This document presents the results of a political economy analysis (PEA) of the health sector in Gaza. It is based on a literature review spanning multiple source types, and in-depth semi-structured interviews with policy makers, health officials and carers of patients (family members caring for patients) in the Gaza Strip.

The data from the literature review and the interviews pointed to five legacies which remain powerful in influencing the Gaza healthcare today. These legacies are classified under two main themes: (1) The health sector as a site of political conflict; and (2) decision-taking and the lack of a unified Palestinian vision. Palestinians’ right to health is highly politicized. The health sector in Gaza has emerged within the constraints and agendas of several occupations and internal conflict. Consequently, the Gaza health system has been shaped by a context of “de-development” – a past (and present) that is characterized by fragmentation, negligence, marginalisation, and dependency, and which continues to affect the population in Gaza.

Because of decades of occupation, health and activism in Gaza has become largely intertwined. Planning for the health system in Gaza was also typically an activity that is taken by ‘outsiders’, including Israel and foreign agencies. This has created inherit weaknesses in the system and a chronic lack of coordination since the health sector was ignored or misused for political purposes. Until today, the Gaza health system lacks a unified vision. In this context, the United Nations Refugee and Work Agency (UNRWA) has enjoyed a competitive advantage over other health providers as a “co-ordinating body”, despite an ‘enduring trust barrier’ between UNRWA and the Palestinians in Gaza continue as they perceive UNRWA’s neutrality as an attempt to normalize the occupation rather than fulfilling its protection mandate of searching for durable solution to the Palestinian problem. All in all, the health sector in Gaza continues to be a site of political conflict. For more details, see (Section. 4.2).