The following is a brief statistical report on the daily life, health and environmental conditions of families living under curfew and in fear and danger during the latest Israeli invasion of Ramallah and al-Bireh, two towns with separate municipalities but intertwined physically, socially and economically. This report is the first in a series of reports covering life events in Ramallah/Bireh, Nablus, Jenin, Tulkarm and Bethlehem. Although we are dispatching each of the reports separately, ideally, they should be considered together. A final report will follow the individual town reports and will focus on the summary results for all the towns combined.
While journalists, researchers and institutions have written accounts of the general conditions in the towns during this period, our statistical reports focus on households and individuals, offering quantitative indicators which can be generalized for all the population, and confirming or negating impressions and observations made in rapid appraisals and through interviews. The invasion of Ramallah/Bireh began on the evening of 28 March 2002 and ended in about two-thirds of the town on 20 April, with the remaining portion continuing to suffer the effects of curfew up until 30 April 2002.
This house-to-house survey was conducted during the first week of May 2002. A stratified random sample of households was chosen, primarily based on locale, and representative of all of the households in the town (Ramallah/Bireh), that is, a population of about 55,000 (Palestinian Central Bureau of Statistics [PCBS], 1997).
A sample of 153 households was selected utilizing stratified cluster sampling techniques. The city was divided into 5 strata, whereby 2-3 random starting points were selected. From each starting point a systematic sample of every 10th household was selected. In this survey, the expected maximum margin of error at the city level is:
E= 1.96*DE*sqrt((P)*(Q)/(n)).
P= The percentage of a certain attribute.
Q=1-P.
DE=Design Effect due to clustering.
The estimated value of DE=1.1.
E= 1.96*sqrt((0.5)(0.5)(1.1)/(150))=8.8%.
Data entry was completed using the Access database. Proper control structure was defined on closed questions. Data was transferred to SPSS using "StatTransfer" software. Double entry was conducted for a sample of the questionnaire to check for errors that could not be detected by the control structure defined in ACCESS. One out of 50 questionnaires experienced swapping values like 1 entered instead of 2 or visa versa.
One hundred and fifty-three household heads or adult family members were interviewed. The mean age of respondents was 41 years. Forty-nine per cent of the respondents were female, and 51 per cent male. Four per cent were illiterate, 7 per cent had elementary schooling, 19 per cent had preparatory and 31 per cent had secondary schooling, bringing the total to 61 per cent who had high school education or lower. Twelve per cent reported having had higher diplomas, a high of 20 per cent Bachelor's degrees and 7 per cent Master's or other postgraduate education. These results are higher than PCBS reports on educational attainment in Ramallah/Bireh District for 1997 (Census, 1997), notably in the high levels of post-secondary education: in the census, 5 per cent attained Bachelor's degrees in the Ramallah District (comprising Ramallah/Bireh and district refugee camps and villages) compared to 20 per cent in our sample, and 1 per cent Master's level or higher education for the District, compared to 7 per cent for this survey. These difference are probably due to Census figures pertaining to the population 12 years or over, while our respondents were all adults. But the differences may also reflect the inequity in educational attainment between urban and rural areas in the district, as well as a possible rise in educational levels in the town since the PCBS census was conducted.
The average household size was found to be 6.84 persons per household, with the smallest household composed of a single person living alone and the largest composed of 24 persons. Of the total households, 28 per cent were composed of extended families and the rest were nuclear. The average household size found in this survey is higher than that quoted by the PCBS 1997 census of 5.9 persons per household for the district (PCBS, 1999), and 5.3 and 5 for al-Bireh and Ramallah towns respectively.
