Wednesday, April 15, 2015

Alice Rothchild post #12 - 3/30/15

Part One: We Don’t Hate You,   

                                            We Just Don’t Understand What You Are Thinking Of Us 

Another sunny day in Gaza, another ride along the beckoning Mediterranean, another trip where the smell of raw sewerage permeates the car for miles.  We are heading to El Wafa Rehabilitation Hospital. El Wafa means kindness or truthfulness, and by the end of the morning I wonder if there may actually be an undescribed Palestinian affliction: too much goodness. 

We meet with Dr. Basman Alashi, engineer, manager and now an extraordinary hospital director and Dr. Ayman Badr, rehabilitation doctor and medical director who received a BA in Rumania, a masters in Cairo, and who has finished his clinical exams for medical school but has been unable to finish his thesis as he has been trapped in Gaza without a permit. Moussa Abu Mostafa, a PhD student in occupational therapy, head of the rehabilitation team, joins us as well.

Dr. Basman, speaks with a formal sincerity and heartfelt openness; he begins by talking about the facility here, the hospital, lab, physiotherapy, occupational therapy, an elder section where folks with no family supports and the need for 24 hour medical care can live out their days at no charge. There is an outreach program to homes in Rafah and Khan Yunis, There are plans to open up other sites in other areas of Gaza. 90% of the wounded are “needy, poor, cannot afford a shekel for a taxi, so they stay at home, they have pride and they are not going to ask [for help], so we ask them if it is okay to ask what they need.”

But I want to know more about the war; El Wafa Hospital was repeatedly attacked and ultimately leveled.  For me this is unimaginable, I am trying to wrap my brain around bombing a rehabilitation hospital. We look at photos before and after: an extensive modern medical facility reduced to a massive pile of rubble. Dr. Basman explains that “in the days before the war, they felt something was going to happen, there was tension in the building, so they prepared an emergency plan for each patient. Do they need to stay with us or can we train their families, so a few chose to go home, seventeen cannot leave, and then the war started.”

The first day or two were okay. “Day three we were hit by artillery. [This is said calmly but this is a mind boggling concept, the Israelis are bombing a rehabilitation hospital, does this bother anyone out there in international justice land?]. “The hospital stood one kilometer from the border on vacant land.  We were hit in the middle of the night, no warning, just a direct hit to the hospital, to the fourth floor.  We had men on that floor but we moved them to the first floor for safety, so we had no injuries. We thought it was a mistake. Israelis know it is a hospital. It is clearly marked.”
“We just went through our daily activity as nothing happened, afternoon day three, another hit, larger than first four; at that time we went to Shifa Hospital for press release, talked in Arabic, English, French, Spanish, German, telling the world, this is unacceptable, we are connected under Geneva Convention, and so forth. Eight volunteers stayed with us as human shield. At night, I drove them to the hospital under fire; they gave me an ambulance, I gave them free access inside the hospital so they can report any activities showing to the world what kind of patients we treat, unconscious, cannot move, cannot feel, some of them sleeping for year or three, coma for ten days.”

“But we continued to use the media to express our concern that Israeli must not target the hospital. I asked Israelis if there is any evidence [of militant activity in the hospital]?  The army released classified pictures saying this is El Wafa Hospital and a red dot saying this is launching missile.  We looked at the “hospital”, this is not the hospital, this is three to five kilometers away from us. [FYI, according to international law, it is never okay to bomb a hospital].  We made another press release, showed evidence, showed how buildings are totally different so Israelis are misled.”

“But Israeli continued asking the hospital and the area to evacuate.  On 17th July, 9 pm we received a call, pretended to speak Arabic but Hebrew accent, asked us to evacuate the hospital.  We took it as a normal call because all of Shejaria received such a call. Five minutes later, a robo call to evacuate, five minutes later a call from Israeli army, you need to evacuate; we will start targeting the hospital in ten minutes.”

Five minutes later, bombing from artillery, the air, we lost power, no electricity, the 8,000 square meter hospital went dark. We cannot see our hands, we had patients that need oxygen, breath through a tube. At that time we decided to evacuate for the safety of patients and staff, ambulances were scarce.  So we moved them in regular cars, two to four per car, carrying them in bed sheets, just under fire and we are moving and ask everyone around the hospital to move these helpless patients that they do not even know what is going on.”

“We were able to move them safely.  The Red Cross, Gail, called saying I have special message from Israeli army, how much time do you need to evacuate the hospital? I asked the management and doctors, they said we are waiting for a special equipped ambulance to carry four patients, with oxygen. I called her and said I need two hours. She said, okay, I will convey the message to the army.  Fifteen minutes later she called back.  The bombing continuing at the hospital while she is talking to them, chaos and darkness.  We lose our sense of direction. What should we do if not trained to dodge bomb?  She called me back, I have another special message from highest authority from Israeli army.  They will not target the hospital.  But the demand was not fast enough to get to the lower command. I was emotionally upset, it is too late. She said I am just a messenger. I told her she should say do not target the hospital. Which side are you on? Israelis know exactly who we are.”
“On March 17, we moved to a maternity clinic, Sahaba Clinic in the middle of Gaza City, and moved from 8,000 square meters, to 800 square meters. We were not able to take any equipment and medicine, just running to save our lives and our patients’ lives.   With the help of God we evacuated safely.  The next day we need medicine, clothes, bumpers, sheets, etc. At that time I went to the hospital which was a war zone at 10 am to look.  The damage and fire was still on, severe damage to every floor. We could stay no more than 30 minutes, drones flying over us, bombs everywhere.  We felt safety is our main concern so we left. We were able to take some medications, enough for one to two days.  We left the area without anything else.”

“On March 18 we called the Red Cross to arrange escort to the hospital to protect us and not to be targeted.  Israelis target ambulances. The Red Cross refused because the Israelis refused to give them safety, so we stood without any equipment, without any medicine or machines that better the lives, a 30 year investment. We extend our hands to local and international organizations.  Many supported us, brought us beds, sheets, water, food, medicines, free, so we started from zero building up the hospital. We took care of patients as day care, also received new patients, wounded, surgery done [elsewhere] and they need rehabilitation.  We are the only comprehensive completed medical rehabilitation hospital in Gaza City.  There is few that does similar services, not as comprehensive as ours.  We receive patients from the Ministry of Health.”

“The war ended on August 23rd, the building we are in now belong to El Wafa Hospital but it is far away from the original.  We were planning to move the hospital to Gaza City and this building was planned for elderly home. This building was donated by a Palestinian doctor, el Alami, the land given by the government, so once the war ended we moved all our patients to here, at Zahar City. We shared with elderly care home, now half hospital, half elderly care center.”

“We start as a team rebuilding the hospital, equipment, medicine, 19 clinics from the hospital were destroyed. Here we are now 225 days later, we are back in business, not of choice. Gaza needs our services due to blockade, continue preventing Palestinians go outside to get medical help. This puts us in a harder position, despite we have no budget or resources, we must continue our services even if only with our hands and comfort them with our feelings and they continue to improve their life.  The world saw us through the eyes of cameras and many organizations support us…UNDP approved us to enhance, extend this building another floor so we can accommodate more patients.  WHO, UNRWA, UNDP, Interpal, Australian charity care, Malaysian came to our aid. I am not saying we are proud of what we are doing.  The specialties that we carry, none similar in Gaza.  People used to pay thousands of dollars in Egypt or Israel, but since El Wafa was here, they came to us for minimum charge.  El Wafa is specialty, unique in service, in equipment, no one is similar to its equipment.”
“Everything we will see is donated even the food, tubes, needles. Who supports the hospital is Palestinian people, no other continuous income, especially Muslims, part of being a Muslim is helping the poor.  10% of donations go to management, this is low.  The staff put in tremendous efforts, as a team and this is how we work, a tremendous effort to bring back the hospital.  20% of the staff lost their homes, many lived close to the hospital or Shejaria, close to the border.  Our staff during the war, they were at the hospital 48 to 72 hours a time, leaving their families. This is my duty, the others who are not direct services they stayed home. Once we came here, all came back.  We lost two staff at home. One was walking in the street, a man with three daughters, he stopped by the grocery store, bought figs.  He was targeted by a drone walking alone; Israeli did not distinguish from woman, man, child, resistance, young, or old.  [The other staff] her home was destroyed, she went to the UNRWA school [for shelter] and it was targeted. She was hit by shrapnel in her head, her brain was out, she was 21 years old, unmarried.”

