This is the third of our brief statistical reports on the daily life, health and environmental conditions of families living under curfew and in fear and danger during the latest Israeli invasion of the town of Jenin. This report excludes the Jenin refugee camp, which deserves a separate investigation. These reports form a series covering life events during Israel's April 2002 reoccupation of the cities of 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.
General conditions have been documented rather well by journalists, researchers and institutions. However, this statistical report focuses on households and individuals instead of communities, offering quantitative indicators generalizable to all of the population, and confirming or negating impressions and observations made in rapid appraisals through interviews.
The invasion of Jenin began on 2 April and ended 21 days later, on 22 April 2002. Then again, since the partial withdrawal of the Israeli army, Jenin town has been reinvaded more than once, usually for a period of several hours, where the Israeli army enters the town, destroys homes and infrastructure, arrests or kills selected individuals then leaves. The local population believes that this will become one of the routines of daily life.
In a recently completed report, international donors estimated the damage caused by the Israeli military offensive of March-April 2002 at 361 million US dollars. The damage assessment was carried out by the World Bank, United Nations agencies, the European Union, the US Agency for International Development as well as other countries and donors, and breaks down losses at 97 million dollars incurred by businesses, consisting of damage to buildings, equipment and spoilage/loss of inventory, and termed as the heaviest toll; 64 million US dollars for damaged or destroyed roads; 66 million US dollars for damaged or destroyed houses; and 48 million US dollars for damaged or destroyed cultural heritage sites. This estimate of losses, however, does not cover the losses of income during the extended curfews and siege, which are likely to exceed the estimates for physical damage. This damage report also does not include the social and humanitarian costs of the Israeli onslaught, which these quick statistical reports address to some extent.
While the donor report indicates that it was the Nablus region that was the hardest hit in terms of physical/inventory damage alone, available reports indicate that Jenin witnessed by far the worst humanitarian crisis of all, mainly because of the tragic events that took place in Jenin Refugee Camp, where war crimes appear to have been committed by the Israeli army, including grave breaches of the Fourth Geneva Convention and the laws of war, as attested in the reports of Human Rights Watch and Amnesty International, reports which also call for an international inquiry. Losses in Jenin city and the camp together were estimated at 83 million US dollars, with 800 families left homeless, primarily in the Jenin camp, and with damage to housing there amounting to 27 million US dollars. In the Jenin camp, other than estimating the physical destruction and financial damage incurred, the level of destruction and human suffering has been described as "unimaginable".
This house to house survey was conducted during the first 10 days of May 2002, just after the lifting of the curfew and the partial withdrawal of the Israeli army to the outskirts of town. A stratified random sample of households was chosen, primarily based on locale, and representative of all of the households in the city.
A sample of 154 households was selected utilizing stratified cluster sampling techniques. The city was divided into five strata, whereby two to three 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 per cent.
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-one household heads or adult family members were interviewed. The mean age of respondents was 40 years, comparable to the mean age in the other towns that were surveyed. Of those, 48 per cent were females and the rest males.
Of the total respondents, 6 per cent were illiterate, 13 per cent had elementary schooling, 26 per cent had secondary schooling, 20 per cent had up to Bachelor's degrees, and 3 per cent had Master's degrees or above, perhaps denoting bias towards educated respondents. The educational picture for the town as a whole and for those above the age of 10 years produced by the Palestinian Central Bureau of Statistics (PCBS) for 1997 includes 9 per cent illiterates, 15 per cent able to read and write, 64 per cent with secondary schooling or below, 7 per cent with associate diplomas and 6 per cent with Bachelor's degrees or above. Given that the PCBS figures pertain to the population over 10 years old, we need to be cautious in making a direct comparison with our data.
