Who Matters? Pandemic in a time of structural violence – May 5, 2020

First published in Mondoweiss.

Focusing on the COVID-19 pandemic as it impacts Israel/Palestine provides us with a unique case study of the realities of health care and public health in a racialized and unequal society.

Israel reported its first case of the coronavirus on February 21, a woman returning from a cruise.* In the second week of February, the coronavirus was found in Bethlehem in the West Bank, introduced by foreign tourists, with another wave brought in by day laborers returning from Israel and Jewish settlements. Gaza’s first two cases were noted on March 22, two men returning from Pakistan. The data from East Jerusalem is difficult, partly because Israel considers East Jerusalem part of “unified Jerusalem” while the Palestinian Authority maintains that East Jerusalem is in the occupied West Bank. That said, on March 10, six East Jerusalem Palestinians were quarantined and the first death was reported April 18. The acclaimed world map and dashboard by Johns Hopkins University’s Center for Systems Science and Engineering initially erased the Palestinians altogether, then acknowledged the occupation, and finally changed their “country, region, sovereignty” to the West Bank and Gaza, with no separate designation for East Jerusalem.

While the virus recognizes no boundaries, each of these regions experienced the pandemic with a different underlying social and political reality. Israel, a first world country (the World Health Organization lists Israel in the “European region”) with a history of top-notch hospitals, research facilities, and universal health insurance, also suffers from a decades-long defunding of the social safety net and grave social and economic inequities. Since the1970s, analysts note that investment in health, transportation and education has declined and the government has focused on tax cuts, welfare for the ultra-Orthodox, building settlements, and maintaining an expansive military. Thus decades of neoliberal policies have left critical elements of Israeli society neglected and poorly prepared. Much like the U.S., as the numbers of cases grew, physicians and senior health officials publically noted the lack of ventilators, “disparities between the central and peripheral communities,” structural concerns, inadequate care in retirement communities, the lack of PPEs, suboptimal leadership, and a lack of attention to other diseases.

Palestinians, who make up 20 percent of Israeli citizens, are systematically disadvantaged with less institutional resources and poorer health outcomes than Jewish citizens. Ultra-Orthodox communities suffer from a lack of modern education and connection to the media and public health. Groups like asylum seekers and prisoners are marginalized economically, politically, and medically.

Palestinian Members of the Civil Defense disinfect the streets as a preventive measure amid fears of the spread of the coronavirus, in Khan Yunis in the southern of Gaza Strip, on March 23, 2020. (Photo: Ashraf Amra/APA Images)
PALESTINIAN MEMBERS OF THE CIVIL DEFENSE DISINFECT THE STREETS AS A PREVENTIVE MEASURE AMID FEARS OF THE SPREAD OF THE CORONAVIRUS, IN KHAN YUNIS IN THE SOUTHERN OF GAZA STRIP, ON MARCH 23, 2020. (PHOTO: ASHRAF AMRA/APA IMAGES)
As the infection rates turned upward during the last two weeks of March, the Israeli government launched an organized public health campaign promoting social distancing, a national emergency was announced with a shelter-in-place order and the closing of all but essential services. Air travel was shut down and entry from Gaza, already severely limited, was closed apart from “exceptional cases.” By the end of March, Israel closed the West Bank as “a precaution against the coronavirus” although the number of coronavirus cases in Israeli citizens was 40 times greater than in the West Bank. By April, Israelis were advised to wear masks, and haredi hot spots were under closure. Sophisticated public health and health care institutions prepared for the rising national medical needs.

In the West Bank and even more so in Gaza, the health care systems have been severely impacted by decades of de-development, occupation, siege, restrictions of movement for health care professionals and patients, and repeated military assaults that have destroyed hospitals, clinics, access to medications, water and sewer treatment plants, and electricity. In the West Bank, of the estimated 775,000 Palestinian refugees, a quarter live in 19 overcrowded refugee camps, while in Gaza 70 percent of the approximately two million people are refugees, of whom 600,000 are spread among eight devastated camps.

Understanding the inherent inability to adequately respond to a massive pandemic, the main focus of the Ministries of Health as well as UNRWA, WHO, UNICEF, and a host of other NGOs, has been on prevention, quarantine and sheltering in place, and upgrading treatment facilities. In early March, the Palestinian Authority declared a state of emergency and instituted strict closures throughout the West Bank with schools, universities, banks, and government offices, hotels, restaurants, and shops shut down. In Gaza, Hamas and the civil authorities closed the Erez crossing to Israel, placed Palestinians entering from Israel or Egypt in isolation, and began the development of isolation facilities in field hospitals, schools, and hotels. Schools, universities and mosques were closed. Crowded refugee camps began disinfection programs all over the occupied territories.