The higher than expected average household size found in this survey seems to be related to families housing other families during the siege, a phenomenon observed in many cities, where families moved out of very dangerous areas to perceived less dangerous ones for the duration of the Israeli invasion. Indeed, the results of this survey seem to confirm these observations at least in part. Almost a third (30 per cent) of respondents reported taking in family or friends who moved out of dangerous areas into their household. Of those taking in other families into their homes, two-thirds reported them as relatives, about a quarter as friends, and the rest indicated that a mix of neighbours, friends and family moved into the household during this period. When asked why households received such guests during the period, over half of the respondents reported fear of danger, since their area was surrounded by soldiers, shelling and tanks, and as the main cause for the move of family or friends into their homes; about one-tenth reported that the army had taken over the homes of families and/or friends who moved in with them, and the rest responded in terms of feeling safer with a family than being on one's own during these trying times (a variation on misery loves company).
Given the generalizability of the data to the population of Ramallah/Bireh, these results are significant in that they indicate a major shift, although temporarily, in household composition, and a substantial temporary internal migration of the population during the invasion from one area into another. These results raise interesting questions for future research, especially research on household management and coping mechanisms to absorb this very severe jolt, and the impact of this on the internal dynamics within the family, on food distribution and on power relationships, to name but a few important implications, especially on male and female members of the household. Anecdotal evidence indicates that women's lives may have been affected by the sudden 24-hour-a-day presence of men at home, frustrated by events, not used to being at home and feeling incapacitated and helpless.
Likewise, the incapacitation that is reported by men during these events and their frustration over their inability to response to the aggression they face and also protect their families may well have influenced social relations within the family, especially in relation to male self esteem and psychological state. Our results are also interesting in that they may be indicative of family and household coping mechanisms set in place to deal with emergency, conditioned by strong family ties and communal support. While it is true that access to travel outside the country was very restricted during the period, if not impossible, this particular coping mechanism of internal migration contrasts to the 1948 and 1967 mass migrations of large numbers of Palestinians out of the country altogether.
Of the female respondents, 75 per cent were housewives. That is, a high of 25 per cent of female respondents reported themselves as holding a paid job just before the beginning of the invasion - again, a rate that is higher than the national average reported by PCBS in the 1997 census for Ramallah of 16 per cent. This could be partially due to the bias towards adult educated working women respondents as being better candidates for interview. Of the male respondents, 16 per cent engaged in private work, either owning a shop or running a private business, 13 per cent were professionals (academics, teachers, nurses, doctors and lawyers), a high of 32 per cent were white collar workers (office workers, technicians, Palestinian National Authority functionaries) and 27 per cent were semi-skilled or unskilled workers. Twelve per cent reported themselves as having been unemployed just prior to the invasion.
Of those working just before the invasion, 23 per cent reported that they are no longer working since the invasion began, that is, that the conditions had led to the loss of their jobs, whether temporarily or permanently. Of those reporting job loss, about one-third stated that the closure and siege was a cause, 40 per cent blamed the collapse of the market, 5 per cent explained unemployment as a result of injury and one-seventh reported the destruction of work premises, resulting in the loss of work. Clearly, the loss of means of livelihood is an important concern that needs to be addressed promptly, especially that prior to the invasion the country was already suffering the consequences of siege and closure in terms of the serious loss of income, estimated by the PCBS as a drop of household income by at least 48 per cent only six months after the beginning of the current intifadah.
Reports of frequent power cuts during the invasion were widespread in Ramallah. These affected not only Ramallah/Bireh residents, but surrounding villages as well. According to the chief engineer of the Jerusalem District Power Company, at least 100,000 persons were affected by these power cuts, which ranged from part of the period of the invasion to most of the period. In this survey, we find that around 20 per cent of households were without electricity during most or all of the period of the invasion, 66 per cent suffered from power cuts some of the time and 14 per cent had no power interruptions. A higher percentage - 37 per cent - reported tap water supply cuts either for most or all of the duration of the invasion, with 40 per cent reporting shortages for some of the time and 23 per cent no water shortage at all. There were several problems that led to these interruptions, ranging from electricity poles and cables being destroyed by the incoming and moving tanks and army, to the destruction of power feeders and pumps resulting from shelling and bombing, as well as accidental destruction resulting from the fact that tanks are not made to move in narrow streets, and were bound to destroy pavements, electricity poles and other infrastructure in their way, mixed with vandalism for the "fun of it". Some areas in Ramallah were more severely affected than others, notably those that lie close to the presidential compound, where households were most severely affected not only by power cuts, but by strict curfew conditions for longer periods than the rest of the town. Water and especially power cuts did not merely affect families negatively, but businesses as well, where incidental reports indicate that a sizable number of shops and supermarkets had lost part of their merchandize that requires refrigeration.