The average household size in this survey was found to be 6.3 persons per household, with the smallest household composed of two persons and the largest of 17. The household reported here is higher than the 1997 PCBS report of 5.4 persons per household, again pointing to a probable shift in household composition, as people sought shelter away from dangerous areas with a heavy presence of the Israeli army and moved to perceived less dangerous areas during the period of the invasion. This is consistent with reports obtained in Ramallah and Nablus. Of the total household, 64 per cent were of the nuclear variety, and an unexpectedly high 36 per cent were of the extended one, compared to a low of 17 per cent for Jenin in 1977 (PCBS), again denoting important shifts in household composition found in this survey.
Of the total respondents, 37 per cent reported housing other family members and friends during the invasion, a pattern that is consistent with our findings for Ramallah/Bireh and Nablus, although at a higher rate (30 per cent for Ramallah/Bireh and 29 per cent for Nablus). Why Jenin witnessed a higher rate of families seeking shelter is beyond the scope of this quick survey. However, it may well be that the Israeli army's indiscriminate assault on the Jenin refugee camp and the accompanying relentless shelling and destruction of homes is a cause. Of those taking in families for shelter, over half reported them as relatives, a quarter as neighbours and friends and the rest - almost a fifth - reported sheltering strangers who needed help during trying times.
When asked why these guest arrived to stay in their home during the invasion, a high of over half reported that these guests came to live in their house because their homes were destroyed by Israeli army activities in their areas, while Ramallah and Nablus respondents reported almost negligible results for this particular response; a quarter reported that the guests came from the camp nearby, obviously indicating the need to have moved out, a fifth denoted fear of heavy fighting nearby and the rest provided a range of answers, such as the army using their home as barracks and the presence of a pregnant woman at home. The people with destroyed homes may well be people who lived in or on the outskirts of the camp, an assumption that is probably rational to make as home destruction took place largely, although not exclusively, in the camp. If such an assumption is true, however, then it seems that Jenin town inhabitants responded to the humanitarian crisis next door in the camp by housing people who have lost their homes, a reaction that can only be deemed natural in these circumstances. It will be interesting to see the impact of this type of heavy and "unimaginable" destruction on the rest of the responses. Already, though, we can begin to delineate a pattern of difference between Jenin on the one hand, because of what happened in the camp, and Nablus and Ramallah on the other, where the physical destruction was severe, but where the humanitarian and social consequences of this onslaught were certainly with less profound effects.
Once again, given the generalizability of the results to the population of the town as a whole, these findings are important in that they indicate an even greater shift in family composition - although temporary - than in Nablus and Ramallah, with internal migration from one area to another in search of safety or even shelter. One can only speculate about the impact of these events on the family, especially in this case, on children.
Of the female respondents, a low of 63 per cent denoted themselves as being housewives, with the remaining 37 per cent reporting that they are working, a rate that is significantly higher than the reports of female respondents for both Ramallah/Bireh (at 25 per cent of the labour force) and Nablus (at 24 per cent). It is not clear why there is this large discrepancy among the towns, especially given that PCBS statistics for 1997 do not corroborate this higher rate of working women in Jenin compared to the other towns, and also compared to PCBS 1997 census figures on economically active females over 10 years old having been placed at 13 per cent in Jenin town. These observations point to the possibly strong bias in favour of educated and working women in this survey. About half of the working women were largely employed in white collar positions. The remaining data is too small to discern definitive patterns in relation to women's employment.
As for the male respondents, 18 per cent reported either owning a shop or running another form of private enterprise, (a low of 7 per cent were professionals (academics, teachers, nurses, doctors and lawyers), lower than Ramallah, where 22 per cent worked in white collar jobs and 38 per cent worked in semi-skilled or unskilled work; only 3 per cent reported themselves as farmers in a once buzzing farming community (the impact of social transformations, land fragmentation combined with, probably, land confiscation) and a low of 8 per cent reported themselves as unemployed.
