Hewers of wood and drawers of water

Note:

This posting first appeared on Mondoweiss under the heading: The challenges of being a Palestinian doctor in the 'Jewish state'

Here is the link to the article at the website: http://mondoweiss.net/2017/01/challenges-palestinian-doctor/

Hewers of wood and drawers of water

Let me start with a reference and ask the reader to check it out before delving into the delicate matter at hand.

How did I miss this article till now, I wonder?!  Makbula Nassar, our proud journalist, community activist and prime instigator of Arrabeh’s claim to medical leadership, in numbers of doctors if not in institutions, is quoted giving me credit as the first Western trained MD in my village for inspiring its flood of local physicians. Let me acknowledge her praise humbly then try here to give a more realistic explanation for the phenomenal statistics that she provides. Incidentally, my impression is that both she and her fellow Arrabeh Journalist, Mohammad Khateeb, underestimate those numbers.

Perhaps at first I overlooked the patronizing piece because it makes two mistaken assumptions: First it describes my town, Arrabeh, as a “medical mecca.” In reality it is far from that: Both its medical experts and its seriously ill residents have to travel out of their town daily whether to seek employment or for adequate care. Also the article spins the story to credit Israel with the miraculous accomplishment of Arrabeh in the field of medical manpower production. That is what all three readers commenting on the report seem to understand. In fact Arrabeh, and the Palestinian minority in Israeli in general, achieved this distinctive feat in clear violation of the wishes of Israeli planners and despite the country’s standard practices. An example of these policies is the infamous Koenig Report of 1976, the historical document exposing the nature of those policies if not their full details. In the particular field of higher education, Mr. Israel Koenig, then the Commissioner of the Ministry of Interior of the Northern District (Galilee) where the majority of us resided, spelled out the steps needed to discourage, to coopt and to control the numbers of our university graduates. One specific recommendation dealt with ways to discourage our overseas graduates from returning. When his secret memo, submitted to Prime Minister Rabin, was leaked its author was elevated to the post of Director General of the Ministry of the Interior. [In his brilliant foreword to my book of memoirs, A Doctor in Galilee, (Pluto Press, 2008), Jonathan Cook gives an excellent assessment of the background and true impact of the Koenig Report.]

The great majority of our physicians, like other professionals in the Palestinian minority in Israel, with the exception of teachers and nurses, received their higher education abroad. Two factors played a central role in this exceptional achievement: Initially the Communist Party, the majority of whose membership in Israel has always been Palestinian, awarded its diligent youth cadre with full scholarships to universities in the Soviet Union. This was conditional on their return upon completion of their studies to serve their communities and to swell the number of educated party members. The first physician who led this process was my good colleague and cofounder of the Galilee Society for Health Research and Services, Dr. Anwar Awad from the neighboring village of Rama in Galilee.

Simultaneously a parallel spontaneous process started to take root in all Palestinian communities in Israel, including in Arrabeh: Members of farming and working class families would join forces and pool their savings to support a younger son (and more recently a younger daughter as well) to pursue higher education at a local university or, more often, abroad. Considerations of expenses and admission requirements made ambitious students who didn’t qualify for Communist party scholarships opt for Italy, Romania or Germany. In my collection of short stories from my medical practice in Arrabeh, Chief Complaint, (Just World Books, 2015), I alluded to this cooperative family spirit in several of the vignettes. And in the preface I wrote the following:

“In the face of the current wave of distrust and enmity culminating in lynch mobs, I struggle to draw courage from my social surroundings: I ask a village neighbor about his family and he proudly announces that his firstborn is studying biochemical engineering in the USA. I wonder about the high expenses and he raises the electric saw high in his right arm and gives a proud buzz in response, his sweaty brow glistening in the light of the setting sun. I pay a visit to a younger colleague seeking his reassurance in the face of some compromised body functions of mine. He reminisces about his own father, a refugee who put his three boys, now a doctor, an architect and a physiotherapist, through university relying solely on the power of his biceps as a plasterer. My colleague flexes his arm in a proud show of Sumud. A half dozen young doctors and nurses, all grand nephews and nieces, surround me for a photo at a relatives wedding and I feel proud beyond the fidelity and solidarity this implies: Yes, in the ‘state of the Jews’ education is the Palestinians’ strong card: We are proud Sumud and education freaks. Entire families pool their combined labor wages to support a student through college. Young professionals are hard at work to guarantee their community a future and measure up to the high expectations of their hard slugging artisan fathers and mothers, descendants of land-stripped subsistence farmers. The practice and the tradition should be enough to sustain us in the face of the gathering storm.”

As is expected, first only few broke through the barrier of unfamiliarity and fear of the unknown. Then their friends or young relatives followed after such pioneers. This trend prevailed more widely with the fall of the Soviet Union and the opening in many of its former member countries of affordable higher education options. Some programs seem to have been specifically designed as commercial enterprises that target our youth as their customers. Fully accredited English-language medical training programs in Hungary, the Ukraine and Moldavia are examples. The student bodies of such programs are almost exclusively Palestinian citizens of Israel. Recently, similar processes also became available in Jordan and in the occupied West Bank, thus opening wider options in the various paramedical professions as well. Some high achievers among our high school graduates get admitted to Israeli medical schools and few of them even qualifying for the occasional scholarship. But this remains the exception. This begs the question of why attempts at establishing a respectable university in Nazareth have met with denial from the Council of Higher Education for the past five decades. The logic of demand and supply should have worked in favor of such a step. But racial and nationalistic considerations in Israel, especially among the higher echelons of the educational hierarchy, mitigate against such a logical step.

