July 1, 2014 Airport Hasbara

The talk on the cab radio is all about the murder of the three settler teens, their bodies were found. I am too disconnected to know the awful details, but I recognize the outraged voices and the words Hamas and Philistini over and over. A great sadness and fear settles over me. I worry about my Palestinian friends and feel for the mothers of the dead boys and tremble at what wave of rage Netanyahu will unleash now. I suspect he will use this catastrophe to make a big attempt to destroy Hamas and eliminate the unity government, but that is a private speculation.

The airport feels remarkably normal; as Jonathan Cook noted last week, there are no more security attack lines and I feel less under siege. One female security guard asks me if I received any gifts in Israel and I brain scan the contents of my bags and decide to say, “Yes.”

“What?”

“Embroidery.”

“Embroidery?”

“You know, handicrafts.”

“Where from?”

“Jerusalem”

“From whom?”

My tired mind freezes, what would be a reasonable answer? Why did I say yes? In that split second, the security officer goes on the offensive.

“You do not know her name?” Is she really accusing me of accepting a gift from a stranger (something really dangerous like an embroidered wall hanging that says “Welcome to our home”), or is the tone and aggressiveness just cultural or both. I come up with a safe and reasonable friend with an Italian name and American citizenship. My bags are tagged, I check my fellow travelers’ bags and they have the same tags as me. Either we are all in trouble or we are all okay. I sail through the security check; it fascinates me that liquids, water bottles, and shoes are not a threat here. Does anyone know what they are doing? A repeating video reassures us that the baggage screening in Ben Gurion Airport is the most modern, high tech in the world so no worries. We have everything under control.

Passport control is a piece of cake; apparently I am not in their system, as it should be. After all, I have not done anything illegal.

There is always a major photo exhibit on the long ramp into the duty free zone and food court and this year it is on civil aviation. I study the framing and language, after all, this is Israel’s final chance at hasbara (propaganda messaging) for all the happy tourists going home to spread the word about the miracles of Zionism.

As would be expected, the tone is heroic, nationalistic, and full of struggle and victory: “Hundred years after the first airplane touched the ground of the Promised Land, the Israeli Airports Authority makes revolution in the aviation world?” My quirky brain asks, “Promised Land” for whom exactly? It all started with a French aviator landing on a Tel Aviv Beach in 1913. There are frequent references to “?Eretz Yisrael’ (Israel)”; again the actual translation would be the Land of Israel and the real name of the place at that time was inconveniently Palestine.

The makers of the exhibit understand the vast arc of history:

“Evolution of the civil aviation in the 1930s didn’t skip the Jewish population in ?Eretz Yisrael’ (Israel). The Jewish national institutions’ leaders fully understood the economic and security importance of the Jewish aviation for the future of the Jewish population.” It is interesting that Palestine Airways was started in 1937 in what is referred to as “Lydda (Lod),” an unexpected nod to an Arab city now renamed and transformed. On the other hand, the messaging is clearly reflective of Zionist mythology building, “From its first days, the civil aviation in Israel was interlinked with the Zionist ethos and symbolized the technological progress.” Of note, the early aviation clubs and flight schools in the 1930s were linked to the Haganah, a Jewish paramilitary organization, and to the Irgun, described as “The national military organization of the land of Israel.” No mention of who they were fighting and the political assumptions of Jewish exceptionalism and violence undergirding the effort (wrong story).

There are archival photos of the Yemenite “Operation Magic Carpet” in 1949 and the Ethiopian Jews arriving with the “Moses Operation” from 1984 to 1985, flown from refugee camps in Sudan through Belgium to Israel. A document reviews the many clandestine flights from Yemen and Iraq from 1948 to 1952, from the Soviet Union from the 1970s to 1990s, and then the Ethiopians in the 1980s. The language fascinates me: the references to some mythical Arabic tale or biblical exodus. This was all demographics disguised as rescue, from what I can see. We need more Jews; the Holocaust decimated the preferred type, so now we will take Arabs and Blacks and even not exactly Jewish Russians. Am I being too cynical?

The archival photos reveal pilots who are all white Ashkenazi men, and then there is the Arab worker with some kind of machine, labeled “aerospace industry production worker,” probably Yemenite. The racial and class differences are already apparent if you care to look.

The airplanes were called the “Iron Birds” and the pilots “the Knights of the Skies”; again the messaging is all strength and heroism that leads to the establishment of modern Israeli companies, now celebrating ten years after the construction of this current snazzy terminal “One of the most modern security inspection systems in the world.” Translation: Israel will keep you safe.

Passengers are left with messaging that is full of nostalgia without all the messy details, reflections on past struggles and victories to come. Tell the world the glorious story of Israel as you head towards the glittering Duty Free zone. There is no occupation, no Apache helicopters in Gaza, no dead settler children, no Palestinian resistance or for that matter, Palestinian anything. As I said, with my binocular vision, a great sadness and fear settles over me.

Obviously, I didn’t get the message.

June 30, 2014 How Do You Say Shalom in Tigrenya? Part two

Ran takes me into the Open Clinic for some reality-based learning.

The rooms are basic health center with shelves of paper charts and two volunteers engaged with their computers. The dress is casual shorts and tank tops, the waiting room rows of black plastic chairs.

Today is appointments only with the specialist, so I will not be seeing the usual flood of humanity, the human refuse as Lady Liberty would say.

Ran explains that in Israel, much like the United States, if someone presents with a life-threatening emergency to a hospital, they must receive care. (Good!) But everything else, including things that are in the long term life threatening, like out of control diabetes, is turned away if the patient has no insurance. (Health care as a privilege not a right.) And of course long-term rehabilitation, mental health, and medical follow up for chronic disease are hindered by access, language, poverty, and culture. Since 1998, the Open Clinic has seen thirty-five thousand patients, and many travel from far to be seen. PHR used to serve mostly migrant workers (after Palestinians from the territories were no longer permitted to work in Israel and employees started importing low-level workers from Thailand, the Philippines, and the rest of the Third World.) Now PHR is mostly seeing asylum seekers and these folks are different: their communities are weaker, their leaders are under arrest; they are usually not working and suffer from all the ills of poverty as well as trauma and displacement. They are alive often because they are basically physically resilient young men. While much of the medications are donated and thus free to the patients, they often need shekels to get home, to eat. They are a more desperate population than the migrant workers. The clinicians are seeing more diabetes and hypertension, there are three thousand volunteers, but eight hundred or so are really active in the organization doing regular clinics.

The Open Clinic sees five thousand patients a year, “less patients but bigger problems than before,” and includes general medicine, ob-gyn, pediatrics, and mental health. I sit down with the clinic coordinator, a feisty, dedicated young woman, former engineer, masters in international relations, and now a paid employee. Her job is to negotiate for the patients, to find the least costly, most possible appointments for specialists, labs, hospital procedures, surgery, and cancer therapy. Working with Assaf, a social care organization, they address medical as well as social issues like homelessness. She also is involved with the United Nations High Commission for Refugees (UNHCR) and helps refugees resettle in countries like Sweden, Denmark, or Norway, obtain citizenship and then medical care for severe chronic illnesses. I try to imagine fleeing something horrific in Sudan, running/hiding/walking across the Sinai, detention in Holot, some terrifying disease in a strange country, and then you end up in a place where everyone is blond, there is no sunlight half the time, winters are really cold, and the language is beyond comprehension. And you are sick and alone? This is staggering; the coordinator admits to many sleepless nights and desperate phone calls.

She talks about how the clinic is seeing many young patients with kidney failure and diabetes, maybe a consequence of toxic pesticide use, of Africans dying of AIDS in Israel in 2014, “This is ridiculous.” And then in 2010, Sister Azezet, who volunteers at the clinic, noticed many pregnant women coming in asking for lateterm abortions with unusual injuries and trauma. The Sister interviewed 1,300 women and discovered the rape and torture camps, the human trafficking in the Sinai, and brought this to international attention. “No one asked, what happened to you?” This is health care in its broadest social context.

The law in Israel now states that if an employer hires a migrant worker, they have to pay for health insurance. But when the employee gets sick, they get fired, and poof, no insurance. So the Open Clinic sees many Eritreans (they now have an interpreter), as well as migrant workers from the Philippines, China, and India.

And then there are the folks from Nigeria, the Congo, Ivory Coast, and Guinea who have overstayed their work permits and live in the shadows, at risk for deportation at any time. Add to that a small number of Russians who arrived with the big migration but are not recognized as Jews and thus have no health insurance (really? Insurance for Jews only?) and the Palestinian women from the territories who married Palestinian men with Israeli citizenship and are unable to obtain legal status.

PHR is doing advocacy work on behalf of the asylum seekers now detained in Holot; they have gone to the Supreme Court applying for release from the center, stressing the illegality of detaining these men. She notes that public opinion is definitely against the refugees, who have been defined by Israeli government mind-makers as “infiltrators”; PHR is accused of supporting criminals, rapists, and disease carrying Africans, the scary, faceless, black other. “It is hard to humanize them.”

The first woman the coordinator sees today is a fifty-five-year old Filipino woman who has been in Israel for eleven years, has had no contact with her family during this time, speaks fluent Hebrew, and has recently had surgery for metastatic uterine cancer. She needs further treatment and the coordinator and I understand that she will most likely die alone and unhappy in Israel. I look at the pack of Marlboros next to the computer and the jumbo size bottle of Coke; this is burnout kind of work and the coordinator pours her heart into each case. The next patient, an Eritrean woman with a four-year-old son, also speaks Hebrew fluently, has a mass in her neck, brings lab results, and gets sent off to an ENT doctor. She is followed by an Eritrean man who speaks sort of English, has back pain, and is unable to work, now is dizzy. She asks him to come back tomorrow for the general doctor. I suggest we check his blood pressure and it is significantly elevated.

I then join the gastroenterology specialist; he is a good-hearted soul who is more in the classic doctor mode. He assesses each patient to see if there is anything life threatening or GI and does not sink his time into the vast psychosocial morass that is probably the source of much of the medical complaints. The first patient surprises me, a friendly, well-organized African American woman from Kansas City, Missouri, with lists and notes, who made aliyah with her family three years ago and is now living in Ashkelon, awaiting citizenship and health insurance. She has multiple medical problems, including a life threatening liver disease, and her granddaughter whose name is Aliyah is having her Bat Mitzvah in a week.

“Can I drink wine for the blessing?” I would love to know the rest of her story!

She is followed by a series of Sudanese and Eritrean men with various levels of disease, lots of stress, experiences in the Holot detention camp, working or out of work, worrying about deportation, “I am not guilty, why keep me there?” Some speak Hebrew or a variant of English or Tigrenya. They are all thin, frightened, obviously depressed and sometimes angry; their eyes give them away.

They are trying to negotiate a system that they do not understand, a language they do not speak, and a country that wants them to go away. The doctor does the best he can given the limited resources, the lack of communication between institutions, the need to beg and borrow to get medications, testing, results. No one is happy and I am haunted by the pained expressions and sorrow framing these difficult interactions. They say a society is only as strong as its weakest link and this link is clearly broken.

June 30, 2014 Zionist Doctors and Jewish Values part one

It is probably not a good idea to write a blog after two glasses of wine, particularly after three weeks of abstinence (except for that lovely Taybeh Beer), but sometimes drastic measures are needed.

I have checked into a funky old hostel in Jaffa that was clearly a Palestinian home before everything happened and I am sitting in a caf? watching the flow of beautiful people: the hipsters and the yuppies and the old-lumpy-young-at-heart like me. The sidewalk restaurant spilling into the street feels like a cross between Soho and San Francisco; gentrification on steroids and delicately rolled cigarettes (have any of you gorgeous people ever heard of lung cancer?); a stream of beautiful millennials with tattoos and fancy dogs and partially shaved heads. I feel like I am back in the good old USA where our troops are off doing Allah-knows-what in Iraq, Afghanistan, Pakistan, etc., etc., and we are obliviously obsessing about our lattes.

After two weeks mostly in the West Bank, the women look pretty naked, there is more than enough cleavage and thigh, men are stroking their lady friends in overtly sexual ways, and I am taking a long, hard look at “Western norms.” I order a shrimp and eggplant dish drenched in garlic and olive oil as a metaphoric culturally transitional meal. I must admit I have a strong urge to just get up and walk away without paying the overpriced bill, just charge it to the occupation I will say (this is my version of civil disobedience), but I don’t. Most of the folks I have been sharing lives and hummus with cannot legally be here, let’s not even mention their yearning for a little dip in that gorgeous Mediterranean water, waves cresting, stretches of white sand (“they” do like to swim you know)? and I have to admit I kind of got used to being called “habibti,” and my Arabic pet name, “Alusi” (my spelling with apologies).

The day started in the Old City in the Austrian Hospice with a predictable conversation with two lovely, older, guilt-ridden Germans who talked about how hard it is to say anything critical of Israel because? (the HOLOCAUST) is literally screaming at our table between the German Rye and the labneh, and I am trying to introduce the concept that it is actually okay. In fact, as a Jewish American, I think that it is imperative; the Germans (after the unforgiveable horror) have done their share of breast-beating and reflection and reparations; as some famous Israeli wrote, The Holocaust is Over. They take my website enthusiastically and I assure them that my book was translated into German, though of course I have no idea what the actual title was, given the wild world of publishing.

Last night I tried to make small talk with my first-in-a-while Jewish Israeli cab driver. Me: “It’s been really hot here.” Him: “No it’s not.” Oh right, the people who do not know how to say I’m sorry. Unfortunately, this morning I was bullied while standing in line for my train ticket, got yelled at by some pretty girl at a counter at the central bus station in Jerusalem when I asked for directions, and got no reassurance from the bus driver that this was indeed #480 to Arlozoroff in Tel Aviv. When I finally worked up my crumpled courage to confirm my hopes about the bus, this blond something said abruptly, “Of course.” On the bus, a bearded Orthodox Jewish father with a gentle demeanor and friendly smile debated with his two teenage sons, “How can we know Hashem when Hashem is unknowable, is everywhere?” We all have our psychopathologies, but really?

