I Shall Not Hate: A Gaza Doctor's Journey Read online

  At that point, any progress we’d made started going into reverse. The Israelis responded to the conflict by creating even more draconian restrictions on access and goods for Gaza. The suffering inside the Strip increased, and as it did, so did the rocket attacks on Israeli towns near the Gaza border.

  The last decade has been a particularly disappointing period in this grinding conflict that keeps us apart. Our leaders bicker like children, breaking promises, behaving like bullies, keeping the kettle of trouble boiling. The people I talk to—patients, doctors, neighbours in Gaza, friends in Israel—aren’t like our leaders. They worry about my family as I worry about their families. We all lament the lost decades, the uncertain future. And as amazing as it may sound to someone watching us from afar, we believe in each other, in our ability to share this Holy Land. It is quite astonishing to realize how similar our two peoples are, in the way we raise our children, in the importance of family and extended family, and in the animated style with which we like to tell stories. We’re argumentative, expressive, emotional people. We come from the Semitic religions and languages. We have many more similarities than differences, and yet for sixty years we haven’t been able to bridge the divide between us.

  How is it that we can look at one life and say it is more valuable than another life? Look at the infants in the birthing rooms: they are innocent children who have the right to grow to be educated adults with opportunities in life. But we fill them with stories that promote hatred and fear. Every human life is invaluable, and so easy to destroy with bullets and bombs or with the accusations and revisionist history that promote hatred. Hatred eats at your soul and takes opportunities away from you. It’s like consuming poison.

  Ever since my time at Harvard, I’ve received invitations to come back to the U.S. to speak about Israeli-Palestinian relations. Sometimes at those events I receive comments from people who really don’t know what it is to live with so much conflict. To be honest, though, some of the people aren’t really interested in asking a question, they just want to use the opportunity to give their own speeches. There have been plenty of situations when I’ve been interrupted, shouted down and accused of not seeing the other side. Most people in the audience wait until the shouting dies down in order to hear what I came to talk about. I tell them—both the sympathetic and the hostile—how we need to go about solving the problems we share with Israel. For example, when people tell me that after many years of occupying Gaza the Israeli soldiers left and we should be grateful for that, I try to explain to them that the way the departure happened created more problems than it solved. Any such major move needs to be coordinated with your partner. The lack of discussion created chaos, and the Palestinians were blamed.

  At one speaking event, all these things happened at once—the interruptions, the shouting and accusing. But once I got past the unpleasantness, I found that the questions were thoughtful and well intended. For example one person asked, “What can we do here, as Israelis in the United States, to encourage dialogue?” Another said, “It’s great that you’re here talking to us, but are you also making this same plea for peace on the other side, in your own community?” My reply was that yes, of course, I make that same plea, and that this sort of conversation is exactly what we need to be having. If we don’t air our grievances, we’ll never get past them.

  Still, one man pointedly asked, “You speak of dialogue between the two nations, but whom do we have to talk to—Hamas? You say we need to respect one another, but your elected leaders are not even willing to recognize the existence of the State of Israel. What kind of respect is that?” All I could do was try to explain that there is a way out of this turmoil; that we need to move forward and stop being mired in what went before. It sounds simplistic, but it’s the only way to get out of the mud our feet are stuck in. The occupation and oppression of the people in Gaza is like a cancer, a disease that needs to be treated. It’s all about the will to solve the problem rather than the determination to keep the anger front and centre. Arguing over who did what and who suffered more is not getting us anywhere. We have to move on; we have to build trust and mutual respect between the peoples. You can’t respect someone you don’t know. So let’s get to know one another by listening and opening our eyes to the other side. We need to encourage kavod (respect) and shivyon (equality).

  Also, we need to focus on realistic goals. Grand plans for peace have failed us. We need to look at what’s possible right now: working toward both sides having more equal conditions, with equal rights and mutual respect.

  Some say I’m wearing rose-coloured glasses, that I refuse to see the hopelessness of the situation. Maybe they’re right. I never see anything as hopeless—not when I’m delivering a baby that’s in distress, not when I’m staunching the blood flow from a woman who is hemorrhaging, not when I’m treating a dozen other ills that have been diagnosed as untreatable. So why would I see the quarrel between two people as hopeless? I care about people. I’m no different than anyone else. We’re created like that, to be social, to live with other people. Segregation is unnatural.

  But I’m getting ahead of my story.

  By the summer of 2007, I was looking for a job again. I had decided not to renew my contract with the WHO in Afghanistan because it had meant too much time away from my family and it was way too tense in Gaza. I concentrated on getting contract work, lecturing at Ben-Gurion University in the Columbia International Medical Program, treating patients in Gaza, and picking up European Union consultancy jobs here and there.