The majority of households (86 per cent) reporting no problems faced in dealing with sewage during the invasion. However, 8 per cent reported that sewage pipes were blown up, resulting in the pollution of the environment, and 7 per cent reported that septic tanks were not emptied, resulting in the leakage of sewage into open areas. Waste disposal, on the other hand, appears to have been a problem affecting almost all households, with 96 per cent reporting serious problems and inability to get rid of household refuse. Most reported that household waste had piled up in refuse containers, attracting flies and exuding odors as during the curfew the municipal waste collection system came to a halt. Some even reported that the curfew was so severe that they were unable to transport household waste to the container located just outside their homes, but in the street, and as a result, garbage simply piled up at home during the period.
Of the total respondents, a high of 43 per cent reported facing a food availability problem during the period of curfew and invasion. During the initial days of the invasion, many basic food items, such as milk and milk products, bread, eggs and fresh vegetables, were unavailable. Between the curfew/siege conditions and the electrical cuts, consumers could not find these items in the market. Households with young children probably felt the impact most.
However, another problem emerged in the second half of the period, as the population began to suffer from the problem of the unavailability of cash, with 54 per cent of households reporting having gone through the period with little cash to buy available foods. This is not merely because of impoverishment, but also because bank transactions were completely halted for a good part of the time. When banks began to open during the second half of the invasion period, the four-hour curfew lifting was certainly insufficient to accommodate need, in addition to the fact that banks limited withdrawal to a maximum of 200 Jordanian dinars. At one point, a sudden availability of most food items after the Israeli army began to allow truckloads of foodstuffs to enter the area during the period of curfew lifting revealed the underlying problem of cash unavailability, with people not being able to buy what they need, even though it was now available to the consumer.
In response, families coped in different ways: 50 per cent simply tried to spend less, a high 34 per cent went on austerity measures and reported that they simply ate less than normally, 20 per cent substituted one type of food with another (such as eating more rice and lentils as well as a heavy reliance on canned foods), 32 per cent borrowed money from friends and relatives, while 5 per cent reported having borrowed food from neighbours; 18 per cent bought food from stores they know on account (Ramallah witnessed a situation where many storekeepers, in solidarity with the community, recorded totals in small account books by the name of customer, hoping they would be paid back once the invasion was over), while 18 per cent of households went back to baking bread at home; 14 per cent used savings, 7 per cent lived off what they had until the invasion was over, and 1 per cent survived on food aid distributed in the town via ambulances and when the curfew was lifted (totals are more than 100 per cent as families reported using more than one strategy to cope with the unavailability of cash). Clearly, families survived, but it was not easy, especially in households with younger children. Moreover, the impact of these events on the nutritional status of younger children is still to be ascertained.
When asked about shooting, explosions and destruction in their areas, 59 per cent of respondents reported that they endured many incidents: 29 per cent reported almost continuous incidents and only 12 per cent reported little shooting and detonations. These results seem to be related to the area where these households are located, as a further examination of the data showed that the most severe reports came from the areas surrounding the presidential compound and central Ramallah, in addition to the Masyoun area.
In response to a question about how households managed, a high of 52 per cent reported hiding in fear, lack of sleep and mental distress; 17 per cent reported that the family hid in one room at times, speaking quietly so as not to draw the attention of the army surrounding the house to its presence; 11 per cent reported having to pay attention to children who were in great fear, crying and wetting themselves, and the rest provided a variety of answers ranging from depression, cursing the Israeli army, wishing to die so this would all end, taking sedatives, waiting in anguish for the army to enter the house, and running away to the neighbour's or relatives' homes.