I spent the afternoon at an extraordinary organization called Physicians for Human Rights Israel. Ran Cohen was somewhat more optimistic than usual. Although the Knesset is probably about to pass the forced-feeding bill, the prisoners’ hunger strike ended (resolution unclear), and this has taken a lot of energy. “We won the battle but lost the war.” For the first time in history, “We got the Israeli Medical Association aboard and this is surprising. They were vocal and said clearly physicians do not do this and discussed this [forced-feeding] as torture.” The IMA was clear that forced-feeding actually involves the cooperation of doctors and that they would not be able to protect them in a court or even at the International Hague. This change in attitude may be related to a new head of the medical ethics committee, Dr. Tami Karni, as well as intense international pressure. Ran was very excited to see the commitment on the part of the doctors, the understanding that medicine and doctors were being used as political tools. The new law that is being argued in the Knesset today states that each case of forced-feeding will be brought to a civil regional court (like Tel Aviv), and then if it is allowed, a doctor may participate without risk of punishment.

The Israeli government is framing this as a desire to save lives (not).

On a TV program, when some big macher said that there will be no doctors willing to do forced-feeding, the government’s legal advisor replied, “We will find the Zionist doctors who are concerned of Israeli security.” So much for Zionism. Framing is obviously the key. The United States does it, so why not Israel?

Last week, PHR Israel had a big success when a committee (that had seemed hopeless) decided to take private health services outside of public hospitals. Until now, in public hospitals, there were private patients that doctors would see and charge, using the hospital facilities, thus creating a boutique type practice on the back of the public system. There was a long campaign against this and, “We succeeded, after it lost in the Supreme Court! This was a public campaign, seven million citizens will benefit with a more equal health care system, oriented towards the public,” as well as bucking the Israeli trend towards privatization (as I say, learning the worst from the American health care system).

Another recent PHR I success involves the citizenship law.

Since 2003, Palestinians in the West Bank and Gaza who married Palestinians with Israeli citizenship were not allowed what is called family reunification, I.e., they could not get legal status to live in Israel with their spouse. The implication of this cruel bill is that one of the couple, usually the woman, is left with no status, either cannot live with her husband or more likely is here illegally. Their children born in Israel are Israeli citizens. This is reminiscent of the undocumented in the United States. At this point, since 2003, twenty to twenty-five thousand couples got married and did not get status for the spouse, who can be deported at any time, has no health care, cannot enter most bus stations, malls, or any place where racial profiling increases the risk of being asked for an ID.

They cannot drive legally, attend university, or obtain welfare benefits. After the NGOs in the human rights community took the battle to the Supreme Court and failed, PHR I started a long campaign to promote social residency, which separates legal status from social rights. This allows people access to health care and welfare regardless of their status. The State of Israel will not give one new Palestinian citizenship due to the demographic war, but PHR argued that the Palestinians are here, they are not temporary, they are married to Israelis, and they are human. PHR became aware of this issue when they started seeing desperate Palestinian women in their Open Clinic. Now, with the Association for Civil Rights in Israel (ACRI) and Kayan (a Palestinian feminist organization), they have “a foot in the door”; they won a court case that allows spouses with permits but no status to register for health funds. This covers eight thousand families, “so this is beginning, from nothing to something is big.” This work is part of PHR I’s advocacy for the right to health for all.

The refugee issue also keeps PHR busy. Since 2003, fifty thousand refugees or asylum seekers (or if you are Netanyahu, “infiltrators”) have crossed the Egyptian Sinai into Israel, mostly from Sudan and Eritrea. Many of them (an estimated 25% of the Eritreans) were kidnapped, tortured, raped, or held for ransom in the Sinai by a Bedouin clan. The Israeli response, wrapped in the hysteria of the threat to the Jewish nature of the state by these disease carrying, Muslim criminal elements, was to build a fence along the border with Sinai, so new refugees are no longer entering and the border is sealed. Sound familiar?

They also built a detention center called Holot, which means Sands, where asylum seekers and refugees are sent without a trial or judicial review for an indefinite period of time. It is “open” in that they can step out into the desert, but they need to be there for three roll calls per day and from eleven p.m. To six a.m. It is an utterly miserable place. Two days ago, six hundred men defiantly marched to Egypt, stating they want to go someplace where they can move their lives forward. They were brutally arrested again and sent back to prison, all documented on video and PHR I was there to help the sick, mostly suffering from dehydration and injuries related to the attack by the security forces. Ran explains that the Israeli government is working to make these people miserable and has actually sent a few hundred to Sudan where many are reported to be detained, in danger, tortured, or imprisoned. Thirteen families have reported their loved ones missing, imprisoned, or murdered.

A few have been sent by plane to third countries, mostly Rwanda and Uganda; Israel has some unofficial agreement with these folks.

In Rwanda, a few have been detained, as documented by the United Nations High Commissioner for Refugees.

At this point Ran notes, there are fifty thousand refugees here, this is not a demographic catastrophe. Israel is a first world country; it could be a model for refugee absorption, and it has done it before with one million Russians (many of whom were not Jewish, but at least they were white). Meanwhile, Lebanon and Syria are both faced with one million Syrian refugees, each with much fewer resources. The least the Israeli government should do is to investigate each person’s refugee and asylum issues and protect them until it is safe for them to return. Ran notes ironically that the whole discussion about protecting the “Jewish nature of the state” really leaves out the nature of Jewish values; this is all about numbers.

PHR is once again working on the separation of legal status from social rights and they have had some successes. In January 2014, the government adopted a plan to treat HIV-positive refugees and established a small mental health clinic for these deeply traumatized people, so there is a glimmer of recognition regarding the right of health, even for people who are African and poor and so desperate they will walk across deserts and endure unbearable suffering to come to a place that might provide work and opportunity.

PHR I also focuses on the occupied territories, and Ran describes a report that will be published in a month investigating basic health indicators for Palestinians in the West Bank and Gaza and comparing them to Israelis. Let’s just say that everything looks bad; even basic life expectancy is divergent by more than ten years, as well as maternal and infant mortality, availability of medications, clinicians, specialists, etc., etc. This gives PHR the opportunity to talk about responsibility and control; if the Israeli government controls the territories as the occupying force (which it is), then it is responsible for the health needs of the population under its control. Netanyahu brags that, “Israel saves lives of Palestinian children while Palestinians are kidnapping teenagers”; this is nonsense.

The Palestinian Authority is paying for the care in Israel, and for decades, the Israeli government has prevented development and actually “dedeveloped” the Palestinian health care system as well as controlled and reduced access to the major East Jerusalem hospitals.

The facts speak for themselves as we say.

And then there are all the other projects: “torture always an issue, the victims are refugees and prisoners.” There is work on the freedom of movement of doctors and patients in the occupied territories, the Saturday mobile clinic as usual, the Tel Aviv open clinic and much efforts to educate Israeli students in universities on the right to health by taking them on tours of East Jerusalem, the Negev, Bedouin villages, south Tel Aviv, Lod, Ramle. Ran notes, “The students are more and more open to it, the problem was with faculty not wanting us to come and talk, but things are getting better.”

June 28, 2014 Tell Them You’re Italian! Part three

Al Manara, the famous square in Ramallah with the circle of lions sculpted in the center, is bustling with chaotic traffic, shoppers, drenching heat, and street venders. I can see the sign for “Stars and Bucks,” the Arab Bank, banners for the World Cup. I think about that odd puff piece in the New York Times months ago describing the city as “the Paris of the Middle East.” I think not. Too much Middle East, not enough Paris. I am waiting for a woman picking me up from her village of Aboud and I don’t know what she looks like. I am on a bit of a mission. Her cousin in the United States is my friend; I have promised to visit his village, “the most beautiful village in Palestine.”

Suddenly this burst of energy emerges from the crowds, a trim, smiling woman of uncertain age, and after a quick search for a functional bathroom (we stop off at a friend’s) and a bag of za’atar covered flatbread, we are wending our way to the services (she calls them Fords because, well, they are Fords). She walks so fast and determinedly, regaling me with a steady stream of commentary, criticism, politics, I can only think: I have come to visit a Palestinian energizer bunny. The Ford only leaves when it is full, and as you can imagine, there are not a whole lot of folks heading towards Aboud.

We wait and chat, sweating from the heat. It is important to drink enough water to prevent heat stroke, but not too much because then we will just be in search of another bathroom. This is a delicate balance. The driver (bless him) finally turns on the air conditioning.

We head north(ish), this being the occupied West Bank, pass the now famous to anyone paying attention town of Nabi Saleh (see the New York Times article by Ben Ehrenreich and my previous blogs) where I joined internationals and villagers in 2012 on a Friday afternoon and watched the town’s youth chant the words of Martin Luther King and Gandhi, throw stones, and run like crazy, while Israeli youth (in full military gear) shot an amazing amount of tear gas and rubber bullets. The Friday ritual of resistance still continues. We pass Halamish, the nearby Jewish settlement that is busy stealing land and water from the folks in Nabi Saleh, who having been living there for centuries. But that’s another story.

Soon we arrive in the small village of Aboud, surrounded by settlements; the population is half Muslim and half Christian. This fact interests me. To my surprise, my new friend lives alone in a large U-shaped house with more rooms than she can fill, a large TV, and a pleasant kitchen. The windows are all closed and she has sprayed against mosquitos, so the smell of pesticide hangs heavy.

Her enduring-the-heat strategy involves strategically opening and closing different shades and windows, sitting on porches on opposite sides of the house, and, when all else fails, turning on the fan, which I do since I seem to be having a permanent hot flash. The walls are scattered with crosses and virgins and saints and various homages to her beloved mother and father and a cast of cousins.

She turns on the music and the Beatles blasts through the house, “It’s been a hard day’s night and I’ve been working like a dog?” She thinks that a salty yogurt drink will revive me and heads toward the kitchen to prepare her version of chicken and rice.

Over the course of the next twenty-four hours, I learn a lot. My friend loves Frank Sinatra. She loves to dance, and in a previous life she wore miniskirts and worked like a demon for five years at a suburban hospital in the United States after training as a nurse in Britain, against her father’s wishes. She and her extended family were all born in Aboud, she received her nursing diploma during the First Intifada, travelling on a Jordanian passport. She flew back home in the days when a Palestinian could fly into Tel Aviv airport, only to discover that everything had changed. She remembers telling a nasty Israeli official, “The pendulum will swing, and we will get it back.” After an emotional reunion with relatives in Jerusalem, her father took her back to the village. She only had a three-month visa (important reminder: to be in her own home). When she saw the large Israeli flag at the entry to her village, the reality of occupation hit her like a jolt of lightening. She stayed five months, her visa expired, and through sheer luck and a lot of chutzpah, she ended up living with a group of nurses from the UK and working long shifts at the US hospital in the days when nurses wore crisp uniforms and probably smiled and said “Yes, doctor” a lot. It sounds like she really enjoyed herself and her freedom.

Her first love married someone else; ultimately she returned home, the responsible daughter, to care for her aging parents, and now she is in a most unusual situation; an aging, lonely Palestinian woman without any children, her swarm of relatives mostly lost to the diaspora. She once had a job offer at Hadassah Hospital in Jerusalem, but Netanyahu nixed that when he forbid employing staff from the West Bank. I feel her regret. “Being a single woman in the village is like being in prison.” When she talks of her long dead mother, her eyes fill with tears. Her stories are peppered with feisty bravado, she tosses around quirky expressions like, “Okay Charlie!” and has had her share of taking wild chances, standing up to soldiers at checkpoints. “They control everything, they control the oxygen you breathe.”

“Kids were throwing stones and the soldiers were beating a kid.

[I said] ?What are you doing? You are a kid with a gun. He is a kid with a stone. Be a gentleman. Put the gun away. And if I catch you throwing stones again, you will hear from me.'”

Once she was interviewed on the street by CNN and asked what she thought of the Israeli withdrawal from Gaza. “So what. I will be happy when they pull out of East Jerusalem, end the settlements, [let the refugees back]! Every night she prays for peace and listens to Voices of Peace, a radio station located “somewhere in the Mediterranean.” Obviously she prays a lot and whichever God is in charge of this place seems to be hard of hearing.

My new friend cannot believe I am Jewish and she cannot believe she has an actual Jew in her home, eating her chicken and her chopped up cucumbers and tomato. “The first Jew in Aboud!” she exclaims happily. (I guess the Israeli Defense Forces don’t really count here.) Her voice gets a bit conspiratorial and she advises me not to mention this fact in the village. She is worried about her Muslim neighbors, “They are a bit fanatic.” She seems to be in the some-of-my-best-friends-are Muslims camp, but I also sense a deep distrust. So much for peace, love, and understanding, united against the common enemy (private thought). She talks of an upsetting night when a large truck and ten jeeps arrived at midnight and as she peered out the window, she saw her Muslim neighbor, blindfolded, handcuffed, dragged into the truck by Israeli soldiers.

She suggests that I tell people I’m Italian.

When the heat abates a bit, she takes me on a speed walking tour, stopping to schmooze with family and friends. She complains about the garbage thrown by ill behaved (read Muslim) teens and when I comment on how hot it must be for women in hijabs and long coats, she says, “They’re used to it. It’s their religion.” The town has wide streets, two Christian neighborhoods and one Muslim, and from what I can gather, three functional churches, a mosque, and ancient church ruins. We only tour the Christian sector. Some of the walls have lovely religious murals and others harken back to a simpler time when people were out harvesting their crops and looked much happier. We pass donkeys and their babies, elegant homes with lush gardens, abandoned properties, the site of my American friend’s former family home (his bedroom is now a driveway for an ancient yellow probably Dodge Dart). A young man gallops by, riding his horse bareback, tail flying freely.

