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MSF psychologist and translator go meet a patient in Burin village. Some villagors live in remote area and are afraid to leave their house to go to MSF clinics because of settlers attacks. West Bank, April 2018. © Laurie Bonnaud/MSF

Palestine

The invisible scars of Palestinians in the West Bank

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MSF mental health programme in Nablus, Qalqilya and Hebron.

    The beauty of the West Bank immediately captivates anyone travelling its roads for the first time. A patchwork of lush greenery and grey rock, the mountains contrast sharply with the blue sky, while olive groves afford the landscape a veneer of pride and single-storey village houses an impression of tranquillity.

    On taking a closer look though, a visitor begins to wonder. Why the many military observation posts set up along the roads leading to villages? Why the barbed wire fences and the seemingly endless, several metre-high walls? Why are roads littered with rocks and the scorched remains of tyres? And what about the signs on the outskirts of large Palestinian towns that state: “According to Israeli law, access to this town is prohibited to Israeli citizens whose lives are at risk”?

    Scars in the West Bank are hidden away - on the landscape, as in people’s psyches. The illegal Israeli occupation and political in-fighting that have lasted for so many years have profoundly affected, both directly and indirectly, the physical and mental health of Palestinians.

    However, as MSF psychologist Frédérique Drogoul explains: “In lower and middle-income countries, mental health usually comes last on the priority list of medical services to be provided to the population.” Given this situation, with the aim of responding to people’s needs, MSF teams work with the Palestinians to raise awareness about the importance of this vital, yet largely unknown, aspect of medical care. They reach out to people in their villages, offering psychotherapy, emergency psychological care and psycho-educational support. In 2017, our teams in Nablus, Qalqilya and Hebron treated a total of 644 patients.

    A double-edged violence

    There are some in Nablus, which is where the second intifada began, who consider that life has been calmer in many of the West Bank’s bigger towns since the fighting ended in 2005. Still, the violence is very real. “The situation in the West Bank is no longer gauged merely by the number of checkpoints or skirmishes. It also requires assessing people’s peace of mind and how safe they feel,” says a member of MSF’s team in Nablus.

    50-year old Reema, 38-year old Heba and 17-year old Estabrak are receiving treatment from MSF’s psychologists in Nablus. They represent three generations of women living amid violence caused by their close proximity to Israeli settlements. They describe incursions by settlers into their villages, launch of projectiles into their homes, insults and provocations.

    Settlers regularly come to the village and hurl stones and tear gas into our houses.

    “Settlers regularly come to the village and hurl stones and tear gas into our houses. Last week they even danced around the streets until the soldiers told them to go home!” says Reema. In Heba’s village, the school is the target. “Our children are terrified. The teacher focuses on his class only half of the time because he has to keep watching at the window for settlers who may be approaching.”

    After being badly wounded by a bullet, Estabrak was left for dead at the entrance to the settlement near her village. She was then put in prison for two years. She was just 14 [1]. In 2017, 44% of the patients who received psychological care from MSF’s teams were minors.

    Everyone has installed protective bars on their windows. Every day Reema looks out from her home and sees the settlement where her son Latib was killed in 2016. “It was 1 o’clock in the morning. I heard a shot and felt right away that my son had been killed.” Everyone can see through their barricaded windows the orange-coloured roofs of the settlers’ houses - constant, painful reminders of their scars.

    From physical to mental barriers

    Not always visible, direct or physical, violence is also hidden among the restrictions that weigh so heavily on Palestinians living in the West Bank.

    Going from place to place is a full-time preoccupation. For “security reasons”, roads passing along Israeli settlements are prohibited to Palestinians; with more and more settlements, getting around has become very challenging. It used to take 10 minutes to go from Nablus to the neighbouring village Kofor Qadoom, but when a settlement was built along the road, Palestinians were banned from using it; the same journey now requires 45 minutes by car. Every Friday, the road becomes the source of skirmishes opposing Israeli soldiers to Palestinian villagers.

