Limitations

Where do I start;

The occupation has had major effects upon business and public resources/facilities in both the West bank and Gaza. That much is plain to anyone who travels east of Jerusalem or south of Ashkelon and should not be seen as conveying a bias. What isn't so obvious is just how much of an impact has been made. Gaza is infinitely worse in standing right now in all markers of social and economic development, not least because its industrial capability is nought, totally razed to the ground during the Christmas offensive by Israel. I think their last factory was destroyed some 2-3 weeks back in an airstrike. Its situation should be discussed separately.

My friends both in the medical field here as well as those involved with the German development services (a German federal govt agency helping public institutions here) have attested to the stagnation and lack of future of the west bank. Foremost in this is the fact that almost all consumer items or the raw materials necessary to build them have to be imported from Israel. Neither the WB nor Gaza have any ports nor foreign borders that are not subject to Israeli embargo. Israeli people are forbidden from travelling to Palestinian major cities, as of 2001 with the start of the second intifada. Though there is no immediate danger of another uprising, most people here seem to think that this travel restriction is punitive, as Palestinian businesses lose their partners on the other side.
As Israel raises taxes from both its own citizens and more well to do Palestinians, it then pays the salaries of civil servants and determines how much can be used for public spending in Palestinian areas. As this amount is painfully small, WB is highly dependant on expertise and funding from foreign donors, either NGO's or foreign governments such as Norway or Germany.

The COGAT - coordinator for (israeli) govt activities in the OT, controls all water and electricity supplies to the OT, with frequent unsanctioned, illegal settlement activity responsible for tapping into what limited resources exist, such as drawing water at a lower level in the underground water table than the Palestinians have, so as to take more of it for their settlements. Saw some yesterday, looks like you've been transported to California or Switzerland with their use of water! Water is rationed to families here, and you pay for extra yourself.
Settlements along with the $5 billion Wall cut up the Palestinian territories with Settler/Jewish/tourist only roads, forcing locals to take detours of more than 45 mins to get where they want to go to. All this is the baseline...in the intifada, this was made unbearably more difficult with the establishment of checkpoints where people would wait hours and hours at before being allowed to pass. Some people in villages such as the one I'm at now, weren;t allowed to leave their towns to travel at all, relying upon the Red Crescent and other such orgnaisations to provide food.
(Israel was reluctant to compromise on control over this in the two state solution talks when Israeli PM Ehud Barak met the former Palestinian prime minister Yasser Arafat, hence why it was so hard to come to an agreement).

Most of this has been told to me in conversation so I will put some anecdotes up later. The hospital situation has some severe limitations too, most prominent of which are resources. Some of the facilities are surprisingly modern, just too few and far between.
Here are some examples...quite random but basically whatever has struck me as being wrong/odd.
There are very few beds in ICU/NICU for critical care patients, or for that matter even in normal wards. Basic first line treatments are usually available for patients but conservative treatment is often advocated for patients who would normally be admitted. Medication is reserved for harder/unresponsive patients, they often have to be transferred to other hospitals in Jerusalem or within mainland Israel. Protocols are sometimes followed but if the patient can be managed by acting minimally, this is done.
There are no transplant facilities, so all heart/kidney/liver patients who have reached the end of the line must be transfered to Israeli hospitals. I may have mentioned this to some of you, but more specialised treatments for complex conditions, eg Prostaglandin treatment to keep the Ductus Arteriosus open in neonates with critical congenital heart disease is unavailable. Such patients must also be transferred to Israel, and must pass through checkpoints that require two hours advance notice to clear the transfer as well as a list of exactly who will be travelling.
Following delivery of their child, women are kept for 12 hours, half the minimal time recommended for post natal observation of patients. Mostly to save cost and to make room for patients who need more specialised care.
The Palestinian population has one of the highest rates of cancers in the region, most likely due to the dumping of industrial waste and pollutants straight into drinking water and generally lax environmental regulations concerning waste disposal in Israel, so long as the Israeli population itself will not be affected.
One of my friends working for the German development agency within the environmental works divsion gave me the example of a factory close to the 1967 border line within mainland Israel, that produces noxious gases as a result of its operations. It is happy to operate without proper filter systems, as long as the wind blows towards the OT and WB, which it does 360 days a year. For the 3-5 days that the wind changes to blow waste back into Israel, it shuts down. This and other carcinogenic industrial processes, as well as the fact that almost 90% of Palestinians smoke, contributes to the epidemic, especially of childhood leukaemia.
Bear in mind however,that despite this situation, only basic radiotherapy and chemotherapy facilites are in place and no provisions for tumour resection. Add to this that there are virtually no trained consultant Oncologists, as should they stay here they would make roughly a 5th of the earnings they would abroad.

This has its impact upon patients in terms of unavailibility of appointments, long waiting times, and inadequate consultations. A typical clerking in ER/A&E lasts at max about 5 minutes, with most doctors taking 2-3 mins. Hardly comprehensive with only minimal attention to past med history and drugs...the focus is usally on just what the patient is coming in with. Its disturbing to often find a very blase attitude towards patients especially if they are not acute injury/emergency cases. One example is a doctor shrugging his shoulders as he continued with his evening fast breaking meal whilst a patient (newly born baby) came as a dead on arrival (DOA). True there was nothing to be done, but to do the same thing in the UK would be grounds for dismissal or at least called up to the GMC. But then after seeing so many cases day in day out and only being able to do the minimum before transfering the very sick elsewhere...I wonder sometimes if I would develop the same attitude.
Insha'allah not.