedly running low. 

Israeli officials said that they might have to slow the vaccination program later this month unless they can convince vaccine suppliers to deliver doses sooner than promised, according to The New York Times.

This potential slow down will continue until a Moderna vaccine shipment arrives in late January, reports the Financial Times.

Israel has ordered enough vaccines from Pfizer and Moderna to cover its entire population over age the age of 16, according to US News.

But, as for the nearly five million Palestinians in the territories, there might not be enough.

Israel has rebuffed a WHO request to provide 8,000 vaccines for frontline workers, according to the Independent. Officials cited a shortage of doses as the reason, the paper reported.

Israel has thus far ordered 16 million doses from Moderna and AstraZeneca, according to The Wall Street Journal. This is enough to vaccinate 8 million people.  Its population is 8.9 million.

"Israel should have been procuring enough for the nearly 5m Palestinians that live under its control, and it specifically didn't," Palestinian lawyer Diana Buttu told the Financial Times.