“Our concern was how to serve patients, we all risked our life just to continue. We had one lady with cancer in her spinal cord, no sensation in lower part of body.  If a bomb hit her, she would not feel her body frying.  We cannot leave such patient, we cannot live with ourselves, feeling that we left a person who was breathing. As Muslims, serving patients is first, serving us is second.”

“Many patients cannot come this far in our new facility, outpatient services too far, no transport, so we have to go to them and it costs. Only in Rafah and Khan Yunis, the areas really devastated, some of them do not understand the extent of their injuries, very poor, they may not know how to treat them. Need to rehabilitate the soul itself, teach the wife and the family, show him the love. This is 50% of recovery.  We have one patient on chronic ventilators. Now he is child, 10 years old, he was injured with his family, missile in cervical spine, C2 quadriplegia.  He lost his father, brother, uncle, girl twin, and four cousins.  His mother was pregnant, they were farming, bombed from a drone.  Whenever Israelis see a group, sitting in the farm, they were just eating, drone targeted them.”
“[Another patient is] two years old, father was killed, mother was injured, he is in coma, not on a ventilator.  He has a deep brain injury, he is at home now.  He was moved to another house, their house was destroyed, we were following them; he has gastronomy tube.”

“The new building is U shaped, the right side is the hospital, the left side is the elderly, the middle is management, so all separate.  We still have a problem that our space is too small, so children and adults are mixed. We had 17,000 square meters before and a garden, this facility is 4,800 square meters.”  The old hospital was very high tech with a high level of care and included a gym, swimming pool, hyperbaric oxygen treatment, video conferencing.  “We lost a lot.  It is difficult that we lost all this but we are all optimists and we look at the positive side of any events, because we are rehabilitation, anything we face, we look at the positive side of it. The hospital destroyed completely on the 23rd, thanks God we are all safe. We sent a message: we don’t hate you, we just don’t understand what you are thinking of us.  We are just human beings like anything else, we live on planet earth; we all look alike.  The Israeli response was the hospital was a terror site, like all other bombings, they justify everything.”

We ask if there have been an independent investigations. “Officially no, but media did extended investigation, eight independent foreigners with full access to the hospital, they have not reported anything. There is no justification to target children, hospitals, [he lists all the buildings targeted]. The only thing is to terrorize people to leave. So then the young boys out of school and working, the girl married too young, it is circle of devastation.  If I don’t give the father a chance to work, that means a problem in the family, but Gaza still survive.  If Israeli came to the hospital for treatment, my glasses looking to him as a human being and to treat.”

“Some departments like urodynamics, diabetic food center, hyperbaric center, the only one in Gaza, are not up and running, patients are waiting.  The hyperbaric, limbs were saved, five year old wounds were healed; we cannot get another one. I cannot plan where I will be in two hours.”  He says that it is harder now to find donors.  The Islamic Bank in Saudi Arabia four months ago offered four million dollars if the Israelis will agree not to target the hospital and Gaza will remain stable, so no donation. Larger organizations and governments are not donating, but individuals still donate who “believe in cause of Palestine. There are also financial restrictions on wire transfer, so bank calls, we have a wire, we need a contract, where it is coming from, what it is for.  We need to show purpose, restrictions from banks outside of Gaza, it has to go to a certain group that is not labeled as a ‘terrorist.’ We see this as a challenge, we don’t have a choice, succeed or just die, we will continue.”

“Another part of the tragedy, of the siege: killing the victim is part of the crime but also forbidding the victim to say we are victims and are human beings.  This is a human feeling.” This is the other face of the crime.

The tour of the hospital starts with an ambulance that was targeted by a drone filled with nails, we see the entry holes in the back door and the exit holes in the front, (dear IDF soldiers, why would you send a drone attack to the back of an ambulance???); they have not been able to replace the fractured glass so the windows are covered with cardboard sheets.
Ambulance targeted by drone during Israeli attack, summer 2014


 The first floor has a large room for physical therapy equipment; the area is clean and orderly.  The nursing stations and patient rooms are improvised but functional; Dr. Basman knows every patient and his or her story.  He greets the conscious patients warmly, there is a lot of joking around, moments of tenderness, a profound sense of caring.  The windows are open, a fresh breeze blows through the rooms, there is no antiseptic smell, families cluster around beds.  The most tragic patients are in various chronic states of unconsciousness and physical constriction from a variety of causes, motor vehicle accidents, cardiac arrest during labor probably due to a difficult intubation and an urgent C section, brain tumor.  But the patient who will always stay with me is the little boy, Hamad al Reify, with the high level spinal cord injury and quadriplegia.  

When the electricity goes out, he has 30 minutes on his battery run ventilator. They have no cardiac and respiratory monitors so nurses sit near his bed monitoring him with their eyes and their hands. He has a tracheostomy, but is able to communicate and has an unbearably winning smile.  He jokes, he dreams, he was given some toys, but he sent them home for his sister.  The staff clearly love him.  Some IT type person has designed a mechanism that fits under his chin and allows him to change the channels on the TV.  Later we see him in a reclining type wheelchair, basking in the sun. If he is lucky, he will spend his life at El Wafa. The staff has not received a salary in the past six months.

Dr. Basman ends with a message to the world. “Gaza is fine.  What you see from the outside, it looks devastated.  But if you live among the Gazans, you won’t leave. I choose not to return to America [where he lived for a number of years]. We are human.  I am born here.  You don’t have a choice where you will be born, but I have a choice for whom I am.”
Too much goodness.

Part Two:  Here Death, There Death, But Let Me Do Something Useful For People

The Wefaq Society for Women and Child Care founded in 2010, seeks to achieve gender equality and improvement for vulnerable children through economic empowerment and psychosocial support in one of the most challenged areas of the Gaza Strip.  We meet with the leadership and women involved with the organization over coffee as the electricity flickers off (there is no fuel for a generator) and the stories emerge in a warm, open, sisterly environment. (Consider that it is extremely hard for the staff to work when there are no functioning computers let alone functioning civil government.) The situation in the southern Gaza Strip is more difficult and more miserable than many areas, but largely ignored by the media, far from Gaza City.  The society has its roots in the Gaza Community Mental Health Program but we are told that Dr. Eyad el Saraj, (founder of GCMHP and for years the only psychiatrist in the Strip), urged them to be independent; they now have a department for women, children, building capacity, and media.  Another branch in the al-Shoka area, the most marginalized part of Rafah, offers psychosocial support in partnership with ActionAid Palestine, funded by Disaster Emergency Committee-DEC. 

“We are here also implementing our project which is psychosocial empowerment, improvement for women and livelihood, a fund for small projects for women who have been bombed and domestic violence, and widows, divorced, and abandoned. Some of the women lost their livelihood during the war, left their sheep and goats and escaped to the center of Rafah during the war. Black Week started on Friday; they [Israeli forces] were trying to occupy the east area [of the Gaza Strip], they destroyed everything, animals, trees and more but the media doesn’t reflect the picture. Bombing and destruction followed us to the sea shore by F16s.   After [the people] leave the area they try to come back during a cease fire, but they were bombed during the cease fire, intentionally. Many died, injured, houses destroyed, they went to UNRWA shelters or to relatives.  They found after the cease fire, their sheeps and goats were dead, the only hospital in Rafah, Abu Youssef al-Najjar Hospital was bombed, (see: http://www.maannews.com/eng/ViewDetails.aspx?id=717391), the injured couldn’t reach, it was the center of occupation.  The hospital was bombed, so they died, so more casualties. This aggression to the hospital made big problem, bodies in the field, in the street.  To treat the injuries, they moved the injured to a private Kuwaiti Hospital, very small and very limited, no equipments.  The main hospital was closed, surrounded by soldiers.”

