As the week moves on, we are hearing more and more words of despair… joblessness, hopelessness, a toxic environment, the trauma of imprisonment and siege and the constant threat of another attack are inescapable.
The ability to concentrate on caring for one another seems one of the strongest factors in sustaining life here. A friend told me today, “I don’t want to hear any more about resilience. We need some ray of hope to hold onto.”
Students who need to complete their graduate studies abroad are prevented from exiting Gaza to travel. The Rafah crossing remains closed – permission to travel through Erez is difficult or sometimes impossible to obtain. The prison.
In a Women’s Empowerment Clinic, the reality of many more women needing care for abandonment after divorce, domestic abuse, hunger, illness – seems overwhelming. When the caregivers are also traumatized, the provision of safe care is hard. Still, the strong commitment to family and the need to make sure family members have food and are safe compels those working even minimal pay jobs to continue.
Most non-governmental agencies are cutting hours or staff or pay – trying to stretch their minimal operations budgets as far as possible. Every management person who speaks to us tells of innovative programs being designed to help the people of Gaza. Finding operations dollars to run these programs is a critical problem.
This afternoon, several of our group paid a visit to the home of a friend in what is known as the ‘slave area’ – the area where descendants of African natives live. We learned of further difficulties involving poverty and violence.
One very bright part of the day – an introduction to five-month-old Gurri (Gerri) – my first namesake!
Each evening, our team gathers to review the experiences of the day. They offer many positive words about the courage of the people here. We have a good team of workers – it’s an honor to work with this group!
There are heroes working here in incredibly difficult conditions to make life safer and more fulfilling for Gazans – despite the critical challenges of life under siege.
Issa Nahal directs a women’s empowerment center – aiding women in Rafah to gain work skills and to cope with life in this economically depressed area. SOS Children’s Village provides family-style homes for orphaned and homeless children. This inspiring facility is one of 518 villages across the world – established to aid the children of war.
Also in Rafah, Wefaq organization assists women and children affected by war. We visited a computer skills training program – one designed to help prepare women for work in technology. When we asked what the women would like us to tell the people of America, their response was similar to that of almost every Gazan: “Remove the siege and let us be free.” There is a deeply resilient spirit in this land – a spirit that wants to fully participate in the world.
In central Gaza, Reem Abu Jaber, a most remarkable woman, has established a cultural center for children. In the midst of constant war threat, Reem opts to help strengthen the spirit of children by engaging them in the most loving and beautiful parts of their culture. She refuses to concentrate on war – she insists on concentrating on what will help children maintain hope and health.
At NAWA Cultural Center, art, music, and storytelling are combined with the pride of service projects in the community. The children and staff also joyfully maintain the immaculately clean Center. Over the last three years, enrollment in NAWA has grown to include hundreds of local children – children who are imbued with the beauty of Gaza’s history and with the joy of being a Palestinian.
Reem’s next project is to be completed this year – the refurbishing of a 1700-year old monastery into a children’s library. She says there is always another project on the horizon to help the children of her homeland.
This afternoon, journalist Mohammed Omer took some members of our group to the tunnel area of Rafah on the border with Egypt. For years, hundreds of tunnels provided access to goods for the people of Gaza. Food, fuel, cars, camels, medicines, etc. came through the tunnels and were an important part of the economy. Over the last two years, Egypt has destroyed most of the tunnels and recently, Egypt has flooded the remaining tunnels with salt water, adding to the salinization of the aquifer and creating cracks that are leading to the development of sink holes along the populated southern edge of Rafah. Military action along this southern border is now common and threatening to the residents of this area.
So we learn about life under siege and we do the work we came to do: teaching, consulting, operating. Grant O’Keefe, trauma surgeon, is occupied throughout the day at Shifa Hospital. This evening, he spoke at a surgical conference – a talk I missed but hope to hear at a later time – perhaps on the bus back to Jerusalem!