She is very angry about the ongoing land and olive grove confiscations, the nearby Jewish settlements, and tells me the story of finding an IDF soldier asleep under a tree. Her friend walked up to the sleeping soldier and yelled, “We gave you the road. You have the beach in Tel Aviv in your bikini. Leave us alone.” The soldier had a gun and started threatening her friend who yelled, “Go ahead, shoot me. I will die defending my land and you will be a murderer.” These women are tough. We come to a premature end to the road, obstructed by a ten-foot tall pile of dirt and rocks, courtesy of the nearby settlers in their orange roofed houses. I ask my new friend if I can take her picture in front of this dirt wall and she says quickly, “No.” She is too upset for photo ops.

We stop at a series of stone patios, friends and relations drinking tea, eating watermelon, smoking cigarettes, hugging children.

I feel like I am in an old French movie or maybe visiting Uncle Morris and Aunt Bessie in Queens, ordinary schlumpy folks, full of opinions and quarrels and family loyalty, eat, eat, habibti. The women dye their hair black/brown and have thin pencil eyebrows.

One guy, an engineer with a couple of charming, engaging young daughters, lived in the Bay area for years but then felt he had to come back. He tells me warmly and honestly, he could not tolerate the diversity, the Mexicans, the Asians, the Blacks. “I am not racist but I want to be with my own people.” He didn’t like the rat race, enjoys the slower pace, wants more time with his wife and kids.

“Have some more watermelon?”

The next morning we see more of the churches, including the Church of the Virgin Mary “Abudia,” which dates back to the fourth century. In the hushed entry, the priest chanting melodiously in the sanctuary, my friend lights candles and prays. We watch Sunday school children play with a gigantic multicolored parachute and act out Jonah and the whale. (What do these landlocked kids know about oceans?) We pour through exquisite Aboudi embroidery. (I am trying to find something without God or Jesus and am thrilled to see “Home Sweet Home.”) The tour of the friends and relatives continues and it is close to heartbreaking. A sweet widow caring for her emaciated dying mother in a dark bare room, the faint smell of urine, three children; her son is apprenticed to a blacksmith.

Another woman’s brother built a palatial estate and visits in the summer. His elderly demented sister sits in the front door, half dressed, camping out on the first floor. She presses candy into our hands when she realizes we are not staying. Another friend tends to her ill brother with severe multiple sclerosis and an angry personality, her face is tight with sorrow. She wants me to send a package of her homemade za’atar to my friend in America and asks that I tell him to call and tell him “to come home.” Another white-haired woman on her way to church says to me, “You are better than my relatives. They never visit.” This is a tough place to be old or sick or alone. I feel that the villagers who escaped to the diaspora are both a source of pride and resentment. Despite all of its natural beauty, the village has an air of stagnation and suffocation that comes with small places, no secrets, and not much in the way of prospects for big happiness.

The visit is sweetened by a stop at my friend’s family home across from her place, where a relative (not sure who) lives with his (quietly depressed?) wife and three gorgeous, lively daughters. The children adore her and I can see that she loves and indulges them like a grandmother. “Very lovely,” she beams.

There is only so much tea a person can take and it is time to return to Ramallah. My friend explains that the Ford driver’s basic attitude (he will only leave when the vehicle is full) is “Why hurry? Aboud to Ramallah to Aboud. We are all in prison.” My friend gives me one more piece of advice: “Okay Charlie, my dear,” we should prepare for a lonely end of life. That is our fate.

I meet up with a thirty-something activist friend in Ramallah, and as we sip our mint lemonade and hide from the Ramadan fasting police, she talks about life choices; she is tired of being beaten and tasered; she is really worried about injury and death; she wants to stop smoking, to have babies, to live. How to do all of that in this very complicated place?

June 28, 2014 In the Container part two

The bus station in Bani Nayim is hot, humid, and thick with exhaust fumes from idling vehicles that have seen better days in the seat and shock absorber department. The service has to fill with passengers before it leaves, and we are in a holding pattern. I am sitting next to a young woman wearing a hijab with sparkly threads, a long coat, long sleeves, and leggings. I cannot imagine how hot she feels cradling an infant and trying to keep a one-year-old in his seat. As she negotiates the crying baby and the discreet breast-feeding and attempts to pour mango juice into a bottle while it drips over the infant’s plump thighs, I feel like we are mothers everywhere and it is time to mobilize for the tasks at hand. Chocolate wafers appear magically from my bag and the little boy stares at me with large brown eyes; he never blinks, ever.

I am wheezing from all the dust and pollution and marveling at what passes for advertising in the local markets. While most of the signs are in Arabic, I am mystified by a clothing store called, “White Woman,” another “Lady Chic,” the “Golf Plastic Industrial Company,” “Four Seasons Furniture.” Do they have four seasons here? There is clearly a lot lost in translation, which seems to be a metaphor for much that is happening in these parts.

We jolt by fields of vineyards and then there is a lush green vineyard that is surrounded by a wire fence and coils of barbed wire.

It is the only fortified field I see and it is owned by a Jewish settler who has bought this land and comes, armed with military guards, to harvest his grapes. This is another metaphor.

My understanding is that there is some Israeli law/directive that mandates the use of seatbelts in the occupied territories but that Palestinians view this as another oppressive Israeli directive, rather than some really good advice, so I watch the on-off seat belt dance as we drive, a quiet (self-defeating?) act of resistance.

I have not seen any car seats for children, so the mother buckles in her toddler, more as an attempt to restrain him in the back seat than to prevent injury in case of a sudden swerve.

The much too loose belt soon comes off and she wraps her arm tightly around him, trusting herself more than those Israeli laws.

He turns a bag of pretzels upside down and we are both back in mothering mode. A honey-toned woman’s voice croons on the radio, I can pick out the word “Allah” but remain mostly lost in translation again.

We pass mountains of watermelon, car skeletons piled in junk yards like corpses, and overflowing garbage bins and soon find ourselves zigzagging up and down the Container Road, a vertiginous highway built specially for Palestinians that takes travelers miles out of their way, keeping that area “clean” for settlers. (see language: racism, entitlement, and fear) The service slows to a halt as we approach a massive traffic jam at the Container Checkpoint.

Passengers get off and the driver asks me to move forward. I cannot tell if this is part of the checkpoint strategy. White American lady nearer to front? I decide to check the time and see what happens. It is a useful distraction and keeps me from total aggravation.

10:05 Traffic slows.

10:10 Full stop, cars and trucks everywhere.

10:14 More aggressive honking; we creep forward; the driver offers us water; we are unbearably hot; I picture myself melting into the warm sticky seat like some kind of Wicked Witch of the West.

10:16 A large truck travelling in the opposite direction needs to make a wide hairpin turn and the vehicles on the opposite lane cluster together to give him space; a truck with a sheep stops next to us and the sheep is panting rapidly and looks deathly ill and thirsty, the drivers keep anxiously looking back at the suffering animal with clear concern but no water.

10:19 We pull ahead in the breakdown lane on the right and now there are four lanes of traffic that need to merge into two; annoyance and frustration is rising and there is more talking and yelling between drivers.

10:20 Full stop.

10:22 Driver negotiates a merge into lane number three.

10:24 Driver asks for my passport and pours through my history of travel, “Cambodia?” There is thick black smoke beyond the checkpoint; a mix of burning garbage and tires adds to the smell of exhaust; I ponder how the occupation increases global warming and childhood asthma.

10:27 Two Israeli soldiers are working the checkpoint and they glance into the service, do not check any documents, and wave us through.

Really?

Suddenly passengers start laughing, joking, the driver pulls out a bag of wafers and passes them around. A victory over the oppressor, time for celebration. There is almost a sense of unity built out of the experience of common, indiscriminate, mindless suffering. The official Israeli line is that checkpoints are necessary for security, a holy cause that is used to justify the oppressive minutiae of occupation and throat-gripping control.

As we approach the village of Qalandia with its arched entry, I see a rotary and a dead olive tree. I think of the gorgeous, watered (stolen) olive trees at the entrance to the Jewish settlement of Ma’ale Adumim and I want to weep. Perhaps the Qalandia tree has died of sorrow as well as neglect. As we skirt the Qalandia checkpoint, the traffic once again backs up into a crazy jumble of vehicles, some trying to get through, some trying to get around, and everyone trying to survive.

I imagine doing this every day, morning and evening, to get to work or school, or to meet a friend in Ramallah. The endless waiting and uncertainty, the never knowing when and if you will get where you are going. This kind of brutality is powerful and suffocating, and it is the universal experience of the people who are living in this prison, their lives effectively under total control at the hands of young Israeli men and women with little life experience, their minds filled with racism, boredom, fear, and the power that comes with the gun.

June 28, 2014 Who is the Terrorist? Part one

I have been thinking a lot about collective punishment and military force and the cost of fear. I am not going to reveal the identity and details of individuals in this story out of respect for their privacy and safety, but several asked me to write about recent events in their village. Let’s just say Bani Nayim is a large Muslim village of twenty thousand, east of the city of Hebron, a region known for large stone quarries and miles of vineyards. I have been visiting an extended family where most everyone is well educated, teachers, businessmen, doctors, people with degrees in education who cannot find employment and “jump the wall” to find work in Israel or to get visas to do graduate work in the United States, or do online PhD programs in Islamic religion and Quranic studies. Families tend to be large, babies tend to be loved and plentiful; it seems that everyone we meet is related. Their idea of a good time is sitting on a balcony with each other at sunset, drinking Turkish coffee, eating sweets, talking (we have some really serious discussions about politics and medicine and health), and smoking nargila. The main issue with the view (besides the stone quarry), is the Israeli military base in the distance and the spy balloon (I thought it was a kite), that hangs above the hills over the fanatically racist Jewish settlement of Kiryat Arba.

The houses I visit are beautiful, meandering, white stone Arab homes surrounded by patches of olive, almond, lemon, fig, and apple trees, gardens with water starved flowers and aromatic bushes like lavender and something called cologne (I think), that just bursts with aromatic perfume when the sun sets. The love of the land and its bounty is palpable. Far from the center of town, there is a larger field with a greenhouse (where I see rows of happy mulokhiya (Jew’s mallow) that gets concocted into this great green soup with rice, and a field of wheat; much has been passed down through the generations.

The living rooms of these houses have big-screen TVs and often some totally discordant American cowboy movie with Arabic subtitles or an overly dramatic soap opera from Saudi Arabia playing in the background. It is stunningly hot and periodically someone talks about the four feet of snow that fell last winter and paralyzed the village. The land is hilly with single homes here and there; throw in some goat herds and minarets and if you keep looking you can see the Dead Sea and the purple hills of Jordan. It is all pretty spectacular.

This is the kind of family that warmly welcomes me into their home, the mother has prepared a ginormous meal of extraordinarily good food which is made of rice and chicken and stuffed grape leaves and stuffed zucchini, and yogurt and spices to die for; everyone is behaving as if I have not eaten in days.

We retire to a living room filled with stuffed chairs and stuffed people, and after more sitting and smiling and Sprite and Coca Cola, I take out my origami directions and a hundred sheets of colored paper. Shortly thereafter, there is a whole collection of family members of all ages and all levels of education making boxes and struggling over cranes and helping the kids get the creases right.

This goes on for an hour and there is so much laughter and good fun; it is just a simple pleasure and feels so good in some primordial, mostly nonverbal human way.

My host then suggests that the family watch my documentary on the Nakba, Voices Across the Divide, and I wonder how that will play, a documentary produced by a secular Jewish woman for a US audience sharing the Palestinian story in a room full of devout Muslims (is this chutzpah or foolishness?) And so we talk and talk and I say they have to be honest with me. Everyone wants to see it and so they invite over more relatives and soon everyone is glued to the TV and we are not watching Bonanza.

I am a bit freaked out since they keep talking and I can’t tell if this is good or bad, but it turns out this is a totally talkative enmeshed family and they are just having a big group experience; they recognize the two college girls holding the Boycott, Divestment, Sanctions sign towards the end of the film and of course the village of Beit Ummar over the hill; they are debating the different family names, who knew? When the documentary ends, I hold my breath, and then the father speaks and says the film is an excellent portrayal of the Palestinian experience and then everyone chimes in and we have this amazing discussion about all of their stories and the making of the film and the American Jewish community and Zionism, and Islam, etc., etc. As you may imagine, this is a pretty stunning, cross-cultural experience and I am so relieved; I feel embraced and welcomed despite my clear differentness. (I am given a bed in a room by myself and the entire family sleeps on long cushions on the floor in the living room.) Perhaps I need more tea and how about some nuts?

So why am I telling you this story? When you hear a news report, these are the “they,” the “Muslim other,” the “Palestinian militants near Hebron,” the faceless families that are being terrorized by Israeli soldiers every night since the three boys (or settlers, or soldiers, or who knows what or all of the above) disappeared.

The day after the disappearance (I will call it a kidnapping when I know that is what it was and, FYI, I am not asking Netanyahu for the real story), The Islamic Center and School for Boys next door was ransacked by the Israeli soldiers and the imam was detained for a few hours and then released. Years ago, his two brothers were “martyred”; one was in a militant group and died in a gun fight when the house was crushed with him in it and the other was killed as “collateral damage.”

