Everything Is Not Okay in the Holy Land (guest blog)

My brother, David McRay, M.D., is leading a small group of medical students on a month-long visit to Israel and Palestine as part of their medical education. With his permission, I am sharing this as a guest blog. David is a gifted writer with a unique perspective on the problems plaguing the Holy Land. I think you will be stirred, enlightened, intrigued, and troubled.

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“Everything okay?” No, everything was certainly not okay. My immediate reaction to his question was frustration, even anger, followed almost as quickly by a mixture of disbelief, subdued laughter, and then despair. My emotions seem to race across this spectrum many times a day when I travel in Israel and the Occupied Palestinian Territories.

We were stopped at a checkpoint somewhere in the middle of the West Bank, on the road from Nablus to Ramallah. It was one of the hundreds of such barriers – most
“permanent” (or fixed) and many temporary or mobile (or “on the fly” as people here call them) – scattered across the Palestinian territory that make life so incredibly difficult for the people who must line up and wait, sometimes for hours, to get to their jobs, farms, and family, if they are allowed to pass at all. Life at the checkpoints is challenging – on a good day – and, on a bad day, may end there.

The young Israeli soldier – certainly no more than 25 years old – stood at the window of our van, clearly marked in multiple ways as a mobile medical clinic van operated by the Palestinian Medical Relief Society (PMRS), asking our Palestinian driver where he was going and why. In the usual posture of a soldier in this situation, with his finger on the trigger guard of his semi-automatic weapon, he glanced inside and saw that the passengers of the van were five Americans (our traveling party) and one additional Palestinian (our assistant and translator) – who is also an American citizen. Pausing briefly, apparently to find the correct English words, the soldier then directed his question beyond the driver to the rest of us. He was implying that there might be some reason to be concerned about our safety – a group of Americans in the company of two Palestinian men. I would like to believe he had our best interests in mind and that, if questioned, he might be able to offer a reasonable explanation as to why he made such an inquiry. In light of the many similar experiences I have had in the past (including the day before when another soldier at another checkpoint asked us, “Where are you sleeping?” and then, in reply to our response of “Ramallah” said, with a sly grin, “Ramallah? Why Ramallah? Why not Jerusalem or Tel Aviv?”), I could not easily find any other explanation for the “Everything okay?” question than the prevalent racial/ethnic/religious profiling that is an accepted approach to security considerations, even a way of life, here.

“Everything okay?” No everything was certainly not okay. Actually, nothing besides our safety was “okay”. For the third consecutive day, we had been driving through the ancient, beautiful hills of the West Bank, covered with stone terraces holding rows of old, but still productive, olive trees, admiring their beauty but saddened by what has happened to them over the past 40 years, especially the last 20. I have traveled these same roads many times since my first visit to this land in 1969. Now, in every direction, one can see hilltops covered with “settlements” -communities, towns, even cities composed of Israelis who, with their government’s permission and support, have built permanent homes on Palestinian land - and valleys transformed by new roads built on Palestinian land but open only to the settlers. I spoke today with a friend who owns a travel agency on the east (Arab) side of Jerusalem. His family owns the land on which one of the “settlements” (“colonies” as they are called by some here) was built. The land was confiscated from his father, without compensation, in violation of international and even Israeli law. The Israeli courts ruled in his father’s favor in the lawsuit that followed, but the court’s verdict was never enforced. No, everything was not okay.

We had been to Hebron where the poverty and malnutrition are devastating and where the conflicts created by a small group of hostile settlers who have planted themselves in the middle of this large Arab city are frequent. No, everything was not okay.

We had visited Jiftlik, a small Arab village in the Jordan River valley, in an area of the West Bank still under complete Israeli control. This was my third trip to this community to follow the status of the community’s health care and the continuing efforts of PMRS to address their needs. They have a new clinic, built by funds from USAID, a good staff, and adequate equipment. Yet the effects of extreme poverty, inadequate and unclean water, and severe restrictions on housing repair and construction imposed by the Israeli military authorities present obstacles they cannot hope to overcome. No, everything was not okay.

We had listened to the stories told by our Palestinian traveling companion, assistant, and translator about his experiences since returning to his homeland. Born in the West Bank, he moved to the US a number of years ago and became a citizen. After deciding he preferred life in his native country among his friends and family, he returned, with his American passport. At the border crossing from Jordan, the soldiers ran his name through their computer and discovered that he had been born in the Palestinian territories, therefore, in their eyes, he was Palestinian and not American. His passport was not stamped with a visa like ours when we arrived. Instead, he received a stamp that included his Palestinian ID number. Now, he is treated like any other resident of Palestine and denied the privilege of entering Israel, even to visit Jerusalem, only a few miles down the road from Ramallah where he now lives and works. (We met with a 20 year old student of Palestinian heritage studying at Beir Zeit University, born in the States and carrying a US passport, who, along with her family, experience the same restrictions because they have chosen to live in Ramallah.) No, everything was not okay.

