‘You are asleep with your family. At 4am your house is surrounded by soldiers and border guards who hammer on the door and break the windows while you emerge, to be told you have 15 minutes to leave. Using whatever violence is necessary – against you, your wife and children – the bulldozer moves in. Israel provides no alternative accommodation (the UN provides tents but never enough), no compensation, although no one contests the fact that you own the land – and you are sent the bill for the demolition.’

Salim Shawamreh
Anata, Greater Jerusalem

What follows are observations from a 10-day tour of Palestine, made by a group of medical and mental health professionals. We visited hospital departments, psychiatric facilities, and met local and international NGOs involved in addressing Palestinians’ psychological needs. We talked to teachers, businessmen, village leaders and anyone else we could to tell us about life under the Occupation. While predominantly concerned to hear from Palestinians, we have emphasised the contribution made by Jewish Israelis. They are far from representative of Israeli opinion, but we believe they constitute one of the more hopeful elements in the search for peace, and are a voice that is routinely absent from British coverage of this beautiful but tragic land.We were there in November 2008. We were already banned from entering Gaza. The West Bank was tense – the Israeli attack on Gaza was widely anticipated – but quiet. Rather than the ‘hot’ news of out and out war, you could say that we were witnessing everyday life under an endless occupation. 

Home is where the heart is
We were shown around Jerusalem by Jeff Halper, a Jewish professor of anthropology, author of An Israeli in Palestine: Resisting Dispossession, Redeeming Israel, and founder of the Israeli Committee Against House Demolitions. He pointed out the disparity in service provision for Jews and Arabs by the same municipal authority. In Jerusalem, Arabs constitute 30 per cent of the population, receive eight per cent of the services, and pay 40 per cent of the taxes. Jewish areas are clean and well appointed, with street lighting, road markings, and pavements. Arab areas have none of these things: thus one moves from the first world to the third within minutes.

From the British media we had heard of house demolitions as a form of collective punishment against ‘terrorists’. Here, though, it was a tactic to serve the aim of racial displacement. Since 1967 more than 20,000 Palestinian homes have been destroyed in the Occupied Territories and only five per cent had anything to do with security.  In East Jerusalem alone, 40 per cent of all construction has a demolition order on it (around 16,000 buildings). The resulting housing shortage amongst Palestinians contributes to the same social and psychological problems that accompany inadequate housing anywhere.

We spent an evening with Salim Shawamreh and his wife Arabiya, whose house in Anata in Greater Jerusalem has been demolished four times. Bricks and mortar take the brunt of the physical assault, but minds carry the scars. Salim spoke with anger and dignity about the Kafkaesque processes by which Palestinians are denied the right to build houses on their own land, eventually forcing them to build illegally and face the threat of demolition. It was impossible to fully comprehend the experience he described. Arabiya became mute and went to Jordan to recover. One daughter went temporarily blind, and another suffers panic attacks at any sudden noise, and can’t find any solace in her father’s attempts to reassure her. The traumatic effect on children of having their parents humiliated in front of them has been written about by Dr El-Sarraj, Director of the Gaza Community Mental Health Programme, and previously reported in this journal.1 The psychological consequences go beyond the family whose house is demolished. The Israelis take out a house here, a house there. Nobody knows who will be next. It could happen to anyone, any day.

Welcome to hell
There are more than 450,000 Israelis living in 200 settlements in the West Bank and East Jerusalem, many strategically placed on top of aquifers. More provocative, and threatening to the daily lives of Palestinians, are the inner city outposts established mainly by ideologically religious Jews in Arab residential areas. The first we saw was perched on top of the Muslim Quarter of the Old City of Jerusalem, surrounded by barbed wire and Israeli flags. We became more aware of the impact of these settlements in Hebron: ‘Welcome to hell’ was how Ronnie Perlman, a member of the Israeli human rights group Machsom Watch, greeted the news that we were about to go there.