With a population of approximately 3.2 million, the West Bank has an estimated 210 ICU beds and between 120 and 256 ventilators. The two million people in Gaza are served by 65 to 120 ICU beds and 63 ventilators. Both areas have a serious lack of testing capacity as well as an urgent need for more ventilators, intensive care units and equipment, PPEs, medications, and trained staff.

In East Jerusalem, Palestinians are residents rather than Israeli citizens. They have suffered from a combination of chronic and acute Israeli neglect and Israeli refusal to allow the Palestinian Authority to establish efforts to combat the virus. The Israelis only agreed to open testing centers in East Jerusalem in the Shuafat and Kafr Aqab refugee camps after a petition was submitted to the Israeli Supreme Court. The Israeli health ministry does not distinguish between Arab and Jewish neighborhoods when tracking coronavirus cases. Currently, while Palestinians in East Jerusalem can be sent for care in Israeli hospitals, they often seek care in East Jerusalem. Of the six hospitals located in East Jerusalem, there are only 20 to 22 ventilators and 62 to 72 beds prepared for coronavirus patients in two or three high level hospitals. The discrepancies in reported numbers in the oPt speaks to the underlying structural weaknesses, competing authorities, and lack of organization in the region.

One of the critical points to this discussion is that the occupation and underlying racism and discrimination in Israel/Palestine persist unabated despite the public health emergency and the interrelatedness of communities and shared risk.

Israeli forces continue to arrest and imprison Palestinians, including children, demolish homes, and facilitate settler attacks that take advantage of the quarantines. Settler attacks have risen 78 percent. Soldiers, sometimes wearing protective gear and masks, raid Palestinian homes, fire at Gazan farmers and fisherman, spray herbicide on crops in Gaza, arrest Palestinian volunteers in East Jerusalem engaged in disinfecting public facilities, and dismantle Palestinian field clinics in East Jerusalem and the West Bank. When the coronavirus was documented, Palestinian communities like Bethlehem, Beit Jala, and Beit Sahour were put under Israeli military closure, while surrounding Jewish settlements like Gilo and Har Homa were not. Similarly, areas with documented infection such as Ashkelon, Jerusalem, Ariel, and Petah Tikvah were not placed under military closure or total quarantine. When Hebron was under closure, Jewish settlers were allowed to march the streets in a raucous Purim parade.

Even when there is coordination between Israel and the Palestinian Authority, Israel refuses to release desperately needed funds it deducts from taxing Palestinians. There are a number of reports that Hamas and Israel are holding indirect negotiations for a prisoner exchange deal in exchange for humanitarian aid. Emergency regulations have ended family and lawyer visits for Palestinian prisoners in Israeli jails, with phone consultations allowed only if cases are imminent.

Racist attitudes and behavior are also clearly seen in Israel within the Green Line. Ironically, Palestinian citizens of Israel represent 17 percent of the country’s doctors, 24 percent of the nurses, and 48 percent of the pharmacists and they take care of everyone. An early issue was the lack of Arabic language updates and critical health information coming from the Israeli Ministry of Health, despite the fact that a fifth of the citizens is Palestinian. There was also a wide imbalance in numbers of cases reported in Jewish versus Palestinian communities, particularly Bedouins, due to disparities in the availability of testing. Similar inequities exist in terms of distance learning as 50 percent of Palestinian students do not have online access and a third do not have a computer or tablet. The situation is even more acute in Bedouin communities who face a lack of electricity, water, and sanitation infrastructure.

Most of the 30,000 asylum seekers from Eritrea and Sudan lost their jobs due to the pandemic and were not eligible for unemployment or national health insurance. Despite an outcry from the World Health Organization, the Office of the United Nations High Commissioner for Human Rights, the International Organization for Migration and the UN Refugee Agency, the Israeli government response was to offer a monetary reward if asylum seekers were to leave the country. In Israeli prisons, Palestinians documented filthy and crowded jails, a lack of hygiene products and a policy of “deliberate medical negligence.”

