My first introduction to the problems that Palestinian physicians, teachers and mental health workers face took place as part of a five-day training program in Cairo, Egypt. Our team from the University of Missouri’s International Center for Psychosocial Trauma consisted of our leader Dr. Arshad Husain, Maureen Allwood, a psychology Ph.D. candidate, Dr. Carla Anderson, a psychologist in private practice, and me.
This was the first time these two women had been on a training team for the center. My wife, Carla, has a subspecialty in marital abuse, a problem that seemed of concern to our participants as many men in Palestine have no jobs, are tense about their futures and are often traumatized by how badly they are treated by Israeli authorities. The pressures are sometimes taken out on wives and children in the form of verbal and physical abuse.
Our host city, Cairo, with 18 million people, was an exotic mob scene of the old and the new — traditional and modern dress, donkeys and BMWs, shanties and expensive hotels — in an ever-changing kaleidoscopic pattern.
Newcomers pouring in from the countryside find themselves vying for limited space. The massive graveyard around the "must-see" Mosque of Qaitbey in northern Cairo is full of the living and the dead as masses of the homeless live among the mausoleums.
The city’s major source of income is the tourists, and the locals are friendly and the guides well-trained. You have a problem? The general response is, "No problem. We’ll take care of it."
Carla and I did some touring of the city with a guide. If the guide said getting somewhere would take five minutes, she meant less than half-an-hour. If she said half-an-hour, it meant less than an hour-and-a-half. It’s called Egyptian time. Getting places in Cairo takes time, and it’s not because drivers don’t drive fast — they do. It’s just that streets seem to run in some kind of pattern where there is much backtracking.
Egypt doesn’t make it onto any of the lists of the most dangerous places in the world. Because of terrorist attacks in the late 1990s, however, there is a preoccupation with security in Cairo. Tourism accounts for one-fifth of the Egyptian economy and any security threats would cut that drastically.
As a result precautions were very apparent. At the entrance to our hotel, there was a metal detector and several guards, and white-suited police were visible everywhere. Even McDonalds had an armed guard.
It was an ideal place for our participants from Palestine who needed the opportunity to move freely and to be treated as valued visitors. They were so excited to be out of the hazards of Palestine that they hardly slept because they found so much to do.
THE TRAINING PROGRAM PARTICIPANTS
Forty of the 60 participants in our training program were Palestinian. In the beginning they had trouble concentrating in the training sessions.
The violence of the Intifada had been very traumatic for them. Having spent recent months dealing with the psychological aftermath of suicide bombings and Israeli incursions into territory controlled by the Palestinian Authority, the participants looked totally overwhelmed and overworked. Like their clients, many suffered from post-traumatic stress disorder and desperately needed a week away from the front lines.
Some had to walk mountain paths to bypass Israeli checkpoints just to attend the conference on violence and mental health. The other participants in the program were professionals from Algeria, Egypt, Kuwait and Yemen.
We felt we were doing as much therapy for our participants as we were training them in helping skills. They needed to talk about their experiences and explore ways of not only their clients’ dealing with the trauma but also with their dealing with their own trauma.
Our training techniques lend themselves to this by our often putting the participants in small groups. This allowed them not only to practice new skills, but also to talk about what was happening to them and sharing ways they had developed to deal with their own trauma.
LESSONS FROM OUR PARTICIPANTS
Although the University of Missouri-Columbia team crossed the globe to provide assistance, it was impossible not to learn from the participants.
Individual discussions provided insight into what the situation looks like through the eyes of mental health workers who have to deal with the emotional consequences of ongoing death and destruction in Palestine.
JENNIFER JORDAN, A CANADIAN PSYCHOLOGIST
Jennifer Jordan, a Canadian psychologist with the Palestinian Red Crescent Association, was the coordinator of the work of a group of Palestinian mental health workers who were in our workshop. I found her account of life in the West Bank troubling.
"Basically we’re living in a community with three million people under house arrest," she said. "The curfew comes and goes. They lift the curfew for a few hours every few days so people can get food. When curfew is on, you can’t even go outside your door. I’ve found it is even dangerous to show yourself at a window; they will shoot at you. Some children who took a chance to play in the street have been shot at."
Because of the actions of suicide bombers, it’s a terrifying time to be a Palestinian, Jordan indicated.
"They (the Israelis) search for terrorists by going house to house, making mass arrests of men 15 to 45 and putting them all in a school that is treated as a military prison. People who are stopped by soldiers may be beaten and things in their houses destroyed. Residents can be in the house when occupied by soldiers, but they are not allowed to move freely."