Hebron is a besieged Palestinian city – though not under lock-down like Gaza. It is home to the most infamous of the inner city settlements – 500 zealots occupying enclaves in the heart of the old city, bringing in their wake violence and fear and protected by 1,500 Israeli Defence Force (IDF) soldiers. We were at first denied entry to one such enclave, designated a ‘Closed Military Zone’, where the settlers have lodged themselves amongst their Arab neighbours. The young Ukrainian on duty changed his mind after it was established that he had grown up in the same area as the Jewish grandparents of one of our party. We walked through the eerie streets, up a hill to the house of Hasham al-Aza. The trunks of the vines around his house had been sawn through and the garden trashed by settlers; the windows were barred and covered in wire netting for protection against their missiles. Inside, the children stood by uneasily while the father described their macabre lives. Settlers had broken the girl’s arm and knocked out her cousin’s teeth, while both were on their way to school. We sat together and watched a film of the settlers breaking into and ransacking Palestinian houses to commemorate the 60th anniversary of the founding of Israel (filmed on camcorders given to the Palestinians
by Israeli human rights group, B’Tselem, as part of their ‘shooting back’ advocacy programme).

While everyone suffers, children are the most vulnerable. We heard this from Rawia Mohtaseb, student and volunteer health worker in the Hebron office of the Palestine Medical Relief Society: ‘My sister has a difficult experience with her children. Her brother in law was wanted by the Israelis, and they attacked her house several times and arrested her husband also many times. They forced them to stay all night under the rain without wearing heavy clothes. The effect of that and how the soldiers were dealing with her and her children was in her son. He was four years old and before that he was able to speak very well. After that time, and many like it, he speaks like a child whose age is two. He was repeating the one word three or four time to speak it in the right way. This problem continued for about three years.’

Splitting: the wall and the checkpoints
The Separation Wall (planned to be 700kms long), the permit system, the Israeli-only roads and the checkpoints together form what Jeff Halper described as ‘the matrix of control’ for West Bank residents. It was hard to credit the degree of cruelty that accompanies the system and its implementation, but it was impossible to escape the conclusion, such was the weight of evidence from diverse sources, that its design is intended to subjugate a people, to encourage their emigration, and to facilitate further appropriation of their land and resources. 

The women from Machsom Watch said they had ‘a million stories’ to illustrate the brutality and vindictiveness shown by Israeli security personnel towards the Palestinians at the checkpoints. Physicians for Human Rights, another Israeli NGO, reported many that show the effect of restrictions on movement on access to healthcare. Our group heard about 33-week old triplets whose journey from Gaza to the neonatal intensive care unit in the Palestinian tertiary referral hospital in East Jerusalem was delayed for several hours, and whose parents were refused permits to accompany them.
On our journey, our driver pulled to the side of the road to make way for a Red Crescent ambulance, lights flashing, speeding on its way to hospital. Five or so minutes later we came to a checkpoint. The ambulance was there, in a siding.

Of the more than 600 checkpoints and obstacles to movement in the West Bank, only 17 mark the current ‘border’ between Israel and Israeli-occupied Palestine. The rest are all within the West Bank. Ronnie Perlman was emphatic about this: ‘Palestinians are not trying to get to Israel. They’re not interested in Tel Aviv. They want to get from A to B in Palestine.  The Palestinians are invisible prisoners, sitting in their homes... The name of the game is frustration.’
Some things seem to have material gain as their rationale – the route of the wall, the system of Israeli-only roads across the West Bank – designed regardless of the inconvenience caused to the local population. Others seem intended to humiliate and provoke, demoralise and depress. Together, the system works to make the towns of  the West Bank a series of ghettoes to their inhabitants. 

Targeting mental health?
Around 300 Palestinian children are in Israeli prisons at any one time, and torture is routinely used against both children and adults detained by the Israelis. Many of the children are there for throwing stones at the (illegal) Separation Wall.

