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Medical Closure


N EARLY MAY, aid organizations warned that the Gaza Strip was on the verge of a humanitarian disaster. They claimed that the health and welfare system of the Palestinian Authority was collapsing. International aid funds had been frozen since the Hamas electoral victory in January. Frozen too were the funds that Israel collects for the PA (import duties and the income taxes of Palestinians working in Israel); by the terms of the Oslo Accords, Israel is supposed to transfer these to the PA – but it refused. This brought to mind a statement by Dov Weisglass, former adviser to Ariel Sharon: in the wake of the Hamas victory, he said, the Palestinians would have to go on a diet. Equally chilling was something that the new PM, Ehud Olmert, said on June 20, while Qassam rockets were falling on the Israeli town of Sderot and Israel's air force was firing on Gaza: "The lives of the people of Sderot are more important than the lives of the people of Gaza."

The main hospital in Gaza is al-Shifa. When the shelves go empty, the first medicines not to be replaced are the expensive ones, like chemotherapy drugs and anesthesia. In the last days of May even the antibiotic Erythromycin disappeared. When it's time to restock and the budget has shrunk, hospital officials have to make difficult calculations. At the price of one expensive drug they can buy ten cheaper ones. The minimum number of dialysis treatments is three per week, but they shrink to two. Not all survive the change. In April and May, four died.

On May 24, I asked Shabtai Gold, spokesperson of Physicians for Human Rights in Israel (PHRI), at what point one can call the situation in Gaza a humanitarian disaster. Gold is accustomed to the cynicism of the international community: "Gaza lives basically from contributions. The US and Europe won't let a 'humanitarian disaster' take place. It serves them badly when word gets out that people are dying from hunger or lack of medical supplies. It goes against their interest in preserving stability for the present. They will find the money to quiet things down again. This is not to say that what's happening today in Gaza can rightly be called life, or that money will bring about an absolute transformation, no. But from their point of view, what's important is that no one should die for lack of medicine on the front page of the New York Times. There was an item like that this week. The first dialysis patient died. I assume that money is on the way."

According to a UNICEF report from March 8, 2006, "chronic malnutrition (stunting) in children under five has continuously increased and has now reached almost 10%. Children in the Gaza Strip are most affected." Among children under 23 months – a critical period for development – more than 15% are malnourished, "making them even more vulnerable after the end of the infant period." The rate of infant mortality in Gaza was 23.54 per thousand in 2004. (By comparison, the rate in Israel was 4.96 per thousand.) "Notably in Gaza, the under one year and under five mortality figures have increased by about 30%, mainly due to an increase in the mortality of children under 12 months. This is the consequence of poor newborn care in hospitals. For example in major Gaza hospitals about one in three newborns admitted in newborn care units are dying." www.unicef.org/oPt/FINAL_OPT_Donor_Update_8_March_2006.pdf

The Gaza Community Mental Health Program fills out the picture: the children used to draw birds in the sky, now they draw helicopters.

Politics versus humanitarianism

PHRI does not view the disengagement from Gaza as the end of the Occupation there. It still holds Israel responsible for what happens in the Strip. It is surprising to encounter such a firm declaration at a time when the Israeli consensus, including many on the Left, holds the contrary.

PHRI was founded in 1988, during the first Intifada, by Jewish and Palestinian doctors from Israel and the Territories. They opened a "mobile clinic," which traveled through the West Bank and Gaza. Eighteen years later, the nature of their work hasn't changed. A medical team, consisting of doctors with various specialties, nurses and volunteers, arrives in a village to provide initial treatment. The number of patients can vary from fifty to more than a thousand. There are days when not all can be treated. In two or three cases, lives are saved. For example, a baby arrives with hepatitis that is diagnosed in time. Or the doctors find cases of diabetes that are not being properly managed. Or cancer or heart disease. All such cases are referred for continued treatment to hospitals in Israel or the Territories.

Spokesperson Gold emphasizes that PHRI is not a humanitarian organization, rather a human-rights group that opposes the Occupation: "True, our work has a medical dimension. We supply initial treatment to a limited number, but we cannot and do not want to relieve the authorities of their obligation to provide for the population of the West Bank and Gaza. Work in the field shows us which human rights are being violated, and we are acting for their implementation. We conceive of health in the broadest sense of the term. We take account of all the factors that determine a person's health, starting with clean water, food, electricity, sewage, education, employment and living space. It is quite clear to us that all these are influenced by the political situation, or in other words, by the Occupation."

Gold's approach is shared by the founders of PHRI, but not by all members. I discovered this later when talking with others. Some are inclined to make do with humanitarian work, while refraining from taking a position on the political conditions that determine the reality within which their activity occurs.

Dr. Ayalet Shauer, an internist at Hadassah Hospital in Ein Kerem, has been volunteering for six years in PHRI field days. I asked her what had led her to volunteer. "During my training period, I read an article about PHRI and contacted them. At that time the group was still relatively small. Its work did not have the proportions it has today. I got excited at the chance to combine my work with a political statement. I know our contribution as doctors can't span the enormous existing medical gaps. On the other hand, my voluntary work in PHRI is almost my only way of meeting Palestinians, and for them it's almost the only way to encounter Israelis who aren't soldiers. That is my statement against the Occupation. It's very important to me that Palestinians become acquainted with another kind of Israeli. There are times when we arrive at a village and they can't believe that we're Jewish."