  The previous December I had been invited to the Third National Conference on Health Policy in Jerusalem. Getting there had been the usual trial, but chasing after the permits and exercising patience turned out to be worth the trouble: at that conference I met Mordechai Shani, the director and founder of the Gertner Institute. Founded in 1991, the institute serves as a national research setting for the study of epidemiology and health policy. It does extensive research on major chronic diseases and assists in the formulation of national health policy. I was fascinated by this sort of work. As a physician, I’d been wondering for many years how to deal with the many Palestinian families afflicted by such prevalent genetic disorders as thalassemia and hermaphroditism, and congenital disorders including phocomelia and anophthalmia. The patients weren’t getting the help they needed, nor were the families, and no one was doing research in this area. I wondered if this Gertner Institute could be the place that would conduct studies on these medical anomalies.

  But there were more immediate research questions to be answered, about the Palestinian patients who currently come to Israeli hospitals for treatment, for instance. Who are they? What are the numbers, ages, sexes of these patients? What ailments and diseases bring them into hospital? How big a problem is this? Research propositions were pouring into my mind even as Mordechai Shani was describing his institute. I knew right away that I wanted to work there, and I asked if I could have a meeting with him. Mordechai is a man of action and few words, and he makes decisions the same way. After I explained my interests and my background to him, he said, “Start your research immediately.” Which I did. Before the year 2007 was ended, I was on staff at the Gertner Institute at the Sheba hospital in Tel Aviv.

  The contract work I’d already been doing had allowed me to travel all over the Gaza Strip and had given me an opportunity to crunch the numbers that I felt told the story of present-day Gaza and explained the sources of some of its medical problems: the unemployment, the deprivation due to the blockade, the deteriorating health, social and economic structures. It’s never been easy in Gaza, but it’s been a lot worse in the last few years. Almost everything can be measured in terms of loss. Agriculture, for example, is down to half of its usual harvest, and productivity in industry has dropped an astonishing 90 percent. There are almost no construction materials coming into the Gaza Strip and certain medicines are banned. The Israelis have even calculated the number of calories a person needs to survive and allow only
bare essentials to cross the border into the Strip. Fruits such as apricots, plums, grapes and avocados, even dairy products, are suddenly declared non-essential and forbidden to us. What’s going on here? Whose goals are these?

  The stiffening embargo, the incursions, attacks and arrests are playing on the psyches of the people. What’s worse is that Gazans don’t see the outside world caring much about our plight. That adds to the angst. Our politicians bicker about who said what and who will recognize whom and then change their minds when a new slate of officials is elected. All this while babies die from malnutrition and mothers bleed to death in childbirth and an old lady with cancer is held up at the Erez Crossing because someone is trying to teach someone else a lesson.

  The International Committee of the Red Cross (ICRC) has criticized the current embargo. In a November 2007 report called “Dignity Denied in the Occupied Palestinian Territories,” it said:

  Palestinians face hardship in their daily lives; they are prevented from doing what makes up the daily fabric of most people’s existence. They face a deep human crisis, where millions of people are denied their human dignity. Not once in a while, but every day, and the people of Gaza are trapped and sealed off. The humanitarian cost is enormous, people can barely survive, families unable to get enough food increased by 14 percent, and Palestinians are being trampled underfoot day after day. In Gaza under siege, Palestinians continue to pay for conflict and economic containment with their health and livelihoods.

  We’ve learned to do without, manage with less and cope with deprivation over and over and over again—for sixty years now. If anyone thinks this does not have an effect on the physical and mental state of the people, that person needs to come to Gaza to check for himself. The situation is simply not tenable. And I’m not the only one to describe it this way. The ICRC confirms that “every day, 69 million litres of partially treated or completely untreated sewage—the equivalent of 28 Olympic-size swimming pools—are pumped directly into the Mediterranean because they cannot be treated.” When I was a boy, we didn’t have running water in the house. Now, fifty years later, we have access to running water, but only on certain days. Why? Because, like everything else in Gaza, the water supply system is damaged and the material needed to repair it sits on an embargo list.

  Everyone in Gaza scrounges for old parts and broken concrete to patch their lives together. The water and sanitation services are on the verge of collapse. One can only imagine the size of the public health catastrophe that threatens us. This is what I mean when I tell people that Gaza could implode. Imagine if we were faced with water-borne illnesses. Imagine the chaos, the unnecessary deaths. And imagine the laying of blame: people would say, if spare parts and water pipes hadn’t been stopped at the border, no one would have died.

  I have been trying to alert authorities to the consequences of a broken health care system for more than a decade. Now the Red Cross is sounding the same clarion call:

  Gaza’s health-care system cannot provide the treatment that many patients suffering from serious illness require. Tragically, a number of them are not allowed to leave the Strip in time to seek health care elsewhere. Health issues in Gaza are often politicized and patients find themselves caught up in a bureaucratic maze. The procedures for requesting permission to leave the territory are complicated and involve both the Palestinian and Israeli authorities. Seriously ill patients sometimes have to wait for months before the relevant authorities allow them to leave the Gaza Strip.