The system frustrates and infuriates, the young are least able to contain their feelings, and stone throwing is an accessible outlet for rage against the Israelis. We spoke to barrister Gerard Horton of Defence for Children International, about the children’s experience of the system of military justice which applies in the West Bank. Issues of proportionality have been highlighted recently by Israel’s actions in Gaza, and here too there seemed a significant disparity between the threat the children pose and the response of the authorities. When we asked about this, Horton suggested that the rationale was not one of security, or of combating crime: ‘On the whole they’re not too fussed about getting the right child... I think the whole purpose of this is to beat the resistance out of them. So it doesn’t really matter if you get the right child or not. The purpose is to intimidate, and by and large it works quite effectively.’

‘It’s a psychological war,’ states Rana Nashashibi, Director of the Palestine Counselling Centre, a local NGO operating a range of counsellin and mental health initiatives, who has written of the psychological impact of the Occupation on the Palestinians.  She described that capacity which determines how the Palestinians respond to this as sumud, translated as ‘steadfastness’ and equating closely with terms like resilience, or staying power. Strong family networks and religious conviction sustained it, she suggested. But it is under immense strain. 

On the Israeli side of the Jerusalem-Bethlehem checkpoint, the wall is covered in murals to divert the tourists. There’s graffiti on the Palestinian side that reads: ‘To resist is to exist.’  It suggests Winnicott’s ideas about muscularity and aggression in self-realisation. In parallel situations of injustice, expropriation, and occupation – familial as much as societal – seeking redress would seem a healthy response. In her book Suicide in Palestine, Nadia Taysir Dabbagh makes the point that feelings of depression amongst the Palestinians were alleviated during the first Intifada, and that amongst those whom she interviewed there was strong nostalgia for the days when the community united in actively resisting their oppression. In contrast, individual acts of violence against Israeli soldiers, for example, were described to us as giving in to provocation, an indication of despair rather than hope.

It was the belief of everyone we met in the mental health field that the absence of any constructive and collective outlet for the loss, frustration and rage that Israeli policy seems designed to foment, in itself leads to illness. Dr Mahmoud Sahweil of the Treatment and Rehabilitation Centre for Victims of Torture, told us that there was a continuum between political, community, domestic and school violence. He was concerned about bullying, but also about violence against children by teachers, seeing both as direct re-enactments of the torture the men themselves had experienced in prison.

He talked of working not with PTSD, but CTSD (continuing traumatic stress disorder), underlining the additional challenges to providing clinical services within an ongoing traumatic environment. He estimated that 100 per cent of children subject to the siege of Gaza would be traumatised – and this before the December invasion.

Zoughbi Zoughbi, Director of Wi’am, a conflict mediation centre in Bethlehem, was convinced that displaced anger lay at the root of neighbour disputes, domestic violence, the rise in drug dependence amongst the young, and of high levels of depression and somatic conditions: ‘Our dreams are shattered. We are hostages to fear. Kids suffer from trauma, but it’s not PTSD. It’s current, layer after layer. Symptoms are nervousness, poor school achievement, no respect for authority, reckless behaviour, bed-wetting, domestic violence, macho toys and games, tension between neighbours, demoralisation, and selfishness.’

Dr Issam Bannon of the Bethlehem Psychiatric Hospital listed the consequences as he saw them: high blood pressure, diabetes, psychosomatic problems and depression, and talked of high rates of undiagnosed PTSD in women and children. He thought that perhaps half the hospital’s patients had been imprisoned and tortured.

Cruelty is a virus
Ni’lin is a Palestinian village that is being dissected by the Wall, losing most of its land to settlements and the new Israeli-only road system. Each week there is a non-violent protest, each week the protest is broken by Israeli soldiers. Two children have been shot dead in the last six months; numerous villagers have suffered eye injuries from rubber bullets. Physicians for Human Rights-Israel (PHR-I) run a weekly mobile clinic in West Bank villages and we were invited to join them in Ni’lin, where psychiatrist Dr Ruchama Marton accompanied them. During the first Intifada in 1988, she and other doctors had responded to calls for help from Gaza, where unarmed demonstrators were being shot with exploding bullets. Seeing for themselves what was happening, the group decided to create PHR-I. 

