Mish mushkela, No problem
The drive to Erez checkpoint is
deceptively bucolic as the rain trickles through lush rolling farmland,
vineyards, fruit trees, wineries reminiscent of the valleys of California; but
the signs for Ashdod, Asheqelon, and Sederot lend that ominous feel: memories of
Israelis, bomb shelters, PTSD, and Qassam rockets. Beyond these troubled border
towns, sprawls the ominous military terminal that is the only way currently to
get in or out of Gaza from Israel if you are not a vegetable or an approved
piece of construction.
Erez was built to process
35-40,000 travelers a day and currently does a tenth of that when things are
quiet. I am hoping for quiet. Last
November, the Physicians for Social Responsibility delegation waited for three
hours at the first checkpoint, today we are literally waved through. Then there is a large open plaza with
particular places to enter for particular papers and stamps. While everyone sails through, I am asked to
wait for some extra security checks, I can see one of the computers but it is
all little boxes and Hebrew. I so wished
I had paid more attention in Hebrew school.
Finally, the security officer asks me about my trouble at Ben Gurion
airport, (so this is what they know!) and I explain that yes I have had a Jawal
phone card, that I am involved with an exchange program with Harvard and Al
Quds medical students and yes I do like to go visit the students I get to know
in Ramallah but you know that is how doctors are, smile smile and gee, how many
hours do you work in this box, it must get really, really tiring, gesundheit, are you getting a cold?….
She stamped my passport. (So here is a persnickety question: if Gaza is no
longer occupied and Gaza is not part of Israel, then why do Israelis get to
decide who gets to go in? Academically speaking of course).
Forgive me if I do not get this
exactly right, but after passport control, we drag our bags through grey Metal
Door 6. There is a huge open building
like a big half-finished warehouse and then a series of long walkways,
hallways, turnstiles (although they agree to open a metal door for us each time
since we have a ridiculous amount of luggage carrying supplies for Gaza and
squeezing through the turnstiles would have been a humiliating joke.) Cameras
are everywhere. We finally emerge into a corridor on the other side of the
concrete wall and gun towers surrounded by a sea of bright yellow flowers
defying the dangers of the buffer zone/no man’s land where several brave and
probably desperate shepherds follow their munching curly cream colored flocks
at the risk of being summarily shot. We
are met by a cluster of tuk tuks, load up our bags and cases of 1 ½ liter
bottles of water, (remember we are heading to the land of salinized water, depleted
aquifers, and bombed sewer treatment plants), and start the ¾ mile walk down
the wire fenced corridor to the Hamas version of passport control and a search
of all the luggage. There is a large ominous poster warning Palestinians not to
collaborate with Israelis. A smiling woman paws through my bags, but her eyes
are laughing and friendly, another man also in uniform grins and says, “Welcome
to Gaza.” Then another short taxi ride and finally, the vans from Gaza
Community Mental Health Program are waiting and a nimble, sun-browned man, probably
in his sixties, scampers up to the roof rack and starts piling up our luggage. I learn a new very helpful Arabic word: mish mushkela - no problem.
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| Eretz Crossing |
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| Eretz Crossing |
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| Eretz Crossing |
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| No Man's Land - shepherds |
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| Hamas border control - 'Don't collaborate' |
No time to mourn
I first saw the spanking new administrative buildings for
the Gaza Community Mental Health Program in 2005; ten years later there is a
rusty shabbiness to the exterior but the people working inside are energetic
and spectacular. The property fronts a road and then a glorious sandy beach and
the crashing grey blue waves of the Mediterranean. Young people cluster on the sand and horses
gallop along the shore. The Israeli navy shelled this area last July and it was
on a nearby Gaza beach that four boys, aged two to eleven, were killed by an
Israeli gunboat in front of a group of horrified journalists during the last
invasion. In any other country, this
would be a resort.
We gather in a conference room with the breath taking view
and are greeted by Dr. Yasser Abu-Jamei, the psychiatrist and executive
director who has taken the helm of the center since the death of Dr Eyad el
Saraj. He welcomes us warmly to “planet
Gaza,” announces that it is “pizza time” (as in red and white checkered boxes
containing Domino taste-a-like pizza) along with sweet orange and grape drink.