After our movie night and the sunset over Kiryat Arba, as we prepare for bed, I am informed that the Israeli Defense Forces have attacked the town, they are at all the entries and have started going house to house. The village has a Facebook page which is suddenly the focus of everyone’s attention. Someone reports that three to four buses of fully armed soldiers are walking through the town, some take control of one house and put a sniper on the roof. TV news is talking about an IDF attack on Rafah, the southern border of Gaza. The electricity flickers on and off, why? The family is anxiously awake until the middle of the night, tracking the soldiers on Facebook and on a local radio program. The father finally goes to the mosque to pray when the muezzin calls at four a.m. (yes I am awake dissecting every sound), and then he comes home and goes to sleep. I learn that like many Palestinian men, he has been arrested twice and was in administrative detention for two months and released without any charges. He has obvious reasons to be anxious; he is a Palestinian male while Muslim, which is an arrest category in itself. No arrests are made here during the night, but everyone’s nerves are a bit shattered and no one sleeps well. The youngest son is curled across his mattress and is in a deep stupor. I wonder how this all impacts him and his sense of safety, his belief in his parents’ ability to protect him. The press is reporting hundreds of arrests, many more injured (collateral damage?), and a steady number of killings. Hamas members (including legislators) are clearly targeted.

Earlier, we passed one of the big “Bring Back Our Boys” signs; it hits me that this is supposed to resonate with the violent kidnapping of girls in Nigeria. I try to imagine a society where that slogan would mean all of our boys, not only the three snatched last week but the thousands of mostly boys and young men lost in Israeli detention centers without parents or lawyers or the legal and human rights protections of any decent society. And then there are all those boys who have lost their humanity, breaking into houses night after night, terrorizing families, turning into frightened, dehumanized monsters. And I realize, we need to bring them back as well.

June 26, 2014 Speak Truth to Power and Choose Joyfulness part three

As a physician, I am always impressed by the combination of intelligence, dedication, weariness, and fortitude that characterizes so many Palestinians working in the field of health care. Our group has the opportunity to meet with professionals who are willing to speaking honestly and off-the-record, to explore the raw contradictory picture that is a health care system (or frankly non-system) that is part first world, part third world, part internally dysfunctional, and simultaneously constricted by the noose of occupation. This is a summary of that meeting and I am solely responsible for the content and commentary.

The requisite Turkish coffee appears along with folders and documents of official information as we settle in for a discussion with a group of Palestinian researchers who examine medical and public health issues with the support and cooperation of a number of local and international agencies. The investigators work on a number of issues including public health surveillance, assessment, research, health systems analysis, and capacity building.

As a women’s health care provider, I am very curious about breast cancer screening, since arranging mammograms has seemed somewhere between hopelessly complicated and undeveloped and inordinately difficult during my previous attempts to provide clinical care, and I would love to know what researchers have been able to uncover.

We learn that an evaluation of mammogram screening programs in the West Bank was done but it was not possible to determine the efficacy of the screening because of an underreporting of cancer diagnosis. But things were even more complicated than that. A research group looked at 6,700 women, ages 30–84, screened in the West Bank in twelve screening clinics in 2011, they found 21 reported to the cancer registry and they called and confirmed all of them and also found 21 more who were not registered in the registry but were being treated. So we already have a data problem here. On further analysis, researchers documented that the Augusta Victoria Hospital in East Jerusalem is the only location for radiation therapy (the Israelis I am told do not allow radioactive therapies into the occupied territories), so most women go to Augusta Victoria, but the hospital does not notify the Ministry of Health cancer registry; too much paperwork, too little time – I am told that if only it was web-based, they would report all cancer cases. So there is a problem with tremendous underreporting. (Big sigh.)

We found that while researchers wanted to determine if mammography screening picks up cases of breast cancer early there were problems with the data and cancer staging; only 5% of cases had the stage of cancer noted, (1/21 registered cases), so it was not possible to determine if there was or was not more early detection. The barriers to care are also immense. Only four doctors actually read mammograms in the West Bank; the waiting times for results are long in many districts. If cancer is suspected, the woman may need an ultrasound or aspiration, but the Ministry of Health only offers these services in Ramallah, thus women often go to private clinics but some cannot afford them and are (as we say in the medical bizz) lost to follow up, i.e., left to die of their cancer. Fine needle biopsies are also only free in Beit Jala, but again many women cannot get there and thus are also “lost to follow up.” Add to this the tremendous cultural stigma around a cancer diagnosis (all the screening is done confidentially); some women do not even tell their husbands. I suspect it is pretty impossible to get cancer treatment if you are not willing to tell even your sexual partner. Just speculating, of course.

And then there is the whole issue of what is the underlying cause of death on death certificates. I have noted in the past that in the West Bank and Gaza there is a lack of organized, reliable data collection and documentation on issues related to public health and medical issues on the larger population level. We learn that a group of researchers reviewed the notification forms for people dying in hospitals, four hundred in the West Bank and two hundred in Gaza. One analyst remarked that the accuracy of death registry is low, which is an issue in many developed and developing countries, but they only reviewed 600 cases so it is difficult to generalize, but the current data is worrisome.

So why does this happen, I ask. I think of the busy clinics I have attended, the overworked physicians, the lack of continuing medical education courses, the long waits for patients and visits truncated by the pressures to make a diagnosis, order tests and medications, strategize how to manage all of this within the cost constraints, lack of insurance, permits and checkpoints that are part of the reality of obtaining and providing medical services under occupation. We are not surprised to learn that many doctors see no value in the numbers and data and follow up information; they are so overwhelmed they barely do their paperwork. If one hundred patients come to an emergency room every day and many of them have mental health issues, it is easier and quicker to default status to “improved,” or not to register deaths as no one is probably going to look at the data anyway. The doctors are often not well-trained, have no oversight and no threat of malpractice. Medical students lack mentoring and support, so they do not learn how to do better and the system perpetuates itself.

Despite all of the shortcomings, it seems that the mammography studies were helpful, the Ministry of Health is training more doctors to read films, and they are at least aware of the need for maintenance of mammographic equipment (rather than just calling when the thing finally breaks); they know about the shortage of x-ray films and the subsequent quality issues related to scrimping on films. I am having trouble swallowing and breathing, listening and typing. We are talking women’s lives here.

On a more positive note, we are excited to learn that there are researchers exploring the possibility of doing a study in Tulkarem, a city surrounded by the separation wall, located on the Green Line, and the host to many Israeli chemical companies and nearby settlement industries that do not want to be bothered with those expensive environmental regulations and worker protections that are the law of the land in Israel. Between the fumes, smoke, chemicals, industrial waste, etc., etc., there is a high incidence of allergies, skin disease, eye problems, and cancer, but this has never been adequately studied, and given the mammogram studies, you can imagine that this would be a challenge. Noting the difficulties of medical record keeping, a group of researchers is thinking of doing something very clever: they are proposing measuring toxics in the land and water rather than trying to track down possibly inaccurately recorded patient diagnoses. If this moves forward, they will be able to do environmental studies from which much can be extrapolated, but they are skipping the deficits in accurate health statistics. (Environmental racism anyone?)

In addition, we are informed that the analysts have another challenge: they do not have accurate information about the factories and are not even allowed to enter them. Got something to hide, maybe?

Other researchers are analyzing a death study and planning an environmental study in the Jordan Valley-Dead Sea area, including areas of Jericho. They are investigating a health profile in the Jordan Valley, looking at communicable disease, malnutrition in children, parasites, scorpion and snake bites, and the mental health of residents. FYI, the Jordan Valley is a closed military zone with several pockets of Palestinian communities.

We also learn of the work of Juzoor, a health and social policy NGO grounded in the socioeconomic determinates of health and wellness investigating risk-taking behaviors among Palestinian youth. They are studying twenty-five hundred men and women fifteen to twenty-four years old in the West Bank (they couldn’t do it in Gaza), looking at drugs, alcohol, sex outside of marriage, smoking, violence, and mental health. I am impressed. This is very first world. Based on the results from the study’s formative phase, the sexually active youth are mostly interested in internet sex and phone sex, oral and anal sex is next, but vaginal sex is the least common due to the importance of female virginity at the time of marriage. We understand that there are honor killings, but the numbers are obviously hard to get. We are told that it is even more complicated than that. For instance, an apparent honor killing in some cases may not really be about “honor”; perhaps the woman was asked to give up her inheritance to her brother, she refuses and he kills her, takes the money and calls it an honor killing. Or a woman’s husband dies and her brother-in-law wants to marry her, so his first wife asks her own brothers to kill potential wife number two and call it an “honor killing.” Or if a father or brother rapes a girl and she gets pregnant, then they kill her to protect the father or brother. There is no data on this horrific crime, it probably happens more in rural than urban areas, sometimes people call it a suicide, the reports are all “just stories.”

Now that we are deep into forbidden topics, we are informed that there is an increasing rate of suicide, especially amongst the youth, “even with engaged women.” Apparently the police say suicide is increasing, but they don’t want to report the numbers in order not to frighten people. Fortunately, there are good hotlines, such as SAWA (“the Listening Ear for Palestinians Experiencing Violence”), for desperate people who are abused, harassed, or raped. I think about what happens to societies that are increasingly stressed and brutalized, how anger and despair turn inward, how women frequently bear the brunt of male humiliation, rage, and impotence. This unfortunately happens everywhere and we are seeing it here.

Eighty-three men and women in the West Bank were asked about health services for youth, and they reported that they do not trust counseling institutes, are worried about confidentiality, are much more willing to speak to peers. UNRWA is training community-based mental health workers, “this is a good program.” There are school health officers who focus on smoking and nutrition and, for adults, community-based organizations, like the Palestinian Medical Relief Society. Drug use is common in the cities, mostly in Jerusalem and Area C (West Bank area under Israeli control), mostly hashish, which is affordable. Addiction carries a social stigma; the Israeli authorities punish dealers more forcefully if they sell to Jews than to Arabs. Drug use has increased with the increasing brutality of the occupation. (We call that self-medication.)

Given our own experiences on the ground, we wonder if anyone is studying the environmental impact of checkpoints, increased emissions due to prolonged waits and long detours, air quality, water restrictions, repeated exposure to tear gas, chemical weapons, sewage. The answer is no. Obvious environmental issues are not a priority when the population does not have enough food and water.

This research is designed to inform policy with stakeholders, always in partnership with organizations like the Ministry of Health or local citizens. But the politics is critical. “In Gaza phosphorus bombs, what happened?

No one cared.” Beneath the Al Aqsa Mosque, right-wing Jewish organizations are excavating, “Muslims all over the world, crying, became normalized [the frog in the pot of boiling water phenomenon]. We are used to it, powerless, can’t fight continuously. We need to write about it, Facebook, social media, tools that are not controlled and create awareness, buzz marketing, attract attention. YouTube gets thousands of views and shares in two days. This is a power, political support is hopeless.” I am impressed by the energy and enthusiasm in the room. The possibility of the Tulkarem environmental study, “Everybody is excited about the study…farmers and stake holders are supportive. There are many organizations and funders for women. Honor killing used to have one month punishment, now there are no more reduced sentences, this is recent
change.”

We are told to check out the Diakonia International Humanitarian Law-Resource Center in Jerusalem, which does advocacy around justice and international law. So many good people doing good work in a complicated place. Obviously, this is difficult and humbling work. One researcher talked about a PhD thesis that was done on mental health and quality of life (QOL) in preschoolers in Gaza. The author found that 50% of mothers suffered from depression (not exactly a surprise), the QOL of preschoolers in Gaza was worse than kids in the US with cancer or renal failure. The risk of malnutrition was solely related to maternal mental health ( ie. a mother with mental illness cannot take care of her child and respond to his/her needs).

Amazingly, the PhD candidate tried to measure the QOL of the mothers and 40% said “Excellent.” This made no sense. (I mean, this is Gaza), so the researcher called the women and the conversations were basically, “How is life?” “Hamdullah, excellent,” and then women would list a thousand overwhelming complaints. When pressed further, they would respond, “You can only complain to God.” So an assessment of wellbeing is totally culturally determined.

It is time to go. I am trying to wrap my brain around these amazing, gut wrenching conversations and this remarkable group of health care professionals who were willing to share their observations and experiences with us. I am feeling that it’s really not about what is happening to you, it is how you deal with it. Two of our contacts suggest that it is actually possible to choose joyfulness as an act of resistance.

The medical student who is our guide this afternoon suggests we go for a “quick visit” to his village of Taybeh, a Christian town half an hour from Ramallah. Soon we are in a clunky, dusty service heading northeast, and then we are sitting at a table laden with flavorful soup made from mulokhiya, chicken with rice, salad drenched with olive oil, lemon, salt, and pepper, dried mint, and then another eggplant, parsley, tahini concoction and of course, cold Taybeh beer, chatting with his welcoming mother, father, and sister who just happened to have a feast waiting for us.

And then there is the tour of the family’s garden, lush bunches of grapes, almonds (very sweet eaten fresh and raw), figs, olives, mulberries, apples, pomegranates. And just a “quick tour” of the Old City; gorgeous views, churches (actually dating to the time of Christ), ruins, multiple layers of conquerors. The town gathers for celebrations and still sacrifices sheep! We stare at the stones stained blood red and the handprints (dipped in the blood) marking the ancient stone walls. And in the distance, Jordan, the Dead Sea, a Muslim village, Israeli military posts and settlements, all leaning into this tiny, complicated paradise.

I learn later that the medical students hosting us are competing to see who makes the best visit for us to their village. They are all winning.

June 26, 2014 The Darkest Aspects of Human Experience part two

I have been thinking a lot about torture lately, given the three murdered Israeli settlers and the most likely revenge killing of a Palestinian teen burned to death and then his American cousin beaten to a pulp by Israeli security and if you should come across the website of the Palestinian Center for Human Rights, this is merely the tip of an enormous iceberg of human violence and suffering.