Over the last few years, Dr. Bill Dienst and Dr. Bob Haynes have been teaching versions of Advanced Cardiac Life Support. With the advent of new guidelines, this year’s courses are helping to certify instructor trainers for ACLS in Gaza – thereby making it possible for this skill to be taught throughout Gaza.
Twelve participants in one hospital and 18 participants in one of the universities will have ACLS credentials by the end of this week!
We were again impressed by the amount of construction here – demolition and building in every neighborhood. During a visit to Al Amal Orphanage today, we learned that a newly funded structure will be built soon.
Presently, the orphanage serves 170 boys and girls, ages 5 years and above, but the last war on Gaza left many infants and very young children without families and the new structure will house children from one week to five years of age.
Orphanage administrative personnel are presently seeking funding for operations of this new facility. The orphanage is also planning installation of solar panels. With severe electrical cuts throughout Gaza (electricity often available only three to six hours per day), the advent of solar energy is eagerly anticipated.
Classes in stress management offered by members of our group continue in several sites. Staff members of the Gaza Community Mental Health Programme are educating health care providers (doctors, nurses, social workers) throughout the Strip to offer mental health services to the Gaza population that is traumatically stressed by repetitive war.
The mental health providers from our group hope to offer support to this effort. No area of the 25-mile-long Gaza Strip has been untouched by the traumas of siege and war. The challenges to mental health care workers are great and the staff of GCMHP has consistently sought programs to help spread available mental health services to the community.
They are heroic and inspiring.
Music and dance are an integral part of Gaza. In a visit today to Meera kindergarten we were treated to the dancing instruction of a now-famous Gazan, known as Sweet Baby – a young man who compels every person in his presence to dance.
This kindergarten is expanding in size and service and is mainstreaming several autistic students. Again and again, the spirit of Gaza is brilliant!
Surgeons Grant O’Keefe and Clyde Farris operated through the day at Al Shifa Hospital and several members of our group consulted and taught classes at the Gaza Community Mental Health Programme Clinic. A good day of work!
This morning, several of us visited the Qatar-funded rehabilitation hospital being constructed near the Mediterranean Sea. The top floor of this hospital will serve hearing-impaired individuals, including those with cochlear implants. The lower floors will serve people with amputations and orthopedic rehabilitation needs.
We had visited the existing Cochlear Implant Center in previous visits and learned that the new hospital will provide improved testing and training facilities. Funding ongoing operations has been and remains a challenge for this center and attempts are being made to find partners who will help with the costs of services and staffing. With the economy of Gaza in critical need, the present reality of work without pay in many sectors continues.
Today, also, we were treated to the first day (after vacation) of school celebration at the Palestine Avenir Association for Children. Children with cerebral palsy are served here in a most loving environment!
Center Director Ahmed Al Kashif led us through the building, greeted at every turn by staff and children, who were obviously delighted by his presence. Testing, needed therapies and academic instruction are offered at this Center.
In the play yard, merry-go-rounds and swings accommodate children in wheel chairs. A new roof structure, complete with solar panels (funded by the Czech Republic) will soon offer full electrical energy for the building. At the end of our tour, we joined the children for their musical celebration – dancing with children who have all levels of difficult movement related to cerebral palsy – including children in wheel chairs – each one smiling and offering to help us enjoy the dance!
The stories we are hearing in our work and in nearly every encounter with Gaza residents reflect the extreme difficulties of life under siege and under the ongoing threat of another attack: unemployment, hunger, very limited electricity, highly polluted water, increasing domestic disputes, depression, school problems.
Life is deeply challenging in this imprisoned land. Yet again and again, we are amazed and inspired by the creativity, dedication to helping one another and amazing coping skills of the people here.
We invite the world to consider Gaza and the realities of life here.
Construction and rebuilding signify hope and aspiration. In Gaza, we are seeing many sites demonstrating hope and aspiration in action. But in Gaza, construction and rebuilding also carry the possibility of destruction by another attack and these activities are demonstrations of resilience in action!
Today, some members of our group were treated to a tour of the newly opened Indonesian Hospital – a beautiful facility funded by donations from Indonesia’s poor. Indonesian volunteers worked for more than four years (without salaries) along side workers from Gaza to complete this 100-bed hospital, now open for about one month.
