Trapped by War - Ärzte ohne Grenzen€¦ · PALESTINIAN CHRONICLES Trapped by War Since the beginning of the second Intifada, in September 2000, MSF’s physician-psychologist teams

PALESTINIANCHRONICLES

Trapped by WarSince the beginning of the second Intifada, in September 2000,

MSF’s physician-psychologist teams have been providing assistance to Palestinian civilians in Hebron and the Gaza Strip.

This collection of articles tells the story of their work and offers testimony to the day-to-day reality of a people

trapped by war and suffering in ways that are generally unacknowledged.

A S P E C I A L S U P P L E M E N T T O M E S S A G E S , T H E M É D E C I N S S A N S F R O N T I È R E S N E W S P A P E R – J U L Y 2 0 0 2

The “PalestinianChronicles” are a way of bearing witness. They were written by psychologists, psychiatrists, doctors,administrators and logisticians who haveparticipated in MSF’smissions in the GazaStrip and Hebron sinceSeptember 2000 and who recorded theirexperiences and observations to continuethinking, working andmeeting. They did notwrite about theories,techniques or, even,about emotions. Instead,they provided facts andfragments of things seen,experienced and felt.They wrote plainly and simply, withoutcommentary, analysis or judgment. They wrotethese chronicles for allreaders, not just forexperts or those whosaw what they saw. They wrote to show with words.

OUR THANKS TO ALL THE AUTHORS OF THEPALESTINIAN CHRONICLES: ZINET AHMED– LILIANA ANDRADE – PIERRE BEURRIER –LORENA BILBAO – HÉLÈNE BOUCHEBOUBA– SARA CARMONA – LAURA CARTAÑA –JIMENA CAVANNA – JORDI COSTA –CATHERINE DAUBRÈGE – DIDIER DEGREGORIO – ITSASO ETCHEVERRY – PAULA FARIAS – CHRISTINE FIRNHABER –ROBERT GENEST – ARNAUD GHIZZ – ANGELIKA GROTERATH – SITA HALLIER –LUDMILA HESOVA – FIMIA INTON – FOUADISMAEL HASSAN – MARIE-HÉLÈNE JOUVE –CHRISTA KRIEG – YVES LALLINEC – HERVÉLANDA – OLIVIER MAIZOUE – CHRISTINEMARCILLY – CESAR MARTÍNEZ – JOSEMARTINEZ – VIRGINIE MATHIEU – MURIELMONTAGUT – SALLIE MOTCH –YOUSSOUPHA NIANG – MARYLIN NOGARO– ELISABETH OLDCORN – KARINE PILLETTE –CLAIRE REYNAUD – DALILA REZZOUG –SABINE ROQUEFORT – FARIBA SAADVANDI –AITOR ZABALGOGEASKOA – DELPHINEZINS.AND TO ALL THOSE PROFESSIONALS –LOCAL AND EXPATRIATE – WHO SINCE1993 HAVE MADE OUR WORK IN THEPALESTINIAN TERRITORIES POSSIBLE.

THE PHOTOS INCLUDED IN THE CHRONICLES

ARE TAKEN FROM A REPORT

PRODUCED BY PHILIPPE CONTI

BETWEEN JULY 2001 AND MAY 2002.

Publication Director: Anne Fouchard

Editor: Alain Frilet

Layout: Frédérique Goursolas

Publishing: Jacques Péron, Olivier

Falhun, and Yann Guégan

Translation: Leah Brumer, Andrew Long

Production: TC Graphite

3P a l e s t i n i a n C h r o n i c l e s – J U LY 2 0 0 2

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An ExceptionalMissionPUT TO THE TESTby Jean-Hervé Bradol

HEALING THE MINDby Pierre Salignon, Fouad Ismael and Elena Sgorbati

TREATMENT FOR SORROWby Christian Lachal and Marie-Rose Moro

PalestinianInteriorFRAGMENTED TERRITORIESThree maps identifying the relationshipsamong Palestine’s various conflictregions.