All in all, these alternative pathways to professional training in the medical field and the various health allied professions made it possible for our youth to bypass the two major hindrances that Israeli universities mount in their way other than the excessive financial expenses and the limited scholarships for non-Jews: First there is the minimum age requirement intended to delay our youth for the specific period that their Jewish age mates spend in the compulsory military service. This service gives the Jewish applicants upon discharge automatic priority whether in admission or in financial aid. And there is the culturally biased entrance exams weighted to disadvantage the non-Jewish applicant. This, of course, is no easy matter given the entrenched disadvantage of our separate and unequal elementary and high school educational system. It is thoroughly infiltrated by the Shin Bet, the Israeli secret police, and operates with government budgetary support at one-half to one-sixth of what Jewish schools receive per student. Add to that the disadvantage of our students having done all their studies in Arabic and then needing to compete in exams administered in Hebrew.  And they need to switch to the Hebrew as the teaching language in all Israeli universities. But they do it successfully. Or they strike out abroad to fulfill the Palestinian version of the Jewish mother’s ambition for her son ‘The Doctor.’ Makbula Nassar sums it up well in two words: “pride and survival.” You could also call it resilience, often verging on plasticity. And we have the directive of our prophet Mohammad, God’s blessings be upon him, prodding us to “seek knowledge even if in China,” China being the far end of the known world at the time and the paragon of its wisdom.

Here is the place to point out the two exceptions mentioned earlier: Nursing and teacher training. Our teacher-training tract has always been fraught with the heavy-handed interference of the Shin Bet. Such programs are essentially self-contained system-designed and sponsored processes under the auspices of the Ministry of Education. Despite the many bad apples, it is actually amazing how many decent teachers manage to keep a low enough profile to sneak under the system’s radar and to do an excellent job of teaching their young charges. As to the nursing schools, a combination of severe shortage and the relative validity of the profession’s claim to humanitarianism above all other considerations seem to have opened the door to our youth. A major factor as well is that the nursing school training process permits the students to work part time and earn enough income to cover most of their university expenses. They serve as nursing aids or as scribes for observant Jewish doctors on Saturdays.

These points apply to the Palestinian minority as a whole. The oddity of Arrabeh’s high number of physicians is only that, a peculiarity that proves the general rule. Perhaps we in Arrabeh have a special knack, a little more than other Palestinian villagers, for following the example of pioneers and lead elders of the profession who might have impressed us. And medicine is not the only field. A standard joke claims that in Israel if you get sick on a Saturday you better speak Arabic. Otherwise an Arab physician will make the wrong diagnosis and an Arab pharmacist will dispense the wrong medication.

Two decades ago I joined Dr. Ali Badarni, a senior psychologist, in establishing a rural child rehabilitation center. In preparation we surveying the health manpower supply in our villages. Lo and behold, Arrabeh had over half of all the licensed Palestinian psychologists in Israel. All in all, not only Arrabeh but the Palestinian minority in Israel as a whole is on its way to becoming a major health manpower base for the entire country. Similar to the particular cases of medicine, nursing and pharmacy, all the health-allied professions are rapidly increasing in their numbers in our towns and villages. The Jewish sector is focusing more and more on high tech, on the military and security industry and on finance. Many of its university graduates qualifying in such fields as well as in medicine, find employment in the wider and better paying world market. A less stressful and more secure life experience abroad, whether in Berlin or New York, seems to attract many young Jewish professionals, including medical experts, and to hold them for the long haul.

This brain drain is hardly noticeable among our own Palestinian professionals in Israel. Even those who make it to Western countries for post-doctorate research or for super-specialty training seem to return home regularly. The brain drain carries them no further than Haifa, Tell Aviv or Jerusalem where more and more impressive positions in the institutional hierarchies are opening to them. They stay a reasonable traveling distance from their village whether commuting daily to work or home to the village for the weekend. Something in their subsistence farming village tradition holds them on a short leash even when that farm no longer sustains the expanded and more modern family. Filial piety and the hold of the extended family, if not tribalism, seem still to play a role. Or perhaps it is the virgin olive oil from the family trees or our world-renowned poet, Mahmoud Darwish’s deep down sentiments of “I long for my mother's bread.”

In sharp contrast, there is also the ‘push’ of the undercurrent of mutual distrust given full expression in state sponsored residential segregation between Arabs and Jews, jealously maintained by municipalities and given the stamp of approval by the Supreme Court. It keeps our top professionals from melting away into the zones of their Jewish work places.

Overall, the domestic field in the less racially contentious area of health has gotten more and more accepting of us as employees. Our oversupply of health professionals is absorbed in medical institutions across Israel. Yet even here discrimination does show its ugly head, even if indirectly: In Israel’s near seven decades history not a single hospital has been opened in an Arab community. With Arrabeh’s central location in Galilee, a district with half of its population Arab, and with our oversupply of young health professionals, the long ambulance ride to a hospital is becoming more and more unacceptable. Rumblings of discontent are often heard, as is obvious in Makbula Nassar’s statement in the article that is at the heart of this diatribe. But mark my word, when the Ministry of Health grants the required license, it will find ample justification to place the needed hospital in a Jewish locality next door to Arrabeh. It is the ‘Jewish State’ reality. After all, not only the janitors and parking-lot attendants but also our doctors, pharmacists and nurses working in ‘Jewish’ hospitals reflect an iteration, albeit a refined one, of the biblical enslavement designs on us to serve as “hewers of wood and drawers of water” for the Jewish masters.

Arafat Started the Fires

Arafat must have started all those fires in our country. Or was it Haj Amine Al-Husseini? After all, we all know the Mufti was the one who convinced Hitler to go after the Jews in Europe. Or could it be Mahmoud Abbas since we can slap him at will?

One of the fables from my Arabic language fourth-grade reader told of the bad wolf and the innocent lamb. On a spring day at a riverbank the hungry wolf saw a little lamb close by and started calling him names and accusing him of stirring up the mud and dirtying the clean water. The lamb was really scared but gathered enough courage to explain that since he was downstream from the wolf he couldn’t possibly have muddied up the water in his part of the brook. The wolf responded with acrimonious reminders of whose son the lamb was. We all remember how often your father stirred up dirt in the river in his days, he retorted. And how dare the lamb raise his voice and speak disrespectfully to him. That was enough for the wolf to charge the lamb and finish him off. It was a very festive meal of course and everyone concerned enjoyed the spring weather and the sparkling water.