During construction, portions of building were bombed, but that damage was repaired and patients, families and staff are enjoying this gift from the people of Indonesia!
Surgeries, consultations and teaching activities in other parts of Gaza began today also.
Maria Filippone, D.O. from Iowa wrote this report:
I spent today in Basmat Amal, a resource center for cancer patients and their families in Gaza City.
I spoke with about 20 women, all survivors of breast cancer. Initially I answered their medical questions. It didn’t take long to get to the real issue. The siege. The occupation. No economy. No opportunity.
Most people live on subsidies from UNRWA, which often isn’t enough to cover basic living expenses, because there is no work. There is no work because of the blockade imposed by Israel.
The blockade is so harsh that some items not allowed in at one time or another include, but are not limited to, crayons, blankets, nutmeg, dry food items, stationery, and coriander. There is no economy, no work, buildings that haven’t been reconstructed since Israel’s latest assault, few hours of electricity per day, a sea of unknown depth full of unmet needs, and an infectious, persistent resilience and warmth in spite of everything.
One woman’s question in particular shook me. She asked: “In the US you have rights for humans, even animals have rights in the US. Why can’t we have those rights? We are human.”
They need to get permits from Israel to leave Gaza for chemotherapy and radiation. These permits are often not given, or if they are, they expire before the receiving hospital in the West Bank or Jerusalem can get the medicine.
Tamoxifen is allowed into Gaza but Herceptin is not. And if the medicine is available in Gaza, it is often too expensive. Can anyone in the US imagine a reality such as this one?
At one point the look on my face betrayed my feelings of sadness, and the women immediately started comforting me, hugging me, apologizing to me for making me sad, crying with me.
After a brief stay in Jerusalem and short visit to the Palestinian Center for Reconciliation in Bethlehem, the January, 2016 delegation of medical professionals sponsored by Washington Physicians for Social Responsibility returned today to Gaza.
In Bethlehem, we met and were inspired by the dedication to learning and service of a visiting group of students from Manchester University (United States) – young people witnessing the situation on the ground in this part of the world. We spoke with them about our experiences in Gaza and our hopes for this visit.
The thirteen members of our group traveled by bus down from Jerusalem to the coastal plain of Israel/Palestine – passing remnants of old war, new wooded areas and productive areas of farming.
The crossing from Israel to Gaza took less time (about two hours instead of four) than previous trips, but the stark contrast between the sides of the border remains. From lush green to brown, from high productivity to barren areas, the reality of the effects of continued conflict remains.
As we walked the long caged corridor into Gaza, multiple bursts of gunfire were audible in the “no go” zone adjacent to the Crossing. Approximately one-third of Gaza’s arable land is in this zone – also known also as the “security zone”. Entrance by Gaza’s farmers (and all Gazans) to this potentially productive area is forbidden and incursions are often greeted by gunfire from Israel.
We learned that more than 50% of the tens of thousands of homes partially destroyed in the 2014 war on Gaza have been repaired. Of the 1800 homes completely destroyed in that time, only five have been rebuilt. Tens of thousands of Gazans remain without homes and continue to live with extended family members, in rubble dwellings or in UN schools.
Winter is particularly hard here. Electricity is available erratically and the cold that enters through fragmented walls is chilling.
After an orientation meeting with program planners from Gaza Community Mental Health Programme (the critically important organization that hosts our delegations) and an informative and gracious greeting from the medical director of the Programme, we greeted old friends, explored a bit of Gaza and prepared for the work that begins tomorrow.
Some members of our group are new to Gaza – we welcome them and are thankful for the work they will do here. For those who have returned again and again, we are grateful to be back and look forward to the days ahead.
Slowly we complete our work here in Gaza – realizing there is no completion. How we wish for open borders and justice for the people here.
We will pass through the checkpoint tomorrow – all of our luggage will be thoroughly searched and we will be questioned about our time here, but we will emerge through the freedom of our blue passports to return to the US.
