Health Under Siege

Silat Al-Harthiya.

The 23-year-old social worker, Sirin, dressed in Muslim orthodoxy–hijab and jilbab (a long, high-collared, floor-length coat)–lives in a village in the northern West Bank. With three others including a Boston-based OB/GYN, a medical student and a public health student, I’m here to get some sense of how Israel’s occupation and war of attrition impact health in the West Bank. The social worker has offered interviews with two of her clients, children wounded by the IDF. Between September, 2000 and March 1, 2004, 2,859 Palestinians have been killed, 82 percent of them civilians. Nineteen percent of these were children under age eighteen. 41,000 Palestinians have been injured of whom 35.7 percent are children, 32.4 percent of these were struck, as was the little boy in the story below, by live ammunition, 64.9 percent in the upper body. 39 percent of the injuries were “moderate to severe”–as were those of our second interviewee. Among the injured, 2500 people have been permanently disabled, of whom 500 are children like Hakim and Mazin, described below.

We travel to the village through hills I haven’t seen for sixteen years. They still bear the same lovely, fragile lines of stone terracing and burdens of olive trees that make this countryside seem like an austere Tuscany. But now the roads I traveled in the 1980s are ground into ruts, potholes and ditches full of muddy pools in January’s bitter chill. Only tanks can decimate roads this way; the last time I saw such destruction of the roadways wasn’t in the West Bank, but in South Lebanon during Israel’s 1982 invasion. Another change since I was here in 1988: far more settlements scar the landscape. With their white box-like houses and red roofs they look like something out of suburban California. In 1978 Matityahu Drobles, head of the World Zionist Organization’s “Master Plan for the Development of Settlements in Judea and Samaria, 1979–1983,” wrote: “The disposition of the settlements must be carried out not only around the settlements of the minorities but also in between them.” (by “settlements” Drobles was referring to towns and villages centuries old, and by “minorities” he meant the Arab majority.) In 2004 Drobles, Ariel Sharon, Israel’s far-right parties and the militant religious settlers who spearheaded the settlements from 1967 on have triumphed: settlements ring and separate all major Palestinian centers of life. I’d long read about the “Jewish-only bypass roads” that take settlers and foreign visitors through the West Bank without having so much as to skim a Palestinian town, but I was hardly prepared for what they were. Plop them down in New York state or New Jersey and they’d fit right in — sleek, smooth, multi-laned. The commuters who speed along them from Jerusalem to the settlements don’t even have to think about, let alone see, the misery that surrounds them in cities like Qalqilya, Tulkarem, Jenin, and the villages surrounding them.

In the 80s I could drive the length and breadth of the West Bank. Travel between East Jerusalem and Ramallah was a matter of fifteen to twenty minutes; to Nablus, an hour; to Jenin, somewhat more. The Palestinian population could move freely within the West Bank. A roadblock meant several soldiers posted in the middle of the road checking the identity cards and passports of passengers traveling in their vehicles, with rarely a major delay. Two decades later both general and internal closures are in force. General closure, which prevents Palestinians from entering Israel either from the West Bank or Gaza, was imposed shortly after the Oslo accords. Internal closure, which restricts a population of 3.4 million to their cities and villages, was imposed when the second intifada began. Families like the ones described below have often not left their villages and towns for three years. Unemployment rates have skyrocketed: in the West Bank, 48% with rates in cities like Jenin and Qalqilya far above that. In Gaza the rate is 67%. 75% of Palestinians live in poverty–84.6% in Gaza, 57.8% in the West Bank. In the 1980s there was occupation, an apparatus of collective punishment–house demolitions, long curfews on whole villages for the alleged acts of individuals–but the Palestinian economy was still viable. Now, after nearly four years of the Sharon regime’s war of attrition, it is not.

Roadblocks and checkpoints are the physical apparatus of internal closure. The roadblocks, usually unmanned, are designed to hamper passage from one point to the next. They assume a myriad of forms, from boulders heaped in the middle of the road to huge steel contraptions barring all vehicles from crossing. Vehicles can circumvent the roadblocks by jolting up and down narrow back roads, but sooner or later they will come to a checkpoint. Checkpoints bristle with armed soldiers, watch towers, concrete dividers or heavy wire chutes that track lines of people towards Israeli sentries, many if not most of whom are as young as eighteen. Everyone’s fate, from infants to the elderly, depends on their whims. According to the United Nations Coordination Committee there are 757 checkpoints in the West Bank and Gaza. It is impossible to overemphasize the catastrophic effect of closure on health care. Given that permission is needed to leave one’s village in Jenin district to access the hospital in Jenin, if there’s an emergency–a child is wounded; a woman goes into labor–it’s too late to apply for permission. You have to take your chances at getting lucky with the soldiers on duty at the checkpoint. Free access to medical care is therefore nonexistent. According to Union of Palestinian Medical Relief Committee figures, at least 100 people have died because the Israeli army prevented them from crossing checkpoints to access hospitals. All of this is said to exist for “security reasons,” but according to Israeli writer Baruch Kimmerling Ariel Sharon’s aim is to finish what he started in Lebanon in 1982–“politicide” (Kimmerling’s word) against the Palestinian people, terminating their viability as a political entity. In this view “general closure” and “internal closure” enforce a government policy driven by the desire to retain all the settlements, especially those in the resource-rich West Bank.