Dr Marton expressed her concern for Israel, whose society she described as characterised by a culture of denial: ‘People do not want to know what they are doing 20 or 30 kilometres from their homes. Psychologically, the power intoxication leads to disturbances in the Israeli collective psyche and in individuals within the collective. These disturbances include, among others, the avoidance of historical perception, splitting, a self-image of victim, increased aggression within Israeli society, manifestations of psychological trauma, the prevalence of hate and antisocial behaviour.’

She was unequivocal about the destructive impact of the Occupation on Israeli society. There has been, she said, a ‘huge increase in violent crime, especially against women, juvenile crime is out of control, minor disputes quickly escalate into murder in a way that is quite new’. Aggression and cruelty, she thought, do not remain at the checkpoints: ‘It’s like a virus; life is seen as cheap here.’

Although there is a debate about why this is happening, no one mentions the Occupation. ‘It’s an active unknowing,’ she concluded, ‘a craving not to know.’ We had not appreciated that only Israeli security forces and settlers go to the West Bank, the rest excluded by the Israeli government. As a trainee doctor told us, ‘We’re walled out.’ A volunteer with PHR-I said that she had joined the group so she could meet a Palestinian, which she finally did at the age of 27.

Palestinians are bewildered by the failure of the west to understand their situation and uphold its professed beliefs in social justice and international law. Jeff Halper argued that a primary reason for this was Israel’s success in setting the parameters of debate about the Middle East. It presents Zionism as an ordinary nationalism struggling for its life against irrational and childish hostility from the surrounding Arabs. Against this, he has put forward two linked reasons
for using the term ‘apartheid’ to characterise Israel’s relations with the Palestinians. First, he argues, the matrix of control constitutes a system that is designed to be permanent. Racism is built into a state that is predicated on
the notion that it belongs wholly to one section of the population. Its laws and practices reflect this basic assumption. Halper distinguishes this from racism where it contradicts the legal and constitutional basis of a society (as occurred with segregation in the United States). Second, he points to the degree of domination exercised by Israel over every aspect of Palestinian life, something we hadn’t previously understood but which impressed itself upon us at every turn.

An international responsibility?
At the end of our tour we visited Yad Vashem, the Holocaust Museum in West Jerusalem. High on the wall, just inside the museum, is the statement: ‘In the 1930s the rest of the world considered the persecution of the Jews to be an internal German matter.’ Given the abandonment of the Palestinians by the international community, this struck us with particular irony. Parallels between the plight of the Palestinians and that of the European Jews are now frequently made – a number of times we heard ‘Gaza’ and ‘Warsaw’ mentioned in the same breath. We did not see anything during our trip that equated to the annihilation of the Jews by the Nazis. But there were strong echoes between the period of Nazi rule from 1933 to 1938, and what we witnessed. The women from Machsom Watch, for example, go to Hebron to form a corridor to shield Palestinian children from stoning by the settlers: in Yad Vashem we listened to the testimony of Jews who had been stoned in their gentile schools in Germany after Hitler came to power. 

The West Bank is a gigantic open prison in which the inmates are allowed a degree of self-management and use this ‘freedom’ to follow, as far as possible, ordinary lives. They open shops, marry and raise families, collect the olive harvest, go to school and university. But the Occupation is not designed to facilitate ordinary life, to lay the foundations of a future harmony between Arab and Jew, to allow social development that might one day help sustain an independent Palestinian polity: on the contrary, the economy is undermined, education disrupted, the infrastructure weakened, and humiliation heaped upon the Palestinians at every opportunity. 

There is a difficulty in communicating this, because the question arises: why would the Israelis do it? When peace surely depends on each party having the desire for it, to suggest that there is a programme of ethnic cleansing going on behind a smokescreen of a declared search for a ‘two-state solution’ by ‘negotiation’ must sound implausible and partisan. From historical and psychodynamic viewpoints, we might speculate that there is something driving this – that there is more to the comparisons with European treatment of the Jews than simply trying to convey to the west the enormity of what is being perpetrated in Palestine. The Holocaust and its precursors might offer some clues to the dynamic nature of the conflict: they should not be used to silence critical thought or diminish our concern about the current plight of the Palestinians. 