This all came to mind when I saw Aymen Odeh, the lead Palestinian member in the Israeli Parliament, arguing in Hebrew with an Israeli TV anchorman about the widely accepted Israeli view that so many fires in Israel were started by Palestinian arsonists, a view advocated by government officials across the field. It is of the same genre as Netanyahu’s panicked SOS about Arabs coming out in droves to vote: Palestinians don’t agree on anything that is not malicious. The fact that they are in the vicinity of every fire that broke out in the country proves our point. There is no doubt about the Arab’s culpability: Secret Police officials have confirmed that they suspect Arabs and have taken thirty of them into custody. In a recent piece Gideon Levy broke the silence and announced that the Shin Bet has evidence: They have caught one Palestinian with toilet paper in his pocket. Let us see Aymen Odeh explain that! It turns out officials at the tax authority are the ones claiming to have evidence for “pyro-terrorism” while the police and the fire department are casting doubts on the theory. But politicians, especially the settler colonialist types, know facts when they see them.

I was a little miffed by the fact that my friend Aymen, a lawyer, didn’t use his training, and he is trained in Israel no less, to share with the journalist the professional secret that in the inner sanctuaries of Israel’s halls of justice a person is assumed to be innocent till proven guilty. Well, we all can write off the one with the toilet paper in his pocket. But what about the other twenty-nine? And some news media make the outlandish claim that some of the Arabs seen close to the fires were in fact firemen. Pyromania knows no limits. Take a look at the map our consulate in New York sent out in which it acknowledges and thanks all the countries that helped extinguish those fires. Each has a plane with its own flag. Do you see one with a Palestinian flag? Don’t make me laugh, please!

Others speak of the impossible: They blame the fires on the hundreds of millions of pine trees that the JNF planted to cover all the eyesores that marred our beautiful countryside, all the rubble that the Palestinians left behind when they ambled off for their elective vacations with their next of kin in neighboring Arab countries in 1948. Well, they want you to believe that the drying effect of the winds off of the desert make the resinous pines self-combust. What imagination! Supposing we accept such nonsense for a minute, whose desert did those desiccating winds blow from? Yes, the Arabian desert of course. And they deny it all and argue that many fires are burning across the Middle East, so why not here? If anything, that proves our point. The Arabs are congenital pyromaniacs, every last one of them. I am glad we Israelis are Europeans by nature and nurture. Even Meri Regev is trying hard.

Let me just remind all those inventors of blood libels of their own admission of our superiority. Their own Islamic religion, the source of such scourges as Hamas and Hezbollah, relates the miracle performed by our patriarch, Abraham. When challenged by burning fire, all he had to do was to have God order the flames to turn “cool and peaceful.” And, lo and behold, cool and peaceful it was for him to tread on it like an expert yogi. Yet, now they think they can overcome us by starting fires in our towns and forests. We will have the upper hand no doubt. They have forgotten those German submarines. But we haven’t. Submarines operate in water. And water puts out fires. You follow the logic, don’t you? That is why Netanyahu was involved in that deal in the first place. Remember those boys pretending to play Soccer on the beach in Gaza? We took them off from far away at sea, didn’t we? Whoever developed that ability can develop the capacity to put out fires from submarines in the sea. And vise versa: Fires on land can submerge burning issues of submarines in international waters. That was the logic of the Prime Minister telling the world how the Palestinians were behind all those fires. The info automatically put out the explosive issue at sea that threatened to blow him out of the political waters.

Naftali Bennett has figured it all out. Who is better than him, our minister of education, at the mathematics of a zero-sum situation: He has “blamed the fires on ‘nationalist terrorists’, adding that the fires could not have been started by Jews.” So who is left to start a fire? The answer is obvious: “only someone to whom the land does not belong is capable of burning it.” As we showed above the Arabs are burning the land. Ergo it is not theirs! You follow? And don’t start getting any ideas. “[W]hen Arab lawmakers speak of their love for the land, radio broadcaster Aryeh Golan wonders whether this declaration of love isn’t like telling the Jews that this is not their land.”

Wow! That is Bennett’s straight-line reasoning, the either-or logic. In fact it is known to logicians the world over as the “Naftali Bennet Binary Meme” (or NBBM). Other authorities on logic use the more descriptive name of Straight Hyperbolic Israeli Thinking. (Yes, you figured the acronym right!) It, of course, leads to my self-evident conclusion that Arafat started the fires: Mahmoud Abbas wouldn’t dare do it. So it must be Arafat.

You just can’t keep up with us, can you? We will always be a step ahead of you. I know the Saudis are trying to catch up with us. But they have no chance. Just watch us syphon off their oil money via the USA grants. We call it fighting fire with oil.

Sister Jamileh

Sister Jamileh loves to hear the bells chiming Ave-Maria at sundown. She sits at the entrance to her home in Nazareth and plots the source of the magic tune on the hazy panorama of old Nazareth painted across the arroyo. It seems even more colorful from memory than from actual light refraction. Past ninety now, her vision has failed after the loss of her late husband. The more the doctors tamper with her eyes the less distinct the individual structures in the Nazareth scene splashed before her become; she has to embellish some of those fading shapes with the original colors she remembers from sitting with Sheikh Salah when they were newlyweds and he, the native Nazarene, would identify the main landmarks on the facing mountainside: St. Gabriel Monastery, the French orphanage, Saint Margaret Schooi, The Farah neighborhood, Nabi Sieen Mosque, El-Qashleh police headquarters, … etc. etc. And there is that gulch between Mount Precipice, Leaping Mountain to the locals, and the next mountaintop where one of the Sheikh’s brothers helped build a hotel in the pre-millennial tourism high hopes that fizzled out leading the owners to rent the facility to the government. It housed illegal immigrants, too many for the regular jail system. She remembers the first time Salah related to her the legend about the name Nazarenes use for their imposing mountain: Jesus, whose mother those bells celebrate every night, was chased up the hill by the Roman Legionnaires. He made it to the top and stood at the precipice but was surrounded on all sides. He simply jumped across the gulch to the next hilltop and escaped. Jamileh now is pleased and secretly modulates the sound of her chuckle under her breath to the tune of those bells still reverberating in her head: Perhaps that is the reason they now use the spot to house asylum seekers. Not only was Salah brilliant but so were his next of kin.