Consistent with the above findings, a high of 52 per cent also reported considerable destruction in their neighbourhoods. Of those, 39 per cent reported rampant destruction of retaining walls, telephone and electricity poles, shops, pavements, cars and even traffic signs; 23 per cent reported the destruction of homes, doors, the breaking of furniture and windows as well water pipes; 14 per cent reported the invasion and destruction, whether partial or total, of institutions around them such as schools, Palestinian National Authority and NGO institutions, and police headquarters; 13 per cent reported the destruction of nearby homes and shops, and the rest provided a variety of reports pertaining to the blowing up of cars, bullets entering homes, and the use of people as human shields.
Of the total households, 28 per cent reported that their homes were directly exposed to shooting, bombing and destruction. Of those, almost half reported shooting being directed at their homes' walls, glass, home entrances and retaining walls; about a fifth reported that the army occupied their building, destroyed and broke windows, cupboards, furniture, threw food out of cupboards and all over the place and soiled their homes; another fifth reported the destruction of water tanks on roofs, solar water heating panels and roof lighting, 4 per cent reported theft of valuables by the Israeli army, and the rest reported other types of destruction to homes, such destruction in some rooms but not others, destruction of sewage pipes and destruction of windows.
In total, 41 per cent of the households reported that their homes were searched by the Israeli army, with a strikingly high 36 per cent reporting at least one family member having been arrested or detained during this period (most probably young men, as the pattern went). Private cars were not spared either, with 19 per cent of respondents reporting the destruction of their cars, either through shooting directly at the car, burning it, or by way of tanks running over cars and reducing them to almost biscuit height, sights that Ramallah/Bireh residents watched in shock the first time the curfew was lifted.
Asking about the workplaces of household members who were working
just prior to the invasion, we found that 41 per cent reported
their workplace as having been exposed to shooting, bombing or
destruction. Although the numbers are too small to discern a definitive
pattern, it does seem that white collar office workers reported
the highest rate of destruction in their workplaces at almost
two-thirds of respondents compared to considerably lower rates
for others. In describing what happened, we find that 54 per cent
of those report destruction of the institutional and cultural
infrastructure variety that has been previously reported, undoing
much of the effort expended during the past three decades in building
the institutions of the state as well as civil society, and confirming
the claim that this has been a war against everything Palestinian,
as opposed to a war waged with a view to only Israeli security
considerations.
A high of 49 per cent of households reported a medication availability problem at home. Of those, 23 per cent reported contacting the Union of Palestinian Medical Relief Committees, and 20 per cent the Red Crescent Society who managed to reach those in need of medication with ambulances. It should be noted that these two organizations continued to operate under curfew and siege, and in great danger, often shot at, with staff used as human shields and even arrested temporarily. Eight per cent managed to get medications from neighbours, 4 per cent used substitutes, 4 per cent managed to reach a pharmacist and got the medication, presumably without prescription, and 23 per cent waited until the siege was lifted, with questionable impact on health. The rest either got to hospital or used indigenous medical practices or moved out of the area to reach health services when the curfew was lifted. Of those who had difficulty accessing the necessary medications, a high of about two-fifths of respondents reported complications, such as out of control diabetes and hypertension, deteriorating health conditions, or complications related to heart conditions. The long-term effects of the sudden interruption of necessary medications can only be speculative, but one would imagine that one result would be an increase in the rate of complications due to lack of control, especially in the case of diabetes mellitus, heart disease and hypertension.
Respondents were asked to report on any problems they observed in the family related to mental health during the period. It was interesting that the results demonstrated that only 7 per cent reported no mental health problems at all in the family, with the rest - a high of 93 per cent - reporting various types of problems affecting different age groups. With children, crying, screaming, fear, enuresis, fever and nightmares were reported. In adults, headaches, stomach aches, diarrhea, heart aches, uncontrolled diabetes and fainting, and pains related to fear, and even disruptions in bodily functions were reported as well. Clearly, these are respondent proxy reports that cannot be analysed beyond these general results. Suffice it to say here that this data confirms that the large majority of households have experienced the impact of the invasion in traumatic terms manifested by symptoms of psychological distress, both somatic and behavioural, and perhaps the exacerbation of their pre-existing disease conditions, notably those diseases that are negatively affected by stress.