Tens of thousands of West Bank Palestinians work in Israel and over half of the coronavirus cases in the West Bank have been traced to workers or their contacts. Nonetheless, the Israeli government has denied any responsiblity to test these workers or safeguard their working conditions. There have been reports of workers suspected of illness being dumped at checkpoints with no concern for their wellbeing and no coordination with Palestinian medical authorities. Similarly, while Gazans are portrayed as “terrorists,” Israeli companies are happy to order protective gear from Gazan sewing factories where workers are paid as little as $8 per day. Millions of masks and hundreds of thousands of gowns and suits have been produced by these exploited workers who are desperate for an income.

Given the militarization of Israeli society, it is not surprising that one of the primary responses to the pandemic was to deploy and empower Israeli soldiers to patrol streets, man barricades, and augment the national and border police. Early on it was reported that the Mossad had become a significant procurer of medical equipment, obtaining test kits, masks and protective gear, medications, and technology that may not have been totally “above board.” In a highly controversial move, the police branch the Shin Bet (Shabak), was authorized to use advanced surveillance methods for contact tracing based on mobile phone data, thus employing techniques long used on Palestinians on Jewish Israeli citizens. By the end of April, in a victory for Adalah and the Association for Civil Rights in Israel (ACRI), the Israeli Supreme Court ruled that the Shin Bet must stop using counterterrorism surveillance on coronavirus-positive people in Israel and that tracking must be brought under legislative control.

In a similar vein, the Israeli Defense Ministry is considering working with the NSO group, a contentious spyware firm that produced Pegasus, the malware that can be inserted onto a mobile phone. NSO is currently being sued by Facebook for allegedly hacking WhatsApp. The firm’s goal was to collect and aggregate information about Israelis and then assign each a grade that reflects the likelihood of any resident’s exposure to coronavirus. Palestinians who wish to confirm work, travel, or medical permit requests are now required to “‘download an app that enables the military access to their cell phones.’ The app, known as ‘Al Munasiq,’ or ‘The Coordinator’” in Arabic, allows the army to track the user’s phone location as well as access any notifications they receive, files they download or save, and the device’s camera.” Israel’s top arms exporter, Elbit, is also advocating “health” innovations that can remotely test for coronavirus by using radar to check temperature and pulse.

A review of this data reveals the underlying context of structural racism and apartheid, a reliance on military solutions, and a disregard for the health and lives of Palestinian people who matter less than their Jewish cohorts in the eyes of the Israeli government. When small tokens of support in terms of testing, training, and equipment occur, these are described as humanitarian gifts and examples of Israeli largesse, when Israel as the occupying power is actually responsible for the health and well-being of the people it occupies. The rise in “digital and algorithmic surveillance systems” in the name of public health is a dangerous example of occupation creep that is now leaking into Israeli society as well.

Benjamin Netanyahu and his cohorts are using the pandemic crisis to consolidate racialized surveillance and domination against Palestinians, moving towards further colonization and annexation, and expanding his dominance in Israel itself. Netanyahu has closed the Israeli courts, delaying his corruption case and maneuvering to stay in power by making an emergency deal with Benny Gantz and the Blue and White party. While only a third of Israelis support annexation, public opposition is muted by fears of the virus and extensive lockdowns.

The Israeli occupation and the second-class citizenship of Palestinians can be viewed as a pre-existing condition in this public health crisis. Added to that is the dramatic increase in obesity and diabetes in the oPt as a result of the post Oslo, neoliberal economic changes and the availability of high calorie foods in a population with restrictions on movement and high levels of smoking and other stress-related illnesses. While increased testing, vaccines, and improved health care are critical to everyone in this region, Palestinians have turned to their own ingenuity, creativity, and social cohesiveness in the face of gravely unjust realities.

Ultimately, Israeli citizens will have to face the rising right wing authoritarianism and militarization of their own government and its responses to this public health emergency. Palestinians under occupation understand that their health disparities are embedded within the broader structural violence that is the core of the occupation and siege and that their liberation is the fundamental and necessary treatment during and after this current catastrophe.

*In this discussion, I acknowledge the limitations of the numbers game: Community spread has been highly underestimated, asymptomatic carriers are important vectors for infection, and the lack of reliable and available testing creates flawed data.

Forward global thinking on Covid 19

First published in MOndoweiss

The announcement that nine cases of COVID-19 have been confirmed in Gaza filled me with a new level of anxiety and despair. Gaza is at the beginning of the pandemic curve. With two million people crowded together in area six by twenty-five miles, 70 percent are refugees, 97 percent of the water contaminated and unfit for consumption, basic measures to prevent the spread of the virus will prove challenging. With above a 50 percent unemployment rate and a lack of supplies due to restrictions on the import of goods, it is impossible for families to stock up on essential items and shelter in place, let alone practice social distancing.