Tonight, we celebrated with Gaza Community Mental Health staff and many people from the professional community of Gaza. We thanked them for welcoming us to their home and looked forward with them to meeting another time.
We had spent the day working and visiting friends. Over and over, the grace and kindness of Gaza’s imprisoned people amazes us. It is stunning that the more than 1.8 million citizens here can cope with the reality that their borders are closed, their industry is denied, their water is undrinkable and that there is little evidence of hope for change in the near future.
Young adults all over Gaza form structured play groups for children – groups whose goal is to teach resilience. No one pays for these groups – they are simply the work of unbroken and brilliant spirits. The young adults of Gaza inspire us.
The world must know of the grave injustice being carried out against the people of Gaza. Basic human rights are denied here every day by the collective punishment of the siege and we know that the work of small groups such as ours will be unnecessary when the siege ends and human rights are restored to Gaza. For now, though, we are grateful to have participated even briefly in the lives of these courageous people.
The friends we part from are brave – they have much to teach the world about love.
One of the main objectives of our Washington Physicians for Social Responsibility medical delegations to Gaza has been empowerment. Dr. Bob Haynes and I have tried to fulfill this objective by teaching elements of Advanced Cardiac Life Support (ACLS) to doctors and nurses here in Gaza.
Gaza has plenty of physicians and nurses. It has its own medical and nursing schools. But what is limiting for Gaza’s health care professionals is post-graduate and continuing medical education.
Due to the siege and closure as a direct result of the Israeli occupation, Gaza is cut off from the outside world; it is very difficult for Gaza’s health professionals to travel outside of Gaza for medical specialty training, or for continuing medical education. It is also difficult for outside educators to travel into Gaza. These interactions inside and outside the strip do occur, but the logistics are very complicated given that Israel controls who may travel and who may not in and out of the Strip.
ACLS is a course developed by the American Heart Association, which teaches current evidence-based clinical practice for evaluating and treating cardiopulmonary arrest as well as pre-arrest conditions. It is designed to maximize the possibility for survival of patients who suffer from these conditions.
In its full form, ACLS is a 15-hour course offered over 2 days. Students are provided with a student manual a month before the course, and it is expected that they thoroughly study the manual before the course begins. In order to be certified by the American Heart Association, students must complete the entire course, demonstrate competency in managing cardiac arrest, and pass a written exam.
Since April 2013, Dr. Bob Haynes and I have brought elements of ACLS to Gaza. It has been an evolving enterprise that necessitates creative improvisation:
1) First, planning a course requires getting into Gaza. This requires approval of our admission by Israeli authorities. Though we have typically applied for travel to Gaza through our delegation months in advance, we often have not been granted approval to enter Gaza until weeks prior to our scheduled arrival.
2) Next, we coordinate with our contacts in Gaza. When, where and for how long will each course occur? This also includes the question of how many different venues we will be able to offer courses in during the week that we are here. We typically do not know this information until after our arrival, nor do we know how many students we will have until we arrive at the venue to teach the course. We have had classes as small as 15 students, and also huge classes in a large auditorium with over a hundred students. These medical and nursing students have varying levels of expertise.
3) Because of these factors, it has been so far impossible to provide student manuals to our students a month in advance.
4) The amount of time allotted for each class has varied from 3 hours to about 10 hours.
5) There are language and cultural logistical hurdles to negotiate. We do not speak Arabic, but fortunately most of our students understand English. In past venues, we have taught in English with the assistance of English-Arabic interpreters.
6) We figure in coffee breaks, meal breaks, and breaks for prayer. These necessities and their timing are often not clear before we start the course.
7) The quality of Audio Visual Aids, IT systems, teaching mannequins, ventilatory equipment and defibrillators varies at each venue.
Our teaching experience has been rewarding. Doctors and nurses in Gaza have appreciated our classes. We can see it in their eyes and feel it by the endless gestures of gratitude and hospitality that they extend to us. Although it is only a small gesture, we are also showing that there are those of us in the outside world that deeply care about Gaza and its people at a time when folks from here often feel that the world has abandoned them.