Ambulance drivers and their families, she noted, are among the most at-risk psychologically.
"It’s dangerous work. Three ambulance drivers have been killed, and 70 percent have been injured," she explained. "The TV here is not edited, so children of these drivers see the bodies of the casualties and the blood. This frightens them for the safety of their fathers. Their families want them to stop, but they are very dedicated."
As unemployment in the West Bank is 80 percent, the drivers are reluctant to give up their jobs, Jordan indicated. With little assistance, the alternative is a life of poverty and, often, crime.
"People are out of money, and some of the women are starting to steal because they can’t pay for food. As many as 22 percent of the people suffer from malnutrition, and dental problems are rife. The U.N. has been effectively stopped from helping, as has the Red Cross.
"Most suicide bombers come from refugee camps. These people have no money, no jobs, no food, and everything seems hopeless. They will commit suicide one way or another, and it carries more honor to do it as a suicide bomber.
"Neither side understands the cultural nature of the other. There are better ways to handle this, but what the soldiers are doing is pleasing to the Israeli public."
SOME OBSERVATIONS FROM OTHER PARTICIPANTS
Jordan’s observations were hardly rare.
Another mental health professional working in the West Bank said life there is a daily struggle to survive. The worker asked not to be identified because of the danger of retaliation.
Just getting to the conference in Cairo was difficult, the worker said, explaining that it was a three-hour walk through the mountains with a donkey. "It is illegal to go out when there is a curfew. At night, they will shoot you on sight.
"During the day, they hold you up. You must take off your shirt" so soldiers can check for explosives. "They take your identity card and check on the radio. Then they may let you go home or they may take you to a location to be held.
"This week is different than last week; it depends on how angry they are, what their orders are from the top. You just can’t guess, and things change by the minute."
It has changed the very fabric of life for Palestinians who need medical attention and other needs--heart, pregnancy, kidney--cannot get it," the worker added. "Some women have died in childbirth because they could not get to the hospital."
The Israelis are trying to force their will on the Palestinians. Since June 20 the Palestinians have been subjected to a curfew almost daily. They’ve become dependent upon charitable groups for survival, but even the Red Cross has been hampered by Israeli soldiers.
"They want to injure or hurt people to create fear," the worker added. "June, July and August the occupation has become much more dangerous. The psychological effect is double over previous occupations.
"What we have rebuilt after the last occupation has been destroyed. At the checkpoints bulldozers have destroyed streets. Telephone lines are cut and transportation shut down. It is almost impossible to get enough food and to take care of basic needs."
The worker said that living with the threat of retaliatory shootings and missile strikes has made the Palestinians tense and uneasy.
"They want to clear the territory and kill the resistance movement. They destroy 20 houses and arrest 100 people. They want to cut off the head of the snake, but if they kill 10 it creates 100 more terrorists," the worker said.
TRAUMA--A WAY OF LIFE FOR YEARS
Other participants were eager to tell their stories, again with the provision that no names be used.
"I was born in a refugee camp. Our generation has been raised here, but we are displaced persons. Proposition 194 says we must have two states. Our people have the position we will not leave our land, and if they come to take us away ... we are not afraid to die," a worker said.
It was obvious that the mental health professionals saw Israel as trying to force them out of their country and that Israel’s retaliation for the suicide bombings was not bringing the situation any closer to a peaceful settlement.
Men who are detained have been shot with the claim that they were trying to escape, the participants said. They were concerned that Israeli soldiers have demolished homes with little pretext.
The Israeli army has destroyed homes and property of relatives of people connected to terrorist attacks, they said. The participants were concerned that the rest of the world is not paying attention to the dehumanizing collective punishment strategy employed by Israel.
The Palestinians believe they have been dehumanized. They feel helpless to do anything about it. The workers were not surprised that some of their people have carried out suicide bombings--in their final moments they feel that they can accomplish something to help their people.
Several stressed that the United States is wrong to classify the suicide bombings in the region with the terrorist attacks on America.
The United States, the workers said, is not an occupied country with no way to fight against oppression. I heard these other comments.
"We’re under occupation. We’d just like rights as normal people living under freedom.”
"The more pressure they put on us, the more we attack. There are reasons for the attacks; we want the occupation to stop.”
"Since 1948 our land has been taken and settlers are squeezing us. We’re humiliated every day, and our IDs are checked everywhere. We are desperate people, and desperate people do dangerous things. We can’t fight back any other way.”
"The army blows holes in our walls to get from one place to another. The dead are left in the streets. It looks to me just like the holocaust. Why didn’t they learn from their own experience?”
"I don’t want to smell death any more."