* * *

At the home of the first child, a 13-year-old boy, Hakim, we sit on cushions that line the floor against the walls. Someone brings the usual tray bearing mint tea and small cups of sweet, strong coffee. The boy is timid, silent, flanked by his father, a lean, unsmiling, withheld man in his 30s in whose face you can see the features inherited by the son. He says he was a worker in Israel but he’s now one of tens of thousands unemployed since internal closure was imposed. “We have nothing, we have no land, no water, nothing to do–they don’t allow us to live,” he says. Father and son have a similar facial expression, wary, watchful. Hakim has large dark eyes and well-shaped brows, a cap of dark hair, a slender face and handsome features. He is a beautiful child, but timid, and he tells his story with downcast eyes, haltingly and so softly that it’s sometimes hard to hear him. Our translator says that tradition dictates his subservience to his father, one reason he’s reluctant to speak without his parent’s permission. Another might be his exposure to the gaze of strangers in his disability. Finally, the boy has been depressed and “not right,” says the translator, ever since the accident happened a year ago.

He was playing with other children outside his house when he suddenly saw “something strange on the ground.” He picked it up, set it down beside the house, and threw a stone at it. A bomb left by the Israeli army, it exploded, shattering his right leg. His uncle rushed him in an ambulance to the hospital in Jenin where he was given first aid. From there he should have been taken immediately to Makassed Hospital in East Jerusalem for treatment: perhaps his leg would have been saved had travel time permitted. But these days it is virtually impossible to rush a critically injured boy from a village like Silat Al-Harthiya to East Jerusalem. So the boy began a long odyssey — from Jenin to a Ramallah hospital where he stayed for twelve days. Then to Makassed Hospital where it was judged too late to save the leg, which got amputated just below the knee. After a month the boy was brought home. So far he has had six operations; another will take place next month. A Jerusalem charitable society gave him a free prosthesis but it’s very heavy and has never fit correctly. He can’t really walk with it, certainly can’t go up and downstairs with it. Not feeling right with only one leg, he didn’t want to go back to school but he finally returned; his father takes him there by car. “How has it been to go through this terrible thing with your son?” Alice, the OB/GYN, asks the father. “I live in sadness because my son’s future is canceled. My son used to play around the house with his friends but now he can do nothing, even to go to the bathroom he needs help.”

We’re all dumbstruck at the dour finality of the father’s pronouncement about Hakim’s future. To give the boy some sense that others his age might support him, Alice asks him if he has “friends who have had such things happen.” He has one friend, but he wasn’t bombed, he was handicapped from birth. Alice: “And can you help each other in this?” The translator interposes sardonically: “We are not like you Americans, we do not do this sort of thing.” At one point the grandparents arrive. The grandmother looks 60 but may well be younger, with a face that was once handsome, deep-set eyes, a jutting jaw. “Nothing can compensate the loss of parts of a body,” she intones vehemently. “Even one million cannot compensate his playing with children, nothing can make up for the feeling of leisure and happiness he has lost.”

What would he like us to tell our friends about him? The father interposes: “To make our cause reach honest people in your country and the whole world, people who don’t like to kill people, who have feelings, to tell them what we face from the Israeli army.” We offer Adnan suggestions about what he can still do; we’re all fighting the family’s bitterness and fatalism, and feeling acutely for this child who is absorbing the conviction that he will always be a helpless victim. We try to get him to say what he would like to do, and after much prodding the translator says, “He wants to go to America.” Then he adds, “The problem here is, children don’t have their own opinions.” He manages to drag out of the boy that he wants to be very good in his studies and become an engineer. What does he want to tell people about his injury? “I want to tell Palestinian children not to play with anything that looks strange, because I don’t want this ever to happen to anyone again.”

