A war against Arab citizens – January 19, 2017

It is 5:30 in the morning and I am awakened with another nightmare.  Israeli soldiers are cutting off my hands and feet.  I am negotiating while they’re hacking through my lower leg, all my muscles and tendons are hanging loose and my foot is only attached by the bones. I feel no pain, I am quite upset, but I still have my voice.

My last meeting during this visit to the Holy Land is with Physicians for Human Rights – Israel, located in a nondescript office in Jaffa. This is another extraordinary group doing critical human rights work in an utterly hostile climate with very little resources. There is a staff of 28, 3,000 clinician volunteers with a few hundred active clinicians and an involved board of directors. Ran Goldstein, the executive director, explains that PHRI is expanding, continuing to work in the West Bank and Gaza (only the Palestinians with Israeli citizenship are allowed into the forbidden Strip). They provide medical teams, perform surgery, training, and conferences. They still run a Mobile Clinic every Saturday in the West Bank, providing health care in some needy village in conjunction with Palestinian colleagues and local residents.

PHRI is monitoring the denial of access and outright attacks by Israeli forces against medical teams (which is against international law). Just recently he notes there was a case at Kalandia, a woman was accused of stabbing a soldier, she was injured, and the medical team was denied access. PHRI documents these incidents and complains to the military police or the border police or whomever, but it is not actually very useful in the immediate sense.  “Mostly nothing happens, sometimes investigation, but rarely any accusations.” The main purpose of this work is to clearly document the extensive lack of accountability of the security forces. The media may pick up the story and this is important; occasionally a case makes it to the Supreme Court, and this may also contribute to cases brought before International Courts in the future, although that is not part of the strategy or work of PHRI.

Another PHRI focus is on the prison system, particularly prisoner hunger strikes. The Israeli prison health service is planning to establish a new hospital inside the prisons that is supposed to be for hunger strikers.  This is bad from a human rights perspective and also from a medical perspective. Most likely, the physicians in the prison service will not know how to handle the emergencies and necessary intensive care that is needed when a person refuses to eat and is near death. The new hospital may become a tool out of the public eye to force feed prisoners, a tool to break the strikers.  Force feeding is recognized as a form of torture and despite a new law permitting the practice, no force feeding has occurred since the 1980s. Israeli physicians in general refuse to participate (which is good) and at this point, Israeli security really does not care if someone dies.  Ran comments, “It is not a big public relations disaster.” Sometimes the Israeli authorities will make deals with the prisoners but it is not always good for the prisoners.  A journalist, Mohammed al-Qiq, launched a hunger strike while in administrative detention, (which can be extended indefinitely, no charges, no trial), and he struck a deal, finished administrative detention with the agreement that he would not be rearrested. But he was rearrested anyway.

PHRI has also issued a report on the use of solitary confinement. The international legal framework has changed and confinement is now increasingly used, not only against political and security prisoners, but also against Jewish Israelis with mental health problems.  There have been cases of solitary confinement lasting several years, which is pretty much guaranteed to make someone psychotic if they are not already deranged and raises serious human rights issues, not to mention just basic decency and common sense.

PHRI receives 300-400 calls per year, 70% from security prisoners.  PHRI issues complaints, defends the prisoners right to health, and works to get them to doctor’s appointments and assist with a more humane transport system.

Asylum seekers and refugees are served in the PHR I Open Clinic.  Israel provides good health access in the public system and PHRI is working to change the policies so that asylum seekers and refugees deserve national health insurance. These folks are treated in the Clinic and then their cases are submitted to the Ministry of Health to find solutions, to treat their cancer or kidney disease.  In many cases, the state will take responsibility, but it is always in the framework of being the exception to the general policy. Ran is hopeful that this all may be changing. Additionally the 40,000 foreign migrant workers receive private insurance from their employers, but this is hugely problematic, the treatment is limited, and the workers are often sent back to the Philippines or Sri Lanka or whatever poorly resourced country they came from where there is no treatment available. Israeli employees only want these workers when they can work and then they are discarded like workers all over the world.

PHRI is also working to close the gaps in healthcare in the periphery of the state, especially in the south of Israel. The South Health Forum for the past ten years has offered training advocating for justice and equal rights in the south; they offer courses to Bedouin women, Jews from Beersheva, kibbutzniks, and develop projects. PHRI is working with civil society, more on the policy level.  Today a group is going to the area of yesterday’s shootings and house demolitions in the south to express solidarity to the community that is repeatedly on the losing end of resources and justice.

Another focus for PHRI is in the area of medical ethics with the education of medical teams, students, social workers and in other university settings to talk about racism in health.  Their general approach is to say, “You are not isolated from your outside world.  If in society there is racism, then there is racism in the health care.”  He points to the kidnapping of Yemini babies in the 1950s where nurses and doctors were involved in stealing the newborn babies and offering them for adoption to families deemed more suitable. In the last two years there has been much attention on this grave transgression and two weeks ago confirmatory archives were released. The medical community (like many medical communities) tends to be conservative and the students (like many students) tend to be more open to examining these difficult ethical challenges. Of 80 students in Jerusalem that had to choose a volunteer placement, 40 chose PHRI. He sees social work students educated by PHRI calling for advice once they are in the workforce, facing violations of human rights and trying to figure out how to behave in a complex and fragmented society.  Ran believes in the power of education to highlight medical ethics and change clinicians’ behavior.