Young and healthy forever

It is Women's Medical Day for the mobile clinic on the outskirts of Qalqilya. The staff consists of three gynecologists, two midwives, a general practitioner, a psychiatrist, a chiropractor, an acupuncturist, nurses and translators. This is a relatively new experiment for PHRI, putting special emphasis on the needs of women. There are routine checks for cervical and breast cancer, but the day also includes discussion groups on health, nutrition, birth, even feminism. The idea is to broaden the clinic's activity to include an educational dimension – for example, on the topic of birth control.

The checkpoints pose a special concern. Dalit, a midwife from Tel Aviv, tells me about a medical day a month ago in Bethlehem: "We arrived with a staff of twenty and found, waiting for us, a thousand men, women and children. We were a bit bewildered. It's impossible for a group our size to treat a thousand in a single day. We couldn't even take half. We decided to organize into question-answer workshops for the women. All the pregnant women were anxious about the day of delivery, even those who'd already delivered before. They worried about being stopped at an army checkpoint on the way to the hospital and having to deliver on the road. There've been 40 such cases in the second Intifada."

Standing with us is Ruhama Marton, PHRI's founder and president. She corrects the figure: "37."

"After the workshop," said Dalit, "we thought that it might be a good idea to create another workshop that would teach women how to give birth naturally at home, and we would train midwives."

Marton counters at once: "And what about those who still have to pass through the checkpoint and reach the hospital? Do we want to teach the occupied how to get along better with the Occupation? With the checkpoints?" Marton, who belongs to the more militant, political group within PHRI, stressed the point: "Our task is not to make the checkpoints more bearable. On the contrary, it's to show people the current reality, to bring home the harm the checkpoints do, how miserable they make people's lives."

To the curse of the checkpoints one may add the new separation barrier: a system of fences in open areas, in the cities a wall 25 feet high. The section being built today around Jerusalem is having catastrophic effects on access to hospitals and clinics. For example, al-Makassed on the Mount of Olives, the most advanced hospital in the Territories, is cut off from most of the population it serves. About 100,000 people in the Jerusalem area, excluded by the wall, are without access to a hospital.

Maskit Bendel, who is responsible for PHRI's work in the Territories, explains the connection between the checkpoints and poverty: "Whoever doesn't have money to finance a two-hour drive to the nearest medical center will postpone treatment for himself and his children. The same is true when it comes to getting medicines or going for an operation."
"Young and healthy had better just stay young and healthy forever," says Dr. Revital Arbel.

The idea for the mobile clinic arose during the first Intifada after a visit to al-Shifa Hospital in Gaza. Since then, PHRI's activities have branched into five main areas:

1. Work in the Occupied Territories. In addition to the mobile clinics, there is a department that helps with the bureaucratic procedures involved in reaching Israel for checkups and treatment.

2. Activity among Palestinian prisoners in Israel, with stress on the conditions of incarceration.

3. Work in the Negev desert among the unrecognized villages, which suffer from the same kind of neglect as one finds in the Territories. Most have no access to electricity, water, education or clinics.

4. Aid and counseling to Israelis. As health services become more privatized, some – especially the elderly – have to pay a large portion of their income for medical services and medicines.

5. An open clinic for migrant workers in Tel Aviv.

The empty shelves at al-Shifa

Shabtai Gold predicted correctly. After the deaths of dialysis patients, the Europeans and Americans sent money. Dr. Jumaa Al-Saqqa, al-Shifa spokesperson, told Challenge that medical supplies had arrived from two humanitarian agencies in the Territories: Médecins du Monde and US CARE. PHRI also collected donations in Israel and abroad, and on June 6 a shipment when out to Rafidia Hospital in Nablus and to al-Shifa.

How long will the medicines last? "Another four weeks," says Dr. Al-Saqqa. Is the hospital functioning? "Yes, the situation is hard, but better than before." One is reminded of the goat story:

A man comes to the chief rabbi of the village and asks for advice. "Rabbi, I have a problem. The situation at home is unbearable. I live with my wife and kids in one room together with the sheep, the goats and the chickens. On top of that, we're poor, the food is barely enough. What should I do?"

The rabbi thought for a moment and then replied that he had a solution. "Buy another goat," he said, "and bring it into the house."

"Another goat!" said the man, dismayed.

"Yes," the rabbi answered, "and come back in a week to tell me what happened."

The man returned a week later, even more despondent, and reported that the situation was worse, more crowded and more noisy. "What have you done to me, rabbi!" he cried. "What shall I do now?"

"Now," said the rabbi, "sell the goat. Come back next week and tell me what happened."

The man came back a week later with a smile on his face.

"How are you?" asked the rabbi.

"Much better." "end"

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