That Jesus must have been a superman like Sheikh Salah. Salah had brought her from Arrabeh, a village he and his citified fellow Nazarenes associated with door-to-door salesmen of virgin olive oil and sweet watermelons. True she didn’t work the fields like all her childhood friends did; she came from one of the few landed families that had local sharecroppers till its land. But in the subsistence farming existence of her childhood the difference was of little significance. No one in the village lorded it over others enough to escape the drudgery and the beauty she now remembers with tender nostalgia. They all lived close to the land eking a life directly from the earth. She and Fatimah, her older sister, had to collect greens from the fields, draw water from the rainwater cisterns at the edge of the village, gather firewood from the mountains and tend to all the household chores. They baked bread, cooked three meals a day, cleaned the yard and tended the little ones and the chicken and pigeon flocks. And there was her father’s prize apricot orchard and vegetable garden that occupied everyone’s cool afternoons. Except for the few rainy months when the red earth turned muddy, they hand tilled that land, weeded around the apples, the pears and the apricots and carried loads of composted natural fertilizer on their heads from the closest garbage dump to the receptive land. And, as if for leisure, they gathered the endless supply of stones that their land seemed constantly to expel from its entrails and carried them to the perimeter of the field for their father to practice his mortar-less wall-building skills clear around all four-acres. Yes, the Medan was always a fun chore especially in early summer when the whole village would come to pay tribute to its owners and to partake of their plentiful fresh produce. And there was that other backbreaking but happy occasion of the olive picking season. That always ending on the day the oil was brought home from the press with a msakhan feast that thinned out the flock of chickens and with a full container of Halva for desert.

Then Fatimah got married. After soldiering on for a dozen more years she lost her mother, a city girl from Akka who never adapted to rural life, to typhus. Jamileh, having experienced the tragic loss of two first-cousin fiancés, one after the other, redoubled her dedication to her diabetic father. Only after his death and her slide down from her prestigious role at his side did she consider marriage again. That was when Sheikh Salah Elafifi happened to ask for her hand in marriage. She accepted and he proved to be more than a worthy match, almost the equal of her late father, may Allah engulf both of them in his mercy. It must be easier for men to achieve greatness than it is for women. How else can she explain encountering so many exceptional men in her life who verged on godliness? And though she loves the Ave-Maria music still wringing in her ears, it was Jesus who performed miracles and jumped over mountaintops. She is now completely torn between her fond memories of her father and of her husband. And there is Jesus, peace be upon him.

True, Arrabeh’s door-to-door salesmen were not how Salah found about her. On the contrary, he was the one to journey north to her village to earn a living as a stonecutter molding his solid ware into a minaret for its very first mosque. That one was built on the foundations of a church. Was that another coincidence, she wondered? The two faiths always played an integral role in her life. Who knows if it didn’t all start as a Canaanite temple of sorts? Arrabeh, with the Middle East undercurrent tug of religious war and the likely secret infusion of Wahhabi oil money, has since flourished into a seven-mosque town. Its own homegrown imam takes credit for most of that. He once sought Jamileh’s hand in marriage, she now reminisces. And he wasn’t the only one. Her father was still alive and her dedication to him in his old age led her to refuse many attractive offers of marriage. But it turned out all for the best. God rewards all good deeds and He knew she accumulated enough credit with Him: Look how many adoring children, grandchildren and their children she inherited from Sheikh Salah, not to mention Anwar, her own flesh and blood who is there for her day and night, a good lawyer and a pillar of a respectable clan in the city.

Yes, the city, their son Anwar and the five children Sheikh Salah brought into the marriage from his former union with his late first cousin. That legacy was the crux of her new life after she turned the page on her rich past of forty years in Arrabeh. Jamileh never took anything for granted. Whatever challenge each new day brought she faced with courage and determination. That was one thing Arrabeh prepared her for; the principle if not the details. Forty years of challenges and surprises all of which she had excelled at negotiating. In the process she had raised and sustained a slew of siblings three of whom she had helped put through high school in the city. She had cared for a cantankerous diabetic father through thick and thin. And she had gone through two traumatic first-cousin engagements both ending in the death of her fiancé and all the filial tug of war to keep the memory of a young martyr alive. On her part, all she salvaged from those prearranged romances were two tiny squares from the cloth presents she had received on those festive occasions. She spent near fifty years of rewarding life in the city under the wing of Salah Elafifi, founder and self-made founder of The Peace Mosque of Nazareth. Then he too departed and she added a third tiny piece of fabric from his present to her on the occasion of their engagement to her secret collection. What more private place to treasure those three sentimental mementos than the drawer of her precious Singer hand-sawing machine, one of the few memorabilia that she still keeps from her village days.

