State-building and embezzlement and public money waste in Palestine –
The health sector as an example
State-building in Palestine was the largest and most important project initiated and developed by former Prime Minister Dr. Salam Fayyad. Building state institutions, whose land and people remain under the claws of occupation and whose economy and sovereignty are hostages to unjust agreements granting the occupier all possibilities of direct and indirect control, is itself a very great challenge. This challenge primarily requires rallying self-determination and strengthening the components and capabilities of the people wherever they are. The most important factor for the success of such a project is attracting the people and convincing all their factions to support the building process. This can only happen if transparency dominates every step and professional competence is the most important basis for holding positions and occupying posts.
Today, after more than two decades of building the Palestinian Authority and receiving more than 20 billion dollars in external support, not counting local tax collection and clearance revenues – funds collected by the Israeli occupation on behalf of the Authority – we can only say that what was spent on 'state-building' compared to what was spent on building the productive national economy and productive job opportunities is very meager.
I am fully convinced that any building process, whether administrative, economic, or service-related, no matter how small, can reveal financial and project management loopholes upon scrutiny. The important thing is how the Authority deals with these loopholes.
Since the early years of the Palestinian Authority until today, the specter of favoritism, bribery, public money waste, and mismanagement has hovered over all projects implemented in occupied Palestine, and these terms have become the most widespread traits among the people to describe the state of the Authority. What the Authority lacked as a permanent companion in the state-building process was regular accountability and asking the question: Where did you get this from? from everyone connected to any project!
Reports on corruption within the Palestinian Authority are numerous and varied, with very large sums of money disappearing and deals made behind the backs of official institutions countless in number, as well as many Authority officials and employees involved in these shameful acts. The corruption investigation committee has not yet brought any major fish to trial. According to Transparency International, based in Berlin, which analyzes corruption levels based on the degree of public money exploitation for illicit enrichment and public office for personal benefit, the Palestinian Authority ranked 107th among corrupt countries and second in the Arab world after Iraq, which ranked 137th globally.
Most corruption and public money waste reports in Palestine relate to investment projects and similar areas. Unfortunately, the service sector and everything surrounding it have not been adequately addressed, with the best example being the health sector, which has become a large and deep swamp where tens of millions of dollars are wasted annually, feeding the small cats: employees in health offices, the Ministry of Health, and some doctors who have lost their humanity and violated the oath of honor they took when they became doctors and their agents in some European countries, as well as the patient traders as I call them. All these exploit professional and legal loopholes in the Palestinian health sector for personal gain.
I see the real reason behind the lack of attention to embezzlement and public money waste in the health sector stems from two main reasons; the first is the broad appreciation and gratitude from all segments of the people to the Authority for implementing the health insurance project for all citizens. This is undoubtedly one of the most important and best achievements of the Palestinian Authority, and this appreciation blinds some from closely observing what happens daily in the health sector. The second reason is that embezzlement occurs in many cases, but the amount in each case is small compared to the money embezzled in investment projects.
In Palestine, health insurance is the responsibility of the Ministry of Health and not within the scope of the private sector. That is, the Ministry of Health funds and pays for all types of treatment and medicines needed by citizens regardless of whether the treatment is provided domestically or abroad.
To undergo treatment or surgery, the patient goes to health departments or government hospitals, where they are referred to a specific entity (a specialist or a private hospital, and in the case of a hospital, the doctor who will perform the treatment is specified by a health employee or a specialist in the government hospital). Here begins the chain of bribery, embezzlement, favoritism, and waste of public money.
Some employees in health departments brazenly demand money from patients to expedite referrals or approve treatment in Israel, as do some so-called 'specialists' among doctors without conscience or ethics. Since private hospitals, whether in Palestine, Israel, or other countries, profit from surgeries, to get more cases, employees in health departments and specialists in government hospitals are bribed. In many cases, especially those treated in European countries through brokers, inflated invoices are issued, and large sums are deducted and embezzled from patient expenses and surgery costs. Examples, especially in Germany and Britain, are numerous, and the names of brokers and their backers in official circles are known to all.
In the health sector, we can observe not only how embezzlement has become part of the official institution but also clearly see how officials, regardless of their rank, treat the people and the institution and how they view them.
The Palestinian people are known to excel academically. Everyone rightly boasts about the achievements of our Palestinian sons and daughters in all scientific fields, especially in medicine. Thousands of doctors and specialists in all fields remain abroad, and no serious attempt has been made to attract them back to Palestine to build a globally competitive medical sector. Although we have specialists with international fame in several fields, and this sector could have been a symbol of building strong, competitive state pillars, family and partisan favoritism have blocked such achievements. Instead of placing the right person in the right place, loyalty, favoritism, bribery, and corruption have been relied upon in appointments. Additionally, this disgraceful dysfunction has worsened the situation due to the actions of Authority officials. It is rare to see a Palestinian official or a family member treated in local hospitals; they all get referrals to Israel or Europe, even though most treatments and surgeries are possible locally, and we have internationally renowned specialists in hospitals in occupied Palestine. (It should be noted that this behavior is not limited to the Ramallah Authority but also the Gaza Authority has followed the same path.) This national behavior indicates that these officials have no trust in their people... so how do they expect to build a homeland?
To clarify to the reader with concrete examples what I mean, I bring the example of neurosurgery at Al-Maqasid Hospital in occupied Jerusalem:
About five years ago, Professor Dr. Sami Hussein, a neurosurgery specialist and one of the most famous specialists worldwide in this field, decided to return home to offer his expertise gained as a lecturer and head of the Neurosurgery Department at Hanover Medical School/Germany to his people in occupied Palestine. His goal from the start was to build a distinguished neurosurgery department and train doctors from our people in neurosurgery to rival all such departments in the Middle East. After arduous work and distinguished effort, he succeeded in building a distinguished department where Professor Hussein works with three specialists and six assistants performing about 1,000 neurosurgical operations annually. The department now accounts for about 25% of the hospital's total income. This number of operations rivals those performed by well-equipped Israeli hospitals staffed with much larger teams than those at Al-Maqasid Hospital. Professor Hussein says about 30% of patients treated in Jordan and Israel come to him because their surgeries were unsuccessful. Ten percent of the department's patients from within Palestine prefer surgery by Professor Hussein's team rather than Israeli hospitals. Some Israeli insurance companies, like Maccabi and Meuhedet, cover treatment at Al-Maqasid Hospital for Israeli patients, while senior officials in both the Ramallah and Gaza Authorities rush to be treated in Israel, wasting public money instead of spending it on national institutions and supporting the national economy. According to Professor Hussein, the cost of surgery in his specialty at Al-Maqasid Hospital does not exceed 50% of the cost in Israel and less than 30% of the cost in Europe.
In conclusion, it remains to say that the Palestinian people possess tremendous capabilities and high potential to build a homeland and honorable national institutions... what they lack is only wise, patriotic political leadership in every sense that appreciates and supports these capabilities to take their role in building national institutions by giving them the trust and support they deserve.