Nearly 20 years ago Joe Sacco gave his impressions of the conflict in his comic book Palestine. He records being challenged by some Palestinians: ‘What good does it do, your coming here to write about these things? For 50 years people have been writing about us... Since the Intifada, journalists have come from all over the world… At first we made them very welcome, we showed them everything... But what’s been done for Palestine?’2 One of the most shocking aspects is that all this has been going on for so long: 10 days’ exposure left its mark on us, and the idea that it could continue for further generations is appalling.

The greatest contribution to alleviating the mental health difficulties of the Palestinians would be the ending of the Occupation. In 2005, Palestinian civil society issued a call for international boycott, sanctions and divestment of Israel. The Palestinians we asked about this were unanimous in their support of this strategy. Challenging the legitimacy of the Zionist project is not the same as trying to get rid of Israel: nobody we spoke to expected to ‘undo’ 1948. The question is not whether Israel exists, but how it relates to its neighbours, and how it relates to its own non-Jewish population.

For Dr Hani Abdeen, Dean of Al Quds Medical School, the boycott was a pragmatic issue, ‘Not to inflict pain or harm, but to make them come to their senses.’ He went on: ‘The most important thing is to be recognised as people. They consider us as outside of humanity completely. They don’t look on us as people. We don’t mind living side by side, but as equals. We’re not terrorists. Extreme activities are a consequence of the circumstances under which we live. They are doing the same thing to us as they are doing to rats and dogs in their laboratories.’

Sahar Francis of Ad Dameer Lawyers for Human Rights in Ramallah, replied: ‘We need moral support. This is not a local activity; it’s an international responsibility. Alone we can’t achieve peace.’ It was ironic, she said, that there was such public pressure on the Palestinians, including sanctions, and none on the Israelis who contravene international law and treaties on a daily basis. Palestinians, she said, had lost faith in the international community.

And Sam Bahour, an American Palestinian and businessman based in Ramallah, was clear too: ‘It’s a non-violent way to resist an illegal occupation. If we are going to condemn people who take a more direct approach, we have to offer effective alternatives... What is needed is to go back to the spirit of the original UN partition resolution, which was about two communities who had equal and just claims, and who need to find a way to live together.’

Our conclusion is that the Occupation has as one of its primary purposes the breaking of the Palestinian people, of their morale, their capacity to function: that the permit system, the roadblocks, the petty restrictions, the insecurity and uncertainty, the aggravated poverty, the lack of work, the loss of status, effective incarceration and the destruction of social life, constitute a continuous assault on the mental health of the Palestinian people.

The expression ‘Arab-Israeli Conflict’ suggests a stark inter-communal confrontation, one nation set against the whole Arab world. The term disguises a situation in which overwhelming Israeli power is used against a dispossessed and stateless people. We were privileged to witness a different reality, of people from both communities recognising one another and working together as equals. As in South Africa, the real dispute does not lie between white/black and Jewish/Arab, but between those whose conception of the future is built on the foundation of racial exclusivity, and those who seek to realise universal human values, reflected in international and human rights legislation, which can alone provide the preconditions for the psychological growth of all.  

Martin Kemp and Eliana Pinto are both psychoanalytic psychotherapists in South East London. Eliana was previously Consultant Psychotherapist at St Thomas’ Hospital and worked for Shanti Women’s Intercultural Psychotherapy Service. Martin set up and practised in a community counselling service in London during the 1990s, and subsequently participated in Open Door’s adolescent therapy service. Further information, including details of the organisations referred to, can be obtained from the authors at markemp@talktalk.net or epinto@live.co.uk

1. Pointon C. Counselling amidst conflict. CPJ. 2004; 15(3):28-31. 2. Sacco J. Palestine. Seattle, WA: Fantagraphics Books; 2001.