It is strange how well she can still distinguish the sheen of each of those three tiny pieces of cloth despite her failing sight. Time has done little to blunt the visual or tactile impact of each of them on her senses. But with aging each of them has acquired its own unique individuality: Opening the tiny drawer she can distinguish them apart without looking at them. Each has its specific personality beyond color, touch and smell. There seems to be an ‘Ahmad El-Ali’ essence and distinguishing character that seeps into her body upon holding that one piece, the oldest of the three; it is imbued with its own special character; it floods her ninety-year-old body with that haughty and rebellious spirit of village youth. And the next one reeks of the majestic power and uprightness of the uniformed soldier named Mohammed Ibrahim. No it is not the color, not the touch nor the size. It is the basic quintessence of the tiny thing that screams with its individuality. How can she ever not tell those three pieces apart! True, the brightest is the one from Sheik Salah. And it is the only cloth with its own distinct scent and flavor. She swears she can still touch her late husband every time she opens that tiny drawer. And she hears his call for prayer from the Peace Mosque of Nazareth, the one he dreamt up, planned in his mind’s eye and sculpted with his own hands. True it was a process and a group effort. But her husband led that process. To her fading recollection he saw to every little step: from collecting donations, including from her and from Moslem and Christian friends and neighbors all the way to calling for prayer the first Friday the mosque hosted the noon prayer of the East Neighborhood of Nazareth. Abu-Othman, her husband, drew the architectural plans, dug the foundations, fitted every stone in its exact place and arranged the carpets and reed mattresses on the floor. He persisted till he purchased and distributing the sweets in celebration.

As one thing led to another Jamileh found herself not only the mother to a ready-made large family but also the hostess to the crowd of Moslem Sheikhs who flocked around her husband, their anointed leader in Nazareth. Overnight she, a village woman, became a central pillar of city society. Always at the ready to face a new challenge, she adopted and adapted herself to the new persona of city socialite, albeit the reserved and respectable Islamic brand of socializing, a sort of Inner Wheel to the organization of salaried Islamic mosque leaders, employees of the Israeli Ministry of Religious Affairs. Fortunately that involved no direct contact with the system for her, for she would probably have failed that test of Sumud. It took Salah’s smarts and social skills to navigate the twisted inroads of the system, catering to the spiritual needs of a community of Moslems from within the inimical reality of an anti-Islamic state hierarchy. Vying for a religious court judgeship the Sheikh lost to a competitor probably because of an initial handicap. He had fought back and continued cutting stones from his huge quarry when Israel confiscated it. It was included in the sweeping land grab Ben-Gurion orchestrated to balance the region’s demographics with the new Jewish-only city of Nazareth-Illit. This criminal topsy-turvy curl in the clash of civilizations that swept over Nazareth in the 1950s and the 1960s somehow landed the Sheikh on his two feet, a recognized community leader but at a relative disadvantage, what with his close association with the communist Nazarene firebrand and poet mayor, Toufiq Zayyad. But how was Jamileh to comprehend all of this regardless how often Anwar explained it. Yes, she can make out the neighborhood of Zayyad in the thickening dusk below her high perch, the nice home her husband built for her on this easterly ledge as Nazareth’s demographics exploded to press physically against the dividing perimeter from the Jewish new neighborhoods.  She can still hear Salah’s effusive welcomes and Zayyad’s roaring chuckles in response as he arrives with Ramez, his deputy, and the entourage of assistants and council members here to wish them well in their new residence. She should better go in. The Sheikh is sure to want her to prepare a festive meal for his guests.

It is a little confusing with no one around to ask about what she thinks she sees and hears while enjoying the Ave Maria bells. Anwar is at his office, Othman and his two sons are at their construction jobs, Samira is at the city rehab club and all three married daughters must be busy preparing the evening meal each for her own brood. What adds to the mystery of her mixed senses is their clarity: She has no doubt that she hears her husband’s call for the evening prayer wrapped within the echoes of those bells. He is dead and gone of course, but they must use some of his beautiful tape recordings. And there he is again receiving half a dozen priests in his guest room. They must have come to wish him well on the occasion of initiating the new Peace Mosque: It is pleasing to see him standing there with his snug white hat in the center of all their black ones. She thinks it is the right reflection of his central position in his community of Nazarenes. They are welcome to borrow the reverberations of his shrill voice to reinforce their beautiful metallic tunes at sunset and sunrise. In death as in life, the Christians are his friends and allies. And that is as it should be. She grew up with Christian friends: The Christians and the Kanaanehs shared the same neighborhood in Arrabeh. And her father always told her we all worship the same God even if we do it differently. She now sees how true that is: In fact she can’t distinguish the mosque on the facing mountainside from the couple of monasteries there. Is it her failing vision and the dimming evening lights? Or is it her father’s insights, her childhood friendships and her husband’s social position and practices enveloping her in a moment of grace? She wishes she could ferret things out. She is sure Anwar will tell her what the reality at the base of all this mix-up is. He always knows what is right for her.

Rest in peace Jamileh. We love you.

Health Sumud, Settler Colonialism and the Layers of Elimination in Historical Palestine

Introduction:

In August of this year, two Israeli mainstream Zionist scholars debated Hannah Arendt’s concept of ‘the banality of evil.’ The divergent views of Eva Illouz¹ and Danial Blatman² on the theoretical issue converge in a new phenomenon: Both agree that evil is being committed in the occupied Palestinian territories (though both use the term ‘Judea and Samaria’ in appeasement of their subjects of criticism). In the pages of a major Israeli newspaper, both concur that the occupation is a colonial project (though they eventually blame it on the settler movement). In the past, such views would have been automatically condemned and rejected out of hand in Israel; they would not have seen the light of day.

Outside the Israeli framework, it is easy to see that occupation, war and conflict contain the seeds of dis-ease. By definition, they negate the basic notion of care and of health as a state of physical, mental and psychological wellbeing. Combining ‘healthcare’ and ‘conflict’ in the same breath is oxymoronic. Military occupation undercuts the validity of using the customary professional tools for assessing healthcare. Put simply, it makes no sense to continue counting orthopedic surgeons in the West Bank while Israeli armed forces continue kneecapping Palestinian youth as part of their regular operations.³ Ironically, the mundane public health task of surveying the nutritional status of Gaza’s children becomes weaponized as a tool in Israel’s cynical practice of keeping that population at the edge of starvation.⁴ A reality check calls for a paradigm shift. It is time we Palestinians reframe our discourse to reflect our reality: We should no longer address our ill health and injuries only as biomedical challenges in the bodies of individuals, as issues of efficacy of medications and therapies, separate from their underlying causes. First and foremost we must call on the world to address the source of our dis-ease, to focus on the lack of justice, freedom and peace that cause our suffering. That is the logic underlying this intervention: Stopping the ongoing settler colonialist assault on Palestinians is an essential part of tending to their health. Or, at a minimum, permit them to tend to their own wounds.