A YEAR IN GAZA AND HEBRONPlaces, dates, interiors, contexts, ideas, descriptions, reactions…Notes taken by Médecins SansFrontières’ medical and psychologicalteams while working with Palestinianpatients provide an inside view of the psychological consequences of a continual war situation.

JERUSALEM, APRIL 4, 2002“The obstruction of medical assistance intended for Palestinian civilians in the Occupied Territories has reached alarming proportions…” The “Chronicles” recount the situation up to October2001, but the situation in the Palestinian Territoriescontinues to deteriorate. MSF remains present.

MSF PressReleases

TABLE OF CONTENTS


In the old city of Jerusalem, aPalestinian colleague showed mearound beneath the pale wintersunshine. Our first problem was todecide which shrine to visit. Israeli

police do not allow non-Muslims insi-de the mosque. Kids in uniform wereinstructing visitors to state their faith.They would then decide whether ornot the visitors could go in. Souvenirstores advertised posters for sale nextto the rebuilt temple that stands onthe site of the Al-Aqsa mosque. In thename of history and religion, extre-mists on both sides justify the use ofviolence, foreseeing a world made freeof their adversaries. The symbolic pre-sence of the prophets in the midst ofthose ancient stones invites all of us,including foreigners visiting for a fewdays, to take sides – even if this meanserasing from our minds the face of theadversary: his humanity, his rights,and his suffering. This may represent adangerous prelude to an even moreradical form of elimination: expulsionby violence.The second stop on my visit was theGaza Strip. My colleagues tried toexplain to me the extraordinary geo-graphy of this small strip of land. Theirwords seemed to conceal a concernthat I might not understand; that Imight not be able to comprehend theinjustice and the suffering caused bythat geographical reality, to under-stand who was strong and who wasweak; or see clearly which was theright side to take. Then, by way of

demonstration, I was taken on a tourthat included houses razed to theground, ravaged strawberry fields,olive trees torn from the ground, blocked roads with figures moving likeshadows, watchtowers, assault tanks,small military fortresses made of con-crete. Gaza is like a vast open-airdetention center, watched, from land,sea and air, by war machines (planes,helicopters, armored cars, and boats)and their faceless pilots. My Palestinianhosts talked of the individual in thetank guarding the end of the road, ofthe missile seen wavering betweentwo trajectories… The Israeli soldiersremained at a distance, protected bytheir armor plating. They do notspeak, they just fire.

Sinister Dialogue of the DeafIn the West Bank, too, the Palestiniansare hemmed in. They cannot travel toIsrael and it is extremely difficult tomove from one town to another. Forthese Palestinians, too, the face of theenemy is a pitiless machine, whichthreatens their lives at every moment.The hundreds of civilians killed sincethe beginning of this phase of theconflict offer confirmation that, as thedesire to separate grows stronger,each side sees less of the other, andthe death toll climbs higher.Palestinians talked to me of theirdesperate weariness of being unableto decide their own destinies, and ofhaving to suffer the decrees of theIsraeli state. Work, transportation,

shopping, security, medical care…everything depends on the will of theIsraelis. An entire life composed ofharassment imposed by a foreignarmy. How can they fail to rebel? Whatis the point of living such a life? Is itworth the trouble? Many ask them-selves that question. Some answer no.Strapping explosives to their bodies,they blow themselves up in public pla-ces, killing as many Israelis as possible,and thereby affirming their refusal tolive a life that has become unlivable.The calculations made by those whosupply them with the explosives aredecidedly more cynical.In Israel, every daily act is accompa-nied by the fear of being the victim ofan attack or of losing a close relative.At any moment, terror can wreakhavoc upon day-to-day life. WheneverI talked to my Israeli hosts about thereprehensible tactics of the Israeli armyin the Territories, their first reactionwas often to cite the suicide attacks.The Palestinians justify such attacks oncivilians by saying that there are nocivilians in Israel, since every citizen,whether man or woman, had eitheralready performed, would perform, orwas performing his or her military orreserve service. It is like some sinisterdialogue of the deaf, where a goodreason is always found to justify thedeath of people who share no respon-sibility for the clashes (provided, ofcourse, that they belong the oppositecamp). In this conflict, the victim men-tality – victims of Palestinian terrorism