Of those working just prior to the invasion, 76 per cent stated that they still held their job after the invasion and 24 per cent reported that they had lost their job since that time. A third of those who lost their jobs reported this as a consequence of the closure and siege, over a quarter blamed the collapsed market; an unexplained fifth said injury was the case and another sixth reported that their place of work was destroyed during the invasion. These results are quite comparable to those obtained in Ramallah and Nablus, pointing to the additional loss of livelihood of families beyond what was reported by the PCBS for the first few months of this current uprising. They also point out the need to look into the issue of spiralling poverty further, in an attempt to better understand the consequences of the invasion on income, poverty and family life.
Jenin suffered serious power shortages during the invasion. Reports from the electricity company there indicate that the electricity problem continued for 15 whole days, in addition to five other scattered days and affected not only the population of Jenin town, but an estimated population of an additional 35,000 people in at least five villages in the immediate vicinity served by the Jenin town electrical company.
In this survey, 65 per cent of the respondents reported the electricity having been cut off practically all of the time, 31 per cent most of the time and the rest (2 per cent) some of the time or (2 per cent) none at all. Judging by these results alone, Jenin was more affected by power shortages than Ramallah/Bireh (20 per cent most or all of the time) or Nablus at 47 per cent), again increasing the suspicion that, although in terms of physical damage assessment, Nablus was most hard hit, in fact, Jenin residents seemed to have suffered most. The running drinking water situation seems to confirm this emerging picture, with 58 per cent of respondents reporting the lack of tap water supply all the time, and an additional 34 per cent most of the time, leaving very few (5 per cent) with only occasional shortages and only 3 per cent who were in fact spared this misery. Likewise with telephone connections: 77 per cent of those with telephone lines reported telephone lines being cut all of the time, 5 per cent most of the time, 16 per cent some of the time and 3 per cent not at all. Clearly, we are beginning to identify a new definition for "hardest hit" that goes beyond the physical damage and includes the impact of the invasion on people and the daily life of families, a point that cannot be over-emphasized.
With the majority of household - 82 per cent - reporting no problems faced with sewage disposal during this period, the remaining households faced troubles either with blown up water pipes - 9 per cent - or the usual emptying of cesspits - 9 per cent. The waste problem was serious, with 95 per cent facing a problem getting rid of household waste, with 91 per cent explaining the problem in terms of the municipal services coming to a halt during the curfew and 9 per cent reporting the inability of even dumping the waste outside the home, as the curfew was very strict; in these households, waste piled up inside the home during the extended curfew.
Of the total respondents, a high of 64 per cent reported facing a food availability problem during the curfew/invasion, a rate that surpasses the rates obtained for Ramallah (43 per cent) and Nablus (37 per cent), again denoting a severity of hardship at higher levels in Jenin town compared to the other towns that we have reviewed so far. Likewise, when the curfew was lifted for short periods so that people could buy basic supplies, Jenin residents faced a higher level of food unavailability in the market, with 89 per cent reporting foot shortages in stores and markets, compared to considerably lower rates for Ramallah (69 per cent) and Nablus (43 per cent).
Yet, in contrast, a lower 34 per cent reported cash availability problems at home during the curfew and invasion, compared to 54 per cent for Ramallah and closer to the 33 per cent reported for Nablus. These results may be related to a lesser reliance on banks and banking, with consequent more cash at home, to more advance warning of the invasion or to lesser availability of products to buy, but these observations are merely speculative, with explanations of these results prompting us to think of further field investigations of the matter.
In response to the food and cash availability problem, a high of over two-thirds reported borrowing cash from friends and relatives, and another 25 per cent did nothing and lived with what was available; the rest relied on food aid and tried to spend less. It is curious to note that only one of the respondents reported taking food on account from food stores, in contrast to Ramallah (at 18 per cent). In terms of managing the food supply at home, only 1 per cent reported baking bread at home as a method of coping, perhaps because baking bread is an ordinary occurrence in Jenin compared to Ramallah; 33 per cent reported living with what was available and eating less, 18 per cent substituted one type of food with another, especially relying on canned foods, 17 per cent relied on the Union of Medical Relief Committees and others for food aid, and the rest reported cooperating with neighbours and family on this matter. Overall, then, while families survived, the main issue now pertains to the nutritional consequences of these events, especially as the state of siege continues in full force, generating a strong suspicion of the presence of increasing malnutrition in this community, especially among children.