* * *

Tama’am means perfection. She is 52 and she has had sixteen children, fifteen of whom have survived. Her oldest is 36, her youngest is four. Mr. Sayed, the father, is a teacher. He wears a traditional white headdress with black band; his beard his gray; he sits hunched, saying nothing. When our translator addresses him it is with the honorific given to older men, “Haj.” It’s the mother–stout, with a white headscarf and long, traditional dress — who speaks volubly in this household. Everyone is seated on cushions: the male children, the father, the mother, Alice, the two American students and I. The girls in the family keep peering into the living room from the little foyer, giggling. Later, they will run up to Alice and me, praising our hair, our eyes, our “beauty,” though in this culture we are old enough to be their grandmothers.

The wounded child is a fourteen-year-old boy, Mazin, also small for his age, but a different type entirely from the first child. He has a stoical, almost adult facial expression — “manly” comes to mind — and he looks us in the eyes. “If you see his body you will feel very sad,” says the translator. His story: “I was going home from school. Suddenly a tank came, very fast. Boys were throwing stones, I tried to escape, and the soldiers shot me. The other boys wanted to give me first aid but the tank prevented them from helping me.” He was taken to the hospital in Jenin. He was there for fourteen days, bleeding; then he was taken to Makassed where he was hospitalized for two months. The family was told that Mazin would probably die and that they should pray.

Even while he was in intensive care the Israeli army wouldn’t let his mother cross checkpoints to reach him. His older brother, who had taken him to the hospital, stayed with him. Mazin spoke with his mother by phone and said–she recounts this with obvious pride–“Don’t cry for me.” During a final ten-day hospital stay in Jordan, doctors grafted skin from one leg to his side. He lost part of his intestines; he still has trouble eating. Ta’mam produces photographs of her boy swathed with bandages, tubes running out of his nose. In the course of six months he has had six operations. At a slight suggestion by his mother and by the translator, he takes off his shirt and lowers his pants. Baring oneself before a group of strangers is shocking in any event but more terrible here because the boy’s torso is twisted and knobbed in a hideous way, with bits of flesh congealed into knots. Everyone photographs feverishly and takes notes, as if the ritual of witness and documentation will itself help a situation in which we are powerless to annul what the soldiers in the tank did to this child.

Is Ta’mam afraid for her other children? She says she has to go to Nablus to see her mother. Since it is women’s job to take care of the house and children, she’s afraid for her children in her absence. Mazin has special problems that weigh on her: after the accident “he became very nervous,” and started being aggressive with his brothers and sisters. “Everyone is very sad for him.” His sense of leisure and happiness has been cut off, too. When we ask what, out of the activities he engaged in before, he can and cannot do, he lists only the ones he misses: “I was playing with other children and going around but now I can’t. I was able to play soccer but now I can’t.” He has no strength in one of his legs, he can’t run. Where he was operated on, he “feels my bones are going to be broken.” There are problems with other boys who say, “You’re handicapped,” though his friends help him carry his bags to school every day. He now has a date to go to Tel Aviv for an operation on the nerve affecting the now defective leg. An organization in Jenin for handicapped people will pay for the next operation. His father will go with him. “He is not afraid,” says the translator, adding: “You Americans always say that we don’t care about our children, that our children play in the sand, in the soil…”

If he could tell Americans anything he wanted, what would he say? “I want to live in peace, like other children in the world.” His ambition: to be a doctor. “You’ve certainly seen enough of them,” says Alice. Everyone laughs and Mazin smiles. “You’ll probably make a very good doctor,” continues Alice, “because you know what it’s like to be a patient.” It turns out that Mazin likes poetry. We ask him to recite his favorite poem and the boy suddenly goes silent; he can’t think of anything he knows by heart. Then he looks up: “I will sing a song.” In a beautiful, low, child-voice, with all the dips and quavers that characterize the Oriental style, he sings a song of bitter, angry lament which, in the Arabic traditional fashion, he composes on the spot. In return, we who are here only on a visit and do not have to stay, sing “We shall overcome.” Alice and Tama’am have been holding hands. The two gaze at each other with warmth and Alice asks, “How do you feel about Israelis? The mothers there?” “It does not matter it you are an Arab or Jewish mother, the pain of seeing your child hurt is the same,” replies Tama’am. “I can understand the pain and sorrow that Jewish mothers have to go through: I experienced this myself.”

ELLEN CANTAROW is a Boston-based musician and writer. During the 1980s she wrote frequently from Israel and the West Bank for The Village Voice and other US publications. Her most recent trip to the West Bank was in January, 2004, with the Jewish American Medical Project.



Ellen Cantarow, a Boston-based journalist, first wrote from Israel and the West Bank in 1979. Her work has been published in Le Monde diplomatique, the Village Voice, Grand Street, Tom Dispatch and Mother Jones, among other publications, and was anthologized by the South End Press. More recently, her writing has appeared at CounterPunch, ZNet, and Alternet.