B Y J E A N - H E R V É B R A D O L , P R E S I D E N T O F M É D E C I N S S A N S F R O N T I È R E S

Humanitarian agencies are being asked to choose sides. They must preserve their independence.

Put to the test


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or Israeli settlement policies, depend-ing on which side is talking – occupiesa central place in each side’s war pro-paganda, so that two symbolic figuresultimately emerge: the eternal victimand the victim of the eternal victim.For the relief worker, the victim ismore than an individual encounteredwhile providing medical care or relief.Above all, and with an intensity rarelyequaled within the context of otherconflicts, the victim has become asymbolic figure, which allows peopleto forget, or even justify the kinds ofviolence that are contrary to the prin-ciple of humanity, to international law,and to policies that seek to restorepeace.The invitation to join one side or theother is accompanied by an obligationto collude with criminal forms of vio-lence. Two examples of this are thedeadly attacks against Israeli civiliansand – less spectacular but ultimatelymore lethal – the Israeli army’s shoot-ing of Palestinian civilians. If humanita-rian action is to be effective, it mustdetach itself from political positionsthat seek to manipulate people’s

various origins, their spiritual beliefs,and their suffering; that invite peopleto deny the humanity of the adversa-ry; and that reduce an entire people toa single figure: whether terrorist orsettler.

An Order Created by the ViolenceUsually it is the relief that MSF provi-des to the wounded, to the starving,and to exiles living in conditions ofdesperate poverty that occupies our teams in countries at war. Here,displaced people and refugees makeup the majority of a people that haslived in exile for decades. ThePalestinian people ask for the creationof a state on the remains of the landon which they used to live and wherethey now are struggling to survive.They have had time to learn how tocare for their wounded and their sickand to establish a public health policy.They receive considerable supportfrom abroad. On the Israeli side, theresources are there to care for woun-ded soldiers and bring assistance tocivilians who are victims of attacks. Apermanent order has been created by

the violence. It is the product of a warthat is cruel, but of low intensity andspread out over decades. There arethose at the top and there are those atthe bottom. For example, occupantsof the upper floors of homes in thenarrow alleyways of the old cities ofJerusalem and Hebron throw their garbage out of their windows ontothe heads of neighbors living on thefloor below and shout at them toclean up the mess. Occupants of someof these homes have installed horizon-tal grills that separate their groundfloor apartments from those above. Asyou look up through the grills, yourview of the sky is obstructed by thegarbage. It is an astonishing sight atleast, to the eyes of a foreigner. Inother places whether Palestinians andIsraelis come into contact with eachother – housing districts borderingsettlements or Israeli military positions– the exchanges are not limited to gar-bage.Palestinian fighters suddenly appearand fire at soldiers or settlers, andPalestinian civilians are fired on likerabbits in a telescopic sight at the


slightest movement deemed suspi-cious by Israeli soldiers. Their homesare occupied or destroyed as a form ofcollective punishment for armedactions conducted by others or, moresimply, as a part of Israel’s securityplan. Palestinians in these districtsmust face constant grief, physical andpsychological injury, and arrests, andlive in a state of growing destitutioncaused by the economic blockade.These are the people with whom wework in the Gaza Strip and Hebron.We bring medical, psychological, andsocial assistance to their homes, whichhave been transformed by the fight-ing into a frontline. The “PalestinianChronicles” offer a collection of des-criptions of this work.

