Health of Palestinian people in the ghettos: from Gaza to Shatila

Abstract

Finally, I managed to get out of Gaza! For two successive years, I had been able to participate in scientific events outside the Strip only through video conferencing. This year, with a few others from Gaza, I passed through Egypt, successfully arriving in Lebanon to present a paper at the third Lancet Palestinian Health Alliance Conference at the American University of Beirut.Back in 2001, I had been admitted to the MPH programme at the Institute of Community and Public Health at Birzeit University in the West Bank; unfortunately, the sealing of Gaza prevented me from joining my classes there. At the conference, I met the professors who would have taught me public health. Among them was Rita Giacaman, founder of the Institute of Community and Public Health, with whom I had been in touch for more than 10 years, but only via email. In her welcome remarks, Rita coined the term “PPES” —post-prison excitement syndrome—pointing to the irony of our inability, as Palestinians, to meet each other inside our country, and our huge excitement when we bump into each other abroad.The 2-day conference saw a smorgasbord of topics and researchers brought to the table. Entitled “Health of Palestinians inside and outside the occupied Palestinian territories”, the conference put Palestinian health back on its feet and could represent a paradigm shift in the way the health of the Palestinian people is addressed. The shift is from the health of different populations in various isolated territories, which have traditionally been assessed and addressed separately, to the health of one dispossessed nation spanning the Levant, which should be tackled as a whole.For decades after the dispossession of Palestinians in 1948, their health was treated as the health of Arab refugees scattered in the Near East. The occupation of the West Bank and Gaza Strip in 1967 and the way the Palestinian socioeconomic sphere, including health, was de-developed by Israel, forced health activists on the ground to put health in the occupied Palestinian territories (OPT) on a separate itinerary, away from Palestinians elsewhere. This separation continued after the Oslo Accords and the establishment of the Palestinian National Authority (PNA) in 1994. Indeed, the creation of the PNA did away with Palestinian bodies that previously took care, albeit insufficiently, of the health of Palestinians outside Palestine. At the same time, the health system inside the OPT was addressed inappropriately: some dissimilarities between the West Bank and the Gaza Strip were ignored, while the illusion of state building under occupation remained the key agenda for two decades.A new paradigm in addressing Palestinian health affairs, as a health of one nation inside Palestine and across the borders, is not a knee-jerk reaction to the failed Oslo process, nor to the geopolitical break-up between the West Bank and the Gaza Strip. A new paradigm is dictated by the national aspirations of Palestinians and by the identical social determinants of health among them, analogous diseases and demographic patterns, and the commonality of the transborder Palestinian health-care system.Before I left Beirut, I phoned a former medical school classmate from the opulent hotel where I was staying in the shopping district of Hamra. I had not seen him for more than 20 years. Therefore, I could not turn down his invitation to go to his home in Shatila refugee camp.A world apart from glitzy Beirut, Shatila main street was accessed by car but then we had to continue on foot in the labyrinth of narrow alleys strung across with a chaotic web of electric cables and rusty water pipes. The misery of the camp was shocking. The high-rise buildings were packed tightly together, allowing only a small amount of light to filter through to the alleyways.“I do not know Beirut well”, he said when I asked him to get something from the city. “I live in Shatila and go daily to the hospital at Burj al-Barajna refugee camp. I come to Beirut only when somebody like you comes from Palestine or when my relatives who immigrated to Denmark visit us and ask for a tour inside the capital…Lebanon is not our place…we live in the camp and think about Palestine.”I realised that his world, like that of most of us Palestinians, is in the ghettos, where we have been forced to live for the past several decades.I declare that I have no conflicts of interest. Finally, I managed to get out of Gaza! For two successive years, I had been able to participate in scientific events outside the Strip only through video conferencing. This year, with a few others from Gaza, I passed through Egypt, successfully arriving in Lebanon to present a paper at the third Lancet Palestinian Health Alliance Conference at the American University of Beirut. Back in 2001, I had been admitted to the MPH programme at the Institute of Community and Public Health at Birzeit University in the West Bank; unfortunately, the sealing of Gaza prevented me from joining my classes there. At the conference, I met the professors who would have taught me public health. Among them was Rita Giacaman, founder of the Institute of Community and Public Health, with whom I had been in touch for more than 10 years, but only via email. In her welcome remarks, Rita coined the term “PPES” —post-prison excitement syndrome—pointing to the irony of our inability, as Palestinians, to meet each other inside our country, and our huge excitement when we bump into each other abroad. The 2-day conference saw a smorgasbord of topics and researchers brought to the table. Entitled “Health of Palestinians inside and outside the occupied Palestinian territories”, the conference put Palestinian health back on its feet and could represent a paradigm shift in the way the health of the Palestinian people is addressed. The shift is from the health of different populations in various isolated territories, which have traditionally been assessed and addressed separately, to the health of one dispossessed nation spanning the Levant, which should be tackled as a whole. For decades after the dispossession of Palestinians in 1948, their health was treated as the health of Arab refugees scattered in the Near East. The occupation of the West Bank and Gaza Strip in 1967 and the way the Palestinian socioeconomic sphere, including health, was de-developed by Israel, forced health activists on the ground to put health in the occupied Palestinian territories (OPT) on a separate itinerary, away from Palestinians elsewhere. This separation continued after the Oslo Accords and the establishment of the Palestinian National Authority (PNA) in 1994. Indeed, the creation of the PNA did away with Palestinian bodies that previously took care, albeit insufficiently, of the health of Palestinians outside Palestine. At the same time, the health system inside the OPT was addressed inappropriately: some dissimilarities between the West Bank and the Gaza Strip were ignored, while the illusion of state building under occupation remained the key agenda for two decades. A new paradigm in addressing Palestinian health affairs, as a health of one nation inside Palestine and across the borders, is not a knee-jerk reaction to the failed Oslo process, nor to the geopolitical break-up between the West Bank and the Gaza Strip. A new paradigm is dictated by the national aspirations of Palestinians and by the identical social determinants of health among them, analogous diseases and demographic patterns, and the commonality of the transborder Palestinian health-care system. Before I left Beirut, I phoned a former medical school classmate from the opulent hotel where I was staying in the shopping district of Hamra. I had not seen him for more than 20 years. Therefore, I could not turn down his invitation to go to his home in Shatila refugee camp. A world apart from glitzy Beirut, Shatila main street was accessed by car but then we had to continue on foot in the labyrinth of narrow alleys strung across with a chaotic web of electric cables and rusty water pipes. The misery of the camp was shocking. The high-rise buildings were packed tightly together, allowing only a small amount of light to filter through to the alleyways. “I do not know Beirut well”, he said when I asked him to get something from the city. “I live in Shatila and go daily to the hospital at Burj al-Barajna refugee camp. I come to Beirut only when somebody like you comes from Palestine or when my relatives who immigrated to Denmark visit us and ask for a tour inside the capital…Lebanon is not our place…we live in the camp and think about Palestine.” I realised that his world, like that of most of us Palestinians, is in the ghettos, where we have been forced to live for the past several decades. I declare that I have no conflicts of interest.