As I write this blog entry (belatedly), it is actually fitting that on June 26, a number of us were invited to a conference hosted by the Treatment and Rehabilitation Center for Victims of Torture in Ramallah, and we are sitting in a large auditorium at the Red Crescent Society in Al Bireh. A lovely Al Quds medical student is translating quietly as we lean towards her and some of the talks are thankfully in English. I will do the best I can here.

There are many professional looking types, men and women, and two rows of guys in army green and berets, apparently soldiers from the Palestinian Authority also have a lot to learn about torture (I.e., why they shouldn’t do it), prevention, and treatment.

On the stage, I recognize Dr. Mustafa Barghouti, who founded the Palestinian Medical Relief Society and is a political leader (you might hear him on NPR for instance as an articulate voice of reason), Dr. Mahmoud Suheil, the psychiatrist who is the head of the center, and a man from the European Union who spoke at a Birzeit Heritage festival we attended a few days ago. We all stand for a bout of patriotic music, the cameras roll, and the conference officially begins.

Today is the annual UN International Day in Support of Victims of Torture. The EU speaker talks about how torture is abhorrent, against moral and ethical values, “it destroys the victim and dehumanizes the torturer, and undermines the state that tolerates it.

Torture is also a crime under international human rights law and unlike many other human rights, there are no exceptions or no justifications to make the unacceptable, acceptable.” He notes that, “these are easy words, the real question is how to combat torture effectively.”

He suggests that torture has to be addressed at different levels that include legal regulations where torture is prohibited by law and mechanisms need to be in place to make sure this is applied. It is also critical to have transparency, bringing to light behaviors at police stations and other places of detention. He asserts that civil society has a role to play here; this work requires public awareness of what torture does to people; this is a constant task, human rights values need to be frequently stated and restated.

In 2013, President Abbas decreed a prohibition on torture and in April 2014 Palestine ratified the UN convention against torture.

(The US and Israel signed decades ago for what it is worth.) He notes these are important developments, but more needs to happen as Palestinian civil society has regularly reported the use of torture by its own security forces as well as by Israeli forces. He notes that the European Union has regularly criticized Israel regarding the conditions under which Palestinian prisoners are held and the use of administrative detention; he congratulates the treatment center and its partners that “deal on a daily basis with some of the darkest aspects of human experience.” I wonder where is the voice of the United States at an important conference like this?

The next series of speakers are talking in Arabic and their main points revolve around the destructive Israeli practices of child arrests, the killing of young children, and the rearresting of prisoners who were freed in previous deals. There is then a long presentation on Palestinian and international rules, laws, contracts, etc., the bad things that have happened, the need for respect for women’s rights, the illegal torture of Palestinians in Palestinian prisons and appalling Israeli policies and house demolitions.

This is all a bit overwhelming. I am looking through the conference literature and learn that the Treatment and Rehabilitation Center was founded in 1997 to defend human rights, to build a society free from torture through community awareness and education.

Their tasks focus on: violence against prisoners, the wounded, families of martyrs, victims of the Apartheid Wall, road blocks, settler attacks, etc. They also offer treatment and support to victims and their families and focus on therapy and rehabilitation, medical and psychological. I am puzzled as someone appears to be setting up an electric piano on the stage.

A woman talks of transitional justice, the need to create official strategies to identify torture, to fix societies that are suffering, and to compensate victims. For victims, the torturer needs to be punished and the victim compensated. She notes that with the ongoing history of torture, this will lead to a loss of trust between individuals and society. She acknowledges that the divisions between Fatah and Hamas have created many victims and many people have been hurt.

After apologies to all the people who were unable to get to the conference due to the heightened delays and blocks at checkpoints, it is apparently time for the entertainment. A singing group from An-Najah University in Nablus, two women in gorgeous embroidered Palestinian dresses and one man playing the thing that looked like an electric piano but clearly is something else, pour their hearts into the music, giving voice and feeling to a society filled with pain and joy. This is all pretty extraordinary.

The second part of the conference is focused on treatment for prisoners and their families, “who are not sick, but suffering.” They talk about men released from prison after over ten years who have never seen a smart phone, have had years of solitary confinement, physical, and psychological suffering, whose families were not allowed to visit. “But what about the feeling about the father, thinking about his kids, what has happened to them, what kind of treatment they can do to support them. They are suffering from beating, abused, not eating or inedible food. Some have abdominal pains due to bad food and no exercise and that makes it worse. The air is stagnant, six people in a room, health worsens.”

The Center is doing awareness campaigns about the torture prisoners are facing, they have branches in places like Nablus, Jenin, and Ramallah, they offer outreach, go to the homes of the prisoners and families, talk to them; many do not have money to go to the center. The staff also uses psychotherapy, I.e., cognitive behavioral therapy; the Center sends staff to Norway to practice and learn to do therapy. Their group includes a psychiatrist and psychologists; they discuss each case and plan treatment, possible medications, psychotherapy, etc. The main goal is to make the victim feel better so he/she can go back to a normal routine and return to society.

The speaker gives a poignant example: one person spent thirteen years in prison, his oldest child was five and now he is eighteen, “So he will not feel like the father, lost that feeling. The child is used to the absence of the father, he, [the father], is not used to being ignored and not asked and is shocked, so he feels like a piece of furniture. He is not asked to participate in family as they are used to being without him.”

When the psychiatrist determines that the released prisoner is ready, he or she is offered professional rehabilitation: the prisoners are paid a monthly income and offered courses to be able to work in their desired field, “so they will be productive in building a future, they want to become productive.” Specialists follow the prisoner and evaluate the results and adjust the treatment program.

The speaker is intelligent and articulate, the audience nods in agreement, and I have a sense that this is a group of sincere, decent professionals honestly working to better the lives of victims and their difficult society.

“The wife of the prisoner, she is the hero, but in the shadow. She is fighting alone to raise the kids, work, so the center is trying to offer the wife work options, I.e., sewing in a salon, which is in her home, so her kids are close, she can care for the kids and have an income while the husband is in prison.”

There are more presentations about the legalities and international laws and the groups that monitor conditions. There are human rights committees that write reports in cooperation with organizations like Physicians for Human Rights Israel, “track all the kinds of violations and torture, in order to find the truth, and follow those reports to see more details, in front of government to take action. The torturer should know that he is going to be punished and is not protected.”

Another speaker notes that in the news recently, “there is an increase of family fights that result in killing, so violence has increased in Palestine, girls are being raped. So the laws must be followed, the killer needs to be punished, otherwise the family takes justice in their own hands and this is dangerous.” There is more discussion about the deaths of Palestinians in Israeli prisons due to inappropriate medical care, the lack of punishment or accountability, the current prisoner hunger strike, the fact that Israeli violations are allowed because they are in power, the possible forced feeding legislation. “It is the worst occupation in history. It is not impossible emotionally to hope for Palestinian society without torture.”

“Even any kind of reporting to Israeli institutions leads to nowhere. So it is time to do it ourselves by legal means.” Another speaker clearly is more agitated. He talks about the continued cases of torture by Palestinians in Palestinian jails. Of the havoc in Israeli jails and the need to use international committees and the media. “If the torturer is not punished, the Palestinian can track them down using international organizations and other countries and laws. Using the law we can find those murdered in Israeli prisons, those who abuse prisoners, and try to stop this. During interrogation they torture them until they die.” He describes “Israel [as] a country of killing, torture, destruction, but we are strong and it is our turn to act, to make the laws and the policy.” I can sense his outrage, voice rising in anger and frustration. He ends with the three kidnapped Israeli settlers and the difference in the international response when Palestinians are the victims. “When Israeli kills our children or rearrests prisoners, this is war, it is our right to ask for help through media as well.”

The last speaker (before more singing) is a freed prisoner. I brace myself for some horrific litany of pain and suffering, the conference has already felt quite overwhelming and my professional boundaries are fraying. The young man begins by reading from the Quran; he explains, “One can face many difficulties, but if there is a huge trauma those who are patient, Allah promises them with heaven.” He talks about the years when water was his only mirror, his speech is urgent and passionate, and soon I realize that it is all poetry and metaphor, filled with feeling and woundedness, the child inside longing for freedom and land, a symphony of words, all beauty and inspiration. A true survivor.

June 26, 2014 First/Third World Medicine part one

The newly built Ministry of Health Palestine Medical Complex is filled with all the expected contradictions of building a health care system under occupation in what is ironically a third world kind of setting. We are getting the grand tour from a medical student who did his internship here, “Lots of experience, low quality.” The impressively clean, modern, white stone facilities were built in 2010, merging a Ministry of Health hospital and a private hospital (donated by an American) in Ramallah. At the gate there is a sign: “Palestine Medical Complex is Smoking Free Area” (insha’allah as they say here).

I have a particular interest in quality improvement (I understand why things are the way they are, but how does health care move forward, even here), and we are soon meeting with Rebhe Bsharat, a PhD in a white coat, with a short mustache and a warm, friendly manner who is in charge of quality and education for nursing. He reviews the different wings of the hospital, including pediatrics, surgery, emergency, general medicine, the ICUs, dialysis units, triage beds, etc., etc. All the trappings of a twenty-first century medical center. They have 126,000 emergency visits, 200,000 outpatient visits, 27,600 admissions, and 7,000 surgical cases per year.

Quality assurance (which is part of the quality improvement lingo) has been a focus at the hospital for the past three years.

Apparently the World Health Organization has a program for “Patient safety friendly hospitals” with lists of standards to be met.

In the United States over the past few decades, the whole focus on improving the quality of care has been to turn from blaming the “bad doctor who screwed up,” which encourages a culture of secrecy and condemnation, to assuming that most clinicians are doing the best they can under challenging circumstances. Thus the task is to analyze how the system of care makes errors more likely (different medications with similar names and labeling sitting next to each other on the shelf), and how to make systematic changes to reduce error (make the labels different colors and put the medications on different shelves.) This obviously has the potential to encourage a culture of joint cooperation and more creative thinking and has the potential to actually make care safer.

Rebhe admits that there are a lot of challenges because this approach involves changing the culture and attitudes of the providers.

I am so excited to learn that one of their quality improvement programs is focused on hand washing. As a point of explanation, one of my major concerns having worked and observed in clinics and hospitals all over the West Bank, is the fact that almost no one washes their hands before or after seeing patients. As you may imagine, this drives me crazy. This is a preventable risk factor. As a firm believer in the germ theory, it seems to me that even under occupation, clinicians could and should wash their hands, and if there is no water, I have been known to leave bottles of Purell on doctors’ desks as a personal contribution to fighting infection.

So you can imagine my delight on seeing a poster in a ward headed with a logo and “Palestine Medical Complex” with a circle filled with bugs and a slash across it, followed by large letters: no germs allowed, WASH YOUR HANDS and some official signature.

It really doesn’t take much to make me happy. As expected, the initial surveys revealed that 20% of doctors and 50% of nurses washed their hands, so now there are weekly lectures, monthly meetings, and patient safety protocols, all good things. Older doctors (like doctors everywhere) pushed back but the trends are good.

Rebhe explores some of the challenges nurses face. He lives in a small village, and because it takes between thirty minutes and three hours to get to work (depending on the checkpoints), the previous shift just has to continue working until the next shift shows up.

There are three hundred nurses; half have a two year diploma, half have a B.A., 55% are women, and 20% are over forty. Many work here for ten years or so and then return to their cities or villages.

They all need continuing education programs, want better patient education publications and discharge planning, and these are in the pipelines. Rebhe was trained in Baghdad and Turkey, as high-level degrees are not available in the occupied territories, and his thesis was on effective planning for cardiac surgery. Meanwhile, he is trying to get folks to wash their hands.

We tour the wards and I am impressed with their order and cleanliness (an incredible contrast to older Ministry of Health hospitals I have seen). The pediatric unit has forty beds, but only thirty are used due to lack of staff. They receive referrals from all over the West Bank. There is supposed to be one nurse for five patients, but the reality is one nurse for twelve patients (safe staffing anyone?) Bears, ducks, Disney-like princesses, and Winnie the Pooh (how did he get here?) cheerfully decorate the walls. There are no psychiatrists or social workers and frequent shortages of medications.

Today the Ministry of Health doctors are on strike, the outpatient unit is closed, and only emergencies are being seen. The month long strike is over salaries and no resolution is in sight. (Jolt of reality.) Politics and medicine, the challenges continue on so many levels and the patients and staff pay the price. It seems they keep on hoping, keep on praying, keep on showing up for work (sometimes) and for care (always). Alhamdulillah. What else is there to do?

June 25, 2014 Medicine: If It Doesn’t Kill You, It Makes You Strong part two

The meeting with the medical students is not that polite. Now I will grant you they had just finished their exams (because of the Hebron curfew and the resultant delays, some had six exams in one day). Many are about to graduate, so they are so done with all the frustrations and they are living in a variety of ghettos trying to get an education in an impossible place (and FYI, my recollection of medical school is also filled with anger and frustration and I did not cross one checkpoint). They have a lot to say and are obviously happy that there are some curious people interested in listening. One student describes Al Quds as “six years of hell.” The students from East Jerusalem discuss the frustrations of crossing the Qalandia checkpoint twice a day, most everyone has had some frightening experience with a gun-toting Israeli who is also their age and sees every Palestinian as a terrorist, everyone complains about the uptight culture of medicine (sounds a lot like the hierarchical culture of hospitals in the 1970s), physicians who act “like gods,” and of course, there are longstanding conflicts with the administration.

As we try to tease apart the miseries of medical school in general from the miseries of this medical school in this place in particular, certain themes emerge. Al Quds (as opposed to An-Najah in Nablus) has no teaching hospital, so students get dispersed all over.

