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Out of Our Hands: Care, Moral Distress and Solidarity at Jerusalem’s Augusta Victoria Hospital


  • Period:  2023-2024
  • Status: ongoing

The aim of this project is to understand how professionals working in Palestinian referral healthcare in East Jerusalem experience and negotiate moral distress and solidarity in their daily practices of caring for patients and their companions. The outcomes are used to co-design strategies for supporting healthcare professionals in coping with the moral distress caused by working in contexts such as the protracted Israeli occupation. 

Description

In a complex political context, Palestinian professionals and institutions in East Jerusalem face the challenge of providing “as good as possible” referral healthcare. They struggle with insufficient financial resources, a lack of proper equipment, restricted access to utilities, and a restrictive Israeli permit bureaucracy. While the Israeli occupation is the primary reason for these challenges, the politics of the Palestinian Authority, as well as international donors such as the EU and the USA, also have a significant impact. In their daily care work, healthcare professionals are confronted with the consequences of this context and the additional suffering it brings to their patients. 


Previous research has shown how nurses from the West Bank have to deal with the experience of not being able to provide adequate care, humiliation at checkpoints during their commutes, tensions between their professional and private obligations, workplace bias related to political affiliation, and blurred boundaries between different medical responsibilities due to a lack of trained colleagues.


To further explore how these challenges affect professionals working in Palestinian referral care, the concept of moral distress offers a productive lens. Moral distress can be defined as understanding the correct moral action to take yet being prevented from acting upon it by institutional and political barriers. This project aims to map the complexities and dilemmas that healthcare professionals encounter and how they navigate them in their daily care practices.


Despite their moral distress, healthcare workers find the motivation to continue. Research has shown a strong commitment to caring as a moral calling and a national duty. Providing care is not only a professional task or requirement but also an act of solidarity with fellow nationals from the West Bank and the Gaza Strip. Together, care and solidarity are important elements of resilience in the face of a complex and oppressive environment. In this project, moral distress is the central concept used to explore the moral dilemmas and challenges healthcare workers experience in their daily care practices. Solidarity serves as a frame to study the motivation and the social infrastructures that support professionals in continuing their work.

Researchers

Results

Interviews and observations for this project began in the summer of 2023 at Augusta Victoria Hospital in Jerusalem. This is one of the six Palestinian referral hospitals that Palestinians from the West Bank and Gaza Strip can go to when they need specialized treatment. The system of referral care was deeply affected by the Israel-Gaza War, as Israel closed the border of the Gaza Strip, and traveling between the West Bank and East Jerusalem became more insecure. This also changed the focus of the research project.


A preliminary exploration of how the hospital staff experienced the first months of the war and how they assess the impact on the care they provide is published in the report: Out of Our Hands: The Experiences of Palestinian Healthcare Professionals at Jerusalem’s Augusta Victoria Hospital in the Aftermath of 7 October 2023. This report also offers recommendations for referral healthcare in similar situations and argues for ensuring the right to health for all, which in the Palestinian context is fundamentally intertwined with freedom of movement.

(Co-)financing

The study is funded by NWO, the Dutch Research Council (Nederlandse Organisatie voor Wetenschappelijk Onderzoek).

Also see

Contact

Dr. Pieter Dronkers (p.dronkers@uvh.nl).

The aim of this project is to understand how professionals working in Palestinian referral healthcare in East Jerusalem experience moral distress and solidarity in their daily practices of caring for patients and their companions.