Reports on living with the sound of shooting, explosions and destruction are also revealing of evident horror and fear: of the total respondents, 36 per cent reported having lived with these events all of the time and 56 per cent most of the time, bringing the total to 91 per cent of respondents. In response to these attacks, 36 per cent of households hid in fear and suffered lack of sleep and mental distress, and 28 per cent reported the family hiding in one room quietly so as not to draw the attention of the army. Fourteen per cent of respondents specified children's fear and crying, urinating on themselves, and the rest gave various answers such as did nothing, no fear, this is normal, escaping to the neighbours and taking sedatives.
Witnessing or hearing considerable destruction in the neighbourhood was reported by 78 per cent of the respondents, higher than the 52 per cent reported for Ramallah and Nablus (67 per cent), again pointing to the greater severity of events that people lived in Jenin. Here, 56 per cent reported rampant destruction of retaining walls, telephone and electricity poles, shops, pavements, cars and even traffic signs; 16 per cent reported the destruction of doors, the breaking of furniture and windows as well as water pipes, and an addition 18 per cent reported the total destruction of homes and neighbouring shops, the use of people by the Israelis as human shields; 5 per cent reported the destruction of cars; and the rest provided scattered answers such as bullets coming into homes, the destruction of public institutions and the like. Of the total, 17 per cent reported the exposure of their cars to shooting, including total destruction in some cases. Evidently, in comparison with Ramallah and Nablus, home destruction was more of a major event in people's lives in Jenin, contrasting to the greater institutional infrastructure destruction reported in Ramallah, for instance.
A majority of 59 per cent, much higher than in Ramallah (28 per cent) and Nablus (34 per cent), reported direct exposure to shooting at their home, again pointing to families and households having been harder hit than in the other towns. Of those, over two-thirds reported shooting being directed at their home's walls, glass, home entrances and retaining walls, one-tenth reported the occupation of their building, destruction of property and acquisitions, cupboards, furniture, food supplies and the dirtying of their homes, and another tenth reported gun shots entering homes. As for the Israeli army searching homes, 30 per cent reported that their homes were searched by the army, lower than in Ramallah (40 per cent) and Nablus (50 per cent). Twenty-one per cent reported the arrest of at least one family member during the period; it is probable that many of these arrests were temporary detentions.
Asked about the workplaces of household members who were working prior to the invasion, 29 per cent reported their workplace as having been exposed to shooting, bombing and destruction, a rate lower than in Ramallah (41 per cent) and higher than in Nablus (a very low of 12 per cent). Most answers here pertained to reports of shelling and/or shooting. On the whole, the impact of the Israeli invasion was felt at higher levels at the household level in Jenin, and at the public level in Ramallah and Nablus. These results press the issue of assistance and actions directed to the household level, and not only to the rehabilitation of the physical infrastructure variety.
Of the total respondents, 34 per cent reported medication shortages during the period of the invasion, lower than the 49 per cent registered for Ramallah but higher than the 22 per cent reported for Nablus. An explanation of these differences is beyond the scope of this investigation, but may be related to the higher dependence of Ramallah's inhabitants on medications as a way of life as well as the fact that Ramallah's residents suffered the first assault and thus were less prepared. On the other hand, a comparison of Jenin's responses to those of Nablus's remain unexplained. Of those who reported medication shortages in Jenin, over one-third reported going back to indigenous medical practices and the rest substituted one medication with another, reduced the dosage of their medication so that the medicine would last, borrowed similar medications from the neighbours or did without the medications altogether, all pointing to a possible problem of untoward effects of these actions. The rest were able to reach hospitals or pharmacies for their medications.