Humanitarian ResistanceMSF has been working in thePalestinian Territories for nearly tenyears. Every day, our doctors andpsychologists witness the profoundtrauma suffered by the Palestinianpeople. Even if Médecins SansFrontières’ presence in this crisis is notas great as it is in Angola, Chechnya,

or Afghanistan, that does not meanthat the suffering of the Palestinianpeople is any less intense. Assistanceto those affected by armed conflict isnever a matter of simply providingfood and shelter or healing bodies:only the key players involved candetermine what can be tolerated, interms of offense to human dignity.The Palestinians’ response is clear:they do not accept the fate assignedto them, and many are ready to die asa result. Our actions are also limited bythe Palestinians’ own capacities formobilization, public expression, andorganization.That could change. Over recentmonths, very considerable damagehas been inflicted on their capacity toresist. The military occupation is be-coming more firmly entrenched, asillustrated by Israelis firing at civilians,ambulances, and hospitals, and by therefusal of the Israeli authorities to allowa commission of inquiry on the violen-ce at Jenin. This clear deterioration inthe situation, seen in the high toll ofcivilian dead and injured over a periodof a few weeks, does not bode at all

well for the future. Amid mountingviolence – Palestinian suicide bomb-ings and bloody acts of collectivepunishment by the Israelis – caused bythe occupation, hopes for a compro-mise diminish by the day, providingmore and more fuel for radicals inboth camps. As it attempts to seal offthe population of the West Bank intothe towns, behind fences, the Israeligovernment is also trying to pressurehumanitarian organizations to beco-me the social workers of an oppressivesystem designed to imprison an entirepeople within open-air detentioncamps. International humanitarianaid, which until now has played only aperipheral role in this conflict, nowrisks being cast in the role of prisonwarden at the heart of a pitiless systemof domination and segregation. ThePalestinian people’s capacity to resisthas been sorely tried. Now it is theindependence of foreign aid workersthat will be put to the test.

Dr. Jean-Hervé Bradol, President of MSF,

June 2002

To address the consequencesof the Al-Aqsa Intifada, inNovember 2000 MédecinsSans Frontières (MSF) ini-tiated medical and psycho-

logical care efforts in the Palestinianterritories of Hebron, in the West Bank,and the Gaza Strip.The goal of this medical interventionin a war setting is to provide care toPalestinian families regularly and fre-quently exposed to potentially trauma-tic events related to the conflict. Mostof these families live in the areas mostaffected by violence; near confronta-tion sites, Israeli Army installations andJewish settlements (1).Since the beginning of the Al-AqsaIntifada in September 2000, the settle-ment policy of the Israeli Army andJewish settlers has continued (2) andrepressive measures taken against thePalestinian population has assumedthe form of collective punishment.The isolation of Israeli and Palestinianpopulations is heightened daily withthe harsh application of a militaryoccupation régime in the Palestinianterritories.Fearing new attacks in Israel, andgiven the escalation in violence sincethe end of 2001, the Israeli Army’sstrategy consists of limiting the move-ments of Palestinians outside thePalestinian territories. The strategyseeks to guarantee the security of theJewish settlements and their access

routes because of firing and mortarattacks of which they are the targetsfrom different armed Palestiniangroups, thus dispersing the residentsof the already-segmented West Bankand Gaza Strip (3).

Living conditions continue to worsenIn Gaza and Hebron, and as well inRamallah and Nablus, Israeli militaryoperations have thus created enclavesin which Palestinian families are effec-tively confined and living in a state ofpermanent stress, suffering to thepoint of feeling completely abandon-ed. The sense of despair is amplifiedby the Israeli Army’s systematic des-truction of their houses and property(factories, greenhouses, orchards,olive trees) in areas adjoining Jewishsettlements and near major traffic rou-tes used by the settlers. This repeateddestruction, often carried out at night,under protection of Israeli Army tanks,increases the Palestinians’ feeling ofhumiliation and revolt.The economic blockade imposed byIsrael against the Palestinian territoriesstrengthens Palestinian families’ extre-me dependency. Men who usuallywork in Israel are deprived of jobs andthus of an income, which means thatthe poorest families are unable to buyenough food on a daily basis (4).Some families are even unable toreach Palestinian medical centers or tohave access to a doctor. For fear of