And, we were on our way to Qalqilya, to visit a city of some 40,000 people completely encircled by the separation barrier – in some places a massive, 30-foot high concrete wall and in others a complex, multilayered fence with razor wire. Suhad, my friend and our guide for our visit, told us about the many severe health care problems created by the restrictions on movement throughout the Qalqilya region, including the death of her mother following a stroke when they could not transport her to a tertiary care center in a timely manner and the death of a mother following childbirth at the checkpoint. No, everything was certainly not okay.

Regardless of what one believes about the necessity of such barriers, restrictions, and decisions to insure the safety and security of the citizens of Israel, one cannot but be overwhelmed with the implications for the health, welfare, security, and life of the Palestinian people. This is part of what we came here to see and experience, in addition to learning about the health care delivery system in the nation of Israel, with its excellent national health “insurance” program and universal access to state-of-the-art care for all its citizens – two drastically different health care systems, existing side-by-side separated by only a few kilometers and a Wall, with two strikingly different outcomes.

We have completed the first two weeks of our four-week journey. Our group is small, but still big enough to make squeezing into a little rental car cozy, and into a smaller taxi, quite cozy indeed! Jonathan (my oldest son and a veteran now of Middle Eastern travel, on his fourth trip here and his second extended stay in Ramallah), Dr. Justus Peters and Dr. Deepa Somcio (both third-year family medicine residents working with me in Fort Worth), and I flew from DFW to Frankfurt and met the fifth and final member of our group, Danielle Smith (a third-year medical student at Northwestern University in Chicago), at the gate for our flight to Tel Aviv. We only had one hour between our arrival from DFW and our departure for Tel Aviv, but we made it with a few minutes to spare. Our luggage did as well!

After a rain-soaked Saturday night and Sunday in Jerusalem (water was flowing down the streets of the Old City), we headed south to Beer Sheva, and to drier, warmer weather in the Negev desert. We received a wonderful reception there from the members of the department of family medicine at Ben Gurion University and from the students of the Medical School for International Health at BGU, operated in affiliation with Columbia University in New York. Our week in Israel was filled with visits to clinics, a cancer community support center, a staff meeting of the palliative care group, a meeting with a group of family medicine residents, a formal presentation on the Israeli health care system, and two lectures I gave (one to the Israeli faculty and residents and one to the MSIH students). Our only major disappointment of the week was the cancellation of our scheduled home visits to the Bedouin community due to the absence of the primary physician (he was in Africa on a global health elective with a group of medical students!) and the illness of the driver. We left Beer Sheva much better informed and satisfied with this brief introduction to a national system of health care that has yielded excellent health outcomes for the citizens of Israel.

Although our conversations with the doctors and students in Israel were mostly medical and only rarely political, we did learn something of their experience during the recent assault on Gaza. The rockets fired by Hamas that fell on Beer Sheva did little damage but they disrupted lives in significant ways and caused deep fear and anger. In a nation as small as Israel, where every citizen serves in the military for 2-3 years after high school graduation, everyone, I have often been told, knows someone injured or killed in one of the wars or bombings. And every Palestinian, I have also been frequently told, has a friend or relative who has been injured, killed, or imprisoned by the Israelis. No, it seems in every way, everything is not okay here in the “Holy Land”.

After a weekend of somewhat arduous but enjoyable travel to Jordan to visit the World Heritage site of Petra, we crossed the Qalandia checkpoint into Ramallah and met our hosts for the final three weeks of our trip. This week has afforded us a broad, and exhausting, overview of the work of PMRS, a 20+ year old non-government organization providing primary health care throughout the West Bank and Gaza via an extensive network of clinics, mobile units, and a host of other healthcare related activities. We also enjoyed a detailed tour of the primary government hospital in Hebron, the major referral center for the southern portion of the West Bank and the site of some 8400 births per year. On Monday we will hear presentations on the history of the PMRS and on the status of another public health project in the Palestinian territories and then, on Tuesday, begin seeing patients at the Ramallah Emergency and Trauma Center (both in the emergency department and the operating suite) and with the mobile clinics conducted by PMRS in the villages around Ramallah. We will continue these activities during our final week and add a visit to the Holy Family Hospital in Bethlehem, a private maternity hospital that provides excellent care to thousands of Palestinian women each year.

Everyone is well and safe. We have never felt threatened in any way. We have had many memorable travel experiences and enriching and challenging conversations about life, medicine, justice, security, and health care. I anticipate we will have many more in the days ahead.

David