“The center has an emergency response plan, so once the war ended, Wefaq quickly responded in shelters, psychosocial program, intervention with people.  The staff went to the shelters, bring donors clothes, food, distribute them.  We are one of the members of the DEC emergency committee in community based organizations, (CBO) with UNRWA.  They formulated an emergency committee and started to respond, especially in the shelters and relatives’ houses.”
“People who are forced to leave especially in the eastern area were without anything, clothes, food, money, nothing; they escaped with nothing. Then it happened during the cease fire! [Israelis] attacked, there is no safe place in Rafah at that moment.  I was at home waiting for bombs. I live next to al-Shoka, my neighbor’s house was hit with a very big rocket; didn’t explode.  The civil defense removed the rocket, many cases like this.”  The women are laughing, gallows humor. “All Gaza like this.”
Another woman explains, “I was leaving my children home in Khan Yunis to bring help and needs for people in shelters. My children say to me, ‘Mom we are afraid, why should you leave us?’  I say, ‘Here death, there death, but let me do something useful for people.’  I was crossing Al Nasser Street while bombing happened ten meters away, another time in Khan Yunis, less than ten meters and the house, they bombed.” I ask, what about fear? “We are used to it, also it was Ramadan.  I have three kids, two in university, one in school. We are as adults, we are fearful, a frightening experience.” So Gazans are experiencing a terrifying unpredictable bombardment and they are fasting for Ramadan. 
Another woman adds, “I was waiting for morning to begin. At night you don’t know when the bombing will begin.  Because of the psychosocial pressure, all categories [of people are] nervous. So violence start to be in every category, not just against female, many incidents in shelters because of the distress of the people.”   (Think New Orleans, Katrina) “Immoral males make it for them, the same for war or not with war, in harassment, sexual threats. The shelter has two to three WCs, how the female teenager can go to the WC? They didn’t have water to wash, they tried to get to relatives’ houses to shower.  Women delivered in the shelters, no medical care, there is no nurses or doctors.  There is no professional equipment. Female doctors were refusing to come to the shelters because they were saying, ‘My children, how could I leave my children?’”
“A mother delivered [in the shelter] but she hadn’t any clothes for baby or for her, so they hired for her the near houses to get some clothes, hygiene was very miserable, UNRWA services were not as proper as they should be.  Three days in Ramadan, UNRWA had no food in shelters, director of UNRWA said he has nothing in Rafah, and probably beyond.  The emergency response of them was to go to restaurants to get food for people. They (the volunteers and NGOs) opened the restaurants even in Ramadan to cook the food. We are trying to get better the situation. We don’t like to talk about war, opens too many wounds, everyone is hurt.  Whatever you saw on TV it is an instant, not as much as actual situation. The Syam family, they bombed their house.  They escaped to the street but there is no place secure, thirteen killed in the street by bomb, plus injured; random killing of entire family, kids babies, many innocent families.”
At this point, the women are crying, the women in charge and the women being served share the same experiences, the same pain, the same tears.
Everyone reconstitutes their fragile psyches and the interview continues.  “Projects here in our branch: we are implementing in cooperation with UNDP, the legal protection for victims of war after the aggression on Gaza for female victims.  We didn’t talk about the other section of the project in al-Shoka, we are implementing psychosocial improvement and livelihood training. [We focus on areas like] gender based violence, IT, young women leadership program for university graduates to prepare them for job opportunities, CBOs, (community based organizations), private sectors.  We also had already finished two months ago a working placement for 200 girls, they got jobs like secretaries, all kinds of jobs, income for their families and this empowers them.  NGOs and us try to change the idea and traditions of people by awareness regarding women’s roles, there is acceptance that the female get out and work, life is very difficult so women will continue working after marriage.”
“We teach life skills, English, sewing, embroidery, but some projects closed, handicrafts and sewing for two years closed, no funds. “Now we are going to make a partnership with Actionaid, new project of psychosocial support and vocational training and small projects. With children six to twele, at al-Shoka, we do drawing, play psychodrama, individual counseling, group counseling, home and school visits, family interventions to fix the relationship between the mother and children.  For low achieving children, there are many success stories in al-Shoka area.”
“Domestic violence, it is a huge problem. Wefaq works on this, in alliance, for combat violence against women.  The procedures we follow, first awareness for the woman about her rights, about gender, the violence and types of violence. We consider this as part of protection for women.  Then home visits for intervention, talks to men, awareness, the same awareness to the men. We do community mediation, separate from the mosque, with mukhtars, leaders, university teachers, social workers, political activists. It is part of changing the tradition of the society towards women’s issues; we encourage women to get independent economically (sewing and handicrafts) especially those who are exposed to violence. Who has the income has the [power of] decision, this is a very effective intervention.”
“We still have problem of early marriage, 13 and up, especially in a bad economy. Previously we start to modify their attitude, but now tradition to make the girl get married early because of economic bad situation. They returned to the idea to get rid of her, the older man has multiple wives.”  There have also been issues of brothers-in-law killing their dead brother’s wives because of money, because of inheritance. “We are implementing legal protection, victims of legal violence, about inheritance, alimony, in divorce.  It is a tyrant’s law. I have three children, divorced, have not seen them for two days, [tears again].  One-and-a-half years ago they were taken by force, I raised them for ten years, I still have my daughter, but they may take her in a few months.” More tears.  So this is woman who is very aware of her rights and her children’s legal rights, she has the support of Wefaz, she has a lawyer, and still her husband has married another woman and has custody of two of their three children. “We are struggling for these rights.  All of us are victims, suffering from one aspect or another, all women in Gaza.”
Another woman is tapping her fingers on the desk.  “We should lead the victim’s movements to help ourselves and to help others.”  I ask if there are safe houses for women and learn that an attempt was made, but the government refused. “The Hamas government, of course they took my children.” We learn that in the past, on occasion, “we refer to Arabs’ safe home in Arab homes in ’48 Israel, to get safe. Now this cannot happen, the border is closed. Hamas and Israel occupation are here and there.”
The center teaches health workshops, “we have health workshop weekly, about burns, about hygiene, but we need a whole program about women’s health.” I give them an Arabic version of Our Bodies Ourselves, sharing my world with theirs. “Why shouldn’t we as females make a committee for worldwide peace? We will make a strategic plan to stop war.  Arab women should work on this idea; the biggest loser is the females.”
The electricity is still off and I discover that some of the more religious women fast on Mondays and Thursdays.  “We get up to wash or iron at 5 am if there is electricity, maybe 12 hours per day, on and off.  Once I come to work, electricity in my house is on, when I back to home, no electricity.  We don’t feel we are alive.  We have tyrant husbands, they do not cook, wash clothes; they are not ready to help.  How will that change here, how to change the culture and attitude? But it is very difficult, women’s work is first step. Of course, the main aim of ours is work. We work hard on gender issue to change the ideas of people and attitude, men a little change, but they are moody in this aspect, not convinced.” I joke that I have heard that men always have PMS and one woman responds, “PMS on a 40 year cycle! May Allah take all men!” The laughter is slightly relief, slightly conspiratorial, slightly guilty.
One woman explains, “I have a terrible story. About twelve years ago I separated from my husband but we stay in the same house, [different bedrooms] just to make a name that I have a husband. In our society, he has no responsibility towards his kids, his house, about money, nothing.”
I ask, how do you help your sons to be different from their fathers?  “We are strong women.  I suffered with my older son, but he start to be older and wiser and he at university.  His father’s behavior made a weakness in his personality, but I intervened, I support him to get stronger and more responsible. Now he is a responsible person. We established this organization for ourselves and our daughters…. and our sons.”
“Daily we meet with about 10 to 12 cases of women victims and provide them with help.”  One of the staff is a psychologist and she feels her problems are small compared to others.  “Occupation circumstances make us stronger, still hard. But I have had enough of getting stronger! I am satisfied, fed up.   We wish you stand by us, this session is good even if it opened wounds; this society helps vulnerable women.”
I ask if guns are prevalent in domestic violence cases? “No guns, but other material for killing, honor killing, related to virginity, are poisoned or with a knife.  These are rare cases, men do get punished if government knows. But Hamas, don’t punish properly, may put him in jail, but are not changing attitudes.”  Two younger men come in, they are the accountants and their relationship with the women is friendly, joking around.  These women clearly enjoy the company of these men, but find the oppressive men in their lives unacceptable.
I turn to the woman who is worried she will lose her daughter post-divorce.  She says she has “a fun life with my daughter, take her to playground, to restaurants, massage.  My daughter misses her brothers, she is confused; what can I do? Try to make her not to think about the explosion in the future if she goes to him [the ex-husband].  He has another tyrant wife.”
“University trained women are desirable because they can contribute to economy in the marriage. Women are used for their money, we are cheating ourselves to say okay [with this].  We are sometimes part of the problem; domestic awareness is a complicated matter.  Mostly, when a woman marries, goes to husband’s family. Independent ones have apartment, no cultural problem with this.  But economic circumstances prevent this. The mother-in-law is practicing violence against who, women practice violence against women. It is about emotions, feelings of the mother that this new woman took her son, a kind of reflection of her inside emotions that this female came and took the son.  The young wife is in competition if her emotions get extremely jealous, this is another issue. Once it is normal for a mother to be jealous of the new bride, sometimes the new wife of the son herself practice violence against the mother-in-law. This is all related to awareness and balance, raising the awareness about domestic violence, gender awareness, how to develop attitudes towards gender and campaigns and community mediation.  None of this is taught in schools, I want to do this, amongst teachers and families, secondary schools, girls and boys, there are a lot of ideas for services, but no funds. We don’t even have electricity.  I am very tired, I have many ideas to develop the community but no funds.”
Talk turns to politics.  “America is the father or mother of Israel but we do not talk about people, we share you in your agonies, it is all about the government.” Then I was asked a most amazing but understandable question: “Is Congress all Jewish?” I launch into a description of the Israel Lobby, AIPAC, Christian Zionists and a quick rundown on how the US system works.  I am amazed to discover that the women have heard about Jewish Voice for Peace but they are unaware of the Palestinian call for boycott, divestment, and sanction of Israel. 