While I hunker down in my first world quarantine (with adequate food, electricity, clean water, a home, and phone calls from anxious friends), more vulnerable populations have a much more dangerous prognosis. Groups without clean water and hygiene products, the ability to socially distance from other contacts, and a functional first-world health care system, are facing much higher rates of disease and death. With competent, honest public health assessments, widespread testing and education, and strategic financial support, these outcomes can be mitigated and possibly improved.

Of course, our inadequately organized and funded U.S. health care institutions and governmental agencies are rapidly experiencing what can only be called third world challenges, (a lack of test kits, swabs, masks, personal protective gear, respirators, uninfected staff). This is only made worse by our deceitful and incompetent national leadership, with the notable exceptions of the head of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, other reputable scientists, and health care and emergency workers. (And all the folks working to be sure we are fed.)

While the most vulnerable populations can easily be defined by poverty and lack of resources, this group encompasses a wide range of individuals from prisoners, asylum seekers on the border and in detention centers, to refugees living in congested camps, to people in occupied territories under siege like Gaza and countries under international sanctions like Iran.

There are louder and louder calls to free people from prisons and detention centers, many of whom are awaiting trial or are detained for lesser offenses, or trapped in the immigration nightmare, for their own safety as well as the safety of their guards. There are fewer voices on the international scale. We know what happens to the health of populations under crushing sanctions. The near-total financial and trade embargo on Iraq starting in 1990 resulted in high rates of malnutrition and death, a lack of medical supplies, and the breakdown of many modern facilities. Some scholars and international aid workers likened this to a crime against humanity or genocide– and that was without a pandemic. The rates of bribery and corruption exploded as Iraqis fought to survive and the society deteriorated into sectarian factions, a weakened government, and failed infrastructure and social supports.

When we look at the situation in Iran today, numbers as of March 25 indicate more than 27,000 people have been infected and more than 2,000 have died, although many experts calculate that the numbers are grossly underreported. After Trump withdrew from the international nuclear agreement in 2018, U.S. sanctions pushed an Iranian economy into deep recession, with rising inflation, skyrocketing food prices, and decreased access and outright shortages of medications, critical medical equipment, and massive financial stresses on the nearly universal health care coverage system.

Gaza suffers from a thirteen-year siege, a barely-functional health care system subjected to repeated military attacks and an inability to obtain adequate rebuilding supplies, a decimated civil infrastructure, and shortages of waste disposal, electricity, and fuel. The Gazans are also uniquely vulnerable due to their declining levels of health in the face of poverty and substandard health care. The World Health Organization has warned that large numbers of COVID-19 patients will cause a “collapse” of Gaza’s health system.

Clearly, this is a time of grave urgency and the need for forward, global thinking. To survive as a planet, we need to take care of each other, it’s as basic as that.

While conspiracy theories, incompetency, and complacency are rampant (this is not a “Wuhan virus” or a “bioweapon”), now is not the time to listen to racist, xenophobic, or free market advice. This virus knows no boundaries and the people in charge need to listen to and share scientific data, take advice from other countries, mobilize industries to produce the products we need, and plan on an international scale how to limit the viral spread and distribute needed resources.

Basic to that is lifting the sanctions on Iran and the siege of Gaza in the name humanity and decency. This is not a war; it is a medical and public health emergency on a global scale.

Coronavirus: A good argument for Medicare for All – March 18, 2020

first published in The Seattle Times

Special to The Times
As an obstetrician-gynecologist and member of Physicians for a National Health Program, I have long supported sweeping changes in how health care in the U.S. is financed, from challenging the cost and gate-keeping roles of health-insurance companies to the price gouging by big pharma. COVID-19 has laid bare the weaknesses in our system and the urgent need for Medicare for All. We cannot nationally isolate or personally buy our way out of this outbreak.

As Washingtonians shelter at home and our economy plunges into recession, the problem with a health-insurance system based on employment becomes increasingly clear. Workers are financially incentivized to avoid screening and show up for work despite symptoms. The threat from loss of wages for small businesses and gig workers as well as those on unpaid sick leave raises the negative impact of insurance payments, copays, premiums and the ability to self-pay. GoFundMe reports that a third of its campaigns are done to pay medical bills. The Trump administration’s talk of sending $250 billion directly to millions of Americans is a desperately needed temporary fix that will explode the deficit and ignore the demands for structural changes.