Students with Ids or permits for East Jerusalem get better clinical rotations and there are no standards or clear-cut expectations in the clinical curriculum, so the teaching is enormously variable and sometimes totally inadequate. (Pediatrics at Al Mokassed hospital is a glowing exception.) The doctors are often brilliant, have trained in high power institutions abroad, but are very busy, have active private clinics, and teaching medical students is often low on their list of priorities. In addition, unlike hospitals in the United States, residents (where they exist) are not required to teach the students, so “everything is personal connection.”

The students would love to see the institution improve and are aware that Al Quds has funding issues, that the Israeli authorities are not allowing them to build a teaching hospital in Jerusalem. It sounds, nonetheless, like there is an unacceptable level of chaos: students talk about being “dumped” in hospitals in Bethlehem and Hebron, then having to rent crowded apartments due to the challenges of getting around. They talk about arbitrary grades, lack of mentors and guidance, and lots of small problems. Everyone plans to train “outside” and everyone “plans to come back.” I love their passion, their rage, and their idealism.

We talk about the challenges for patients. Due to lack of funding, patients having surgery sometimes have to buy their anesthetics, Ivs, and pain medicine and bring them to the hospital before the procedure. (As a quick orientation here, the world class Hadassah Hospital is a few short miles away and you can be sure they have enough fentanyl and IV saline to do surgery, but I digress.) Some hospitals have no electricity for two hours per day (this would certainly crimp a specialist’s style, not to mention some poor patient on a respirator). If a Ministry of Health hospital is unable to perform some type of care, they will refer the patient to a private hospital, but the government then fails to pay for the care, so private hospitals have growing loans and debt as they struggle to survive.

And beyond the occupation’s political impact on health care, we start talking about the additional social determinants of health: how all the pollution from prolonged bus and taxi routes, endless idling at checkpoints, huge quarries and stone cutting dust, piles of uncollected garbage, the contaminated, radioactive water dumped by the Dimona reactor south of Hebron (that would be dumped on Bedouins if I recall), how all this makes people sick. And then they face a health care (non)system that is ill-prepared to deal with the totality of disease and its profound and complex etiologies.

No wonder these medical students are not only articulate and smart and ready to take on the world; they are also profoundly angry about all the right things. If these are Palestine’s future doctors, I feel very hopeful for the next generation. If they only come back.

June 25, 2014 Teaching in the Ghetto part one

The Jerusalem neighborhood of Abu Dis ended up on the wrong side of the wall. Every time bus #36 from East Jerusalem turns this particular corner, there is the monstrous “barrier” (which is quite a euphemism), up close and personal, all eight meters high of poured concrete stretching along the edge of the road (or rather defining the edge of the road and in some ways, the edge of existence); I have the distinct impression that military-city planner types are giving us and all the wrong-side-people, a gigantic concrete finger in the eye.

Most of Al Quds University is on the wrong side too if you live in Jerusalem, and of course on the right side if you live in Ramallah or Tulkarem or Jenin or Hebron. For students who are old enough to remember, getting to school from East Jerusalem used to be easy and quick. Now, the journey involves a long tunnel, skirting Ma’ale Adumim (one of the largest Jewish settlements or shall we just be honest and say colonies on the West Bank), swinging through Bethany (the biblical one which seems more industrial, and auto shops and less Jesus, Lazarus, and lepers), and making a huge snaking swing east and south to get to the bedraggled neighborhood of Abu Dis. Let’s not even mention the increased use of fuel, the challenged shock absorbers that need constant repair, the choking air pollution, the lost time and rising aggravation, and the need to plan life around buses and permits and when is it safe in the first place to try the daring trip to school. What do these people have to complain about anyway????

We meet with Hani Abdeen, the dignified and somewhat burned out dean of the medical school, neat mustache, wire rimmed glasses, striped shirt, very old school, and I feel like this should be called “soldiering on against all odds.” Al Quds Medical School was founded in 1994 and graduated its fourteenth class last week, for a total of 720 graduates to date. Hani is very pleased with his students.

He brags that they do very well on qualifying exams for residencies all over the Western world: Canada, United States, Europe. “The students are doing a good job, under duress people excel. We do not have a large faculty, all the resources, teaching materials, yet with all these shortcomings students do well. In the USMLE (US Medical Licensing Exam) Palestinian students are in the top 1% of foreign graduates.” What doesn’t kill you makes you stronger.

This is of particular interest to me as the health and human rights project was involved in starting an exchange program between Harvard and Al Quds Medical School and the students rotate through Harvard hospitals and receive “glowing reports.” Hani is very worried that while the medical school is doing a good job, they are essentially “training doctors for America, there is a big brain drain. Once they see how good life is, the standards of medicine, they leave and stay where they train.” He notes this is a problem for all of the third world.

Sadly, “even if they train, but should come back, we are starved of medical personnel.” Hani notes that there is not one well trained hematologist or nephrologist in the occupied territories, and this is true in much of surgery, medicine, and ob-gyn as well.

I am surprised to hear him say, “One way to address this: how to change ratio male to female. He notes that now the medical school class is 60% female and he wants to increase this to 75% females, “because they stay, they are more loyal to their societies, stay with families and are more of use to the Palestinian population!” His theory is that females, “do much better on post high school exams, have less diversions, are more focused, while males have other goals, politics, etc.” He wonders if women, “may be more intelligent, or more driven to try to prove themselves.” I am not sure how to wrap my brain around this reverse sexism, but I have to agree, this is a creative solution to a vexing problem. I secretly wonder if once again, women hold up (more than) half the sky, put up with the less dynamic careers, and keep the family functional.

“We don’t have good residency training, do not have the hospitals, and Israelis do not let us. Everything you build, then there is a fracas and then the whole thing collapses again. This is a big problem.

Two days ago, the IDF entered the university at night, wreaked havoc on the infrastructure,” and they did the same at a university in Jenin and another in Bethlehem (remember the policy of collective punishment). There are repeated mass arrests of students and professors (collective punishment?still illegal under international law). “Obviously what is happening, the Israelis are not interested in Palestinians having their own entity, all they want is ethnic cleansing, get rid of Palestinians and evict them. We are trying to develop, but nipped in the bud? We are fed up with all this talk about human rights. This is how it is on the ground? It makes your blood boil, there is a limit; what are the Israelis trying to do? They have Nobel laureates, etc., in Israel, but don’t they understand what is going on?”

The grinding reality is revealed by the fact that three weeks ago students were about to start two weeks of final exams. But students from Hebron (twenty-five of eighty) couldn’t get permits, so the exams were delayed, and now as the clampdown continues (people with Ids from Hebron are unable to travel), students are taking their exams at home from a computer or on pen and paper (you know, that little problem of needing electricity and internet connection while occupied), so the work is multiplied.

“Imagine [a student] prepared for exam, then cannot take it, then [the exams are] bunched together, this creates psychological trauma, [but] we do not have enough psychiatrists. There is not one child psychiatrist in the occupied territories.” Students get supports from tutors, secretaries. “One of our faculty’s house was ransacked in the night, I do not know why.” He lived in Hebron, guilty as charged. “This happened to students’ families as well, imagine preparing for exams, the students seventeen to eighteen years old,” and then the “oasis of democracy in Mideast” enters their bedrooms at night, finger on the trigger. So what does a seventeen-year-old do with all that trauma and rage?

Hani describes what is going on, “It is madness. We need to educate Israeli society, the majority is ignorant of what is happening in the West Bank. The separation wall is a psychological barrier. They have succeeded, everyone behind the wall is a terrorist, and they are not interested in knowing what is happening. What is needed, to educate Israelis, how to get out of their isolation ghetto mentality.

We are also in a ghetto, two ghettos, this is more important than educating the Arab world. Human life is sacred, if you want to live with neighbors peacefully, then why are you doing this? Arabs, what have they done to Israelis? How many [Israelis] killed in buses? They [IDF] killed over one thousand people in Gaza. This is disproportionate killings; they are all the same, even doctors are participating in force feeding prisoners.”

Hani’s exasperated frustration is palpable. He states he is, “disenchanted with building bridges, when it comes to the crunch, they are professional killers. It is heart breaking as a medical professional, those people who they are detaining have not participated in any crimes.” There is “no court of law.”

We try to focus on the medical school, a six-year program that starts after high school. Hani describes a traditional curriculum that is changing to a more integrated, organ-based approach next year. The first three years involve basic sciences, the last three years are clinical. They are also planning on a graduate entry program, four years of medical training after college, like most US programs.

Students at Al Quds do their clinical rotations at affiliated hospitals like Al Mokassed, Augusta Victoria, St. Johns, and the Red Crescent Hospital in Jerusalem and hospitals in Hebron, Ramallah, and Jericho in the West Bank. He says there is a curriculum for the different clinical settings, but this is in theory only. The hitch is that the first-rate hospitals are all in East Jerusalem, so only the students who can get permits to enter Jerusalem can go on these rotations, and the rest of the students are forced to train in what are seen as second-rate facilities.

But medical care is even more complicated. The Ministry of Health runs community-based clinics, and the NGO Palestinian Medical Relief Society has clinics that are focused on providing health care to poorly served communities. Hani suggests that all of these settings have issues around quality of care and he wants his students to learn medicine, “in a proper manner.” The quality issue is a big one. There are “no post graduate courses here,” no continuing medical education courses (in the United States, I am required to do fifty hours of CMEs per year and that is part of the task of staying up-to-date). Additionally, “Everyone doesn’t have a computer, cannot travel, cannot access villages, so logistics are a big problem.” The school has no connection with UNRWA, the UN agency that provides health care in the refugee camps, and that care tends to be low quality, overwhelmed, and underfunded.

In Gaza, the medical school Al Azhar is under the tutelage of Al Quds, and the Hamas-run Islamic University also has the same curriculum. Yes, there are medical students filled with aspirations and drive in Gaza and they get caught in the incursions and the phosphorus bombs along with everyone else. Hani reports that the graduates do well despite the conditions, although the last time I checked, the Gaza hospitals were still recovering from being bombed to smithereens and unable to rebuild basic infrastructure like drinkable water and stocked pharmacies, so I suspect he is being a bit upbeat here. There is also a medical school in Nablus, called An-Najah.

Hani notes that the French government offers scholarships to two to three postgraduate students a year for PhDs in medical science or specialty training, others go to Jordan or the United Kingdom, “but they never come back.” He explains that the students make commitments to return, but then they buy themselves out. They are the top 1% in Palestine, high achievers, they want to be good doctors, but “our hospitals and infrastructure are not conducive to that. Nursing is not that good, physical therapy is not that good. It is not a solid team, so it is much harder to do medicine here. The pay is better, standard of living, career development all better outside.”

I wonder why Hani is still here. He trained in the United Kingdom, but “my mother was ill and alone so I came back [thinking] I will stay for a year and then I got myself sucked up.” The immense need, the possibility to build something better, the inertia and grinding difficulty of getting through each day let alone planning a career or an escape, the small victories and sense of place, and then family and commitment, and decades later? he finds himself still here, talking politics and medicine with some curious folks from the United States who are trying to understand.

June 24, 2014 Travelling while Occupied

Blogging retrospectively is a challenge, I am reporting from the ground and the ground is in constant seismic shift mode.

Let me acknowledge that the deaths of the three kidnapped Israeli youths, Gilad Shaer, Naftali Fraenkel, and Eyal Yifrach, provided the Israeli leadership with the opportunity to unleash a horrific barrage of military might, home incursions, arrests, and killings that had little to do with a careful investigation of the crime and the capture of the perpetrators. Collective punishment is still all the rage, and at this point I would just call it official policy. Even the Israeli generals are trying to tone down the “let’s destroy Hamas” rhetoric coming out of our dear prime minister’s mouth. The abduction, killing, and burning of Mohammed Abu Khdeir, on the other hand, is being approached in a totally different manner; there is the police statement that they are not sure if the murder was “nationalistic,” I.e., done by an Israeli, or “criminal,” I.e., done by a Palestinian. Then there was the false rumor put out by the police that Mohammed was gay and that this was some kind of revenge killing by the homophobic family (not). To the Palestinians in Shuafat, a neighborhood of East Jerusalem, this is clearly a revenge killing, and to my eye, given the explosion of Arab hatred, the attempt two days earlier to kidnap a ten-year-old called Mousa Zalum (his parents called the police, no one responded), and the gangs of right-wing Jewish teenagers roaming the streets of Jerusalem chanting “Death to the Arabs!” I vote with the Palestinians. Maybe we should just go demolish a few Israeli homes and arrest a bunch of teenagers, probably start with the lovelies in Hebron and Kiryat Arba; oh, but we don’t do that to Jews. As East Jerusalem explodes, the police use live fire on the inhabitants in the neighborhood (East Jerusalem ID carriers and Israeli citizens, also read: not Jews).

To give this a little context, according to official statistics, since September 2000, more than fourteen hundred Palestinian children have been killed by the Israeli military, which is equivalent to one child killed every three days, and some six thousand injured in the past thirteen or so years. I think a year of national mourning is in order, but this is a military occupation and well, what can I say about who counts and who doesn’t. Which brings us to some other realities of daily life.

I was hoping to tell you more about the realities of occupation, in particular, travelling while occupied. I (and every Palestinian I know) dreads Qalandia checkpoint, the major checkpoint between Jerusalem and Ramallah. It is a chaotic, traffic-plagued military terminal with guard towers and concrete walls and grimy garbage and narrow turnstiles, and people waiting, waiting, waiting. Faces range from utter resignation and defeat to outright indignation and rage. I vary.