  

Monday, April 13, 2015

Alice Rothchild 3/24/15 part 1 post #11

The Most Massive Child Abuse In The World

UNRWA, the United Nations Relief and Works Agency for Palestinian Refugees in the Near East, has been given an impossible task.  Originally a temporary agency to assist and protect the 750,000 Palestinian refugees created by the war in 1948 with Israel, the refugee population has grown to over five million in Syria, Lebanon, Jordan, West Bank, and Gaza.  Despite the catastrophic conditions in Gaza, UNRWA this week is actually focused on the Palestine refugee camp of Yarmouk in Damascus, Syria, where more war and dispossession and humanitarian crises face an already beleaguered population.

But we are in Gaza and it is a bright sunny day as we head off to several UNRWA facilities, starting in Gaza City.  A quick review of the UN Gaza Situation Report for April 3, 2015 (check UNRWA website and yes I am running behind in the blog effort but last week was a lot like this week and that is the problem), will give you a sense of the challenges ahead:
·         According to the report, movement and access restrictions continued to fragment the occupied territory, undermining Palestinians’ livelihoods and impeding their access to basic services. “Continued occupation undermines the ability of Palestinians to live normal lives. Were these factors removed and related policies changed, international humanitarian assistance would not be necessary here,” The Humanitarian Coordinator concluded.
·         UNRWA continued its exceptional food distribution during the reporting week, with a total of 21,970 families having already received food parcels of flour, oil and rice…The distribution to approximately 35,000 families (bolding is mine) aims at ensuring sufficient access to food for refugees in Gaza; it also serves to inject essential commodities into the local market. The food parcels are provided in quantities according to family size…The distribution comes in addition to the regular food assistance provided to approximately 868,000 refugees and the daily rations that UNRWA is providing to more than 7,000 internally displaced persons sheltering in 12 UNRWA Collective Centres across Gaza.
·         During the reporting week, US $667,199 in funding from the Japanese Government was paid to 199 affected families across the Gaza Strip through local banks. In January 2015, UNRWA was forced to suspend its cash assistance programme supporting repairs and providing rental subsidies to Palestine refugee families in Gaza. This week’s payments do not change the fact that only US$ 175 million has been pledged in support of UNRWA’s emergency shelter programme, for which a total of US$ 720 million is required. This leaves a current shortfall of US$ 545 million.
·         To date, some 60,000 Palestine refugee families have been able to complete the repair of their damaged homes with assistance provided through UNRWA. A further 10,760 families whose homes were totally or severely destroyed have received one TSCA payment typically covering four months subsidy; over 1,300 displaced refugee families have yet to receive even one installment. Of the families receiving TSCA, over 7,600 families also benefited from the $500 reintegration grant. A further 1,270 families whose homes incurred major damage benefited from the reintegration grant. However, more than seven months after the announcement of a ceasefire, not a single totally destroyed home has been rebuilt in Gaza. The GRM, a temporary agreement between the Governments of Israel and Palestine concluded in September 2014, currently allows the entry of building materials for repair but the process for rebuilding totally destroyed homes remains yet to be agreed upon. Whereas import of construction material is banned by the Government of Israel but possible for UN-led projects following a lengthy approval procedure since 2010, the UNRWA shelter self-help programme is completely reliant on the GRM.
·         to date 9,061 Palestine refugee houses have been considered totally destroyed and 5,066 have suffered severe, 4,085 major and 120,333 minor damages. Also, to date, the Agency has only received funding to reconstruct 200 of the 9,061 houses totally destroyed.
·         Youth female unemployment rates amongst Palestine refugee women in the Gaza Strip skyrocketed to 83.3 per cent in 2014, according to recent statistics from the Palestinian Central Bureau of Statistics. Across the board unemployment levels in Gaza sit at 43.9 per cent, the highest rate on record.
·         Whilst the eight year Israeli imposed blockade may have devastated the economy and caused chronic unemployment, it has not blocked the imagination and innovative business ideas of young people in the Gaza Strip. UNRWA continues to pilot its social enterprise, the Gaza Gateway, as part of an ongoing commitment to enhancing employment prospects for young Palestine refugees in Gaza, an initiative that is designed to help young IT graduates gain work experience and employability training, and create new opportunities within the devastated Gaza economy…
·         (the report reviews a series of important UN programs and initiatives…)
·         UNRWA continues to support and provide for the basic needs of 7,072 Internally Displaced Persons (IDPs) living in 12 Agency-run Collective Centres across the Gaza Strip. 
So, the largely invisible to the western world humanitarian crisis is mind boggling, especially if you consider the budget of the Pentagon or the amount of money Americans spend on health care for their dogs, but we are going to focus on health care in Gaza.  Dr. Ibrahim Mohd el Borsh graduated from Tripoli, has a Masters in Public Health from the Jerusalem University branch in Gaza. He and a female physician, Ghada al Jadba, are briefing us; UNRWA focuses on the immediate needs of the refugees, about 70% of the Gaza population, as well as on human development and protection of the rights of refugees.  The UNRWA health program provides primary care to 1.2 million refugees here. Dr. Ibrahim’s colleague is a refugee but she lives in Gaza City, 60% of Gazan refugees live outside the camp, ie., people do leave when they can economically accomplish the cost of housing, etc.

Dr. Ibrahim Mohd el Borsh and Dr. Ghada al Jadba,
physicians working in UNRWA health centers in Gaza

Dr. Ibrahim Mohd el Borsh and Dr. Ghada al Jadba, physicians working in UNRWA health centers
UNRWA has 21 health centers, “the main component is mostly maternal and child, then chronic diseases like hypertension, heart disease and diabetes. 25% of the population is women in reproductive age; also [because of] political challenges, instability, fertility rate high (4.3 per woman in reproductive age), this is a very high maternal morbidity and mortality. Living in this difficult situation makes those women vulnerable, the situation affects them more, with poverty, low social status; they need more care.  UNRWA provides ante and postnatal care, physical exams, labs, ultrasound.  Midwives, medical officers, and obstetrician-gynecologists rotate to the health center.  The women also receive postnatal care, with a visit one week postpartum. Women are discharged a few hours after delivery,” [Heads up: discharged to what? A shelter? Partially destroyed home? Shack with no water and erratic electricity and a crying newborn?]  Another reality check: on the family health team: the physician sees 80 to 90 patients per day, the nurse 40 per day, the midwife 20-30 per day. (Just do the math for length of appointment and remember that sessions usually end between 2 and 3:00 pm).
mother and daughter at an UNRWA clinic in northern Gaza
Anemia is a major problem (probably a reflection of malnutrition and lack of adequate supplementation combined with frequent pregnancies). Family planning is “a priority, not that successful, despite measures.  IUDs are preferred, [along with] pills, condoms, and [depo-provera] injections.” It is hard to change cultural expectations regarding family size and the desirability of having many children when people have little else on which to rely and children are expected and celebrated.