  Even when patients do obtain the necessary permits to leave, the transfer through Erez Crossing into Israel can be arduous. Patients on life-support machines have to be removed from ambulances and placed on stretchers then carried 60–80 metres through the crossing to ambulances waiting on the other side. Patients who can walk unassisted may face extensive questioning before they are allowed through the crossing for medical treatment—or, as sometimes happens, before they are refused entry into Israel and turned back.

  Some of the health issues have been addressed, some even solved. But every time there’s a government change on either side, the rules for transfer and treatment change. It’s a life-threatening situation that creates rage among those who endure it. Here are the facts the Red Cross reports:

  They depend on a timely and reliable supply of medicines from the Palestinian Authority’s Ministry of Health in the West Bank, but the supply chain often breaks down. Co-operation between the health authorities in the West Bank and Gaza is difficult. Complex and lengthy Israeli import procedures also hamper the reliable supply of even the most basic items such as painkillers and X-ray film developers. As a result, some patients, including people suffering from cancer or kidney failure, do not always get the essential drugs they need.

  For example, the ventilators for newborns at Al-Shifa hospital are out of order. It’s not possible to get spare parts to fix them. How do you explain to a mother and father that their baby will die because the truck with the parts for the ventilator is being held at the border?

  Gaza has been the centre of war so many times, it’s not surprising that the number of Gazans who have lost limbs is high. Dozens of amputees wait for treatment. Why? Does importing artificial limbs pose a security risk? Or is this about punishment? How do you explain this to a five-year-old who lost a limb when his house fell on him after it was shelled by the Israeli army, or to an angry young man who can’t get off the floor to learn to walk again?

  That the Gaza hospitals are rundown and that they can’t be repaired because of an embargo is preposterous. This is a medical issue; it’s not about recruiting soldiers and making rockets. Here are the facts as reported by the ICRC:

  Much of the equipment is unreliable and in need of repair. Complicated procedures for obtaining approval to import spare parts make it difficult and time-consuming to bring in and maintain hospital equipment, such as CT scanners, and spare parts—even for hospital washing machines. Daily power cuts and power fluctuations continue to damage medical equipment. Most hospitals have to rely on backup generators for several hours a day, but it is never certain that enough fuel will be available to run them.

  Unemployment stands at 44 percent. Seventy percent of Gazans are officially below the poverty line with monthly incomes of less than US$250 per month for a family of seven to nine. Forty percent are classified as extremely poor with incomes of US$120 per month. Because of industry shutdowns, 70,000 jobs have disappeared. We rely a lot of the time on goods coming through the tunnels that have been dug underground into Egypt. But the tunnels can’t begin to meet the needs of 1.5 million people. What’s more, they’re regularly bombed by the Israeli air force.

  Even farming, which has always been part of the lifestyle and economy of Gaza, is in danger because of the embargo. Gaza used to export tons of fruits and vegetables to Israel, and thousands of workers as well. Not anymore—there’s no place for farmers to sell their produce. Drive around Gaza and you can see the evidence. Drainage ditches are destroyed, and so are greenhouses and water wells. Irrigation systems have been wrecked by military operations and trees have been uprooted. The ICRC examined the issue and found that many farmers “are effectively denied access to parts of their land because of the Israeli-imposed ‘no-go’ zone on the Gaza side of the border fence with Israel.”

  At least 30 percent of the arable land in Gaza lies within this buffer zone, which can extend up to one kilometre from the fence. A farmer never knows for sure if it is safe to work his land or to harvest within the zone. Farmers risk being shot at when tending to their land and incursions by the army often leave fields and parts of the harvest destroyed. Getting agricultural production up and running again is difficult not only because of the destruction that has occurred, but also because Israel does not allow the importation of suitable fertilizers and because many types of seedlings are difficult or even impossible to find in Gaza.

  Fishing faces the same impossible restrictions: Gaza’s boats are not allowed past the three-nautical-mile l
imit, which effectively cuts our fishery off from the bigger species and the sardines that made up 70 percent of the catch before the 2007 embargo was enforced. Israeli gunboats guard the perimeter, aiming their guns by day and night along the shore and onto the small boats of hapless fishermen.

  In other words, Gazans are trapped. Even students I know who have received scholarships to study in the United States have been denied exit visas from Gaza. In 2008 there was a boy with a Fulbright scholarship who had to turn this huge opportunity down because he couldn’t get the permit he needed.

  The International Committee of the Red Cross has appealed for the lifting of restrictions on the movements of people and goods as the first and most urgent measure to end Gaza’s isolation and allow its people to rebuild their lives. The report says:

  A lasting solution requires fundamental changes in Israeli policy, such as allowing imports and exports to and from Gaza, increasing the flow of goods and people up to the level of May 2007, allowing farmers to access their land in the de-facto buffer zone and restoring fishermen’s access to deeper waters. Humanitarian action can be no substitute for the credible political steps that are needed to bring about these changes. Only an honest and courageous political process involving all States, political authorities and organized armed groups concerned can address the plight of Gaza and restore a dignified life to its people. The alternative is a further descent into misery with every passing day.