For the past 32 years PMRS has been at the forefront of the health sector in Palestine and has been serving some 495 communities between the West Bank and Gaza.
Throughout this time, it has steadily expanded its mission to include the developing of long-term strategies to tackle and counteract the harmful effects that the occupation has on the physical and psychological wellbeing of Palestinians. As an internationally renowned NGO that is agile, flexible and ready to take on new challenges, PMRS has been working to shift the focus of its work from service provision to human rights advocacy.
It has identified the promotion of health as a human right as a stepping-stone to the creation of a democratic society. Health, in fact, encompasses all aspects of everyday life and directly affects the ability of each one of us to enjoy our right to education, leisure and movement, as well as our ability to work.
PMRS continues to create healthy and resilient communities able to withstand the occupation in areas that remain outside the reach of the Ministry of Health (MoH), such as Area C, Gaza and East Jerusalem. It is also eager to build on the successes achieved in service provision and advocacy, to assist more of its beneficiaries in the long-term aim of seeing their human rights guaranteed and fulfilled by the authorities in charge.
PMRS is increasing the capacity of its advocacy program to move one step further along the road to democracy and independence. By combining a bottom-up and top-down strategy to promote the concept of health as a human right, it wants to trigger change, mobilize communities, strengthen civil society and lobby authorities and stakeholders nationally and internationally.  
As an NGO that understands the shifting political and socio-economic situation of the oPt and is able to monitor, cater for and interpret the ever-changing needs and concerns of its communities, PMRS has used its work at micro and macro levels to fulfil the demands of its beneficiaries as well as those of the international community, for example by making environmental programs and gender mainstreaming an integral part of its work.
PMRS has grown from within the community and remains very much anchored in the local context. In the bottom-up portion of its advocacy strategy it can avail itself of a well- established presence on the ground that functions as a direct communication channel between its staff and beneficiaries. This is key to the ongoing success of awareness raising efforts and the setting up of new lobbying groups targeting specific needs. 
PMRS is also one of the largest providers of health care in the oPt and an active member of PNGO, the Health Nutrition cluster, the Non Communicable Diseases thematic group and other National and transnational Health Groups. Therefore, as part of its top-down strategy, it can advocate effectively with the MoH and other governmental institutions at policy and legislation level to raise standards of best practice, implement new protocols and improve health policy.
It has also hosted delegations of consuls and country representatives to vulnerable areas, raising their profile overseas. It also regularly invites international solidarity groups to witness and document human rights abuses. These groups are then able to set in motion a grassroots advocacy campaign through meetings, conferences or exhibitions in their country of origin.
The advocacy cycle is complete when the results gained at policy level trickle down to the communities who instigated the participatory lobbying effort in the first place.

The Advocacy Program
PMRS works successfully in five areas of advocacy to promote the right of Palestinians to quality and dignified healthcare and advance the concept of health as a human right.
1. Lobbying for individual beneficiaries
• This is done on behalf of and in collaboration with beneficiaries who may be entitled to cancer treatment, specialist care or medications through the Government Health Insurance scheme (GHI) but are in practice regularly denied their rights.
• PMRS lobbies the MoH through direct contact with specific departments, for example the central store to enquire about deficiencies in drug supply to chronically ill patients; or the referral department to coordinate and facilitate transport of underprivileged patients for specialist treatment abroad.

2. Lobbying for communities
• This is achieved through the wide network of volunteers, doctors and nurses, as well as 22 Primary Healthcare Centres (PHCC), health clubs, health clusters, support groups, Community Based Rehabilitation (CBR), emergency services and women's health clusters throughout the West Bank and Gaza. These groups can identify specific problems affecting the wellbeing of their communities (such as settlers violence, isolation garbage disposal, pollution of water resources due to solid waste from settlements; etc...).
• With the help and assistance of PMRS staff, the community sets up grassroots campaigns that lobbies local authorities, IGOs or the international community for immediate improvements. At the same time, PMRS lobbies at policy level directly to the authorities in charge for long-term solutions to the problems at hand.
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3. Group advocacy
• PMRS helped establish the lobby group 'Aswatna' (Our Voices) which started as a small group of families concerned at the lack of services for their mentally disabled children. 'Aswatna' has now grown into a powerful lobby ,campaigning for the right to dignified care and medical assistance to mentally disabled Palestinians.
• PMRS is looking to establish similar groups with kidney transplant patients and the mentally ill. The first are a vulnerable group often denied basic post-transplant care that could minimise the risk of rejection. The latter remain highly marginalised in Palestinian Society and are faced with an appalling lack of services within the GHI scheme.
 