In 1948, Zionist forces ethnically cleansed most of the Palestinian nation from its native home⁵ and in 1967 it further occupied the remainder of historical Palestine. The remaining Palestinians’ citizenship or residency in Israel was emptied of many socioeconomic benefits that impact the general health of a population, such benefits being exclusively reserved for members of the Jewish nationality. The Zionist settler colonialist project that shapes these events contains within its folds the destructive seed of the “logic of elimination⁶” of the native population. This process, referred to by Ilan Pappe⁷ and Michael Ratner⁸ as “incremental genocide,” best explains Israel’s conduct towards the Palestinian people as a whole. Inflicting injury and ill health on the Palestinians and impeding Palestinian efforts at improving our living conditions is part and parcel of this ongoing Apartheid process on both sides of the Green Line.

Viewed from the colonizer’s side, the zero-sum internal logic of settler colonialism runs counter to the survival of the native population. When the land is “our holy land” the natives can’t farm it; they shouldn’t fish off “our coast;” ultimately their breathing depletes the oxygen in “our atmosphere;” their elimination is the apriori condition for the success of our project. Settler colonialism is inimical to the natives’ health and survival. The degree of responsibility that international law assigns to Israel for the health of the different Palestinian groups under its control places some constraints on its behavior towards them, but cannot undo it’s ultimate goal of replacing them.

The settler colonialist successes of 1948 and 1967 are fortified by the apartheid ‘othering’ of Palestinians as ‘unpeople.’ Noam Chomsky coined this term to explain such Israeli practices as the killing of more than two Palestinian children a week on average over the past 14 years⁹. The daily life experience of Palestinians in Jerusalem, the West Bank and especially in Gaza mock and debase the elementary concepts of health leaving little space for meaningful healthcare. Given these facts, it is limiting to focus on healthcare and within that to recount the static numbers of such standard criteria as hospital beds, clinical facilities, doctor’s visits, and medical personnel per thousand Palestinians in this or that location. No tallying of the numbers of facilities, staffing and patients can reflect the relevant health concerns of an occupied and fragmented people, not to mention an exiled one. Let us remember that in the best of cases healthcare ranks fourth as a determinant of a population’s health¹⁰.

From our vantage point, Palestinian health is shaped by how the settler colonialists have applied the “logic of elimination” to the various segments of our native population. Conceptually, Israel’s conduct toward the native population in the area of health in historical Palestine constitutes a continuum of harmful practices: from discrimination and neglect of the Palestinian citizens of Israel, through impeding the daily processes of normal life in Jerusalem and the West Bank, all the way to extrajudicial executions and waging periodic wars on Gaza. The voracity of “elimination” attempts at various segments of the native Palestinian population depends, among other things, on the value of their targeted resources, their level of resistance and the degree to which Israel’s Hasbara—propaganda—has tarnished their image in in the international media. This requires us to view healthcare through the prism of Health Sumud—steadfastness— and the form and extent of local Palestinian resistance strategies.

Layers of elimination:

1. Heath Inequality for Palestinian Citizens of Israel:

Within the Green Line we need to examine the over fifty discriminatory laws¹¹ that reserve major benefits to members of the Jewish race and establish structural inequality in every aspect of life. The near full segregation of residence locales by ethnicity facilitates the application of such laws. In this context, the underlying othering and dehumanization of the Palestinians (even when they are increasingly indispensable as staff) leads to such scandalous practices as the separation of mothers and their newborn babies by ethnicity in maternity departments¹². The experience of the Palestinian citizens of Israel points to ongoing separate and unequal development of services despite the 1995 compulsory health insurance law that guarantees them equal services and equal taxation. The absence of a hospital in my area of residence in central Galilee, a contiguous collection of Palestinian towns of over 120,000 people in total despite the current oversupply of health professionals, is another stark example of the persistent and institutionalized discrimination. Not a single hospital has been established in an Arab community in Israel since the establishment of the state. We estimate our current level of services to be at 70-80% of the level provided in adjacent Jewish locales.

Israel has never mustered the political will to aim for equal health conditions for its Palestinian minority, currently over one fifth of the total. Judging by the persistent and widening relative gap in health status outcomes of Arab versus Jewish co-citizens in Israel (such as Infant Mortality Rates and Life Expectancy at Birth) a full investigation of contributing factors is called for.

Ideologically, in the eyes of the average Jewish citizen of Israel, we, their Palestinian co-citizens, represent the “other”. To them we embody the enemy, unwelcome remnants of the Arab and Islamic masses against whose will the Zionist settler colonial project was imposed. Take for example the logic of Maternal and Child Health. Its spirit and practice are contradicted by such concepts as the ‘demographic time bomb’ and ‘existential threat to the state,’ concepts well entrenched in official circles and among the majority regarding the reproductive health of the minority. In political terms, this is of the same essence as Benjamin Netanyahu’s alarmed SOS call on the Jewish public in the 2015 elections to save his premiership from the threat of Arab voters coming out “in droves.”¹³ As David Lloyd explains:

“In Israel, those Palestinians who remain on sufferance are faced with the malicious shell-game of holding formal citizenship (ezrahut) while being denied the right to nationality (le’om), which is reserved for Jews only and which grants the most substantial rights, including that of return. … [They survive] in a post-holocaust world where the traditional forms of genocide directed at native peoples are no longer publicly acceptable.”¹⁴