Last year the Israeli Medical Association changed one of its ethical codes, “Charity begins at home,” which is translated to mean that in the case of mass casualty events, when faced with injured Jewish and enemy (read Arab) patients, the Jews get taken care of before the “enemy” Arabs, no matter the severity of disease or injury. This is in violation of basic medical ethics and was changed in 2015.  “The doctor is not judge or police.” Health care must be offered in a human rights framework, the sickest get care first; it does not matter if someone is the attacker or the victim of the attacker.

Another social issue is the segregation of maternity wards between Jews and Arabs. This is not hospital policy, but obstetric patients represent a profitable and steady source of income so hospitals are eager to please these women. When a Jewish woman demands a Jewish roommate because she feels “more comfortable” or just doesn’t like Arabs, the hospital complies. PHRI contends that this is racist behavior and is working to establish with hospitals that this behavior is unacceptable.

In particular, they are also working on educating staff about racism in health care with Meir Hospital in Kfar Saba where the patients and staff are mixed, the hospital is near many Arab villages in Israel.

Ran is concerned with the changes in Israeli society, the attacks against NGOs and their funding. He notes that Breaking the Silence, a group of Israeli soldiers that collect testimonials and are critical of the occupation, is facing opposition to entering schools and they have received personal threats and death threats. When they started in 2005 they were celebrated as the conscience of Israel, invited to speak in the parliament.  Now they are considered enemies of the state. The government is a leader in this rightwing phenomenon, monitoring progressive groups, taking statements out of context, and leading attacks. With the training in southern Israel to promote equal rights, the Beersheba municipality pulled out of the effort after pressure from rightwing groups. There is less tolerance for human rights organizations, not only those working against the occupation.

The NGO Law passed last year states that if your funding is more than 50% from foreign governments (like the EU or foundations related to the government) then you have to declare yourself as a foreign agent.  This is mostly an attack on progressive organizations and leaves out the right wing groups that receive many millions from the likes of Sheldon Adelson and Christian Zionists who are obviously not governments (yet anyway). This kind of hostility is also reflected in the PHRI Facebook page.  When there is information about the health of Israelis, they get lots of positive comments.  If they focus on the health of Palestinians, they are showered with hostility and branded as traitors. It is difficult to challenge racism in a society when institutional racism is normative.

Ran leaves for a meeting and Dana Moss continues the conversation.  Today there is a general strike in Arab towns in response to the demolition of eight houses in Umm al-Hiran and to troubles in Qalansua. The Arab schools are open but the teachers will take two hours to talk with the students. (FYI there are Arab and Jewish towns; Israel is a highly segregated society.) The general feeling is that the Israeli government has launched a war against its Arab citizens.  The latest killing of the school teacher hit a nerve as he is being framed by the government as a terrorist when he clearly is not. This is provoking anger in Israeli Arab society and the Negev is a very sensitive area after 70 years of suffering, lack of infrastructure, inadequate health care, or even ambulances.

In the occupied territories PHRI deals with the right to health in its widest interpretation. One of the projects focuses on freedom of movement for Palestinians from Gaza and the West Bank. 200-300 cases per year apply for medical permits and are denied, and then ask PHRI for intervention to change the Israeli authorities’ decisions. PHRI collects the details, talks with the army, sends letters and puts pressure on the authorities. In 2014 they succeeded in 47.5% of the cases, 2015 62%, but in 2016 25% (due to policy changes). Patients are generally denied “for security reasons. We understand most decisions are arbitrary, there are no security decisions to deny a cancer patient or a pregnant woman treatment.  One of the problems is the interrogations of patients. Patients are ‘invited’ to a meeting with Shabak and clearly told that if they want their permit for medical care then they have to be collaborators with the Israeli authorities, spying on family and friends. Patients who refuse are denied the permits and do not get desperately needed care.”  PHRI not only deals with specific patients, but collects general information and reports trends to agencies and diplomats.

The monitoring of attacks on medical teams started in October 2015 after the Palestinian Authority, Ministry of Health, and Palestinian Red Crescent Society reported a large number of assaults on medical teams, more than 400 physical attacks.  (So let’s stop a minute.  You are a Palestinian doctor or an ambulance driver or a nurse attending to patients that are bleeding or have broken bones or are unconscious and you are at risk for being physically attacked doing your job because your patients are viewed as less human, less deserving, less less…. in the democratic State of Israel). This is clearly a violation of international law and the Geneva Conventions regarding the treatment of medical personnel in conflict settings. PHRI collects the stories and information, sends complaints to the investigatory departments in the army and police, details that they are not responding according to local and international law. Lately, the army sent them a letter nine months after 18 complaints were submitted.  Dana states, “This was attributed to a ‘technical delay.’ This is very problematic.  The same with the police.” PHRI does this work to highlight the culture of impunity, to bring this to international groups and the press. Dana feels “things are getting worse. This is the beginning of a very dark period.”

Between Netanyahu and Trump I couldn’t agree with her more. There is so much to do, from protecting the right to health of the individual to creating a healthy, less racist society. Ran and Dana want to know if I have any ideas for funding.  Ah…. NGOs….Perhaps we could get another one of those tanks…..

previous blog posts about PHR – I

June 22, 2013 Symbolism meets solidarity: the Saturday mobile clinic

June 30, 2014 Zionist Doctors and Jewish Values part one

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