Looking for Trouble

(Gerri will give a report on the current situation in Gaza at the Northlake Unitarian Universalist Church in Kirkland at 7 p.m. on Tuesday, June 22.)


In May, 2010, I traveled to Gaza with eight other members of Physicians for Social Responsibility to work with medical colleagues in hospitals and clinics. This land has been under siege by Israel for more than three and one half years. The passage of essential goods into and out of Gaza is severely restricted by guarded walls, fortified gates and a sea blockade enforced by Israel.

The World Food Programme reports that 80% of households in Gaza depend on international food aid. The Palestinian Health Ministry recently reported that 70% of Gaza’s residents suffer from anemia. Ard Al-Insan, a health organization in Gaza City, states that 10.4% of households in Gaza City suffer from chronic malnutrition.

During our visit, we heard again and again about the critical state of public health in Gaza. The current population is estimated to be 1.6 million people. By 2025, Gaza Municipalities estimates the population will be 2.97 million. With this increasing population, the health crisis – pollution of the water, air and soil and the challenges to the mental health of the population will reach increasingly urgent levels.

Reflecting on what we heard and saw, and the possibility that there may be some positive benefits to the opening of the siege on Gaza in the wake of the Free Gaza flotilla tragedy, this article is a review of some of the critical issues and some possible solutions for the public health of Gaza.

Water

Gaza is a semi-arid land; the over-all rainfall is approximately 317 mm/year and this is decreasing through drought. (The average rainfall is Seattle is 920 mm/year.) The groundwater aquifer, sole source of water, which extends from Haifa to the Sinai, is not being adequately replenished by rainfall. Also, according to Gaza Municipalities, Israel has constructed wells along the eastern part of the Gaza strip to catch the flow of water before it enters Gaza, and Israel has built dams along the Gaza valley to collect the flow of rainwater outside of Gaza for use by Israel.

Lack of replenishment and increased demand for water is resulting in over-pumping of the aquifer in the Gaza area – resulting in the seepage of sea water into the aquifer.

The United Nations reports that 90 – 95 percent of Gazans do not have access to clean water. Untreated and partially treated sewage is seeping into the soil and the aquifer and flowing directly into the Mediterranean.

Lacking basic equipment, spare parts and adequate electricity because of the siege by Israel, the sewage treatment system of Gaza is unable to handle the level of sewage that needs to be processed.

Fishing, a primary source of income and food in the past, is restricted by the blockade – deep water fishing is closed to Gaza and fishing in the nearby shallow, polluted water yields an inedible catch.

To remedy the water crisis, construction of sewage treatment and desalination plants will be essential. This will require access to Gaza by sea or through Israel and/or Egypt in order to bring in critically needed equipment.

Also, given the present level of unemployment and poverty (70% below the poverty line), financial aid from the international community will be required.

Air

Based on observation and anecdotal evidence, the air quality in Gaza is poor. The absence of reliable electricity (bombing by Israel of Gaza’s power plant in 2006, the unavailability of repair parts due to the siege and lack of fuel to run the functioning parts of the power plant) results in power cuts that last from four to eight hours per day for all of Gaza. The use of small, private generators is wide-spread and the resulting pollution of the air is felt throughout the region – concentrated in the cities where the population also is concentrated.

Physicians report a high incidence of burns from touching generators and pouring gasoline into generator fuel tanks and that childhood asthma is rapidly increasing. Whether the increase in asthma is caused by poor air quality or pollutants from other sources is under study.

Soil

In parts of Gaza the groundwater and the soil are contaminated with nitrites, from pesticides and sewage, and chlorides, from seawater intrusion. Both carry health risks, particularly to developing fetuses and small children.

Mental Health

The presence of the siege, profound lack of employment, death of loved ones through air and ground attacks, presence of continuing disabilities from injuries sustained in those attacks, death and injuries caused by fighting inside Gaza, and the ongoing threat of further attacks by Israel have created a sense of despair, tension and fear – and a level of hopelessness in the population of Gaza.

Every person our group spoke with had been affected by the siege and the 2008/2009 attacks by Israel. While the pervasive belief that “all things come from Allah” provides comfort, the daily life of the average person in Gaza is fraught with difficulties.

Mental health workers describe seeing what has been reported in the homes of U.S. war veterans: increased rates of episodic rage and domestic abuse. They also report high rates of depression and an inability to find hope in any activity among the people of Gaza.

However, during our visits to women’s clinics and during our work in health care facilities, a sense of resilience was palpable. Innovative efforts to overcome the health crisis go on despite desperate conditions. The Gaza Community Mental Health Programme – host to our delegation – is developing a program to teach primary care providers how to assist patients in recognizing normal responses to the abnormal situation of life in
Gaza.

Ultimately, the most essential remedy for the public health crisis in Gaza is to end the collective punishment of the population by ending the siege. Among many other things, this will allow the resumption of trade which will create jobs in Gaza and lead to the revival of hope for a healthier future.

As she did last year, Gerri has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created. She has been sending back reports from inside and outside the Israeli blockade. This is her final post before returning to the United States. (While her flight was delayed in New York, Gerri added to this post.)

This morning, we traveled early to Haifa to attend the first part of a conference addressing a one-state solution. We met colleagues from Physicians for Human Rights, Israel, and learned of the work they are doing. Their representative, Sameeh, told us that PHR’s main objective is to get good access to health services for the West Bank and Gaza.

Sameeh described the difficulties in getting people to services – sometimes requiring that patients be taken long distances “out of the way” to get to nearby facilities that are almost inaccessible because of the separation Wall.

PHR is also working on a nutrition project – studying how the siege is affecting nutrition in Gaza. They are gathering and compiling information from NGOs in Gaza – focusing on what Israel allows to be taken into Gaza, on the prohibited fishing situation, and on agriculture.

Almost 48% of agriculture land in Gaza is not workable. The land in the buffer zone is not accessible and bombing has made much of the earth unsafe to farm. Most importantly, water is a critical issue in Gaza.

Sameeh reported that 95% of the water is contaminated and 80% of drinking water is privately supplied – an economic disaster. Many of the wells have been bombed. NGOs report that because of the contamination of the water, the growth of children is stunted. There will be an ongoing study by PHR on these issues.

Comments on a one-state solution varied from the hope for this possibility to an opinion that such a state already exists – but that many of the citizens (West Bank, Gaza and Palestinian Israelis) have few or limited rights.

During our visit to this region, we have heard many opinions about solutions to the current untenable divisions – with the majority of commentators to our group holding that a one-state solution is impossible and a two-state solution is a distant hope.

We had a walking tour of the Old City in Haifa and visited the lovely Bahai Gardens, then turned south to the airport.

We will fly home tonight – again grateful for this time and the wonderful people we know here.

(Here is Gerri’s add from New York.)

Hello from New York – Our plane will be a little late and I want to complete this blog with this message from a lovely 23-year-old woman from Gaza. Sahar is an interpreter and teacher and she sends this message to all:

Dear people on the other side of the land,

I am writing to yourselves from Gaza where insecurity and uncertainty and a second war, in every moment, is expected.

I write this and I am aware and sad that on the other side of the land, Palestinian rockets are expected, too. This needs to come to an end.

I, and most of my people, believe that people everywhere, regardless of their religious, political, cultural and social state, are entitled to peace and love; respect and dignity. You, the same as we, are entitled to a decent, safe life that no one on the planet has the right to violate and spoil.

If you believe in the above mentioned, you are my partner to start the first step towards peace, comprehensive and endurable for all.

May peace and love come to the world and to you,
Sahar Salem, Gaza, Occupied Palestinian Territories

As she did last year, Gerri has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created. She has been sending back reports from inside and outside the Israeli blockade.

Today felt like a bonus day. We waited for a meeting that didn’t happen, then were treated to an exquisite history and tour of East Jerusalem by Yohav, a member of the Israeli Committee Against Housing Demolitions. With brilliance and humor, Yohav dismantled Israel’s approach to occupation and settlement development.

Using maps, he demonstrated the diminution of Palestinian land and told us that Israel’s dilemma is, “land we want and people we don’t want.” The governmental expansion of what constitutes the municipality of Jerusalem from a relatively small area around the Old City to an area that stretches from Ramallah to Bethlehem was, he said, an effort to address that dilemma. By taking into Jerusalem Palestinian land which was sparsely populated and then walling out (with the Wall) more heavily populated Palestinian areas, Israel effectively protected their need for more land with a Palestinian minority – making Jerusalem ever more difficult to share. This process of walling out cut off families from relatives, children from schools, people from economic possibility and agricultural land from the people who own it.

He claimed that the decrease in suicide bombings is not due to the Wall, but more probably due to a very effective Israeli secret police force and a decision by Palestinians that suicide bombing was not being effective. Since 20,000 Palestinians move “illegally” into Israel every day to work (without a permit and by moving around the Wall), he held that it is illogical to believe that the Wall is the major cause for a decrease in suicide bombings.

Since the Palestinian residents of East Jerusalem pay the same taxes as the Jewish residents of East Jerusalem and should therefore have the same municipal services, Yohav invited us to compare the appearance of the two areas. West Jerusalem: modern roads and sidewalks; East Jerusalem: “where the sidewalk ends” along pot-holed roads. West Jerusalem: classrooms with twenty-plus students per classroom; East Jerusalem: in need of 1500 new classrooms and double-shifting its students. The Israeli Supreme Court has adjudicated this issue but only about one-third of the mandated classrooms are under construction and due for completion on the time-line established. West Jerusalem: modern sewage system; East Jerusalem: ancient septic systems that drain into the ground water and affect the health of the entire area, etc.

Building permits are rarely awarded to Palestinians in East Jerusalem and residents who build without a permit are fined and/or their home is destroyed. Since 1967, more than 25,000 Palestinian homes have been destroyed. New, permitted, construction is underway in East Jerusalem – for Jewish Israelis. We drove through Sheikh Jarrah – an area under present contention.

This afternoon, we traveled to Bethlehem to visit WPSR’s 1993 World Peacemaker Award winner, Zoughbi Zoughbi, director of Wi’am, The Palestinian Conflict Resolution Centre. Zoughbi talked with us about the political situation in Palestine, the devastating effects of the Wall on the people of his area, the problems with water (Israel turns controls the water to Bethlehem and recently turned off the water to the entire city for 13 days) and his constant hope that justice and peace will come.

Zoughbi is a member of the City Council of Bethlehem and very active in conflict resolution for the people of his city. As we walked with him to the Nativity Church, almost every person we passed greeted him by name.

In the Wi’am office, we met Amira – a delightful woman who is studying and writing about the Nakba. She related her tunnel experience in 2006. Unable to gain admission to Gaza, she walked and crawled through one of the tunnels – spent two weeks learning about the situation of that politically tumultuous time – then walked and crawled through a tunnel back to Egypt.

Having just seen the tunnel area in Rafah, we were stunned by the thought of this petite and courageous woman finding her way in and out of Gaza through this most dangerous route.

Reluctantly, we said goodbye to Zoughbi – our friend since the first WPSR visit to this area of the world in 1993. He has traveled with WPSR delegations to Iraq and Syria and throughout his home.

We wish for Zoughbi and all the people of this region a pathway to peace.

As she did last year, Gerri has organized a Washington Physicians for Social Responsibility delegation of doctors and other health care providers to work in hospitals and clinics in Gaza in an effort to directly help the people there and to bring attention to the ongoing humanitarian crisis that the Israeli blockade has created. She has been sending back reports from inside the Israeli blockade.

As we said “goodbye” this morning to our friends in Gaza, we were acutely aware that, no matter what the stresses of crossing through the Erez checkpoint, we could freely leave – our friends cannot. Thankful for this time to serve in Gaza, we know that the solution lies not in temporary visitors, but in justice for the people – for the opportunity to live freely.

At the checkpoint, there were only a few Palestinians crossing – nearly all of them were temporarily leaving Gaza for medical care that is not available in Gaza. One tiny little boy with a dialysis shunt in place left with us. He was traveling with his grandmother who told us he is ten years old – although he looked at maximum two years. He moaned and cried out from his wheelchair throughout the long walk between the Palestinian entry point and the Israeli exit. We were thankful he is able to receive care, but wished he did not have to make this arduous journey. We wished again for the citizens of Gaza to have full access to care in their homeland.

As we rode through Israel into Jerusalem, we noted the fields of blossoms and vibrant agriculture along the way – and the presence of F16 fighter jets over our heads. We had heard from a friend that bombs were dropped yesterday by Israel in Gaza – none of us had heard the explosions, but tonight’s news told of further destruction along the “no man’s land” area of Gaza. The F16s were a reminder of the tenuous nature of life in Gaza.

The Old City beckoned and most of our group toured through the market areas and some of the sacred sites of Jerusalem. Tonight, Hillel Schenker – long time friend, member of the International Physicians for the Prevention of Nuclear War and co-editor of the Palestine-Israel Journal – and David Helfand, son of our friend, Ira, National PSR Board member, joined us at the Notre Dame for dinner. David, a U.S. citizen, is living temporarily on a kibbutz between Tel Aviv and Jerusalem and is planning to pursue Middle East studies. Hillel has lived most of his life in Israel and gave us some of his views on the current complex situation and his hope that the present opportunity for peace will be realized. Hillel is a strong supporter of peace and a two-state solution. We spoke of the potential for a one-state solution, but were advised that this is an unlikely solution – promoted more often by U.S. citizens than by residents of Israel or Palestine.

Tomorrow, we will meet with three Israeli groups who work for peace – then travel to Bethlehem to meet with Zoughbi Zoughbi, director of Wi’am, The Palestinian Conflict Resolution Centre.