Beyond the ‘black and white’ examples of discriminatory laws, we suffer discrimination in the application of laws not explicitly discriminatory. Our homes are nearly the only ones demolished for lack of building permits; our crops are the only ones sprayed with agent orange for being planted on contested land; our youth are the only citizens killed by trigger happy policemen; our defendants are found guilty much more often and receive harsher sentences; the national media deals with our issues without our participation in over two thirds of the time; our schools receive one half to one sixth the subsidies Jewish schools receive per student. Every such separate and unequal practice impacts health. Yet the main focus of the Unit for Equality in the Ministry of Health (established in 2010 and run with one fulltime and another recent part-time worker) has been the disadvantaged Ethiopian Jewish community. This blinding preoccupation with the ethnic identity of the state to the exclusion of Palestinians reinforces Israel’s security-mindedness in all aspects of life including its health services. This has played socio-cultural havoc in hospitals to where show of power has replaced compassion.¹⁵

2. Violating Life In the Occupied Palestinian Territories of Jerusalem and the West Bank:

Israeli occupation controls all aspects of Palestinians’ daily life in the OPTs. The essence of Israel’s military occupation has evolved to empower its settlers to access Palestinian land at will. In the process, the natives’ freedom of movement is obstructed by a maze of military checkpoints, some 630 in the West Bank, and surrounded by a wall three times the height of the Berlin Wall. In the process the rhythm of normal life is disrupted, access to services is impeded, ambulances are delayed, women in labor deliver at checkpoints and acutely ill patients expire. Further afield medical teams are attacked, ambulances are targeted¹⁶ and commando units violate the sanctity of health facilities commandeering a patient in a wheelchair and shooting up a hospital ward.¹⁷ Such Illegal acts under international law gain legitimacy among Israelis and their allies by camouflaging them with security related claims. In the process, natives’ health and life are devalued to zero.

Well beyond Israel’s neglect of Palestinian health and of its obligations under international law as an occupier, the state has directly caused mental and physical injury to the subjects of its occupation on daily basis. Many Israeli physicians break the ethical axiom of “do no harm” and participate in teams conducting torture as interrogation¹⁸. A new law disposes of internationally accepted humanitarian principles and permits them to force-feed hunger strikers whose only demand is not to be held indefinitely under administrative detention¹⁹. Beyond the checkpoints with trigger-happy teenagers acting out their fears of their inner demons, the environmental damage caused by the Israeli state exacts a heavy toll on Palestinian health.  Whether it is the theft of the Palestinian aquifer to the tune of 84% of its output, or hilltop settlers regularly releasing raw sewage on Palestinian towns and villages below, the health impact is high. All in all it adds the excess burden of PTSD and clinical depression reported at 40% of adults²⁰.

3. Inflicting Death and Disability in the Gaza Strip:

It would be demeaning to the public health profession were I to stand here and rattle off healthcare statistics about Gaza. Israel’s naked aggression against its charges in Gaza’s open prison is appalling. It should shame us all as health professionals and as human beings. Between attacks on Gazans as collective punishment and testing new weapons systems²¹, it is obscene to even speak of Israel’s obligations under international law towards occupied and besieged Gazans while sidestepping its fully articulated genocidal practice towards them of regular “mowing of the lawn²².” The image of members of the Israeli public lounging on a hill in Sderot²³ with cold beer in hand to view the Phosphorus lightshow over Gaza is emblematic of our collective complicity Our pretention of caring about the inflicted suffering, whether in Syria, Yemen or in Palestine, by lecturing to each other at this safe distance is a measure of our culpability and collective loss of humanity..

In the open-air prison of the Gaza Strip, one of the most crowded spots on earth, the logic of elimination of settler colonialism is more stark and direct. The enclave under Israeli siege is judged to become unlivable in four years from now²⁴. Palestinian children aged 8 years and older have lived through three prolonged Israeli attacks in which nearly all of them lost family members. They continue to live under the constant threat of a repeat of the same trauma any minute. The resultant PTSD cases are more the rule than the exception. Healthcare facilities and their staff and clientele are routinely targeted from the air, land and sea. Palestinian patients needing healthcare modalities not available in Gaza and their families are regularly subjected to a process of bargaining the lives of their sick loved ones against collaborating with the occupier and informing on their next of kin, friends and neighbors²⁵. Physical survival is a constant issue at the collective and individual levels with families constantly staring death in the eye. Read the writings of Dr. Mads Gilbert and marvel at human cruelty and at human resilience²⁶.

Health Sumud:

The “logic of elimination” of settler colonialism necessitates a survival strategy on the part of the native population, the “logic of Sumud.” It is the Palestinians’ default option, their ingrained mode of peaceful resistance. For many millennia their predecessors practiced steadfastness intuitively in the face of life’s vicissitudes, natural or manmade. To quote activist anthropologist Jeff Halper:

“Despite the flight of many middle-class Palestinians, one cannot but be impressed by the steadfastness (sumud) and resistance to occupation on the part of the peasants, working classes, and petite bourgeoisie—resistance that takes the form of daily coping, an insistence on carrying on one’s life and a refusal to be cowed, as well as active and intentional forms of struggle. Be it intifada, evading checkpoints, tax revolts, or merely posing a “demographic threat,” Israel has not succeeded either in driving or “transferring” Palestinians out of the country or even in routinizing its control of them.”²⁷

It is testing to single out one illustrative sammple of health Sumud from the life of the Palestinian communities under discussion. An example from the field of health manpower development comes to mind: Within my professional lifetime, the supply of indigenous health professionals among the Palestinian citizens of Israel has gone from near zero to a glut. With the separate and unequal educational system and discriminatory higher education, our high school graduates find admission to Israeli universities in the health field most challenging. They study abroad at great expense to their working-class families. Parents, older siblings, aunts, uncles and grandparents pool their meager savings to support such investments in the youth. With few exceptions, the students return to their home villages. Despite the bottleneck of the national licensing exams they now flood the Israeli healthcare market. Some of our towns claim to have the highest ratio of physicians to population of any community in Israel, perhaps in the world, estimated at one MD for every 70 people in my hometown where, in 1970, I was the first Western-educated physician ever.