Pediatric care is critical as “45% of the population is under 18. This is a fragile community with high dependency needs, the siege affects them. Collective punishment is the most massive child abuse in the world due to siege, crowding, infectious diseases.” Fortunately there is “100% vaccination coverage, but people feel insecure. Vaccines protect their children, but sometimes there is a delay in procurement, mothers come daily asking for vaccines.  Even during the war they came for vaccines, H. flu, etc, prevention for TB, MMR injections.” There are breast feeding counselors, and most women nurse exclusively for six months, this is encouraged by the society.

Mammography has long been a challenge, there is a center at the Ministry of Health with good screeners. “We have agreement with them to refer suspected cases, but is not screening [program due to] budget problem.”  For those nonmedical folks out there, screening and early detection is the main benefit of mammography. I have noted minimal emphasis on preventive health care when a population is focused on food security, housing, etc., although there is some screening for risk factors for cardiovascular disease and diabetes, (both higher than expected in this population but diseases that I consider partially induced by the stressors of occupation, poverty, and lack of traditional exercise in an agricultural society).  Smoking is a big problem; however cessation programs are “one of the future goals.” It seems that they have started with smoke free health centers and at this point most doctors do not smoke.  (Halleluiah.  It used to drive me crazy, not to mention provoke bronchospasm, when I attended medical conferences with Palestinian MDs.) 

Funding is an enormous issue. UNRWA has most essential medications, provided according to WHO guidelines. The private centers provide more expensive new medications, the UN is trying to upgrade their supplies.  Of course newer medications are not necessarily better medications, but they are definitely more expensive, but that is a struggle for another time. The medications are imported from pharmaceutical companies in Amman Jordan. There are also societal attitudes of shame towards mental health disorders, problems with drug addiction, and pharmacies that are not well regulated.  (I certainly have been able to get prescription medications in Palestine by just walking into a pharmacy and saying I am a doctor; that sector feels very third world.)

“Infant mortality per 1000 live births in Gaza in 1960 was 160 and it has now dropped to 16.5.” The US stands at 6, Israel at 4, while Afghanistan is 122, Egypt 24, Syria, (probably before the civil war) 15, and the West Bank 14.5 to give you a sense of the distribution by country and level of health care.  http://www.indexmundi.com/g/r.aspx?v=29. UNRWA does growth and development monitoring and finds 10% of children have birth problems, iron deficiency is present in 50% of children under three.  To add to everyone’s troubles, poverty and unemployment is also high, university graduates frequently cannot find employment.

Attention is paid to psychological and life cycle support, but “psychosocial increased so much, increased domestic violence, gender based violence in each health center, main category is women and children.  [We see] multiple symptoms that are not organic diseases, are depression, we work with GCMHP for more challenging cases. There are big challenges. The environment is poor, sanitation, all this affects health, endemic parasites, enteric fever, another burden, life expectancy is up to 73,” which can create new age challenges with few resources at the end of life. Just for starters, think accessibility and mobility.

Tramadol addiction is another big issue, people wonder out loud whether Tramadol was introduced by Israelis, did it come via tunnels, what is true? “Why not, not, most of tunnels are now destroyed, a lot of medicine entered Gaza illegally; many of the adolescents are addicted.  I hear the same thing in the West Bank, they [Israeli authorities] encourage the use of these drugs in Jerusalem and the West Bank.”  Since the destruction of the tunnels during the 2014 war by Israeli and Egyptian forces, “now everything is worse. 100,000 people worked in these tunnels, got construction materials and could build. [There was tax collection] from Hamas, now unemployment is much higher, there are no cheap medications or cheap goods, so increased suffering. UNRWA started having more demands for medications and other needs.”

UNRWA realized that with scanty resources, it is critical to be more efficient.  “We have adopted in service delivery, went from fragmented to family teams, Dr Akhiro Seita, [Director of UNRWA health programs] developed this…[with the] family team approach, we have health teams: a medical officer, a practical nurse, a midwife, [each team] meets the health needs of a specific number of families. We are now more efficient, have more relationships, [better] use of resources, and more effective and higher quality.  The doctor knows the family well; there is high staff satisfaction and community satisfaction.  [for official UNRWA statement see: http://www.unrwa.org/newsroom/press-releases/new-family-health-team-reforms-improving-un-health-services-across-middle] Most of the centers, (17), have electronic medical record, knows everything by one click, so this helps family team, the modernization of health care.

UNRWA does “not have our own hospitals, but we go to Ministry of Health, like Shifa Hospital [which was bombed during the 2014 war], most patients have insurance, but the waiting time is very long, so we decided to contract with other hospitals, NGOs, for some surgeries and all deliveries.  In that setting, “70% [of costs] are covered, 90% if abjectly poor.” 

We ask about murders and crime rates, “They are low but maybe rising.  Hamas is clever in controlling.”

“In July 2014, we don’t know how we survived, very difficult, we kept most of the UNRWA centers open except if they were restricted by Israel or Hamas.  Like Beit Hanoun, Shejaia, all other centers stayed open, 65% of the workers came under difficult situations.  They were provided with UNRWA cars [which were not really protected from Israeli bombardment despite international law], gave healthcare to refugees and anyone. I have three kids, 17, 14, 10. I was leaving them alone, my husband is a vascular surgeon in Shifa Hospital and he cannot leave the hospital these days. I had to go to work to manage health care and the shelters [UNRWA schools].  I was responsible to provide for them; we had to provide food, safe food, avoid epidemics, surveillance, medical person in each center.  We recruited nurses, an emergency appeal; we highlighted the emergency: hygiene, water supply, lack of electricity, no water or hygiene or sanitation.  We were afraid of cholera and made the community in the shelter to be responsible for these issues, with strict surveillance and we prevented an outbreak.”

“It was like a nightmare, not sleeping due to bombing, I was afraid, no safe place in Gaza.   Even the hospitals, UNRWA, health centers, we were not protected.  When we go out, we left our children not protected, we do not know, anything can happen.  People came from the shelters to the health center, they needed psychological support, many of the Ministry of Health hospitals were closed; they were threatened.  Two health centers in Beit Hanoun [the IDF] bombed the center, we lost eleven staff members in UNRWA and many injured and many, hundreds, lost their houses during the war, and they were displaced to relatives or to school and they still come to health center to serve their people.”

Just checking in that you have not glazed over at the enormity of this catastrophe as well as the decency and bravery of the health care providers who are also victimized by the same bombs as their patients.   The challenge is of course to stay human in the face of inhumanity. I keep trying to imagine what if this was happening to me and my family and where else in the world are there people with similar kinds of stories thanks to the destructive power of our global military/industrial wars for power, oil, hegemony, fill in the blank...

Ghada continues, “The children have had three wars and continuous instability.  The first of the war, my children were afraid of every sound, by the end they were no problem, fed up.  Nothing we can do, waiting, expecting everything, praying all the time, afraid when parents left for work. The most difficult in life this war, all these innocent people killed without any reason. Take care of each other, it’s a joke, frustration, depression, not a big difference between us and the other people.  You don’t know if you will wake up the next day or lose your family members.  I went to shelters and saw people who lost their family members. I met eight year old child and he is sole survivor from Shejaria, [which was completely dessimated].  He was smiling, too shocked, he was injured.  We have a lot of them, 1,500 orphans after this war.  They need a lot of care.  
No one care about those innocent people, and even the international community.  Israeli claim they are democracy and they kill innocent people.  What about the international community? [We had] massive destruction, many people lost all of their family and houses. The most difficult war since 1948, worse than Nakba, more aggressive, more violent, more inhumane.  During the war half a million displaced from their homes, 300,000 in UNRWA schools. How much the load on UNRWA staff?  So the nightmare of the war itself and those people now under our responsibility.  Two nightmares.” She says, “Dr Seita called daily.”

“No one expected the war would last so long.  Some sharp pain you cannot tolerate for a few minutes, difficult if it continues for days.  This is what happened in Gaza. My son is twelve years old; he was following news on the mobile, reports every ceasefire. I was trying not to be depressed in front of them.   No one cared about that kid.  There was a bombing next to us, near our building; we were so afraid.  A family neighbor was hit, the family of his best friend, he was crying, first time I saw him [cry].  He started to imagine his friend was killed, called him but he didn’t reply, but he was not in the house.”