To make matters worse, the Trump administration’s public-charge rule, recently upheld by the U.S. Supreme Court, allows federal officials to refuse immigrants green cards if they use social-safety-net programs. Add to that the tens of thousands of migrants and asylum seekers housed in the more than 200 immigrant prisons and jails in the U.S., not to mention our general prison population, and we have a vast pool of vulnerable, disenfranchised people who suffer from lack of access to adequate nutrition, health care and housing. Poor communities are most susceptible to infectious disease and to a lack of resources to screen and treat. Recently, 700 public-health experts called on the federal government to maintain safety programs, to fund local health centers in underresourced areas, and to be sure that testing, vaccines and treatment be available regardless of ability to pay.

Even before this crisis, millions of U.S. citizens suffered financial disasters due to medical bills, were forced to declare personal bankruptcy, or forego needed care. Some polling shows there is support for Medicare for All, even in populations that are “satisfied” with their health insurer. Often not reported is that Medicare and Medicaid recipients are even more likely to be “satisfied.” The myth that most citizens are “happy” with their private insurance belies the fact that the private health-insurance industry restricts our choices, dictating which physicians, hospitals, treatments or medications we can use. Under Medicare for All, every physician would be in-network, and physicians and their staff would not spend hours battling with insurers.

Ironically, despite the fact that we spend much more money on health care than other first world countries, we are not the healthiest. U.S. infant mortality is 5.8 per thousand live births, in Canada 4.5 and Britain 4.3. The “mortality amenable to health care,” i.e., deaths that could have been prevented by medical intervention, also reveals distressing numbers: 112 per 100,000 in the U.S., but 78 in Canada, and 85 in the U.K.

Medicare for All would restrain drug prices and dismantle wasteful administrative costs, freeing up billions of dollars for health care. This isn’t about restricting care, but rather developing a more effective and fair way to pay for it. Traditional Medicare spends about 2% on administration, less than one-sixth the cost of private health insurance companies.

The Democratic Party needs to solve the critical, fundamental political and moral question: How can we guarantee that no one is locked out of the health-care system due to cost while providing quality care to all? More than 2,500 physicians have signed an open letter supporting Medicare for All. Our patients desperately need an end to the inhumanity of our health-care system exposed once again by this devastating pandemic.

Trump’s ‘Deal of the Century’ is a flawed, ahistorical plan with major health consequences – February 27, 2020

first published in Mondoweiss

Patients at the MSF clinic in Gaza (Photo: Doctors Without Borders/Médecins Sans Frontières)

The Trump administration plan for Israel/Palestine, ironically titled “Peace to Prosperity: a vision to improve the lives of the Palestinian and Israeli people,” is a flawed, ahistorical document that is basically a gift to the Israeli government, affirming and giving international blessings to much of the status quo. The document is framed in classic Israeli hasbara: Israelis are peace loving, Palestinians are plagued by violence and terrorism. The struggle is described as intractable, a clash of religions and cultures, that can only be solved by ignoring history and international law and proposing technocratic solutions to political problems and issues of social justice.

The release of the plan coincided with snarky comments from its authors clearly involving attempts to belittle Palestinians – White House senior advisor Jared Kushner told CNN, if Palestinians reject the plan, “they’re going to screw up another opportunity like they’ve screwed up every other opportunity that they’ve ever had in their existence.” He also said on PBS, “Look, they played the victimhood card. Now, it’s like they want their rights. They want a state[…]Basically what we’re saying to the Palestinians is put up or shut up.”

Meanwhile, in Gaza the health system is on the verge of collapse. Unemployment has reached nearly 50 percent, the per-person ratio of doctors and nurses has dropped, more than two-thirds of households are food insecure, and just three percent of Gaza’s aquifer water is safe to drink, according to official statistics and aid agencies.

More than 400,000 university graduates are unemployed. Seventy percent of those under age 30 cannot find work. Back in 2016 Sara Roy of Harvard University’s Centre for Middle Eastern studies warned, “innocent human beings, most of them young, are slowly being poisoned by the water they drink and likely by the soil in which they plant, all with the knowledge and acquiescence of the world community.” Water is contaminated by sewage, salinization, bacteria, and military contamination. In Gaza this is especially acute for the victims of sniper fire. Bone and tissue biopsies have shown that 83 percent of patients seen by Medicine Sans Frontier in Gaza have infections. “Of those with infections, 62% have multi-resistant organisms like MRSA (methicillin-resistant staph aureus).” Many doctors have left for well-paying jobs abroad. Medicines, medical supplies and equipment are in short supply. Many of the thousands of people who have been injured by gunshot wounds (while exercising free speech) are at risk of losing limbs, “because the surgeons, medications and supplies needed to prevent amputations are unavailable.” There is no need to “play the victimhood card,” when two million people are objectively victims of collective punishment and a brutal siege.