Responses obtained on the management of symptoms of psychological distress are interesting in that perhaps they demonstrate different methods of coping, as well as the strong family and communal ties that come in handy during these times, when people are locked up at home in danger, uncertainty and fear. Of the total reporting symptoms, 24 per cent said they tried to cope by watching television, playing cards and computer games, reading and entertaining themselves with neighbours, and cleaning the house - basically, an intensification of the activities that usually happen in normal times; 25 per cent focused on caring for fearful children, explaining to them what is happening around them, playing with them or caring for them in sickness; 22 per cent reported that they tried to exercise self control, drew on their patience and ability to withstand and cared for others; 6 per cent resorted to praying as a means of coping and 4 per cent did nothing. The rest reported a wide range of responses, such as all the family sleeping in one room, telephoning family members outside the household to check on them, and other such activities, all geared towards withstanding these enormous pressures on the household. These initial results beg for an analysis of coping mechanisms by the gender of respondents, as the clusters that seem to arise pertain to male versus females activities related to coping (caring for children, versus playing cards, for instance). However, the data at hand is too small to yield meaningful results at this stage. On the whole, this initial evidence strongly indicates a generally traumatized household, old and young, and calls for more attention to be paid to this aspect of family health.
Finally, respondents were also asked to express their view and how they felt about the current situation. A very high 71 per cent reported views pointing to their feeling of despair and misery over what is happening to their lives, 8 per cent reported serious worries regarding financial matters and 6 per cent just did not know what to say. The rest provided answers ranging from "very serious conditions" to "occupation is a serious problem" to "a crisis in politics" to even "excellent, as this has exposed the masked face of occupation, the Oslo accords". Given these initial results, combined with observational and personal notes, the issue of despair appears to be key to the understanding of people's attitude's to prevailing conditions now, greatly surpassing even the more obvious financial difficulties, perhaps influencing their current approach to managing their daily affairs, and future course of action and events that can only be understood in this particular context of seemingly generalized despair.
This report shares insights and observations of the events in Ramallah and al-Bireh, Palestine, during the Israeli army's Invasion of the area using existing and useful qualitative and interview-based reports. However, this statistical survey allows for the quantification of observed events and tragic conditions that ordinary people - men, women and children - endured during the period in ways that reinforce and confirm previous reports. What this population experienced in this unilateral war cannot be justified simply by the prerogative of Israeli security, and can only point to a more insidious purpose for the invasion, a purpose that in the Palestinian experience could only have been the destruction of the structures and framework for the survival and the social development of the Palestinian nation.
This study also assists us in estimating the numbers of households and people that were affected by specific serious difficulties in dealing with daily life as a consequence of this invasion. Given the generalizability of our results, and based on PCBS's census reports of about 55,000 people living in Ramallah and al-Bireh and an average family size of 5.1 persons per household, we can note the following figures for affected households and individuals:
Total households in Ramallah and al-Bireh: 55,000 population /5.1 household size= 10,784 households
Households and individuals negatively affected by the invasion:
1. Family composition change during exceptional circumstances
2. Unavailability of basic services
3. Shortage of food and cash
4. Shooting, explosions and destruction of property and nearby institutions
5. Medications
6. Mental health
Palestinian Central Bureau of Statistics (PCBS), Population, Housing and Establishment Census, 1997: Final Results, Population Report (Palestinian Territory, 1999), Part I
PCBS census data obtained from the PCBS website
PCBS, Poverty in Palestine, January-December 1998 (2000)
PCBS, "Impact of Israeli measures on the economic conditions of Palestinian households," April 2001
*Institute of Community and Public Health, Birzeit University