“We know Hamas and Israel, I will not talk about them. But what about the international community?  They were just waiting and doing nothing, you must not forget what happened in Gaza, but there is no money for reconstruction. And in the news, maybe another war in the summer.  Beit Hanoun, looks like earthquake hit it.  So we struggle, there are increases in skin diseases, no showers, scabies increased, lice, we bought shampoos.”

“We need people like you to make their voice higher, we are isolated from all the world, even from Palestine, we have a lot of disappointed stories, millions.  It would be a disaster without UNRWA,  We educate 250,000 students, we are free at health care and drugs, good quality of care with dignity.”

We continue to a field office, passing tuk tuks loaded with chairs, merchandise of all sorts, street vendors with hanging columns of yellow bananas and pyramids of oranges and potatoes,  pass the Islamic University, the newest medical school in Gaza after al Azhar University. Dr. Ibrahim recounts a funny story that when he was once in Japan, (learning about family centered care) he was a minute late and his Japanese colleagues called the police.  They are clearly unfamiliar with the concept of Palestinian time.
Refugee children leaving UNRWA school in northern Gaza

The senior medical officer at a health center in the North near Jabalya, Dr. Anad, meets with us for more conversation.  Some additional vignettes:
1.      We meet with a family health team: two doctors, two practical nurses, one midwife, the doctor is smoking, the facility is clean and orderly, their records are improving, they encourage patients to make appointments rather than come and wait.  There is a big blue and white sign: “Great Thanks Go To Greek Government and People.”
2.      We see patient education materials particularly focused on mother/baby care and diabetic foot care.
3.      Most of the cars we see came through the tunnels at the Egyptian border.
4.       A pack of Marlboros used to cost 9 NIS but the price went up to 25 once the tunnels were destroyed.  It may have been a black market economy, but it is clearly cheaper than no economy.
5.      Dr Ibraham reveals that his own house was partially destroyed.  Three meters away, a neighbors house was bombed and he suffered from collateral damage. He lived for 50 days in his mother-in-law’s house.
6.      The thirteen story Albasha Towers was bombed leaving 70 families homeless, we pass a massive crater, the site of the towers.
7.      In Gaza people suffer from Hamas or Fatah.  “We don’t want either.  We need civilized people.  We cannot fight the Israelis. Peace is the solution. Yesterday in Rafah there was a demonstration focusing on the suffering of the civilians due to lack of electricity. Hamas shut down the demonstration.”  The doctor reports that he has four hours of electricity per day and also uses a generator.   As I have mentioned, these generators use fuel which is very costly and are loud and polluting.
patient education poster at an UNRWA clinic on the topic of diabetic foot care

As we drive I notice this kind of reckless apathy, pedestrians walk right up to moving cars, people seem totally fearless, cars challenge each other inches apart, traffic rules are kind of optional, I wonder if there comes a point where there is no fear left and death seems fatalistically just one smart bomb or one screech of the breaks away. I repeatedly hear some variant of the feeling that death may be fast or slow, but either way, in Gaza it is coming soon.

  

Thursday, April 9, 2015

A. Rothchild 3/28 & 3/29/15 post #10

Sisterhood is still powerful 

The Al Bureij refugee camp is located in the Middle Governate of Gaza on the eastern side of the main north/south road, Salah-ed-deen, which used to run from Khan Yunis to Erez check point, with Al Nuseirat camp on the western side. I am on my way to visit with Al Zahraa Society for Woman and Child Development which is located in Al Bureij. In the last few years, three women’s organizations spun off from the Gaza Community Mental Health program: Aisha, (which is the name of one of the Prophet Mohammad’s wives), in the center to north of the Strip, Al Zahraa (which means flower) in the middle, and Rafah Wefaq (which means accord) in the south. There were a number of painful organizational issues, but financing has been a major challenge. They got funds previously from PGS/Sweden and the Global Fund for Women.  

Another delegate and I meet with the administrative leadership of Al Zahraa and then I meet with a group of women who are receiving psychosocial support, crafts and vocational training.  We sit in a small office, sipping Arabic coffee, and talking over the loud din of voices in the central areas of the building where women are working and talking energetically.  Although I have permission to write this essay, because I am reporting on personal, sensitive issues I am not using the women’s names and I have blended their stories to protect their privacy.

The main role of Al Zahraa is to support women from violence: physical, sexual, cultural, etc., to provide empowerment, awareness, and consultation, individual and group psychosocial support and links to organizations in society for further support and intervention.

If a woman suffers from a psychological disorder, she may receive treatment with organizations like the Gaza Community Mental Health Program (GCMHP) or the Palestinian Center for Dispute and Conflict Resolution.  Some vulnerable women get vocational training (like hairdressing) so they can get a job; there are negotiations with families to allow this, there is coordination with education ministries and universities for women to go to school.

The programs from this tiny agency are impressive. Female high school students are offered sessions on gender awareness and sexual education, hospital staff are trained to be sensitive to gender based violence and diagnosis; starting with the basic principles: Ask the woman who committed the violence against her and offer her personal and legal supports, consultation and referrals. The women have worked on changing discriminatory laws around the custody of children where women tend to lose that battle.  They have worked on the issue of honor killings.  I am told that men receive a reduced sentence in prison but if a woman is guilty of a sexual transgression, she is killed, often by her male relatives. Women are disadvantaged both culturally and politically.  They hold only 20% of political positions and are not in positions of power in the government or the political parties.

During the 2014 assault, the refugee camp, Al Bureij, which is on the border with Israel, was evacuated after shooting started, the most vulnerable as usual were people living in marginalized areas on the borders. Al Zahraa coordinates with other organizations to offer humanitarian and financial support for displaced people who are in UNRWA shelters. They also coordinate with Islamic Relief in coordination with civil society committees.  (We are offered small cups of coffee, juice and each of us given an embroidered purse as we talk. The feeding and the giving are so central to this culture, even when the needs of the givers are so great.)

While working as a women’s department under the umbrella of GCMHP, the staff realized that women were very focused on their children so the work was expanded to include women and children development, psychosocial support, working with Mercy Corp which is a large organization that partners with USAID.  I learn that a number of organizations refuse USAID support because they have to sign an agreement that they are against “terrorism” but they know that the definition of “terrorism” includes militant Palestinians but not Israeli aggressors and human rights violators.

I am very curious about the power dynamics and cultural norms of marriage in this society.  I am told that there are legal rights for married women but it gets complicated quickly.  A married woman is given a dowry by her husband which is supposed to function as a kind of insurance policy for the woman if the marriage goes bad. In real life, an unscrupulous husband sometimes takes the dowry money and leaves the woman with nothing, or a woman technically inherits money from her family but the family finds ways to deprive her of this right, that moment where culture, sexism, and economics clashes with law. Somewhat like the US when an abused woman goes to the police and often finds herself in even greater danger, if a Palestinian women goes to the police, she is at risk for punishment by her family, including divorce, and police mainly considers the cultural dimensions and often advise her to go to the Mukhtar, the head of the family or clan.  Some Mukhtars are fair to women, others not. There are, needless to say, no “Mukhtaras”. There are also male religious mediator/committees. I learn from the psychiatrist I am with that in the US there is project empowering women to be Mukhtars and some are actually functioning that way. Check out facebook: Faten Harb who lives in Gaza in the middle area for the Gazan version.

But what is it like really for women here?  One spunky woman recounts her bachelor’s degree and two graduate degrees including study abroad, (plus she had passed the old age of 30), the indirect financial pressure she felt to marry someone she now realizes is unsuitable, and yet despite her professional job and tremendous accomplishments, she is still unable to decide where her children go to school because her husband has the final word in the family. She knows other women who were more directly forced to marry and after the honking cars, and huge plastic floral arrangements and nuptial feast for a ridiculously large number of relatives, there is immediately huge pressure to have children, preferably of the male variety.  

Another woman whose husband is unemployed, (big problem in Gaza due to death of much of the functional economy), explains that if you are the only one earning a living, that actually gives you power in the marriage, although it may not give you happiness. Husbands often pressure their wives to stop working or feel stigmatized and shamed if the male in the family is unable to find employment or suffering from PTSD from war trauma or torture in prisons.