Another Trump administration strategy is to bully Palestinian leadership into submission, from defunding the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) which supplies care to millions of Palestinian refugees, to removing support for a major tertiary care hospital in East Jerusalem. Trump also recently stopped all USAID funding to the West Bank and Gaza. UNRWA clinics in the past few years have made major strides with family-based health teams, cooperation within team groups, the use of e-health medical records, the focus on pregnancy and pre and post-natal care and non-infectious chronic diseases such as diabetes and hypertension and dental care. Nonetheless, physicians see 70-150 patients per day with two to four-minute visits, there are increasing shortages of medications and a very bureaucratic and inadequately funded system. (Non-emergency cases, like hernia repair, are not covered by UNRWA). Refugee, as well as non-refugee patients in the occupied territories, face a mushrooming fragmentation of their health care “non-system” with care provided by UNRWA, the Ministry of Health, NGOs, and private clinicians with duplications, gaps, and chaos complicated by the priorities of international aid groups and donor agendas.

Other countries and institutions are attempting to close the financial shortfall. The 2018 and 2019 budgets for UNRWA were $1.2 billion for their work in the occupied Palestinian territories, Lebanon, Syria, and Jordan. With the $500 million in Trump budget cuts, UNRWA launched the #Dignityispriceless campaign to raise money for health and education. Gulf States provided $200 million for essential services and the EU and Saudis provided funding to upgrade buildings that are often dilapidated and desperately in need of renovation and repair. Japan committed approximately $11.15 million for food assistance and a school for 1,000 students in Gaza, and a sewer system in the West Bank. Despite the Emergency Appeal for the West Bank and Gaza, UNRWA was forced to downgrade programs like community mental health and mobile clinics. UNRWA is also responsible for water and sewer infrastructure in the refugee camps, but the funding has not kept up with population growth.

For 2020, UNRWA has called for at least $1.4 billion for essential services and assistance for projects across the Middle East. Beyond Israel/Palestine, they face daunting needs in Syria, a political crisis in Lebanon, and increasing demands in Jordan. “Many of the 5.6 million registered Palestinian refugees live in 58 camps across the Middle East,” and under international law they are entitled to certain rights such as decent health care, housing, and education.

The World Bank has also stepped in with a new grant of $9 million “to improve Palestinian early childhood development. The project will expand coverage and quality of services for Palestinian children from gestation until age five.” Predictions by the 2018 Human Capital Index reveal that “a Palestinian child born today will only be 55 percent as productive when she grows up as she could be if she enjoyed complete education and full health.” The project will support prenatal care for pregnant women, adequate child nutrition and growth monitoring, as well as early learning opportunities that are crucial to a child’s development.

In the West Bank and East Jerusalem, the U.S. has officially sanctioned the growth of Jewish settlements with the rush of land grabs as Jewish settlers grow ever more aggressive and the very existence and rights of refugees are questioned. This creates rising levels of poverty, depression, and hopelessness while Israeli attacks continue along with increased levels of resistance and militancy. This produces a steady rise of mostly young men injured and killed by Israeli guns and a stressed health care system unable to meet the escalating needs.

In addition, public health threats are mounting, from the lack of potable water and massive environmental contamination from military detritus and Israeli spraying of pesticides in Gaza, to the lack of drinking and agricultural water, pollution from settlements and unregulated industrial zones, and severe restrictions in movement and access in the West Bank.

In the Trump/Kushner plan, there is no recognition of the Nakba, (Catastrophe) – the Palestinian experience of the 1948 Arab/Israeli War, scant mention of the realities of ethnic cleansing, settler colonialism, occupation, siege, or Israeli aggression and duplicity. Oslo failed because of “waves of terror and violence.” Palestinian refugees are mentioned in passing as “pawns” of the powers that be. They are also discussed as the other half of the Jewish refugee problem, an apparent attempt to balance these issues and vaguely hint at the benighted idea that in 1948 a refugee exchange occurred, thus taking this pressing concern off the table. The plan notes, “The Arab-Israeli conflict created both a Palestinian and Jewish refugee problem.” Gaza is described as “a very complicated situation,” the humanitarian crisis solely due to Hamas and its violence and corruption. The views on Jerusalem, (“The State of Israel has been a good custodian of Jerusalem. During Israel’s stewardship, it has kept Jerusalem open and secure.”) can only be described as alternative and perhaps delusional facts. Claiming that Israel has “already withdrawn from at least 88% of the territory it captured in 1967,” must mean that Kushner is counting the Sinai in his calculations, which is not particularly relevant to this conversation.