Another example close to my heart is the Galilee Society, the organization that three colleagues and myself established in 1981 to deal with the many neglected health issues in our community. For my volunteer role in leading that nonprofit institution, in 1992 the Israeli minister of health interfered personally to fire me from the highest-ranking position for a non-Jew in his ministry. Today he is in jail for corruption while the same NGO has a major headquarter, plays a central civil society role in our community, boasts a regional research center with a dozen PhDs, maintains a regularly updated data base on all aspects of life of the Palestinian citizens of Israel and much more, all thanks to the persistent low-grade fever of Sumud that simmers in our veins.

A more heroic struggle goes on in the West Bank, further impeded by the occupation’s military rule and travel permit regime. Suffice it to point out that Palestinian civil society handles most of the population’s healthcare burden on a volunteer basis and keeps their health outcome statistics at the top of the MENA region. No less heroic is the Palestinian population of Gaza, one of the most crowded and most severely punished and under-sourced open prison systems in the world. Their mere physical survival against all odds defines the very concept of Sumud. The legendary self-healing efforts of Dr. Eyad El Sarraj²⁸ on behalf of Gaza’s traumatized population are but one of many examples.

Conclusions:

What relevant lessons in the area of health can we learn from the native Palestinians’ struggle against Zionist settler colonialism over the past century and a third?

1. No healthcare system reliant on the goodwill of an occupier and on its compliance with international humanitarian law can be adequate or sustainable. (Of course, the transfer of responsibility to international donors feeds a dependency on foreign generosity and further diminishes the efficacy of such a system.)
2. The medicalization of the consequences of a people’s suffering under war, imprisonment, occupation and apartheid diverts attention, efforts and resources from the basic required recipe of justice, peace and freedom.
3. Conceptually, no significant health improvement is possible independent from the collective socio-economic, cultural and environmental determinants of health. Given the reality on the ground in historical Palestine, only one possible winning option remains to reach such a goal: living together in peace, freedom and equality. Israeli current decision makers show no sign of containing their mythology-inspired dream of greater Israel devoid of its native population.

Fortunately, a rising minority of enlightened anti-Zionist Israelis and Palestinians, particularly among intellectuals and academicians, gives hope for an alternative future. But only concerted outside support by a groundswell of international activists can reverse Israel’s settler-led megalomaniacal colonial process. That is why even pure public health considerations lead us to the unavoidable logic of Boycott, Divestment and Sanctions. BDS is the international rendition of Palestinian Sumud, a modality of peaceful resistance. Barring total genocide of the Palestinian people, it is destined to succeed.

References:

1.    Eva Illouz, The Monster in ordinary men, Haaretz, Aug. 5, 2016.

2.    Danial Blatman, Each one evil in its own unique way, Haaretz, Aug. 19, 2016.

3.    Amira Hass, Is the IDF Conducting a Kneecapping Campaign in the West Bank?, Haaretz, Aug. 27, 2016.

4.    Amira Hass, 2,279 Calories per Person: How Israel Made Sure Gaza Didn't Starve, Haaretz, Oct. 17, 2012.

5.    Ilan Pappe, The Ethnic Cleansing of Palestine, London and New York: One World, 2006.

6.    Wolfe, P. (2006). Settler colonialism and the elimination of the native. Journal of Genocide Research, 8(4), 387-409

7.    See: https://electronicintifada.net/content/israels-incremental-genocide-gaza-ghetto/13562

8.    See: http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=12155

9.    Noam Chomsky, in On Palestine, Frank Barat, ed., Haymarket Books, 2015. (Kindle Edition.)

10. See: http://www.cdc.gov/nchhstp/socialdeterminants/faq.html

11. Most legal issues covered in this presentation are drawn from documents available at Adalah’s website: https://www.adalah.org/en

12. See: http://www.haaretz.com/israel-news/.premium-1.712936

13. See: https://www.theguardian.com/world/2015/mar/17/binyamin-netanyahu-israel-arab-election

14. David Lloyd, Settler Colonialism and the State of Exception: The Example of Palestine/Israel, Settler Colonial Studies, 2:1, 59-80. (2012)

15. Eva Illouz, The militarization of the system: What the death of my father taught me about the demise of Israeli compassion, Haaretz, Mar 14, 2015.

16. See: http://www.phr.org.il/en/40-incidents-medical-teams-wb-jerusalem/

17. Amira Hass, These Are Israel's New Heroes? Haaretz, Nov. 21, 2015.

18. https://www.hrw.org/reports/pdfs/i/israel/israel946.pdf

19. http://www.phr.org.il/en/high-court-ruling-tramples-medical-ethics/

20. https://challengetochange.me/clinical-depression-affects-40-of-palestinians-in-the-west-bank/

21. http://www.globalresearch.ca/the-benefits-of-the-israeli-occupation-gaza-is-a-weapons-testing-ground-for-military-contractors/5403047

22. Noam Chomsky, op. cit.

23. See: http://www.nytimes.com/2014/07/15/world/middleeast/israelis-watch-bombs-drop-on-gaza-from-front-row-seats.html

24. See: http://unctad.org/en/PublicationsLibrary/tdb62d3_en.pdf

25. See: http://www.phr.org.il/en/denied-new-report-phri/?pr=24

26. Mads Gilbert, Night In Gaza, London: Skyscraper Publications, 2015.

27. Jeff Halper, A Strategy within a Non-Strategy: Sumud, Resistance, Attrition, and Advocacy, Journal of Palestine Studies, V.35, 20056.

28. Brittany Dawson and Zeina Azzam, Interview with Dr. Yasser Abu Jamei: The Gaza Community Mental Health Programme, Journal of Palestine Studies, V45, 120-126.