I ask, “Can a woman be raped in marriage?” and receive the quick reply, “Yes. According to religion you cannot say no.  The problem is that people misinterpret religion, but religion also says be gentle with the woman,” so people read the Quran and Hadiths selectively (note: as in all known religions).  Women also get that you-have-got-to-be-available message and thus fear that if they do not have relations on demand with their husbands, they will find a second wife who is more cooperative.

I push a little further and learn that incest and rape do happen (like in all other societies) but because the culture is conservative and religious it is actually rare. With the tightening of the noose around Gaza, the increasing unemployment and humiliation of the male population, women (as usual) bear the brunt of male rage.  Not surprisingly, honor killings in the West Bank and Gaza are up: eight in 2011, twelve in 2012, 28 in 2013.  I have also heard that honor killings are often reported as suicides or accidents so I suspect these numbers are artificially low.  Bureij Camp had the highest number of honor killings after the takeover of Hamas and in one particularly gruesome tragic story, a man in the camp cut off his daughter’s head and took it to the police station when she was accused of having sex with a man. It is also possible that some people may kill their daughters to prevent them from claiming their inheritance and UNDP has set up legal aid for women, opening the door for women for legal consultation and representation, and creating a massive awareness campaign.

In a less egregious example, one women shares the story of her brother’s wife who owned land in northern Gaza (here I am thinking that this land has probably already been claimed as a shoot-to-kill buffer zone by the IDF so there are so many ways this woman can get screwed). Through legal manipulations, she was forced to sign over almost all of the land to her brother with the caveat that when she is ready to sell her portion she has to sell it to said brother at below market rate.

And then I have heard all of these wicked witch of the west type stories about mothers-in-law and new wives coming to live with their husbands’ families and being emotionally tortured. (Oh but we have those in the US as well, just pointing that out.) I am told that this was more of a problem in the past but now a majority of men get married and live in an external apartment and get away from the nuclear family. In the emotional and cultural world, however, one woman confides, “there is conflict forever between the wife and mother-in-law.  If a woman is working and will not pay the mother-in-law, then the grandmother won’t take care of children, or if there is a large extended family and a flock of daughters-in-law, there is discrimination between them and this creates conflict, always there is conflict.” Another woman reflects on a horrific case where a mother-in-law and her daughters killed her daughter-in-law in Khan Yunis.  I am reassured that this is really rare.

I have noticed that there are very dark Palestinians in Gaza, (also Jerusalem and Jericho) and I wonder how racism fits into the culture scheme.  I learn that there is a term “slave Palestinian” referring to people who came from places like Sudan to work in the region and they have faced many decades of the usual varieties of racism.  Apparently someone asked a white male administrator about racism and he denied this problem exists, (another I am not a racist type?). I was told, “If you want to know about discrimination, ask a black person.” They are teased in school because of their hair, children sometimes throw stones at them, lighter skinned Arabs don’t interfere with cases of harassment by children. Although this is contrary to Islamic religion, white families shun black families, white families will refuse to attend the wedding of their son or daughter marrying a black Palestinian.  In another quirk, Palestinian men who get educated abroad, sometimes bring home their lovely white Romanian/Russian/name your country wife, which then reduces the pool of available white men so more white women are marrying Black Palestinian men leaving the Black women once again at the bottom of the selection pool.

Even today one woman reported on the difficulties her child is having in school where she is in a high quality school that is almost all “white.” 99% of black Gazans are poor, they very rarely get well educated, they rarely get employment.  They cannot afford to go to privileged or superior schools, teachers discriminate against these students who often drop out.  The majority who stay in school are girls, they often work as cleaning women for well off Gazans to pay for their educations.  They are more motivated to go to school but rarely can afford attending the higher level universities and struggle to find good jobs.

I also learn of families that are suffering from the toll of domestic violence, fathers, (who are often unemployed, depressed, humiliated, traumatized by war and prison and all of the things that stimulate male rage but do not excuse it) beating their wives and children. Wives are trapped in conservative families, afraid to report their husbands to the police, entire families desperately in need of a thousand interventions.

I am feeling a bit run over by now, and it is time to change rooms and meet with a group of 30 women who want to talk about…. Well I am a gynecologist, the niqabs are flipped up, women are obviously yearning for knowledge and thrilled that this doctor lady has just dropped in (along with a copy of Our Body Ourselves in Arabic).  We launch into an utterly frank conversation about everything anyone wants to know about the female body.  So we talk shamelessly without embarrassment about vaginas and yeast, ovaries, sex, birth control, over active bladders, back pain, how to make a male baby, menses; for me a totally fun sharing of questions and information, woman to woman, just the way I like to do medicine and these women are just like women everywhere in my experience.

I also am invited into the crafts room to admire the embroidery and other crafts, and soon I am handing over my shekels to become the happy owner of a very unusual shawl with lovely sandy brown to orange embroidery with bits of sparkle.  Everyone is beaming and laughing. We are all sharing our expertise, celebrating our connections, and our powerful sisterhood.   

When I first entered the center I noticed that there was a (training) hair salon and I mention I would be honored to pay a visit to the salon.  The woman who clearly knows what she is doing, takes my hand and soon I am sitting in a chair with a cluster of women all offering advice, showing me wedding photos of them without their hijabs, hair movie star coiffed, and I am wondering, what have I gotten myself into? (For those of you who do not know me, my husband trims my hair every few months and that is the full extent of my salon experience.)  It seems the technique here is to clip up bunches of hair in little balls, take a hot dryer and take each ball and pull and dry it until every hair is very straight.  There is general admiration and a most universal conversation with the dark skinned woman who bemoans her African hair, the irritations from hair relaxers, the cost of extensions and braids.  Where am I?  I suggest that maybe she could just learn to love her hair?

I am informed that I really need to take care of my split ends! The beauty transformation is met with major appreciation and then one women suggests I really should do something about my unfashionable bushy eyebrows and faint mustache.  I am not about to go that route (I do stay true to my flower child roots) and suggest, how about make up? Soon my fashionistas are consulting about what color powder, creams, eye shadow and who knows what else are needed to complete my make over.  I go for the full effect eyeliner, lashes, kohl.  This is all met with that kind of connectedness and pleasure in the simple joys of sharing and laughter that makes sisterhood so powerful.
Alice after hair and make up at the salon at Al Zahraa Society for Woman and Child Development
A roller coaster day: I take my new face and light heart with two women to make a home visit at the camp to see a woman who lost her husband in the 2014 assault.  We walk into a moderately bare apartment she is renting, I sit on one of the mattresses along the wall; there is a poster of her husband, green head band, Kalashnikov ready.  She is 40 years old, has five daughters, two sons, three miscarriages and is still recovering from a C-section. We joke, she says she was once beautiful and even when married, men were interested in her.  A young teenage girl brings in glasses of Coke, a dumpling of a baby in yellow flannel squawks to be nursed.

When I ask her would she feel comfortable talking about what happened, the mood changes dramatically. The tears are flowing as her voice becomes very soft and whispery, she seems disconnected, I wonder if she is having a flashback. She says she tried to watch a video of her husband and felt suffocated. Her grief is fresh and powerful. She also has seven children and no means of support.

“I was very close to him, when I feel worried he always assured me he will be okay.  He was my cousin, very close, very worried.  I don’t sleep until he comes home.” When he died she was unconscious for four days in shock, her face contorts in pain. “Although I know he went to paradise, I miss him all the time, sometimes I talk to his picture.” She does not want me to take a photo of his poster because she is not ready to share him.

They were married when she was 18, he was 27, he was a farmer living on the eastern border of the Gaza Strip in Johr El Deek. When the shooting started, they were forced to leave their home. “Though I left the border area to be more safe, I was saying I will return back to my home. I was insisting to go home.  One day he said, ‘Let’s go.’ He went up on the roof to sleep as it was hot…. After a while he came down.  I was about to pray,” and she saw him floating down the stairs, “flying, his beard turned white, his wrinkles disappeared, his brown teeth turned white. I cannot understand what I saw. He came down, we sit with each with other, it was Ramadan.” She is speaking very softly. She made him and her kids breakfast and did not share it with them, just sat in front of the home; he came to her wondering why she did not want to eat and asked if she wants him to bring the food outside for her, she refused and accepted only a glass of water. Her face is almost trancelike. “After he finished, he went out.  I said stay. He told me he will hurry.  ‘Don’t be late.’  He hesitated twice and said, ‘I will not be late.’”