seeing their house requistioned or des-troyed in their absence, some patientsavoid seeking treatment. Access tohealth care is now uncertain, whileviolence against Palestinian familiesand climate of terror in which they livegenerate intense stress, fear and panic,which call for immediate medicalattention.If the Palestinian Red Cross, with helpfrom the International Committee ofthe Red Cross, the U.N. and variousnon-governmental organizations, areactive in health care and provide sup-port for caring for the wounded andfor primary care facilities, there are fewspecialists trained in trauma care.Following an October 2000 evalua-tion, which confirmed the scope ofthe need, it seemed to us a priority tointervene immediately, even while theconflict was still underway.

When events lead to suffering or traumatic consequences of living in an occupied territory.Nearly the entire Palestinian popula-tion suffers from the confinement,occupation, fear and an absence ofhope for the future on a daily basis.However, the intensity and the num-ber of traumas differ, as do thepsychological after-effects. In this warin which civilians are on the front lines,reactions are extremely variable. Stressis a normal reaction for those subjectto daily violence and humiliation, in an


B Y P I E R R E S A L I G N O N , F O U A D I S M A E L A N D E L E N A S G O R B A T I

The theory behind, and limits to, MSF’s psychiatric approach in the midst of the Palestinian conflict.

A critical examination of a long-term project.

Healing the mind


environment in which remainingconfinement offers the only possiblehope of safety and security.In the most exposed areas, leavingone’s house could risk death, as couldgoing out at night. But staying athome is sometimes hardly more secu-re. Often riddled by bullet holes, thesehouses are regular targets for Israelisoldiers. Israeli Army tanks travelingnearby all day long make terrifyingnoises. Children can no longer playoutside or go out along. Nowhere issafe anymore. In such an environmentchildren, like adults, develop fears and experience repeated nightmare.Children no longer want to leave theirmothers or go out of the housewithout them.This stress may also trigger severe anddeeper psychological suffering. Alongwith what is known as “adaptation”stress, found widely, some individualsdevelop more serious, severe andchronic reactive psychological syndro-mes, including various forms ofdepressive states and PTSD.Some people remain prostrate and canno longer speak or feed themselves.Others experience delirious episodesfollowing an intense fright, like themother who ran to find her childrenwhen firing began. She thought “Wedie together or we survive together.”One week later, she developed a per-secution mania, with auditory halluci-nations, profound anxiety and sleeploss. Paralyzed by extreme fatigue, shewas unable to care for her children.

Appropriate action?On a daily basis, the MSF team meetsPalestinian families suffering fromthese kinds of psychological disorgani-zation, revived when shooting is heardand planes bomb.Another frequent situation is that ofthose people who were imprisonedand tortured during the first Intifadaand who are now experience psycho-logical decompensation (traumas andinjuries from the first Intifada take onmeaning after the event). Their disor-ders reappear as the result of newtraumatic events. This is also the caseof young adolescents who as childrenhad terrifying experiences and whohave forgotten some of what theyexperienced. Psychological disorders

emerge during the Al-Aqsa Intifada,sometimes several years after the firsttraumatic event.According to the methods establishedby Western militaries to treat troopsconfronted by traumatic events on thebattle field, such patients requiredimmediate care, even in the field, andat the outset, for a limited time.Relying on this experience of psychia-tric intervention in war, Médecins SansFrontières adopted a practice in theheart of the most exposed areaswhere many Palestinian families stilllive. MSF doctors, psychologists andpsychiatrists, assisted by Palestinianinterpreters and drivers, come toge-ther in a joint clinical and curativepractice (5).This approach is based on home visitsbecause the obstacles to free travel aswell as the fear felt by patients pre-vents them from leaving home fortreatment. Palestinian health workersdo not have access to them so MSFteams’ home visits are often the onlyway of breaking through the isolationin which some families live.