There is a sign on entry that says in English and Arabic: “Please keep terminal clean,” but the Hebrew reads: “Please keep order and cleanliness.” Can’t trust those frisky Arabs to stay in line. People queue in narrow chutes, two to three feet wide, with vertical, floorto- ceiling bars and an excruciatingly narrow turnstile that makes passage with luggage, shopping bags, or small children a humiliating joke. The turnstile is controlled by the Israeli security and I note that even the green light does not necessarily mean the bars will turn. Once in the maze, bags are x-rayed and I walk through the metal detector. Sometimes in protest I do not take off my watch and the metal detector buzzes and no one cares, sometimes they do.

I then approach a bulletproof window where I press my passport up against the glass and sometimes get the attention of a twenty-something in uniform on the other side. Sometimes not. There is always a cup of coffee or a phone call or? Communication is challenging.

Two members of our delegation were pulled aside for extra security investigation and were asked questions like: “Do you love Israel?” “Are you afraid of us?” “Are you sure you are not an Israeli citizen?” “Do you love Palestinians?” (Really). Then there are more turnstiles of the humiliation you-are-a-rat-in-a-cage and-we-really-controlyou- in-case-you-did-not-already-get-the-message variety and then you are free to fight for a taxi or a bus or a service with the license plate appropriate for whichever side you are on now. On the “other side” I note a sign in Arabic that says “Judea and Samaria,” in case you are not clear on the concept. My recollection is that there is a sign in English that says, “Have a good day!” or some such thing.

So I was thinking, if I were bent on revenge or strapped in a suicide vest (this is all about security right?) would I really hazard a visit through Qalandia? I think not. So what is this massive, time-consuming, demoralizing daily exercise about? Control and humiliation comes to mind. Also, it might just be easier to stay home and skip that visit to Al Aqsa this year, if one were lucky enough to get a permit in the first place.

June 23, 2014 Building Dreamers in a Nightmare part three

I write this blog belatedly about a visit to the Old City of Jerusalem and Yasser Qous, an Afro-Palestinian who runs a youth center in a cavernous stone structure dating back to the twelfth century. And because this is about two visits in June that now feel like a decade ago, I need to acknowledge the murder of the three Hebron settler youth and the frightening revenge/pogrom- like behavior that now characterizes the Israeli military and some of its citizens. Perhaps if you get to know some of the folks who are now at risk (I.e., any Palestinian), although they were at risk before, it was just more invisible, you too will be filled with dread and worry and horror.

Yasser Qous is wearing a dashiki and has a warm, open face, a shaved head, and a rolled cigarette in his mouth. He is dark, has very expressive hands, and an intelligent, laid back manner. He says, “The Old City is like our house,” and welcomes us as if we are his personal guests. He grew up here, became active as a student at Bethlehem University, his father came from Chad in 1952. He works with city youth doing photography and alternative media, and he is involved in psychosocial interventions around issues like drugs and sexual abuse. He comments that there are no addiction treatment centers, that drug use is a symptom of hopelessness and lack of opportunity, and thus it is a political problem. His program is preventive rather than treatment-oriented. He finds that the Israeli government is only concerned with drug use when it starts affecting Jewish youth. There are the usual stories of house demolitions and a new policy of house arrest for teens.

We see a drop-in caf? with sprawling couches, drinks, and ice cream, and a TV that is nonstop World Cup. He is very excited about the upcoming Ramadan events; there is a competition between neighborhoods for the best light decorations. (The Old City is starting to look a bit like Christmas in Queens.) He explains that the rituals of Ramadan include all night celebrations with Sufi dancing and music, followed by quiet (thirsty) days. I am told that hunger is less of an issue around day three of the fast, which lasts from the morning prayer (three to four-ish a.m.) until sunset (in the unforgiving Mediterranean heat).

Since unemployment is such a huge problem in East Jerusalem (60% poverty rate for Palestinians in East Jerusalem), the center is involved in training and supporting small business. They are part of a tourism coalition that sells handicrafts, but the crafts are all from Nablus and Hebron. “What is the East Jerusalem identity?” he asks. The center is involved in reviving East Jerusalem handicrafts based on research and training. They have a good relationship with a French development agency and an upcoming project involves supporting ten street sellers (they all need permission from Israel). Twenty youth will be trained to create a photo studio on Al-Wad Street (the main street); they will take photos of the Old City and sell them, create and sell handmade accessories, and do alternative, socially oriented tours from four p.m. To midnight. They also do art and music, have a band, dance dabke (traditional Palestinian dance), hip-hop, and Brazilian capoeira. They have made good relationships with African American students from the United States and did an event for a South African representative.

Yasser explains that most Africans came in the fifteenth century to Jerusalem as Muslim pilgrims on the hajj (to pray at Mecca and Al Aqsa), but many settled here, particularly towards the end of the Ottoman Empire and during the British Mandate when it became more difficult to go home. This youth center was previously a prison after the Arab revolt, before that a compound/hospice called a ribat [see Wikipedia: “a ribat (Arabic: ???? ) riba?t, hospice, hostel, base or retreat? These fortifications later served to protect commercial routes, and as centers for isolated Muslim communities.

Ribats were first seen in the 8th century.”]. This compound is the oldest ribat in Jerusalem, founded by a Mamluk sultan who brought slaves from Egypt.

With the British Mandate, the property went to the Mufti and the African community settled here. After 1948, half left to Jordan, some to Lebanon, and others to Jericho, Tulkarem, Khan Younis in Gaza, and the Negev. There are now 350 mostly Afro- Palestinians in Jerusalem out of a total 183,000 Palestinians in the East Jerusalem municipality; they call themselves “coconuts,” Black outside, Palestinian inside. Their main connection with each other lies with the hajj. They have been part of Palestinian resistance, martyrs in all the wars, and many have been imprisoned. The first female political prisoner was Afro-Palestinian and she spent thirteen years incarcerated. The neighborhood is subjected to frequent collective punishment at the hands of Israeli security. Many have intermarried with Palestinians; “marriage is between families, not individuals; we want someone from the same class.” They are proud of their roots but not well-connected to Africa, are Muslims and Christians, and face discrimination (Black, Palestinian, lower class) and high unemployment in Jerusalem. Most are from Nigeria, Senegal, Sudan, and Chad.

A week later, he takes the delegation on a tour of East Jerusalem, through the many Muslim and Christian sites. Warning: I find religion very problematic here. We are talking the BIG ONES like the Fourteen Stations of the Cross and the Church of the Holy Sepulcher?where Christ was crucified, for the Jews and atheists and generally uninformed in the group. We are swarmed with teeming Christians of all colors and stripes, each tour in different colored tee shirts or hats; they are obviously deeply moved by the religious holiness experience that seeps in everywhere in this ancient, complicated city. Interesting tidbit: by legal tradition, a Muslim family opens and closes the Church of the Holy Sepulcher each day because there was too much fighting for the honor between the many Christian sects. (Sigh, Christian values?) He keeps advising us to “stay in the shadow” so we won’t get roasted by the sun. A right-wing Jewish group, Ateret Cohanim, which conveniently has established a yeshiva in the Muslim Quarter, using Palestinian collaborators, rents and sells houses to Jews and displaces Palestinians.

(Jewish values? Oops, displacement is the goal). We see four Jewish families in their gated and guarded home, armed guards walk the Jews out of the Muslim Quarter to the Jewish Quarter (which was depopulated of Jews in 1948 when it was taken by the Jordanians).

Yasser explains that not only are these folks expanding into Muslim and Christian sectors (no one else can get permits FYI), but they are creating a Jewish ghetto for themselves. In the Jewish sector, which is obviously well-funded and pristine from an archeological and touristic point of view, along with the arty shops, great jewelry, etc., there is evidence of all the different conquerors who built on top of the preexisting civilizations lo these many centuries. We wander down the Cardo, the ancient Roman market with a multistory excavation that goes deep into the ground. Armed security guards escort herds of young children to their destinations, and I can only think they look like tough teen boy babysitters with guns and walkie talkies and what are the children learning from this daily experience? Life is dangerous and “they” all want to kill us? The abnormal becomes normalized.

The youth center created the Longest Chain of Readers at Damascus Gate, six thousand kids reading books and then donating them to libraries. They were celebrating a kite festival with three hundred children, but the Israeli Defense Forces attacked the event and destroyed the kites. (Do they really have to be this way?)

When Yasser was ten years old he was given a book, Children of Palestine, and the introduction explained that life is like theater, there is the audience and there are the players. It was at that point he decided that he wanted to be a player. Just imagine the dreams that were crushed in those flying kites. So why are kids throwing stones? Wouldn’t you?

June 23, 2014 Water and Salt part two

We meet with Randa Wahbe, the dedicated and articulate advocacy officer at Addameer, on the sixty-first day of the longest hunger strike by administrative detainees in Israeli jails. The strike is a political strike, I.e., not for improving prison conditions but for ending the Israeli policy of detaining people without charges or adequate access to a lawyer, sometimes for years; six years or more is not uncommon. At the time of our meeting, there had been no negotiations, but as I write this a week later, the strike has ended, some secret deal has been met, and there is mostly speculation: What was decided? Did the hunger strikers feel that this was not the right time when the public is obsessed by the three missing settlers and the World Cup and Ramadan? Who knows?

Whatever the outcome, prisoner issues are central to Palestinian liberation; eight hundred thousand Palestinians have been arrested since 1967, 40% of the male population. Thousands of Palestinians are held in this limbo land of administrative detention. The striking prisoners are put into isolation, cannot go outside or have family visits (they often do not see their families because of permitting and travel issues anyway). The prisoners receive monetary fines taken from their canteen account. Sometimes they have limited or no access to lawyers or they are transferred around to different prison hospitals so the lawyer cannot locate them. At the time of our visit, there were at least 130 hunger strikers, the movement was growing and may have reached 300. The hunger strikers are beaten, denied medical care, and are only treated by prison doctors (who clearly have lost their ethical compass), who are known to be abusive, dangle food or force-feeding tubes in their faces. Prisoners are shackled twelve hours per day and, as you can imagine, the conditions are pretty horrific.

The prisoners were drinking water and salt for fourteen days; Randa reports the Israeli authorities then denied them salt, some may be taking some unknown supplements that “barely keep them alive. As an organization, we are very concerned because of the lack of negotiation between the Israeli prison service and the prisoners, will there by martyrs?” A lot of administrative detainees are older than sixty and not striking, but other prisoners are striking in sympathy. There appears to be a trend to arrest Palestinians shortly after their eighteenth birthday as they can be tried as adults. The youngest hunger striker was arrested five days after his eighteenth birthday, “He is still a child, but he has been in prison for two years.” There have been over four hundred arrests since the 12th of June; seventy-seven are in administrative detention.

And then there is the heart-breaking issue of child arrests.

Although Israel technically changed its policy and has child courts, Randa reports that children are treated like adults. They are often arrested between midnight and five a.m., families don’t know where they are going. They are interrogated without a lawyer, not allowed to see their families. The military court judge is the same as for adults and Randa explains that the children are routinely tortured by their interrogators. This is mostly psychological torture, threats that they will be killed, sexual abuse; they are put into solitary confinement, have florescent lights on twenty-four hours per day, are placed in stress positions, and beaten. The forced confessions are then used to arrest adults in the community. So imagine you are an eighteen-year-old boy, you have seen your father and grandfather humiliated at checkpoints, you have watched settlers steal your land and water, and, very possibly, you have thrown stones at a passing Israeli jeep that has arrived to make your life a living hell. And then you crack in prison and are responsible for your own brother’s arrest.

Many children never return to school, develop bed-wetting and behavioral problems. With these brutal policies, we are witnessing the slow destruction of Palestinian society and the creation of environments that will create more angry, hopeless, militant men seeking revenge. In Silwan, there is a fourteen-year-old who has been arrested six times, mostly for throwing stones, according to IDF soldiers or settlers. So why are we doing this Mr. Netanyahu? Palestinian parents pay fines to release their children, and last year, Palestinians paid thirteen million shekels into the Israeli military court, in a bizarre sense, financing their own imprisonment.

And did I mention that prisons are increasingly privatized, sort of like the United States?

In general, Randa explains, administrative detention under international law is allowed if an individual is threatening the security of the state. This should be used rarely. But in Israel, the military claims the Shin Bet has “secret files” that show that this person is a threat to the state. “This is used arbitrarily, there are obviously no files. Let’s look at who gets arrested: prominent activists, academics, regular folks. Recently a political scientist was released, after two-and-a-half years without any charges. He has no idea why he was arrested this time, [suffice it to say that] he is an academic who writes about resistance, attends demonstrations, and has been in and out of prison for years. One of the hunger strikers is a prominent community member, part of an agricultural union who promotes farmers’ rights; he has been in and out of administrative detention for years and was rearrested in February.”

At the time of our visit, a bill to allow forced feeding was to be voted on in the Israeli Knesset, although forced feeding is regarded as a form of torture, people have died during the procedure, and it is used to break the strikers. Even the Israeli Medical Association is against it. The bill did not pass, but today (June 30, 2014) the Knesset is voting on another bill that would permit doctors to do forced feeding without risk of punishment. Netanyahu has framed this as an issue of internal security: forced feeding is for the safety of Israeli citizens, because if a prisoner dies, “it will threaten security of Israelis in Judea and Samaria.” And then they play with words, artificial (not forced) feeding, moderate restraints (rather than the full shackling that is used), etc., etc. The doctor has to recommend forced feeding, “for the benefit of the prisoner”; this is signed off by a district court, which gives the whole process the air of legality.