The electricity was out “as usual.  Suddenly I heard a loud voice and saw a big flash of light, I found myself beating my head.  The missile went directly to her husband’s head. The accident was eight meters from home.” At the beginning they told her that he was injured, she mentioned that one day before the accident he was nervous, talking about death.

“He was targeted by an Israeli airplane and the plane called the ambulance and told them not to rescue him or to pick up the body.” It took them a day to find his missing arm. As soon as he was shot relatives called and she wanted to evacuate him.  “I will carry him to the hospital even if I’m pregnant I could pull him.” A relative said no and she felt he was dead.

Her home was demolished 20 days later.

“I cannot describe, the children could not stop crying.  I told them he went to paradise. He was everything for us. They carried me to say goodbye to him, I was shivering.  They were in a hurry to bring him to the cemetery because shooting all the time, it was very fast.  They took me to the hospital and then took me to my family home.” She was then told to evacuate that home and she came to Bureij Camp and some cousins.  There was another shooting and she fled to Deir Balah area.

She reports that during the war, the IDF called people in Bureij on mobiles and told them to leave to Deir Balah. She heard a loud speaker warning and a direct call to her son.  When told to evacuate, he retorted “Why? I don’t want civilians to be affected! Really were you worried about all the thousands of civilians that you have killed. Do whatever you want.”

During the war she remembers planes flew over Gaza and dropped leaflets with the names of kill targets. After her husband died lots of leaflets included the names of those already killed, including his.
She is now renting in Bureij Camp. UNRWA paid the first payment, she paid the second. She doesn’t know how she will pay this month.  All she has are her children. She hears rumors that the government will build housing units. She does not know how to negotiate with her landlord, “the owner is shy.”   We leave her breastfeeding her baby.  What can we say?

So If You Killed My Child, You Think You Are Strong?

One of the greatest casualties of the ongoing war on Gaza is childhood. The Gaza Community Mental Health Program Deir al Balah Community Center has an extraordinary exhibit of post-war children’s drawings that gives us a window into the loss of the sense of order and safety that comes when one of our smart bombs lands in your bedroom.

The drawings are breathtakingly painful and simple in their honesty, a child’s view of a world gone horribly wrong:
    
  
  
The delegates stare, take photos and are pulled into each drawing; some of us are weeping, some of us just floating in a sea of societal trauma.

Children chained together in front of a soldier with a whip, families lined up in front of a tank, bombers shooting birds out of the sky, pools of blood, lots of blood, bloody circles on people’s chests, over and over again, fallen trees, smiling men in kaffiyas waving the Palestinian flag, a dove holding a circle of wounded people facing a missile, apache helicopters dropping bombs, walls crumbling and crumbling, neatly drawn piles of rubble, fires, ambulances, more dead people, doves the color of the flag dripping with blood, lots of blood, naval boats bombing from the sea, tanks, planes, and soldiers with prominent stars of David, curled barbed wire, missiles landing on vegetable trucks, more tanks and planes and fire and people lying on the ground bleeding, four boys on a beach flying kites with bombs falling on their heads, a heart with the word Gaza written across it in black, white, green and red, split in half, pierced by two missiles bearing the Star of David.

Not only am I appalled by what these children have witnessed, but I am sickened (once again) that in this world, the Star of David is synonymous with military violence, grief, and death.

Dr. Amal Bashir the only female psychiatrist in Gaza, explains to us that the children are six to 14 years of age and were involved in art therapy workshops to address their posttraumatic stress disorders after the war. She reminds us that behind every picture is a story and she is filled with these stories. Most of the children lived along the border towns. One of their fathers picked up a stranger looking for a ride and both were killed, he has two daughters and is also related to Amal.  The targeted assassination hit the wrong guy. One of the children wrote on his/her drawing: “So if you killed my child, you think you are strong?” Another: “I want to live in peace.” She admits, “I cried a lot during their therapy.” Another family, the grandmother was killed, the family was running in the street to the UNRWA school, rockets and bombs flying, a sister and a chicken were killed in front of the child and (s)he did not respond. “They get used to the situation.  A six year old witnessed three wars, this is normal. They get strength.”

She has treated 34 children and 24 are cured of their symptoms.  She has a collection of 300 pictures and we sit with her piles of paper. She tells us of Mohammed, an angry 11 year old, aggressive gun play, doing poorly in school.  He drew a child in bed, black shirt, jeans, blood on his chest.  He told her, “’This is Ahmad [his friend].  I saw him on TV he was killed.’ Now he is cured, at the last session he was playing with toys” and doing well at school. “The stories are overwhelming.  They taught me how to be strong.”  A very gentle soul, Amal started as a general practitioner but was drawn to psychiatry, trained at GCMHP and feels that she is called to work with children on these challenging issues. She meditates to reduce stress and feels that “in Gaza there are a lot of opportunities to support people….I let go of hate. I have so much love.  I love Moses. I love Jewish.”

Our next stop is at the extraordinary Atfaluna Society for Deaf Children, a Palestinian NGO for Deaf Children in Gaza City working in the field of deaf education, vocational and community training since 1992.   Atfaluna is Arabic for “our children” and the center focuses on academic education for deaf students who were traditionally hidden away by their families and treated as mentally defective, and the building of human and vocational skills to prepare students for productive and independent lives.  They are famous for their gorgeous embroidery and furniture making program and we thoroughly investigate their craft store and make our contribution to the Palestinian economy and the school.  They report a dramatic increase in hearing loss in babies born since the last war. A scientific study needs to be done, urgently I might say.

The NAWA for Culture and Arts Association is a phenomenal children’s art and culture program led by Reema Abu Jabir, a visionary force of nature. She is the kind of person that makes me actually want to be a child in Gaza! Started after the 2014 war, Reema created a center to support and empower young Palestinians using traditional culture and arts, directed towards families in the Deir El Balah area.  They provide psycho-social support, early childhood education, professional development for educators, and preservation of Palestinian culture. As we enter, there is an immediate sense of calm; they chose the wall colors “to mimic a mother’s tummy” and each room is bordered in a traditional red pattern evoking palm trees. We visit the children’s library (there are no electronic or internet connections for the children per Reema), look at drawings and poetry and sayings: The famous political cartoon character, Handala, “bitter fruit,”  with his back to the world, Darwish and other poets,  “You can’t find the sun in a closed room.”  At the end of the morning and evening shifts, the children gather in a closing circle, chanting phrases like: “There is no sun under the sun except the light of our hearts.” “We need little things in life and if we are happy we will be kings.” “You and me, he and she, we will all be different. There is a difference between him and her though our lives are beautiful like flowers.” The children do increasingly complex rhythmic movements to the chanting and singing, engaging their minds, hearts and bodies fully. (I cannot resist pointing out how monumentally inaccurate it is to say that Palestinians teach their children to hate…just want this on the record.) 

Reema explains that the children participate in much of the building with recycled wood, there is a lively art room, a family pays 10 shekels a year.  Reema believes in setting clear rules (these are children whose lives have turned upside down) and providing a clean, safe space, and at the same time, this center is a home; she is addressed as Auntie.  The center is open for all citizens, not just refugees.  We wonder how she keeps her focus and her strength, so much has been accomplished in such a short time.  She admits that she does get depressed and angry, fights with her friends, shouting and then apologizing the next day.  She goes to the sea to relax.

Reema’s next dream involves turning a 1700 year old monastery with a mosque downstairs in Deir Balah into a garden and children’s library.  We drive to the ruin which is in a very poor area and she is obviously animated and planning for the future. The children have cleaned the ancient stones and arches, the Ministry of Tourism has signed an agreement, money for restoration is being collected, and she is in contact with UNESCO for the restoration. The major difficulty is the lack of cement in Gaza which made donors a bit hesitant.  Reema says defiantly, “I am stubborn like a donkey, this is from my father’s side.”  The monastery is a mosque and a monastery and thus a reflection of the message of tolerance at the arts center. Reema complains that UNESCO asked her to get the building materials for the restoration. “Don’t ask me to get cement for Gaza!” And you just know that she will make this incredible project happen.

We chat with the cab driver on our way back to the guest house.  He says, “Welcome to Gaza! Take me in your suitcase to America!”