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  1. M K Lim
  1. Associate Professor, Department of Community, Occupational & Family Medicine, Faculty of Medicine, National University of Singapore, MD3 16 Medical Drive, Singapore 117597; coflimmk{at}

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    “Welcome to Gaza, the safest place on Earth!” announced our driver Mahmoud, with deliberate hyperbole, as we passed the last of a series of alternating concrete barriers designed to make gate-crashing at the Israeli border checkpoint an impossible feat. Feeling reasonably secure behind ¾n^-inch bullet-proof glass, I thought to myself: So this is Gaza—land under occupation, where occupational health takes on a whole new meaning!

    The scene before us on that bright sunny morning, as our Cherokee four-wheel-drive negotiated the narrow and dusty streets of Gaza City, was one of uneasy calm punctuated by the intermittent honking of impatient drivers in competition with slower moving mules, men, women, and children, for right of way. Only the day before, thousands of defiant Palestinians had marched on these streets to mark the second anniversary of the Al-Aqsa Intifada (literally, “uprising”) and to protest the incarceration of their leader, then under siege in his office in Ramallah, surrounded by Israeli tanks, troops, and bulldozers. Two deaths and 15 injured were incurred. Tension had been high the day before that (when I arrived) because the militant group Hamas had publicly promised retaliation after Israeli helicopter gunships had, on the previous day, obliterated a moving car carrying three wanted men and wounding 45 bystanders, including 15 children on a busy street.

    As my intended destination, Gaza City, was temporarily “off limits”, I had remained in East Jerusalem for two days in the cosy American Colony Hotel, which is popular among foreign journalists. Nevertheless, I managed to cross the “green line” on foot and walk 200 m to the World Bank’s office building in the West Bank for a three hour teleconference with the Gaza health team. The “green line” demarcates West Bank and Gaza (WBG) from Israel and, anachronistic as it sounds, will soon be replaced by a concrete, 360 km long “separation fence” currently under construction.

    Life in WBG is severely restrictive. Outside travel is a closed option (the newly completed airport on the Gaza strip lies in ruins) while internal travel is problematic, thanks to Israeli military checkpoints, some 120 in all, which practically divide the entire area into 220 separate clusters. Daytime curfews and nighttime military incursions have become a regular feature.

    “Did you hear the ‘bub-bub-bub-bub’ last night?” was how Kareem, an IT specialist with the Ministry of Health, greeted me one morning (in reference to the sound of distant automatic gunfire). “We are used to it”, he said casually, but with a subdued look on his face. Despite their brave front, the despondency among the civilian population is palpable. Potholes in the middle of the road and rubble on the side, where once stood homes and buildings, bear testimony to Israeli firepower and fury. The subjugation, at least on the surface, appears total.

    There are signs that the deterioration in daily life of WBG’s 3.5 million people may be reaching crisis proportions. Unemployment rate has risen to 50% and the poverty level based on two dollars or less consumption per day is increasing at an even more alarming rate, reaching 70% in Gaza and 55% in the West Bank.1 Potable water and safe sanitation are reportedly cut off in some areas while considerably curtailed in others. During a visit to a “refugee camp”, I heard residents complain of an increasing rat problem. Health officials expressed to me their fears that the build up of solid wastes (a consequence of disrupted access to landfills) may be threatening an environmental disaster. I also wondered about the mental and psychological wellbeing of the people under these abnormal conditions.

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    The author with Dr Thabet (front right) at the Al-Quds School of Public Health, Gaza Campus.

    At the Al-Quds University School of Public Health, I was happy to meet Dr Abdel Thabet whose recent article in The Lancet highlighted significant post-traumatic stress reactions among children exposed to home bombardment and demolition.2 A kind and affable man, he drove me to his home to fetch copies of his other publications. Palestinian mental health specialists report an increase in nocturnal enuresis, insomnia, and phobia among children, and increasing neurosis among adults. This means a longer term price will have to be paid, in addition to the 1800 already killed and 40 000 wounded in the last two years of the Intifada.3 The latter figures include 17 medical personnel killed and another 340 wounded in the line of duty. I was taken aback on learning that “accidents”, as a category, has become the leading cause of death for the 15–19 year and 20–59 year age groups.4

    The Israeli side is not spared either. Official Israeli sources classify 625 dead as “victims of terrorism” occurring between September 2000 and 31 August 2002, in virtually all parts of Israel, and in diverse circumstances: from crowded buses to homes, from a college campus to a discotheque, from a pizzeria to a busy street corner. Anxiety and paranoia naturally run high. During the same period, Israel’s ambulance service, the Magen David Adom (MDA) treated a total of 4425 casualties, among them 11 MDA crew members, in a total of 1072 terrorist attacks.5 This, after all, is not a one sided, but a two sided tragedy involving “blood brothers”6 deadlocked in a longstanding conflict, the origins of which have become fuzzy.

    Sadly, there is no end in sight. According to a poll conducted for The Jerusalem Post by Smith Research and Consulting, 60% of Israelis believe they are fighting for their very existence.7 A parallel poll conducted by the Palestinian Jerusalem Media and Communications Center between 21 and 25 September 2002 showed 64.3% of Palestinians support suicide bombings against Israeli civilians.7 In fact, it was Palestinian suicide bombings since mid June that led directly to Israel’s harsh response to these “murderous acts of terror”. But military harassment, collective punishment, and targeted, if bluntly executed, assassinations of militant leaders have failed to achieve the security that Israel seeks. The “tit for tat” strategy, if anything, has only fuelled the cycle of violence. Will peace ever come to Palestine?

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    Palestinian children in Gaza—peace in their lifetime?

    “I have lived in Israel for 20 years and believe me, there is no answer”, intimated Ben, a fellow passenger I happened to sit next to on the Lufthansa flight out of Ben Gurion airport. “The situation is just too complicated, too impossible to resolve …” “It is too difficult …”, he added, and lost for words, simply shook his head. Moments later, at 35 000 feet above sea level and Wagner’s Der Ring des Nibelungen in my ears, my thoughts turned to my friends—mostly medical colleagues, both Israeli and Palestinian. All highly intelligent, sincere, and warm hearted human beings, none of them espousing extreme views. In fact, their commonly expressed wish is for peace.

    Is peaceful coexistence such an impossible dream? Is breaking with the past and starting afresh for the future that impossible a thing to do? Before I closed my eyes and drifted off, I remember thinking: Ben could well be right, but for the sake of my friends and all of humanity, I sincerely hope he is wrong …

    October 2002



    • Prof. Lim was recently in West Bank and Gaza as a World Bank Consultant in Health Sector Development