    Those same “security reasons” justify the encircling of many Palestinian villages - like Beta, where Heba grew up - with barriers and barbed wire. On the road into Beta there is a sturdy, bright yellow barrier that only the Israelis have the key to. When the situation is deemed stable, the barrier is opened and people are free to go in and out as they please. But at other times, in response to stone throwing or an arrest, the Israeli military close the barrier and the whole village comes to a standstill. “We, as Palestinians, live in a cage and it’s Israel that decides when to open or shut the door,” explains a member of MSF’s team.

    Checkpoints are yet another obstacle Palestinians have to contend with in their everyday lives. In addition to the permanent controls between the West Bank and Israel, which can be crossed only with a permit issued by Israeli authorities, so-called “temporary checkpoints” are set up arbitrarily - once again citing “security reasons”. Estabrak’s family explains. “We never know what the “security reasons” are. All we know is that we have to turn back.” 30-year old Ziad is attending psychotherapy sessions with the MSF teams in Nablus. Resigned, he tells us: “Obviously, we can never ask the Israelis for an explanation. So, when I hear a temporary checkpoint has been set up, I just leave for work earlier. My boss understands when we arrive late because temporary checkpoints are set up constantly.”

    Then there’s the problem of land and its administration. The terms of Oslo II - the 1995 Israeli Palestinian Interim Agreement - established three areas (A, B and C) in the West Bank, dividing up control between the Palestinian Authority and Israel. This was initially intended to last for a transitional period of five years and end with the creation of a sovereign Palestinian state. 23 years late though, this division is still in effect and the Palestinian State has yet to be created, let alone recognised. Thus, many villages find themselves caught between two systems of administration and control. “Although there are areas A, B and C, the occupation is everywhere,” explains Jamal*, a disillusioned 38-year old patient. “Even though the Israeli soldiers aren’t supposed to enter area A, they do it anyway because they’re stronger than us. Who’s going to dare tell them they can’t enter? The Palestinian Authority that carries no weight?”

    There are only Palestinians in Reema’s village, its inhabitants split between areas B and C. Because her home and land are situated in area C, Reema can’t construct any new buildings without the permission of the Israeli authorities. “My neighbour asked to be able to add another floor to his house. We’re allowed to build on top of our homes but not new buildings. It took two years for his requested to be granted.”

    Heba’s family has a plot of land where it has been growing olive trees for generations. “The plot is in our village, but in area C. So we have to ask the Israelis for permission to go to our own land. We’re only allowed to go twice a year - one day to prepare the soil and then another three days to harvest the olives. It’s not enough! Last year we managed to harvest only half of them.” Heba goes on: “Anyway, what’s the point? Every time we go to gather the olives, the settlers have been there before us.” Harvesting olives is often punctuated by insults and shouting and sometimes even physical blows.

    In the face of such restrictions, anxiety and paranoia are quick to set in. Palestinians in the West Bank feel they are constantly watched by the Israeli authorities. Everyone agrees their social media accounts are kept under surveillance and the Israeli authorities know everything about them.

    Do you remember what you had to eat yesterday? I do. We’ve got our eyes on all of you.

    “Before doing anything whatsoever, posting on Facebook or taking a step in a certain direction, I always ask myself, could the Israelis wrongly interpret this as something political? They know everything we do,” explains 23-year old Mohammed. Estabrak adds, “One time a soldier at a checkpoint asked my father, do you remember what you had to eat yesterday? I do. We’ve got our eyes on all of you.” Reality or myth? Nobody can say to what extent the Israelis actually scrutinise the lives of Palestinians. But the anxiety and pressure they feel at the very suggestion are all too real.

    “But the violence doesn’t just come from the occupation. It also exists among Palestinians,” adds Ziad*. Mohammed comments: “The Palestinian Authority works hand in hand with Israel. You never know who you can trust. If something bad happens to you, nobody can protect you, not even the Palestinian Authority.”