While there is language in the proposal that acknowledges the yearning of Palestinians for self-determination and a better future, and phrases like, “Peace should not demand the uprooting of people – Arab or Jew – from their homes,” the underlying message is clear. Israeli expansionist and security concerns are paramount, the Jewish settlements in East Jerusalem and the West Bank will remain, the new truncated, mini State of Palestine will be demilitarized and fragmented, the lack of territorial contiguity will be solved by “pragmatic transportation solutions,” “transportation corridors,” and other sleights of hand. Everything will be fine if Palestinians stop resisting, Israel retains massive military and economic superiority, is allowed to continue to expand its borders, and the international community pours billions into the region. Refugee compensation is dismissed in favor of economic assistance. Palestinians must give up their “culture of incitement.” And so on. There is no mention of Israeli culpability or vast military superiority and aggression. Why ever would this be acceptable to Palestinians and their leadership, however damaged that leadership may be?

The utter failure to resolve these issues, to end the occupation and siege, to contain the rightward swing of Israeli politics, to recognize the political and human rights of Palestinians, will be part of Trump’s sordid legacy. An emasculated mini-state is not the answer to these life and death matters.

This plan cannot possibly be supported by those who care about a viable future for Israelis and Palestinians and by those who understand the realities on the ground. In this time of rising autocrats, fascistic and racist policies, and profound disinformation, governments and their institutions are failing. The need to be educated about this crucial corner of the Middle East and to support a strong boycott, divestment, and sanction campaign to create political and economic pressure and to challenge the current discourse is ever more acute.

A hierarchy of vulnerability – February 1, 2020

First published in Mondoweiss

I was recently passing through customs where I popped my US passport face down on a little machine which then opened a gate that led to two yellow footprints in the next compartment. I placed my feet on the footprints, faced the camera, tried to look like my friendly passport photo, and bam, the next gate opened and I was in. It occurred to me that this is both reassuring and creepy. The fact that I have “papers” means that I officially exist, that I am recognized on this planet as a human with some value and protections. Someone in officialdom (not to mention my husband and daughters) will notice if I disappear.

The fact that surveillance systems (at least in the First World), all recognize my passport and my face, can check the criminal history/no fly/terrorist watch list in two seconds flat, and come back “All good,” is actually frightening. As you are probably increasingly aware, between our i-phones, social media, public surveillance cameras, credit card history, and every airport we breeze through or wait for hours, our existence, buying habits, and locations are being closely watched and recorded.

International travel easily provokes some serious thinking about borders and freedom of movement. For me it was an ample opportunity to observe and ponder my first world privileges and the insanities and cruelties that pass for borders and the institutions that create and guard them. I am also old enough to wonder, how did we lose the privacy that we used to take for granted? Or maybe didn’t even know we had, until it was lost.

This problem, however, is ironically a privilege that is only available for people with papers and appropriate documentation. I face the exigencies of travel armed with old fashioned paper books, and the most relevant book I read on the issue of borders was Francisco Cantu’s The Line Becomes a River, Dispatches from the Border. Cantu wrote eloquently of his experiences as a US border patrol agent, his realization that there are no “good” border guards (or soldiers at checkpoints for that matter), when the institutions themselves are corrupted. Borders are imposed political boundaries that reflect states of war, conquest, and colonialism. Migrants and asylum seekers (to clarify: mothers, fathers, children, farmers, teachers, churchgoing Christians, unemployed hungry teenagers, etc.), attempting to cross said borders without “papers” are dehumanized by the militarization of the security institutions, reduced merely to numbers, “wetbacks,” often just skeletons lost in the desert. Even death is no longer counted when the human being lying in the sand or the holding cell has no documentation besides the fact of their existence.

This led me to reflect more seriously on the “borders” with which I have the most familiarity, in Israel, East Jerusalem, the West Bank, and Gaza. Over the past twenty years, I have seen many of those “borders” morph into military installations with the potential for intensive scrutiny and control. This is further complicated by the fact that the State of Israel does not have internationally-accepted and agreed upon borders and even the language describing the land and its legal status is disputed.