Of those facing medication shortages, about a quarter reported the deterioration of the condition for which the medications was needed, one-tenth of those specifically mentioning deteriorating diabetic conditions, again raising the issue of the need to investigate the impact of the invasion on the control of chronic diseases, where lack of control can lead to more serious problems; the rest pointed to living with pain until the curfew was lifted, or "taking it out on the children", or no effects at all.
Reviewing the responses to mental health problems observed during the invasion in their household, we find that 89 per cent of the respondents reporting various types of problems affecting different groups, a rate that is slightly lower than that of Ramallah (93 per cent) but higher than that of Nablus (70 per cent). The reasons for these differences are not clear but may be due to the severity of the experience combined with consciousness and awareness of mental health as an important category of family health .
When asked about what they did with such problems at home, a high of 21 per cent each resorted to praying or doing nothing, 13 per cent reported packing the family in one room and waiting, perhaps an indication that being together may have been of help, 15 per cent focused on soothing and helping the children at home who were presumably traumatized, 10 per cent played cards and watched television, read and tried to entertain themselves with neighbours and embroidery or cleaning the home; and the rest reported that they called on family to ensure their safety, or sitting down and doing nothing, inability to sleep, waiting in expectation, or taking turns sleeping to keep a watch on the events. Suffice it to say here that the results demonstrate that trauma and trauma management should very much become a priority action for health care providers and institutions, as so far we are witnessing a situation where the majority of households in all three towns reporting mental health problems that require immediate intervention, in the hope of minimizing longer-term effects on people, especially children.
In response to the question of how they felt about the events taking place in their lives, a very high 93 per cent reported feelings of despair and misery over what is happening to their lives, compared to 71 per cent for Ramallah and 74 per cent for Nablus, once again pointing to personal despair as being a major issue to address as a priority for action.
The Jenin case may well be a case in point, demonstrating the need not only to pay attention to the damages that took place during the invasion of the West Bank by the Israeli army in terms of physical infrastructure or loss of income or both, but also in terms of the social, medical and humanitarian costs to households and people. To this end, this report indicates that, given a people-oriented definition of the severity of the attack, the population of Jenin, by far, has been the most hard hit, certainly more than Ramallah/Bireh and even more than Nablus, which suffered the most in terms of physical damage, according to the assessment of the World Bank and other donors. What happened in the Jenin camp, what the population of Jenin witnessed and lived, and the results of this quick survey not only point to Jenin as a priority for people-oriented action which assists households in picking up the pieces, finding employment and dealing with the medical and mental health consequences of the invasion, but also point to the need to redefine our terminology of damage to focus on the damage incurred to people and their needs. This is especially important in view of the fact that infrastructure without a healthy and optimistic people to rebuild, operate and push this nation back into action, without people that have hope that can restart the engine of development is like placing a band aid on a seriously infected wound.
To estimate the number of households and people that were affected by specific serious difficulties in dealing with daily life as a consequence of this invasion, we are using the PCBS census report of Jenin's population of 26,681 persons and 4,880 households:
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 institutions
5. Medications
6. Mental health
1. Local Aid Coordination Committee press release, "Damage to civilian infrastructure and institutions in the West Bank estimated at 361 million US dollars" (Jerusalem, 15 May 2002)
2. Reeves, Phil, "Amid the ruins of Jenin, the grisly evidence of a war crime," The Independent, 16 April 2002
3. Hass, Amira, "What kind of war is that?", Haaretz, 19 April 2002
4. Palestinian Central Bureau of Statistic (PCBS), Population of Palestinian Communities, 1997-2010, (Ramallah, Palestine, 1999)
5. Human Rights Watch, "Jenin war crimes investigation needed: Human Rights Watch finds laws of war violations" (Human Rights Watch press release on issuance of 48-page report on events in Jenin camp, New York, 3 May 2002)
7. Palestinian Central Bureau of Statistics, Population, Housing and Establishment Census, 1997 (City Reports Series. Final Results Jenin City, 2000)
*Institute of Community and Public Health, Birzeit University