No humus and pita?
After the kissing and compliments and the tribute to our
strong partnerships, the serious talk begins. Yasser notes that “after the
agony,” “people are walking around, they are not obviously in shock; people are
carrying on; it is uplifting.” “This is a nation of survivors, there is no
other chance. We are under
occupation.” 75% of Gazans are refugees
and everyone is subjected to the siege. “This nation has no other choice, we
are freedom fighters, we have all the international resolutions but that
doesn’t change the fact that we are still under occupation. We were subjected to three different offenses
in six years and we are still under siege.
Construction materials are not allowed to get into Gaza; people who have
totally lost everything are scheduled to get funds ‘later’ so the worse the
damage the less the help.” He notes that “Israeli citizens are cheated by their
leaders,” that the idea that “Palestine will be a danger to Israel is nonsense.
Occupation will never continue forever, we will have our own state.”
Yasser is equally harsh on the topic of the conflicts within
Palestinian leadership. “We do not even
have a pizza to fight over…. We are closed minded people, we need new
leadership.” He shares a current joke
making the rounds of the Middle East: Netanyahu is a new *Arabic* leader, “He
makes big high tone speeches with empty meaning!” When things get politically
tight, he manipulates just to survive. Privately I think it would be more funny,
if it were less tragic.
We are worried about how Yasser and the staff are doing
after the July/August 2014 invasion. After the joking, “terribly good,” he
describes 51 days of intense fear and insecurity for adults and children, the
daily fear of death. The GCMHP staff were urged to stay with family until the cease
fire, but staff called each other once or twice per week, “so we are like one
family.” During a small truce, staff returned to work, small management teams
stayed in direct communication. When the
war stopped, “our work started, everyone give help.”
They found an enormous basic catastrophe, but also worked to
stay sensitive to the amount of intrusion people could tolerate. Visiting a
devastated family may expose them more than is helpful, their privacy is gone,
the wreckage of their home and their lives is too public. Despite a financial deficit
the GCMHP continued to function.
Donations came in, capacity and referrals increased. Yasser explains
that the challenge is that with this level of trauma the normal capacity of
people to overcome horrendous experiences is crippled, the political conditions
are not improving, the environment is not improving, there is no
reconstruction, people are depleted, they have no coping strategies, and no
hope for improvement. This is a form of
continuous PTSD (or as I like to say, it can’t be “post-traumatic stress
disorder if it is not yet post.”
Despite all this pessimism, there are fundamental shifts in the
US post the Gaza wars, in Obama, and in Netanyahu’s speech to congress. Husam el Nounou, the administrative director,
explains, “We are winning the battle over Israel, occupation, colonialism,
racism, this will not prevail, everyone who comes here is changed.”
Unfortunately, Palestinian politics is linked to regional politics, so there is
much proxy behavior as well as influence between the US (via Saudi Arabia) and
Iran. “We Palestinians should have one
Palestinian leadership that can agree on a national project. Interestingly, the
GCMHP supports the Boycott, Divestment, and Sanction movement, “this is the
most important thing, boycott as an occupation not as a state of the Jews. We
have nothing against Jews for being Jews. BDS is increasing internationally; this will
result on political pressure.”
The big challenge is how to link mental health with human
rights, a fundamental belief of the founder and late Dr. Eyad. International
peace is the basis for Palestinian peace.
Husam explains that ISIS is filled with anger, frustration, desire for
revenge. In general people are heavily
frustrated and hopeless and this is a recipe for violence which can take the form
of violence against self, family, children and women, as well as communal and
tribal violence, shootings in the neighborhood.
All of this is increasing, most of those who cannot express their anger
are like a time bomb, “young, poor, hopeless is time bomb, easily maneuvered by
more militant groups…the environment encourages this, we need to diffuse [the
anger], open the borders, improve the economy.”