The doctor-psychologist team identi-fies and takes on the most vulnerablepatients. If listening is important, thedoctor’s home visit, often conductedoutside by the entrance or under olivetrees, allows the targeting of untreat-ed medical problems and psychologi-cal disorders. The doctor offers stan-dard advice, and drugs for illnessesthat the local network cannot provide.But in general, most of the chronic ill-nesses are aggravated or reactivated(cardiovascular illness; digestive disor-ders, primarily ulcers; skin problems).Family members leave home little ornot at all. There is no money. Localdoctors are overwhelmed, have lostmotivation, are exhausted. And finally,there are very few Palestinian psycho-logists or psychiatrists.

The MSF doctor carries out the role ofhome visit doctor. His or her interven-tion lays the groundwork and roundsout the intervention of psychiatristsand psychologists. The M.D. cares forthe body before the mind are treated.The doctor refers patients sufferingfrom psychological problems to thepsychologist or psychiatrist. This canbegin a therapeutic work allowingindividuals and families to expresstheir fears, to treat their traumas andreduce their stress. The referencemodel is that of therapeutic consultsand brief therapy (individual, familyor group, depending on the case);treatment lasts on a few weeks on thebasis of two visits/week (close moni-toring).Intervening while the conflict situation– the cause of the trauma – is stillunderway allows to give meaning tothe event or to the reaction, to identi-fy the trauma with the patient andthus to avoid later a more severe reac-tion to some new aggression (whichin this context of violence is certain).The psychologist seeks to anticipate

occluded emotional states, emotionalpain transformed into dispairs that aredifficult to reverse.Médecins Sans Frontières has alreadyexperimented with this approach inother conflicts, including in Bosnia. Toease the pain of trauma, the MSF teamsought to “build connections severedby trauma” and “the working out ofan account where trauma led to shut-down” (6).The MSF psychologists are assisted intheir clinical work by their Palestinianinterpreters. The cornerstone of thepatient/therapist relationship, they arethe “voice” of the doctors andpsychologists and play an essentialintermediary role in a complex politic-al and cultural environment.On a regular basis, discussions of cases

MSF doctors and psychologists worktogether, complementing the typical home

visit with several weeks of individual or family therapy.

from the field are also organized bet-ween MSF expatriates and an Israelipsychologist based in Israel (she can-not travel to the Palestinian territories).These meetings promote clinicalexchanges among trauma “professio-nals” outside the Palestinian territories.Finally, MSF’s consulting psychiatristsand the organization’s operationalstaff meet regularly to guarantee thesupervision of MSF teams (nationalsand expatriates) and, if necessary, toredirect the mission’s medical goals.

The limits of our actionsThe first limitation is that this kind ofcare cannot substitute for regularpsychotherapeutic treatment. Certain

kinds of problems cannot be address-ed in the former context because of the conditions and techniques for maintaining the relationships.However, the presence of the MSFdoctor provides, if necessary, theaccess to psychotropic drug pres-criptions for the most serious casesuntil the patient can be referred else-where.Another limit, if it is truly such, is thenumber of Palestinian patients andfamilies who seek the intervention of the MSF team. The numbers arequite high; even limitless. That is whypriority is given to treating the mostfragile patients who are suffering from

extreme stress, multiple depressivestates and PTSD. Each month, everyMSF psychologist and psychiatristconducts some forty individual orfamily consultations (with approxima-tely one hundred people). The res-ponse to MSF’s treatment is very posi-tive. Palestinian families themselvesoften identify those individuals ingreatest need and refer them to theMSF team.This medical intervention is underwaytoday in the Gaza Strip and theHebron district of the West Bank.The daily pain, the adjustmentsrequired to deal with material cons-traints and human limits still remainfor the MSF teams. The fear of bomb-

ing and firing remains, too. Becauseone of the key limits to the work ofthe MSF doctors and psychologistsresides in the physical risks they takedaily to reach the most isolatedPalestinian families. Negotiationswith the Israeli authorities underwaysince the outset of this program donot always guarantee adequate andfrequent safe access to civilian popu-lations in the most-exposed areas.This limit imposes frequent interrup-tions of treatment, delaying expectedvisits by several hours or several days.Such interruptions are particularly difficult for the families sustained byour care.