Surely the children of this land are among the most beautiful in the world. Studies of these children speak of resilience but cannot reveal the exuberance we see as children joyfully greet us wherever we go. Still, these greetings do not reveal the reality faced by Gaza’s children.
Parents tell us they have prepared their children for the steps to be taken in evacuating their home if the ever-present possibility of another attack by Israel becomes a reality. I hear this and know that no child should have to grow up with such a “game plan.”
Conversations with medical professionals here center on survival, treatment, plans for the future, needs and strategies. We hear of the critical difference between adaptation and coping.
Adapting to life under siege carries the inference that the present situation will become normal. Coping with life under siege does not allow the possibility that the present reality is permanent. Coping requires the daily evaluation of the situation and decisions about how life is to be conducted. Coping allows the continuance of hope. Adaptation is passive and admits to the power of the oppressor. Coping is active. There is personal power in coping.
Further discussion centers on “needs” versus “rights”. Clearly, we are told that basic human rights have been evacuated in Gaza. Of course, food and clean water are needed, but we hear again and again that partially filling these needs does not replace the essential right of people to provide for themselves – the right to freedom, the right to security, the right to dignity.
“If our basic rights were respected, we would be able to fulfill our needs. We are an industrious people. We are an imprisoned people.” I am reminded of the role my taxes play in this imprisonment.
I copy below the articles of rights as articulated by the United Nations doctrine of human rights. This may seem long – unless you live in Gaza.
All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.
Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.
Everyone has the right to life, liberty and security of person.
No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.
No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.
Everyone has the right to recognition everywhere as a person before the law.
All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.
Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.
No one shall be subjected to arbitrary arrest, detention or exile.
Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.
(1) Everyone charged with a penal offence has the right to be presumed innocent until proved guilty according to law in a public trial at which he has had all the guarantees necessary for his defence.
(2) No one shall be held guilty of any penal offence on account of any act or omission which did not constitute a penal offence, under national or international law, at the time when it was committed. Nor shall a heavier penalty be imposed than the one that was applicable at the time the penal offence was committed.
No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.
(1) Everyone has the right to freedom of movement and residence within the borders of each state.
(2) Everyone has the right to leave any country, including his own, and to return to his country.
(1) Everyone has the right to seek and to enjoy in other countries asylum from persecution.
(2) This right may not be invoked in the case of prosecutions genuinely arising from non-political crimes or from acts contrary to the purposes and principles of the United Nations.
(1) Everyone has the right to a nationality.
(2) No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.
(1) Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.
(2) Marriage shall be entered into only with the free and full consent of the intending spouses.
(3) The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.
(1) Everyone has the right to own property alone as well as in association with others.
(2) No one shall be arbitrarily deprived of his property.
Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.
Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.
(1) Everyone has the right to freedom of peaceful assembly and association.
(2) No one may be compelled to belong to an association.
(1) Everyone has the right to take part in the government of his country, directly or through freely chosen representatives.
(2) Everyone has the right of equal access to public service in his country.
(3) The will of the people shall be the basis of the authority of government; this will shall be expressed in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by secret vote or by equivalent free voting procedures.
Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality.
(1) Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment.
(2) Everyone, without any discrimination, has the right to equal pay for equal work.
(3) Everyone who works has the right to just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection.
(4) Everyone has the right to form and to join trade unions for the protection of his interests.
Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
(1) Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Elementary education shall be compulsory. Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit.
(2) Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups, and shall further the activities of the United Nations for the maintenance of peace.
(3) Parents have a prior right to choose the kind of education that shall be given to their children.
(1) Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits.
(2) Everyone has the right to the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author.
Everyone is entitled to a social and international order in which the rights and freedoms set forth in this Declaration can be fully realized.
(1) Everyone has duties to the community in which alone the free and full development of his personality is possible.
(2) In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society.
(3) These rights and freedoms may in no case be exercised contrary to the purposes and principles of the United Nations.
Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein.