No Permit to Live with Dr. Yasser Abu-Jamei, MD and Ran Goldstein

The mobile clinic also goes to Gaza; we are the only Israeli organization which goes to Gaza on a regular basis. Every five to seven weeks we have a group of doctors who enter Gaza, perform surgeries in hospitals, doing training – also the surgeries that they perform have a very important training part because they do it with the local staff, of course, so they try to train them. Part of this training is also when we try to bring people from Gaza to Israel from training, and it didn’t work in the last couple of years, but before I arrived here, just the week before, we succeeded to facilitate the exit of eleven doctors for a three day training in one of the Israeli hospitals. It was very unique, and also, we realized how huge the gap in knowledge is. One of the doctors told me, you know, in five years there will be no doctor in Gaza who will know how to do an IV because all the good doctors left. And we’re talking about a health system in Gaza where the electricity runs only like twelve hours a day, and all the rest the hospitals are using generators. We’re talking about a medical system that has no medications, no disposables, and according to the Palestinian Ministry of Health, we’re talking about a $4 million gap for a day. They need $4 million a day to be able to rebuild the health system in Gaza.

During the last war, we organized a fact-finding mission: eight international experts who went into Gaza during the war and then also after the war, and we published a report. You can find it online under “Gaza Health Attack.” And the experts were from Europe, two of them were from the States, one of them is Professor Jennifer Lanning, if you’ve heard her name – she is the head of the public health school in Harvard. And they found out many things, but one of the things that really terrified us is the fact that the hospitals could not cope with the number of the wounded. So sometimes people who were seriously wounded were put with the bodies. And I’m not talking about regular patients who didn’t have any solutions, someone who just had a heart attack, someone who has chronic problems: those people could not get any treatment during the 51 days of war because the hospitals and all the medical facilities were dealing with wounded people, and we’re talking about more than 11,000 wounded in a strip which is very small, as you know. And the mobile clinic – I said we also do policy change – so from the mobile clinic or from the fact that we help people from Gaza go out to the West Bank, Jordan, or Israel for medical care, we learn about the phenomenon, meaning that someone who wants to leave Gaza, you know, every one of us who wants to go to a doctor, sometimes we want to see a second opinion. In Gaza, they can’t because if you want to leave Gaza for a medical check you need, first, to prove that this medical service does not exist in Gaza. Okay, we prove that it does not exist; then we have the security issue. With the security issue, if you are 18 to 45 years old and you are a man, it’s very difficult to get a permit to leave. So in those cases we intervene, and in 50percent of the cases in which we intervene, we succeed in changing the decision of the authorities. So suddenly someone who just until yesterday was security prevented, suddenly he got the green light and he can go out for medical checks. We see that as proof that the system is not really about security. We think that the system is about control.

And, maybe we’ll get to that a bit later, this closure that was implemented beginning in 2007 obviously failed. Even if you think from the Israeli point of view, why did they do this closure? [Aside from] the fact that it’s immoral, and it’s collective punishment, and all that, they did it because they thought that with the closure there will be more pressure on Hamas, and then, you know, there will be a revolution in Gaza or whatever, and it will be easier for Israel, probably, to, I don’t know, negotiate or whatever. But what we see is exactly the opposite: we see that now you have other groups, not only Hamas, and you see that [of] the people in Gaza, the ones who really suffer are the civilians. So I think that after so many years of closure, Israel, to continue with the same policy which will bring another war probably, needs to change completely the policy of closure. You know, before the closure, before 2007, every month half a million people used to leave Gaza. You know how many people now leave Gaza? More or less, it is 10,000 people a month. So we see that the closure really affects the civilians in Gaza.

I will go to that in a minute again – I have, still, ten minutes. So just, in general, to go over other things with Physicians for Human Rights, we have another clinic in Tel Aviv, which is in Jaffa, actually. It’s an open clinic, so everyone who doesn’t have Israeli national health insurance can come and get treatment, so it’s mostly for refugees and asylum seekers who live in Israel who have no access to medical care. It’s also for Palestinians who are married to Israelis and don’t have access to medical care because, you know, there is this civilian law in Israel which means that if you are a Palestinian who married an Israeli Palestinian, you will not get citizenship unless you go through a special humanitarian committee, but it is very difficult to get really legal status. So people sometimes live for 30 or 40 years in Israel; they have Israeli kids who have insurance and a partner – most of the time it’s a man – who has insurance, but the wife doesn’t. And she lives like that for years and years and years. We are the only place she can come and get treatment. And what do we do when she needs surgery or something like that? So then, in Israel, if your situation has deteriorated and you go to the hospital, they must give you treatment. Never mind if you have insurance, don’t have insurance; they will deal with how the patient will pay later on. So then some people get the treatment, but rehabilitation is something that they don’t have. So we sometimes intervene with the Ministry of Health and we succeed [in convincing them to] take responsibility for something, which usually they don’t do. But we say that anyone who lives in Israel for that many years should have Israeli national health insurance. Not only does it makes sense, like the closure, it’s not only more moral, economically, it makes more sense because then, when you have the prevention care, their situations don’t deteriorate, then you don’t need to hospitalize them for a long time, then it costs less money for the states. I assume it will take a little bit more time to convince the Israeli authorities to do that, but we are working on it.

Another thing is regarding the medical community. This is a campaign we did with our doctor volunteers that is saying we will refuse – I don’t know if anyone reads Hebrew here – but this is a campaign [about] refusing to obey the force-feeding law. The force-feeding law was just passed two or three months ago with the aim to force feed Palestinian hunger strikers because in the last four or five years there is a phenomenon – by the way, it happened in the eighties and nineties already – but in the last five years we see more and more that Palestinians who are under administrative arrest protest their arrest in a hunger strike. The Israeli response was to say, okay, we will allow doctors – because Israel doesn’t really fear that somebody will die from this hunger strike – so they passed a law that will allow doctors to force-feed. Never mind that in the eighties two patients who were force-fed died from the force-feeding process, which is very risky as well. So now they think that this is the solution. We were very happy that in Israel the medical community at least was very vocal and strongly against it. Even the Israeli Medical Association did a really good job, a public job against this bill.

But what we see in other cases – probably you are aware of this photo. Most of the people, what do you see in this photo? Just shout. Handcuffs, his face beaten – okay, this is Ahmad Ansawa; he is a thirteen year old boy accused of stabbing an Israeli boy, also thirteen years old. I don’t know exactly what happened; he’s going to be in court soon. But he was also shot by Israeli people, and he was taken to the hospital. Then, Mahmoud Abbas, last week or so – no, it was when I was in Israel, so two weeks ago – did a public speech and said that this boy was killed by Israel. Israel, in order to show that he’s not dead and getting treatment in a hospital, published this photo. They published a photo of a thirteen year old boy, hospitalized, under arrest, shackled to the bed – you see here that he’s shackled to the bed – and violated all the [laws protective of] minors. They didn’t ask his parents, they didn’t ask his lawyer, even the hospital was against the publication of this photo, but in the propaganda war – and there is a propaganda war between the two sides – Israel violates every single moral point of it. So we use that in an aim to criticize Israel. We distributed a press release of course, but we expect doctors in hospitals to intervene in the fact that he is shackled to the bed because, you know, there is at least one guard with him.

And I’m sorry for the next photo; it’s tougher than that. Also here is a seventeen year old. Never mind what they did or didn’t [do]; we don’t deal with what they did or not. He is in the hospital. He is a patient. If he is your patient, you need to take care that he will not be shackled. And you see that one leg is injured; the other leg is also, you know, bandaged or something. He will not escape. In this case, he had two guards in the room. And we want the medical community to be more involved also with those issues.
And from time to time we get phone calls from hospitals saying, you know, just now the ISA (Israel Security Authority), Shabak, took one room and they are interrogating a patient. So sometimes we do have these kinds of calls, and then we intervene immediately. But most of the time, if a doctor sees someone who was beaten and he’s in detention – not only Palestinians, by the way, but also Israelis or Jewish detainees – they don’t speak with the patients, they speak with the guards. They give the guard the medical checks, they give the prison authorities the permission, you know, “Okay, you can go back to interrogation.” This is not the role of doctors. Doctors should protect their patients. And this is something that, we go to universities, we go to hospitals to speak with different people – it’s not very easy because as you know in the last – let’s say since Cast Lead, I think – the respect for human rights organizations is less in Israel, and we’ve been attacked all the time. There will be new laws that will probably [affect] the way we fund ourselves, but we will deal with that later on.

I will finish with just another example of permit issues. Ayman is from Gaza; his wife is an Israeli, and he wanted to be at the birth of his son. So he asked for a permit, as every Gazan person should do when he wants to leave Gaza, because they cannot plan their lives, they cannot travel for holidays, they cannot study abroad, they cannot visit their family in the West Bank; they need, first, to get a permit to exit. And this permit process always takes two to three weeks. Then, when he was security prevented, he contacted us. We intervened, and very happily, we succeeded to get him a permit. It was five months after his baby was already delivered. But there is also a small victory in this story because since then, the rule [has] changed and Palestinians who married Israelis and they’re going to have a baby will be allowed to go with them to the hospital in Israel. So it’s a small victory. It probably will not make a change for many people, but we see that from time to time we also succeed in changing the policy somehow.So thank you very much, my time is over as I can see from there. Probably you will have more questions later, and I want to invite my partner for this trip, Yasser Abu Jamei. Actually the cooperation of our organizations goes from the first day. Ruchama Marton, the one who established Physicians for Human Rights went to Gaza, and one of the people she met was Eyad Serraj, who back then was the only psychiatrist in Gaza. And two years after, he established Gaza Community Mental Health Programme. And Dr. Serraj passed away – what was it, two years ago? And now Yasser Abu Jamei very successfully went into his big shoes and is now the executive director of the organization. So, welcome.

Dr. Yasser Abu Jamei:
Sabah al kheir and good morning everyone. Thank you, Ran for the nice introduction and I would like to start by thanking the Palestine Center for arranging this event. I don’t know from where to start but I’m sure that most of the audience are well equated with the Gaza Strip. You know, it’s one, tiny space there on that map. Do you see where is Gaza Strip in there? Well it’s painted in yellow, I think, you know it’s right next to the sea. I think there are a couple of issues about the Gaza Strip. First, what is the geographical area of the Gaza Strip, does anyone know? It’s not a very big one. It’s about 25 miles in length and about 6 to 8 miles in width; it’s a very small one. Twenty five by eight. And how many people live in there? About 1.8 million people. And more than 70percent of these people are refugees who are uprooted from the historical land of Palestine.

So it’s one of the areas that has a very high density of population and at the same time, it has been occupied since 1967, and it has been under a siege, as Ran mentioned, since almost eight years. And that siege started in a very brutal way, you know [with] many things that were not allowed to get into Gaza, including even children’s clothing, children’s shoes, anything that you could imagine. And the 17 items that were initially allowed into Gaza were mainly food items.

Well it’s not enough, there are all the time different agencies, different international agencies, UN agencies that speak in general about the conditions in the Gaza Strip. And all of them, if you go back to 2002, 2004, 2006, 2008, all of them speak about the difficulties and the living conditions of people in the Gaza Strip. They speak about problems with water, the recent reports say that more than 90 percent of the people in the Gaza Strip do not have access to clean water that is good for the children to drink. And they all the time raise the issues of the power supply, of the reconstruction issues, and they raise the concerns about Gaza and generally they speak about a de-development that is taking place in that very small, tiny area in the Middle East.

And it’s not only like that, on top of this, people who were in Gaza were exposed to three different operations, offensives, attacks. One of them was in 2008-9, one of them was in 2012, and the third one was in 2014. And when we speak about those three offensives, let’s talk about the most recent one, the one that ended about 14-16 months ago. People say that, you know, different media sources that more than 50,000 shells were falling in Gaza during the 51 days. And of those 50,000 shells, some of them were airstrikes, some of them were artillery, some of them were tank shells, some of them were just from the navy, you know all the types of shells that you could imagine, they were used. And let’s imagine that those 1.7 million people were in that very small geographical area and there were almost 1,000 shells falling on that area on a daily basis. Half of the population of the Gaza Strip, 52 percent, are children, so something like 900,000 children live in that area. So let’s imagine that continuous falling of those shells, falling all the day and night in that area, what would that look like? How would people under an occupation, under a continuous shelling feel?

Of course, the feeling is very simple, the continuous feeling of fear, insecurity, helplessness, loss, and imminent death. You know, the statistics that come from the number of people who were killed all the time keep saying that 70 percent of the people who were killed or injured were just simply civilians, they are just simply civilians. And what aggravated the condition was when the land operation started, which means that more than 500,000 people were displaced from their houses – 500,000 people were displaced to the other areas. Here let’s keep in mind the small geographical area and already existing problems with housing. It’s not all like that, but there are some statistics that say that more than 2,000 people got killed, more than 500 children, more than 11,000 people were injured, including 3,300 children. More than 18,000 residences were fully destroyed and this led to the more than 100,000 people who were simply without homes to return to, homeless. Of course in the Gaza Strip, in that culture, you do not find people sleeping in the streets, never, that’s impossible to see, but those 100,000 people are basically living in some neighborhoods with some of their relatives and this again impacting the lives of not only the 100,00 people but also the other people they are living with. And then the question is, as a mental health professional, how does this impact the psychological health and mental wellbeing? I am really glad to see Brian Barber who is sitting here. He is one of the most qualified people in research, and he has done [a lot] of research on the Gaza Strip. He could definitely help later on while we have the discussion. But here I bring three small paragraphs. UNICEF estimates that 373,000 children were in need of psychosocial support and that was in August. That was the initial assessment of the situation immediately after the ceasefire took place. The WHO, generally speaking, they say in areas of emergencies, 20 percent of the people might have mental disorders. We did our research in 2013 and that was one year before the 2014 attack and we found out that 30 percent of the children who were exposed to high level of trauma were still having symptoms of PTSD and have some neurotic disorders. And the question is, if that is the case, who is going to help the people to provide the services? Well there are mainly two institutions or two organizations that are capable of providing services in the Gaza Strip. [Of the] specialized care services, which are in the top of the pyramid of the services that are usually provided to people in these areas, on top of them is the Ministry of Health and the Gaza Community Mental Health Programme.

So our institution works on top of that pyramid and tries to provide, as much as possible, care to those who are victims [of] all these offensives. What makes us a little bit distinguished from the Ministry of Health is that we have the resources, capacities, skills and training to work with children, which is a very important issue when it comes to the people in the Gaza Strip, and let’s keep in mind that we have more than 900,000 children. So what do we do? Here I would like to show just a short video about the Gaza Community Mental Health Programme. It’s not a long one, two minutes. The video was made by one of our organizations, not one of our organizations, it’s called Just Act, it’s UK-based and they were raising some funds for the Gaza Community Mental Health Programme. And they sent me an email and they said, “We made an email about you and we are putting it on our website so people will know to whom these donations are made.” So I want to take this opportunity to show the same video that they made about our work.

So the very easy question is what would you do with a child? Children are not able [to] express themselves as adults do. Some of the terms we use like “disappointed” or “frustrated,” they do not have it in their vocabulary. And you need to understand really what is wrong with a child. Why the child is awakened in the middle of the night screaming from night horrors? Or why a child who is seven or eight years old started to wet his bed? It’s very strange. Or why a child who is in the 6th or 7th grade, why his marks start to decrease? He is not good at schooling, like he used to be. Or why someone start to not discipline well. There should be a story behind those things. So how do you find out this story, especially when a school counselor refers the child to you and you need to investigate and find out what’s wrong and then you need to ask yourself how to help? One of the very basic things that we do is we have a play therapy room, full of toys. You get the child in and you say to the child “pick whatever toy you would like to play with.” Some children would like to pick a family structure and play the role of the father, the mother; he might show that he feels some jealousy. But other children will pick different issues, they will pick maybe ambulances, they will pick maybe planes, they will pick something they are afraid of or something they would like to talk about and when they start talking, they will just start to talk about their fears, they start to talk about what keeps their minds busy.

And then you will invite the parents in and you tell them simply, “Your child is afraid of one, two, three, four. Let’s try together to find means of dealing with this feeling of insecurity or unsafety. Let’s try to find ways of dealing with these fears.” The child comes to the GCMHP clinic maybe one or two times per week, they spend two hours maximum. The rest of the day, the rest of the time, they are with their parents. So you need to tell the parent that your child is misbehaving not because he became a bad child, but because he is afraid of something. So if you go tell him a story before he goes to sleep, then he might stop bed-wetting, then maybe he will not just wake up and scream in the middle of the night. So we involve the parents as much as possible at the therapeutic intervention. Sometimes this does not work, [some] children wouldn’t even speak, so in that case, you invite them to draw something. Pick a pencil or a crayon and paper and start to draw whatever comes to your mind. Fortunately sometimes they come with these drawings. It’s very unfortunate that children who are like seven or eight, they come with these drawings; they draw the destruction that surrounds them. Unfortunately until today, in many areas of the Gaza Strip, you still walk around and find piles of the destruction, piles of the rubble that are not removed yet. This is very challenging. How could you work with those children when those piles are still there?

And let’s all the time keep in mind that the Palestinian children are like any other [children] in the whole world: they deserve to have good education, good water, and they deserve to have a good place to play. It’s not good that a child is playing in a partially destroyed house. He is a little bit lucky because some parts of his house are still there; unfortunately you see what’s here. Is this a good place for a child to play? It’s not, but that’s what he has. So, amid all of this chaotic situation, you try to add some colorful memories to the minds of those children. If I ask anyone in the audience, what is the earliest thing that you could ever remember about your life, you would bring a memory, sometimes it’s a good memory and sometimes it’s a bad memory, but you still remember something. I don’t know ten years from now, what my eleven-year old son, Muhammed, I don’t know what he will remember. Maybe the 2008 war, [when] he was five. Maybe the 2012 [war], he was nine. Or maybe the 2014 one when he was ten. I don’t really know which one he will remember, what memory he will think of…we will find out.

So we try one way or another to add colorful memories to the minds of children and we do it in a very good way. Sometimes we make children sing, sometimes we make children dance, sometimes you [involve] them in folklore. Sometimes, despite the closure and the difficulty of us going out, the difficulty of us going out, even the patients, you try to invite some people from abroad. In this case, we invite Mickey Mouse. He is not that man to the left; that is one of our professionals. And children are really happy. So you need all the time to do it one way or the other to keep the children smiling because hope all the time comes from the children. And if you don’t have hope in the children, then we don’t have hope in anything. What I speak about is not quite known to many people in Gaza, so we need to talk more to the people, to let them know that if a child is misbehaving, he doesn’t need more discipline, maybe he needs some mental health attention.

So we go speak about this in the neighborhoods and communities, and sometimes when this is not enough, and this is not enough because it was a large scale operation, we go to media outlets, we go to the radio, to the TV. We try to spread the news, we try to work against the stigma, we try to minimize it. And one way or the other, you try to bring one more time, more hope to the people. You try to bring more smiles to the faces and this summarizes the work we do at GCMHP. We just try to do as good as possible to bring these people hope and smiling again. Just one more word before we finish. It might sound as though all of our clients are children, no, actually half of them are children; 50 percent are adults. As I see the faces here, I want to say one more thing, we don’t lose hope in GCMHP, we make the population more hopeful and if we feel hopeful in Gaza, then you shouldn’t also lose hope. You should also be hopeful, and you think in creative ways how to help the people in Gaza. So thank you very much.