In the last month, there have been other worrisome bills: one to deny amnesty to prisoners who are released in exchanges (Israel has released seventy prisoners arrested before Oslo in 1993); this perpetuates the definition of prisoner as automatic permanent terrorist. Pro-prisoner demonstrations were suppressed by the Palestinian Authority and the IDF, especially in Hebron, where there was a demonstration by mothers of prisoners. Since June 12, five Palestinians have been killed, and, in addition to the four hundred arrested, there have been eight hundred home incursions, lots of injuries and road closures. The Palestinian Authority has security coordination with Israel, which is facilitating the siege on Hebron. Two nights ago in Ramallah, PA officers shot demonstrators storming the police station. Currently this is the largest military operation since the Second Intifada, and for me, the strangeness is that it is largely happening under cover of darkness. By the time the sun comes up, most of the Israeli forces are out of the villages and homes and universities and everything looks deceptively normal unless you live in Hebron. The world community may not even notice, there are no tanks and no phosphorus bombs to catch anyone’s attention.

Randa talks about a host of other human rights concerns and the picture is grim. Children born to mothers in prison are kept in prison for two years with no extra space, food, or medical care; they are basically born with a prison record. Pregnant Palestinian women who are arrested get no prenatal care, no special food, etc., and give birth shackled. The prisons are dirty, prisoners have to purchase their needs from a canteen, there are often no family visits; it is an utterly dehumanizing climate. There is a case now that won’t allow a granddaughter to visit her grandfather, the courts say they have to prove their relation to each other, or mothers are asked to prove their relationship to their children in prison.

When people are released, there is some support from the ministry of prisoner affairs, dedicated to legal aid, financial and medical assistance, but not many resources available for rehabilitation. The prison experience is so normalized within the community, there is lots of community support, but not much treatment for PTSD (posttraumatic stress disorder), which just about everyone has.

Interestingly, there is no housing or employment discrimination; the community views these as largely political arrests.

If arrested, there is a higher rate of re-arrest, the IDF targets former prisoners, which basically destroys their lives. There are students who have been attending Birzeit University for eight years because they are repeatedly arrested around exam times, and their education just drags on, or students arrested during the final year of high school so they cannot take the exams critical for university admission.

So why do people get arrested? For starters, there are sixteen hundred military orders that govern life under occupation. (Yes Virginia, there is an occupation; the place is not administered or liberated or whatever euphemism you may hear.) Organizations like student unions and all political organizations are illegal, including technically the Palestinian Authority. This gives the IDF very broad discretionary powers. People get arrested because they are activists like those in Stop the Wall or because they do volunteer work to empower youth. Basically the charges are used to suppress Palestinian resistance in all forms. Randa notes that there have been three arrests of Addameer colleagues in the past year, charged with giving legal advice to youth about interrogation, which is after all part of their job description. “We are all in jeopardy? Going to a demonstration today we could be charged, this is the climate.”

Randa was studying at a university in the United States and was involved in their Students for Justice in Palestine. She moved to Jordan to learn Arabic, came for a conference; Addameer had an opening and she took the job. While her family is still in California (and it is often hard for Palestinians to get a visa), she believes that it is important for Diaspora Palestinians to come back and to do the challenging work of ending the occupation and its immense hardships.

You can read the Addameer website for further depressing details about the realities of military occupation. Think about how Palestinians are portrayed in our media (the boy with the sling shot, why exactly is he throwing that rock and why not portray university students arrested during exams? Doesn’t fit the stereotype?) Think about the meaning of resistance and the unchecked power of an occupying force. And the next time you pay your taxes, think about our US military industrial complex that provides the weaponry and machinery that makes this military power possible.

June 23, 2014 Tarnishing the Israeli Brand part one

Our meeting with Omar Barghouti, one of the leaders of the Boycott, Divestment, and Sanctions (BDS) movement, starts in a stairwell, since the office where we are meeting is locked. (Palestinian time runs, how do I say this? With less urgency? Perhaps related to the cycles of the moon? Still trying to figure this out as an obsessive Westerner.) He is talking about how the Palestinian Authority is “existentially necessary” for Israel, how a single democratic state is the long-term goal, not ideal but a more ethical solution than anything else.

We get ushered into an open office and Omar starts officially talking; words just pour out of him so rapidly, succinctly; I struggle to keep up. Things have really changed in the past year. What many do not realize is that BDS is now a mainstream Palestinian movement that is supported by almost everyone, it is not an isolated fringe activity. Even Fatah supports BDS. The strategy is anchored in international law and, Omar explains, “Targets Israel because it is a regime of occupation and apartheid. This is not about being Jewish.” The Israeli establishment clearly considers BDS a strategic threat. Netanyahu mentioned BDS eighteen times when he gave his talk to the UN; second only to Iran (but who’s counting?). Omar states, “Israel does not know what to do with nonviolent movements.” This defeats the narrative of the Palestinian as terrorist. I think of the Israeli official who admitted, “We do not do Gandhi well.”

While there are well funded, well organized efforts to Brand Israel as a “beacon of democracy” (to quote Netanyahu), to highlight Israeli artists, academics, gays, to present a “pretty face,” “all this washing [I.e., pink washing, green washing, etc.] gets wiped out by one massacre.”

In 2014, Omar asserts BDS is in a different place: the financial, economic sphere. The Gates Foundation recently divested from G4S, a private security company which is known to torture prisoners, builds the Israeli security apparatus, and is deeply involved in the occupation. The CEO of G4S committed not to renew the contract with Israeli prisons, the first time such a public statement has been made. It does not matter that BDS was not mentioned. It does matter that a large company decides that it is too (economically? Politically? Strategically?) costly to do business with the Israeli state. Obviously, pressure will continue until the company comes through on its promise.

Omar informs us that major banks and pension funds in Europe have divested from the top five Israeli banks involved in the occupied territories. Apparently the Dutch are saying that if these banks have operations with companies in the territories, they will divest from the entire bank. “Do not punish the crime, punish the criminal.”

It has always been difficult to figure out which products come from the settlements, and Omar agrees that it is too hard to boycott settlement products. They are often disguised or relabeled (like from the Netherlands), but it is very realistic to boycott companies that operate in the occupied territories, so the tactic should be boycotting companies rather than products. I take note of this development.

Unlike my Massachusetts governor, who is swooning over high tech ventures with Israeli companies, the German government announced that it will not work with all high tech Israeli companies including those in East Jerusalem. The European Union is not joining the BDS movement but implementing their own guidelines in response to grassroots pressure, so they will not give grants for research in the territories. The Luxemburg pension fund divested from the top five Israeli banks. The Norwegian pension fund divested from Israeli companies involved in settlements, but then they took Africa Israel off the list because the company denied involvement. The Israeli group Who Profits? Went to the Jewish settlement of Gilo and documented their presence, but Africa Israel said that Gilo is not in the occupied territories (you know, just part of the expanding Jerusalem neighborhoods). Organizers demanded that they consult the United Nations, who might know a bit more about international law, and the Norwegians got the message and divested. From 2013?14, four US academic organizations endorsed BDS. These are all major developments. Really big.

Omar has a subtle kind of sarcasm. He says that the Israeli government has been totally hijacked by the settler movement and this is new. The labor party is a kind of “smarter Zionism,” but the leadership is now a “dumber Zionism.” Israel is no longer even pretending to stand for peace, coexistence, etc. The academic and cultural boycotts have tarnished the Israeli brand. Even John Kerry acknowledged that there was something seriously wrong with settlement building. In much of Europe, people choose not to buy Israeli products. “We rely on the grassroots to build pressure,” even though in the international world, “the Israeli government is untouchable,” is not held accountable for obvious unjust practices.

So, “do one church, one university at a time.”

The delegates want to talk about the nitty gritty, on-the-ground issues that come up. Omar is asked if there are any mutual funds that are BDS compliant. “Not yet, but it is in process.” He explains that SRIs (socially responsible investing) do not use BDS language (though they traditionally avoid military and environmentally damaging companies), but the change is coming.

We then engage in a fascinating discussion that speaks to Jewish privilege and Jewish power on the left. At the Jewish Voice for Peace conference last year, Omar spoke. He notes that supportive Jewish voices on the BDS issue give it legitimacy and fend off the accusation of anti-Semitism. At the same time, Jewish voices run the risk of expropriating Palestinian voices, thus entrenching Jewish exceptionalism and maintaining the belief that only Jews are “allowed” to criticize Israeli policy. This actually is a form of anti-Semitism, a promotion of the fear of Jews; of powerful Jews who will destroy you if you criticize Israel (thus you need the cover of left-wing Jews). This is not good for anyone, but many Zionist groups thrive on this fear.

Omar maintains that while Jewish voices are critical, it is equally critical to work in coalition, such as with the American Friends Service Committee, the Presbyterians, Adalah New York, etc.

Jewish Voice for Peace, who initiated the TIAA-CREF divestment campaign, pressuring the company to divest from companies that profit from occupation in their SRI portfolio, now works in a wider coalition called WE DIVEST; they are careful not to monopolize the movement but are ready to counter the charge of anti-Semitism.

The recent success in Boston with ending a Veolia contract is related to a large coalition that included union groups as well as Jewish and other faith-based organizations who brought a wide variety of complaints against the company, one of which included its behavior in the occupied territories.

Another delegate wonders how to work in academic institutions like Brandeis University that are largely hostile to the BDS movement where there are something like eight “pro-Israel groups,” (I would like to redefine what it means to be pro-Israel, but that is for another conversation.) Omar explains that he went to Columbia University in the 1980s, where there were twenty “pro-Israel” groups from right to left, and six “pro-Palestinian students.” They felt completely isolated, so they found coalitions with Blacks, Latinos, feminists, and liberal Zionists who were opposed to the occupation (which was a radical idea back then).

They worked on mutual interests such as opposing war, improving the environment. He reminds us that now as well as then, it is important to select a target that makes sense within your community, look for levels of complicity in international law for instance, and potential for cross-movement work; the company’s offenses have to go beyond oppressing Palestinians. Thus it makes no sense to go after a company that makes some great cancer drug in Israel or the settlements, but it makes a lot of sense to link the activities of G4S in building the US-Mexico wall and walls in the territories.

“Trying and failing is not okay unless it leads to education, otherwise it is not strategic.”

But what if there are no Palestinian-led BDS organizations, like in Boston, where there is a lot of BDS activity? Omar advises that we must fill the vacuum until the Palestinian community becomes more active. There are lots of challenges that discourage Palestinians in the United States, from fears related to targeting post-9/11 to Islamophobia. Omar remarks that many in that community are not politically active, but their sons and daughters are.

He notes that campus based Students for Justice in Palestine (SJPs) are no longer having Jewish leadership and that leadership is often coming from Palestinian women. “I understand having Palestinian voices up front, but this is a universal issue. I do not believe in identity politics. The anti-apartheid movement was my movement.

I was doing something right as a human, I own this as my own struggle.” Focus on effectiveness, the quality of the work, anti-racist principles.

In response to another question about how to work in progressive community organizations that partner with Israeli groups on community development, racial and economic justice issues, etc., Omar suggests that we need to broaden the conversation, to “South Africanize the issue.” As an example he asks, what would we have done if Boston University was working with a South African university on cancer treatment during the apartheid era? Yes, that is good for humanity, but the research institution is also complicit within an apartheid system, and this collaboration would have been inappropriate.

He suggests we ask Palestinians about joint research projects with, for instance, Tel Aviv University. It is fine to do research with Israelis but not with Israeli funding (I.e., institutions). So, in our hypothetical case, Boston University should fund the research not Tel Aviv University, thus not legitimizing a university that is complicit in the occupation. In the same vein, Israeli filmmakers, artists, and poets can be invited to festivals in a “BDS friendly way.” For instance, at the Edinburgh festival, the Israeli embassy in London paid a filmmaker to screen her film. The festival was told that if they accepted this money, people would boycott the festival.

The festival returned the money from the Israeli filmmaker and paid for her to show the Israeli film; “there must be no institutional links.” In another example, Omar explains that a Canadian LGBT artist in a Scottish festival found out that an Israeli artist was sponsored by the Israeli foreign ministry. The Canadian put pressure on the festival, wrote a letter to every artist. The Israeli embassy said the artist is pro-Palestinian, this is a dissenting voice, etc. “But we do not care about content; this is not about censorship, it is about funding.” The Israeli sponsorship was cancelled and the artist came to the festival.

A particular challenge involves communities of color, who often come to Israel on religious pilgrimages or as cultural exchanges.

Omar explains, “It is easy to get a free trip to Israel, so South Africanize the issue.” If you want to come on a “fact finding mission, then do it without complicity, do not cross the picket line. This is happening more and more. Israel helps us to convert people, if they come on an honest fact finding mission, they see what is going on.” We talk about our African American governor, Deval Patrick, as a particularly challenging case. Omar advises that the “the black community is key to BDS, we need to win them.” There is already a high conversion rate among young Jews (see the work of Peter Beinart), who at this point are largely somewhere between apathetic about Israel to supportive of Palestinian rights, but clearly different than their Zionist parents and grandparents. The Israel machine focuses on African Americans, Native Americans, the Asian community, framing the issue as, “Jews are the indigenous people!” “Join us in our struggle.” Colonialism is conveniently overlooked.

African Americans, students, women leaders, are invited to Israel to promote an historic Jewish?Black alliance, we led the civil rights movement and we can do it again.

Friends of Sabeel, the Kairos document, and Christian liberation theology work to counter this Zionist ideology, but it is a frustratingly slow process. Omar advises us that, thinking of the recent alliance between Cornell University and the Technion, the Israeli establishment will continue to score big successes at high levels; the US establishment is profoundly “pro-Israel,” (in the classic use of that word). “Forget the big elephants, chip away, and attack smaller things. The Technion was not selected because it was the best, there was a well-planned conspiracy and work was done before to make it happen.”

I am beginning to feel like a white civil rights activist working in the Deep South in the 1960s. The parallels are striking and the historical connection revives me. Time to take all of this conversation home.