Editor—The study reported by Rytter et al attributes a risk for added admissions to hospital to delays from checkpoints, detours, and curfews imposed by the Israeli Defence Forces (IDF) during January 2005—described as “a relatively calm period in the West Bank.”1 However, a review of their data raises some questions about the internal consistency and coherence of the findings and their interpretation. Of all 2228 contacts, 394 (17.7%) were delayed, and of these, 125 (32%) required admission to hospital, resulting in an overall risk of 5.6%. But 51 of the 125 would have been admitted anyway, based on expected risks of hospital admissions in people not delayed for military reasons.
Therefore, 74 admissions—or 3.3% of all contacts—were specifically attributable to delays, which were self reported. Using the authors' data on travel times, (18 km/h and 15.5 km/h in non-delayed and delayed groups), and estimated average trip length of 15 km, we estimated median travel times to be 50 minutes and 58 minutes, respectively. Although these estimates omit ranges, it seems a bit odd that a 16% increase in median travel time—an additional 8 minutes within the golden hour—should account for 59.2% of the 125 delays. These findings do not make a persuasive case for the role of IDF checkpoints, detours, and curfews in producing major delays in access to emergency health care.
Figure 1.
Graffiti on the security barrier separating the occupied territories from Israel
Credit: BANKSY
The period leading up to January 2005 was anything but calm in our region. From September 2004 to February 2005 terror attacks, originating mostly from Palestinian regions, killed 76 and wounded another 234 people, mostly Israeli civilians, Jewish and Arab people, and foreigners.2 The checkpoints—themselves not very safe areas—foiled other attacks and smuggling of arms. Now they are fewer, having been replaced by the barrier, an even more effective deterrent.3
Competing interests: Over the past 25 years EDR has participated in investigations by human rights groups on the use of tear gas and the health conditions of Palestinian prisoner detainees, as well as initiated, supervised, and participated in joint Israeli-Palestinian projects to investigate and prevent epidemics of lead poisoning and asthma in refugee camps, and to assess the distribution and determinants of lead exposures of children in Israel, Jordan, and the Palestinian Authority. RB is a researcher in trauma and bereavement and interethnic conflict around the world. AR has overseen Hadassah's trauma care during the past 15 years, which has provided care for all injured and provided training for Palestinian healthcare workers.
References
- 1.Rytter MJH, Kjældgaard AL, Brønnum-Hansen H, Helweg-Larsen K. Effects of armed conflict on access to emergency health care in Palestinian West Bank: systematic collection of data in emergency departments. BMJ 2006;332: 1122-4. (13 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ministry of Foreign Affairs. Victims of Palestinian violence and terrorism since September 2000. http://www.mfa.gov.il/MFA-Terrorism (accessed 6 April 2006).
- 3.Richter ED The Barrier: protection of the right to life from incitement and terror in the Israeli-Palestinian conflict: an epidemiologic working paper. (30 pp; unpublished available on request). 28 February 2004. Submitted to International Court of Justice in The Hague.