4. Lobbying for proper health policies
• Through its network of services and programs within the community, PMRS is always listening to the grievances of its beneficiaries with regards to their experience within the health system; and remains concerned with much-needed improvements in service provision both in the West Bank and Gaza.
• PMRS lobbies the MoH both individually and as part of PNGO and large Health Coalitions in order to push for better healthcare policies; universal healthcare cover; better access to GHI for the underprivileged; and better quality healthcare.
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5. Campaigning against measures and restrictions imposed by Israel
• PMRS campaigns locally, nationally and internationally to denounce Israel's occupation. It produces reports, hosts conferences, invites international delegations, collects testimonies on the ground and bears witness.
• PMRS has campaigned, amongst other issues, to expose shortages of clean water in Gaza; denials to medical treatment in Israel or abroad for patients from Gaza; restriction on access to medical facilities in Jerusalem; and on the effect of the apartheid wall on access to healthcare.
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Success Stories

PMRS has had the chance to assess the efficacy of its advocacy strategy on many occasions. Below are some of the success stories grouped by area of intervention.
The empowerment of women and young girls starts at the local Health Club - Qalqilia and Tulkarem Governorates
Joining the Health Club in Qalqilia, made a big impression on Amani Abu Hamad and her friends as they were pushed to think deeply on the subject of personal empowerment and fulfilment of their abilities. As a result of her visits to the Health Club, Amani took part as a 'Leader' in the Summer Camp organized in Qalqilia and then went on to volunteer with PMRS Rehabilitation program. Through the Health Club, she also began volunteering her free time to lobby the local authorities on behalf of vulnerable beneficiaries for access to medications.

Environmental problems are tackled by the Ithna Health Coalition - Hebron Governatorate
As a member of Ithna Health Coalition, Yousef Tmezi was very worried by the fact that 20 tons of materials containing valuable metals that can be sold as scrap, were burnt in Ithna every year. As the burning was taking place in an unregulated manner, the debris would fall on the whole village including land used for agriculture. Concerned about the health consequences on the health of their families and the quality of their crops, the Health Coalition lobbied the municipality and in cooperation with the police managed to curb the burning by 70%.

The Emergency Service provides humanitarian and first aid service to Silwan - Jerusalem GovernorateBassel, a volunteer with PMRS Emergency Service, explained that due to the ongoing aggression and attacks at the hands of the Israeli occupation in East Jerusalem and its suburbs, it became crucial to reactivate the first aid teams trained and qualified by the PMRS. The idea came in order to fill the gap in first aid services provision in East Jerusalem. The volunteers’ work focused on the vicinities of the Al-Aqsa Mosque throughout the Month of Ramadan. Furthermore, in 2010 volunteers were able to help and provide first aid to 423 injured persons in the Old city, Silwan, Ras Al-Amud and Sheikh Jarrah..

The Iskaka Health Club makes environmental improvements - Salfit Governorate
Oday, member of Iskaka Health Club, reports that villagers were very concerned about the amoutn of mosquitoes in the area. The Health Club put forward the idea of spraying pesticide to put an end to the situation. Therefore the Club, in cooperation with the village council, worked on obtaining the pesticide needed for the four phases of the extermination program. PMRS provided the pesticide and fuel needed to operate the spraying machines and one of the Club’s members volunteered to spray the pesticide in the village.

PMRS and PHR reveal human rights violation in the Gaza War
In collaboration with Physicians for Human Rights and following an investigation by an international team of medical experts, it published three reports on the impact of Operation Cast Lead on the people of Gaza.
The reports documented 80 war crimes and violations committed by IOF troops during the Israeli war on Gaza such as assaults on and wanton killing of civilians, delaying and preventing evacuation of the wounded, attacks on emergency medical teams while on duty, and the use of internationally-banned weapons. And in an international awareness raising effort, the reports were distributed to news outfits across the world and presented at conferences, including one at the EU parliament in Brussels.

Conclusions

The present expansion of an already successful advocacy program, brings PMRS in line with global trends in the field of humanitarian aid and development. More importantly, though, it acknowledges the immense value of the advocacy work until now carried out behind the scenes by staff and volunteers, as part and parcel of every program. PMRS is now pushing to bring that work out into the open to better maximise its impact, assess results and evaluate efficacy.
PMRS finds itself working within the constraints of Israel's apartheid system and while it is very much conscious that awareness raising, lobbying and campaigning efforts are tools that can pave the road to democracy, it is ultimately Israel's military occupation that remains the biggest obstacle to a democratic Palestinian society.
And while assisting its beneficiaries in lobbying and campaigning against the separation wall, settlers violence, uprooting of olive trees, closures, restrictions on movement or pollution from settlements, PMRS never loses sight of the bigger picture: that all of the elements curtailing the right of Palestinians to a healthy existence, are to be looked at within the context of the military occupation, the removal of which remains PMRS' aim.