    Over the years, physical and intangible barriers, as well as overt and hidden violence, have gone on to become as many mental barriers in Palestinians’ minds. In addition to what people experience individually, they suffer from the stories they hear from each other. It is a shared affliction in which the Palestinian collective psyche carries the burden of the entire community. “People often complain of persistent headaches, backache or fatigue. They see the doctor, have tests done and are told everything’s normal, that they’re in good health. But these symptoms are in fact manifestations of anxiety and permanent stress,” explains a member of MSF’s team in Nablus. “It’s often said that there’s no health without mental health, which is exactly what we observe in our patients. Many physical symptoms are in reality manifestations of reactions to the pressure people have experienced,” adds MSF’s programme coordinator in Nablus.

    Between fatalism and resignation

    Confronted with the occupation, violence and restrictions meted out over so many years despite international condemnation, resignation and fatalism are tangible among people in the West Bank. Heba tells us with a heavy heart that, given the situation, she, like many mothers, is steeling herself for the possibility that she might lose one of her children. “Every mother ends up going through it: their children getting wounded, thrown in jail or killed.” When she was a little girl, she used to dream of an end to the violence and the occupation. She still has the same dream, but now it’s for her children.

    Many keep a tight rein on themselves so as to not expose themselves or their families to violence, to ensure their actions won’t be interpreted as sedition by the Israelis or indeed the Palestinian Authority; despite being supposed to represent them, the latter is often viewed as a corrupt organisation on Israel’s payroll. “People get arrested every day. It makes everyone really anxious,” declares Jamal*.

    Of course, in addition to these necessary preoccupations brought on by occupation are the fears and concerns common to all societies, associated with events such as the death of a relative, the pressure of wanting to succeed in a professional or social context, illness, separation, discrimination or exclusion. Like any other society, Palestinian society is not immune to such types of stress. For Mohammed, the pressure from having to find a wife is what brings him to see regularly MSF’s teams in Nablus; for 4-year old Ghena, it’s the trauma caused by a horrific accident during which part of her house was destroyed.

    A crushing longing for a life of peace

    There are bridges between Israelis and Palestinians in the West Bank, or at least between individuals. For business purposes, to start with. Israelis often work with Palestinians at harvest time or in the construction and clothing industries because they are cheaper to employ. Jamal* works as a tailor in Nablus, making uniforms for Israeli companies. “Of course there are Palestinians who have good relations with Israelis. Sometimes we even give presents of money for weddings and new babies. But the conflict isn’t about friendships. It’s about land.” According to Jamal, the level of the stakes is a barrier to peace.

    According to a member of MSF’s team in Nablus, the barrier is quite simply political. “All of us in the West Bank have a Jewish or Muslim friend we get on well with. And there are lots of places in the world where Jews and Muslims live peacefully side-by-side. But when it becomes political, there’s nothing we can do. It’s beyond our control.”

    People are utterly drained. Palestinians in the West Bank long, half-heartedly, for peace. Our colleague continues: “We can’t do anything about it. It’s not as if in recent years we haven’t been trying. It’s been going on for 70 years. We have neither the means to fight, nor a leader. It’s now we have to live. We have to think of the future, of our children and of peace.”

    Palestinians resort to small acts of resistance. Staying put in their homes even after they’re attacked by settlers, carrying on going to school, sharing opinions freely on social media, cultivating fields, smiling in the face of aggression. “Some Palestinians keep smiling, even when their homes are destroyed. It’s our way of resisting, of saying to the Israelis that even if they destroy our houses, they’ll never destroy the Palestinian people,” explains Estabrak. That the occupation has made them stronger is often heard.

    Many also say that because the Israelis aren’t able to destroy Palestinians, their culture or their identity, they are trying to progressively break them psychologically. In the West Bank, the task of MSF teams of social workers, psychologists and psychiatrists is to support and restore the mental health of a people shattered by many years of Israeli occupation.

    [1] Since we met, Estabrak has been arrested again, this time by the Palestinian Authority. She was protesting at a checkpoint. She is now in prison for the second time.

    * Some names have been changed to respect the anonymity of the people we interviewed.