Yasser talks of intervening as early as possible, working in
schools with students and teachers, with people who are subjected to oppression
or bullies in school, teaching teenagers other ways to deal with anger, it is
important to listen and hear,. If
someone is showing anxiety and depression, people need to talk, make themselves
hear themselves and hear it in a different way. “Your ability is limited
because the environmental conditions are so bad, with 40% unemployment overall,
much higher in the 25-30 year old age group.”
He sees people are desperate, fleeing to Italy by sea. “Is this suicidal or trying for better life,
or join ISIS?” The media he notes is often less than helpful. He notes that even Israeli generals are
advising Netanyahu to lift the siege for the sake of the Israeli government.
But Syria, Yemen, Iraq, Libya, and Egypt complicate the
picture and he is not optimistic. Even
when the border with Egypt opened up, 200,000 Gazans left to shop, see
families, etc, but when asked to return, they complied. If all the necessary reconstruction
materials were to reach Gaza and a vigorous Marshall-like Plan enacted, it
would take ten years to rebuild, but otherwise the estimates are more like 50
years before an improvement in living conditions, barring further wars. Between
dysfunctional Palestinian leadership, Israeli control, and Turkey’s wavering,
political conditions do not exist that would allow a positive future; Gazans
cannot even rebuild their destroyed homes.
Yasser is strongly in favor of the boycott, divestment, and sanction
campaigns.
On a more personal note, Yasser explains that he lived in
the UK, but returned to Gaza with his wife and children because, “this is my
country and my children deserve to live in a dignified country where their
grandparents live.” He was born in Saudi
Arab, but feels Gaza is “my land.” He talks of changing the very constructs of
people’s mentality. “With a patient, I cannot offer something I cannot have for
myself, I can only offer containment of fears and processing of trauma and
direct him to a better future, get him back to school, help abusive parents,
etc.” It seems to me, in Gaza the therapists are suffering at similar levels to
their patients.
Husam relates a troubling story; he was driving his car ten
years ago and there was a rocket that landed in front of him and his son, a
huge BOOM. The child grabbed his neck, but Husam was able to reassure him and
drive home. Two days later the child
developed symptoms of post-traumatic stress syndrome (PTSD). Husam tried to help him. I week later he told his father, “I want to
die, I want to be a martyr. You cannot understand how you feel. I am a bad
father, I cannot help my children, why?
What is the meaning of life if you can be killed for nothing? So kill
and be killed for something. I was in a
big moment of confusion, it is good to die for home/people but it is much
better to live for it. Need to convey this message, so containment and love
from extended family and religious faith” is critical. He continues that in
Islam, “it is said everything comes from God, and if it is good, be grateful, God
will reward you. If it is bad, be good
and God will reward you. This gives you
strength and power. The lucky ones come to our clinics. I am really concerned for the thousands who
cannot come to our clinics.”
We ask, so how do providers care for each other? Yasser tells
us a story of Hassan al-Zeyada, a staff member
whose family was killed. “It was something
very unique. I have 24 years of experience.
I hear bombardments continuously. You do
not know who is dying and who is living. I had to maintain good internet connection
and smart mobiles do the trick. They keep you all the time connected good and
bad.” When the IDF bombarded the
compound with people, Hassan left immediately.” The family received a warning
missile he explains pensively. “I know
that Hassan’s family lived there, born there, raised there, I didn’t know what
to do… and the mobile phone was ringing…They all died of the shelling. That was a question. What to do.
The news was really shocking… it is very dangerous. They were destroying everything, what to do?”
He spoke with another staff member and then talked to Hassan. “I didn’t know
what to say, I lost some of my cousins, but it is not like losing your
mom. I heard him breathing, and crying,
I couldn’t speak.”
“‘Hasan, I don’t know what to say,’ Yasser said, ‘I know,’
some words you try to say; that was one of the most intense phone calls during
the offensive. I had to call, we have 65
staff, I try to call them all (every week or two). When the place is more
affected than another, you start to worry.
We were thinking of creating toll free hotline operated by male and
female hotline. I picked the male,
social worker, ‘How are you?’ ‘I am fine.