The Mediterranean Sea is an obvious boundary that delineates the western portion of the country. Landing in Ben Gurion Airport south of Tel Aviv is an easy entry point for folks the state deems to be acceptable, from happy young adults on Birthright trips to respectable Israel-loving tourists to Christians in search of Jesus and a spiritual moment walking the sacred stones of Jerusalem. But (in my personal experience) there is also a high degree of surveillance that zeros in on travelers who are Muslims, Arabs, Palestinians who have passports from other countries, human rights activists, and supporters of the boycott, divestment, and sanction movement (BDS).

There is also the question of the passport history, i.e., it must be “clean.” The last time I visited Lebanon I had to have a separate unused passport so that neither Lebanon nor Israel knew where I had been. The kinds of folks that are pulled aside are often subjected to hours of hostile questioning, repeated combing through and x-raying of the luggage, demeaning body searches (including strip searches), and if all does not go well, some time in detention while deportation and a ticket home is arranged.

When it comes to papers, in East Jerusalem, which is part of the “eternally united capital of Israel” according to the Israeli government and “occupied territory” according to international law, the Palestinian people living there carry an East Jerusalem residency card. This can be easily rescinded by the authorities in response to a long and constantly changing list of accusations that include lack of loyalty to the State of Israel, or living, studying, or working abroad for some unclear amount of time. East Jerusalemites are also subjected to increasing amounts of mass surveillance, facial recognition, and monitoring of social media. That is also true of Palestinian citizens of Israel. (See the 2018 conviction of Dareen Tatour, an Israeli citizen living near Nazareth, for a poem and social media post.)

Entering Gaza or the West Bank (Judea and Samaria per the Israeli government) is even more byzantine. It is almost impossible to obtain permission from COGAT (Coordinator of Government Activities in the Territories) to cross the Erez checkpoint (a massive military installation) and walk the ¾ mile caged corridor across the no man’s land that is the northern perimeter of Gaza. This is true whether you are trying to get in like me (bringing medical aid and expertise, humanitarian assistance, or journalistic investigations) or out (seeking work, healthcare, university studies, or a visit to your dying grandmother in Hebron).

Access to the West Bank largely depends on who you are and where you are going. The West Bank is divided into three areas with different rules. Jewish Israeli settlers (mostly living in Area C) easily enter on bypass roads, major highways that connect Jewish settlements with each other and with the state within the 1948 armistice line. Israeli citizens are forbidden to enter Area A (Palestinian cities), although human rights activist types often do. Foreign visitors are less restricted but it is best not to mention your intention to visit the region when trying to get into Israel proper, often referred to as ‘48.

For Palestinians living in the West Bank, life is more complicated, restricted by permitting requirements that curtail movement within the occupied territories (and a host of other things like digging a well, building a home, harvesting olives on family land, etc.). There are also restrictions on their ability to leave, which they are required to do via Jordan. The occupied territories is also constrained by the massive Israeli surveillance industry where the latest in internet and social media trawling, language analysis, avatar creation, etc, is tested and used. Biometric data is clearly the new frontier and Israeli and global corporations are eager to do business “in the field.” There is reportedly a network of over 1700 cameras across the occupied territories, perhaps using the same kinds of technology that let me enter foreign countries with a nod and a smile.

As Trump announces new travel bans and further restricts Palestinians in the West Bank with his bogus “plan of the century,” in the world of citizenship, visas, and permits clearly there is a hierarchy of vulnerability, who gets into which fortress, who is left banging on the doors, who is trapped in an increasingly impoverished ghetto. Having papers is both an opportunity and a marker in our increasingly surveilled world. At the same time, we do know that migration (considered “legal” and/or “illegal”) is part of our human history and is only going to increase with rising temperatures, droughts, water and food shortages, and economic catastrophes. While data shows that refugees, migrants, and asylum seekers largely contribute to and enrich the societies they join, in our Trumpian universe their value and humanity is demeaned and demonized.

Which brings me back to Francisco Cantu. He wrote,

“Possessing freedom of movement frees us from the burden of a migrant identity, frees us from the fear that our lives might become defined by undocumented-ness and pervaded by the constant threat of arrest, deportation, and anonymity.”

On the other hand, having freedom of movement is a privilege that is fraught with modern dangers in the context of ever expanding state and global surveillance. Think about this the next time you wave your passport at some anonymous globally interconnected little box or stand with protesters opposing Trump’s wall, monitored by cameras that have become a “normal” part of our environment. As we examine all these systems of control, we must remember that our first loyalties must be to human life and not to the inhuman institutions that currently dominate the world in which we live.