How is everything?’ Yasser finds that the colleague’s whole building is
not there anymore, he is staying with colleagues, in the north of Gaza, (close
to a dangerous area).” Yasser asks how can a staff person who has lost his
house, “What would he offer someone? How could he contain the sorrows?”
Some staffers appreciated the phone calls and text messages,
the attempts to stay in touch. But it was difficult to be the person making
those calls. “I cannot never forget the moment that Hassan was on the phone. I really couldn’t meet him until the truce….”
“The other thing our receptionist, Osama Al Ramlawi,
he lost his brother and his house was partially affected. His brother was a member of our crisis team, a
social worker after the second offensive (2012). Yasser planned to hire him after the most
recent assault. “At least he could have
some income, he has two children, he said it was early morning, they decided to
leave the neighborhood of Shigaia. Ahmad decided to stay in a few minutes, he
was standing in front of his house doing nothing. He was killed at that moment by shrapnel and
suddenly he was not there and it happened after Hassan…”
“I left one day pass, gathered myself and I called him, I
know what happened, I couldn’t come to you, there nothing we can do. We talked about religion, Osama was weeping.
His twin brother, that brother used to bring happiness to the family and I
remember…. So suddenly Ahmad is not there.”
Osama had an extremely difficult time, “we stayed with him, more than
once, he needed lots of support. A few
months ago [his wife] gave birth to a boy and they named him Ahmad, after the
brother who was killed. So you live with
such people, you work with such friends, and you have community but you have no
other chance but to go on.”
We discovered that it was impossible to observe a
traditional mourning period due to the Israeli assault, “because they were
targeting any gathering immediately, like praying in a mosque, going out
together and it happens like that they were bombarded, no mourning at all took
place. My grandmother died, 95 years old
for natural reasons, she passed away, we took her from the hospital to her
daughter’s house and then to the cemetery, everything happened in 10-15 minutes. People were targeted in the cemetery.” Yasser
explains, “that something delays the processing of PTSD, because even natural ways
of grief and closure does not take place, people couldn’t say goodbye to the
dead.” He feels “crazy but I come to work everyday. We have one million nine hundred thousand crazy
people.”
Husam adds that the desire for life, family, and religion
along with the responsibilities and supports of family have kept the
Palestinian community from collapsing over the past 70 years. “The bad effects
of trauma, trauma makes you stronger and stronger, for sure there is something
changed in you, more power to cope with the difficulties in your life.” His grandmother is from Lod, (now Lyd in
Israel) and his mother was born in Yaffa. His family fled south and he
remembers the stories of the Egyptian refugee camps, and life in Gaza. “You have these memories born in the camps,
had to face the difficulties, the trauma, the poverty, at the end they are
different, they are strong, they have an innate capacity to survive.”
Yasser questions, “What could we do? If people here are
given the chance to become productive, things will become a thousand times
better, but it is unfortunately not allowed.” He reviews the growth in Jewish
settlements in the West Bank and East Jerusalem, “It is not logical.”
Husam adds that peace is critical and that when it comes to
genuine politics, the details of the right of return for Palestinian refugees
to return to their homes is negotiable.
Every Palestinian knows they can never go home,” even his 75 year old mother does not want to return to Jaffa
because she has children and grandchildren, but an acceptable compromise needs
to be developed. Netanyahu’s recent election does not bode well for
Palestinians, “He is a fox, a liar, excellent with making money and it just got
better.”
According to the Gaza Community Mental Health Program
website:
Dr. Yasser Abu Jamei has reportedly
lost 28 members of his family when an Israeli air strike on July 21 flattened
the house in which they were gathered for the evening meal at the end of the
daily Ramadan fast.
Other GCMHP staff members who have reportedly also suffered personal losses include Hassan al-Zeyada, Osama Al Ramlawi, and Marwan Diab.
Other GCMHP staff members who have reportedly also suffered personal losses include Hassan al-Zeyada, Osama Al Ramlawi, and Marwan Diab.
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