ConclusionIn conclusion, we simply want tounderline the intricate relationshipbetween two sets of activities underta-ken by MSF in the Palestinian territo-ries: on the one hand, bearing witnessand speaking out and, on the other,providing medical care. This involvesgathering factual evidence, supportedand enriched by daily contacts bet-ween MSF doctors and psychologistsand Palestinian families on the GazaStrip and in Hebron. In the face oftheir suffering, we are responsible fordescribing the war’s consequences onthem. It involves relating that whichwe witness in the Palestinian territo-ries.This has particular therapeutic impor-tance for the families. The considera-ble media attention to this conflictmakes no place for individuals to telltheir stories. We are trying to com-pensate for that lack by publishingregular descriptive reports on theconsequences of violence against thecivilian population.

Pierre Salignon is an attorney andprogram director at MSF’s Paris, France

operational center.Fouad Ismael is the head

of MSF’s Jerusalem.Elena Sgorbati is program director at

MSF’s Barcelona, Spain operational center.


(1) See the Internet site www.paris.msf.org and the web pages on MSF’s activities in the Palestinian territories (in French).

(2) According to the “Palestine-Israel”Journal, (Volume VII, 2000), the number of Jewish settlements in the Palestinianterritories increased from 3,176 in 1976 to 200,000 in 2001.

(3) Palestine is a “scattered” territory. Itsarea totals 5,200 sq. km. The population ofthe West Bank, with more than 4,000 sq.km, is 1.8 million Palestinians (333people/sq. km) and the area is divided intothree separate zones. Zone A, made up of13 percent of the West Bank, constitutes the territories placed under the Palestinian

Authority’s exclusive control. SinceSeptember 2000, the Israeli Army has conducted regularincursions into Jenin, Hebron, Nablus andRamallah. Zone B includes the territoriesunder shared authority, but the Israeli Army is responsible for the area’s security.Zone C is under the direct authority of the Israeli Army. In Gaza, 1 millionPalestinians live on a 400 sq. km. strip of land (2,758 people/sq. km) under thecontrol of the Palestinian Authority. Sixthousand settlers occupy 30 percent of theterritory. Finally, 250,000 Palestinians liveunder Israeli administration in Jerusalem.

(4) In August 2001, more than 1,400,000Palestinian refugees in the West Bank and

Gaza Strip were totally dependent on U.N.and Palestinian Red Cross medical and foodaid. The unemployment rate was close to 70 percent.

(5) MSF teams in the Gaza Strip and Hebrontake the same form: a doctor, psychologist,psychiatrist and a non-medical fieldcoordinator. They are supported byPalestinian interpreters and drivers as well as by administrative personnel, for a total of 23 staff.

(6) In Humanitarian psychiatry in the formerYugoslavia and Armenia, PUF, 1995,“Psychological support to former BosnianMuslim detainees and their families,” MSF’smission, by Yves Gozlan and Pierre Salignon.

The considerable media attention to this conflict makes no place for

individuals to tell their stories.


Médecins Sans Frontièreshas been active inPalestine since 1993.We have worked withchild victims of the

first Intifada, Palestinian prisoners,malnourished infants and theirmothers and, since September 2000,with children and families in the midstof the current Israeli-Palestinianconflict in Gaza and Hebron. Our pro-gram initially provided medical carebut given the situation, soon expand-ed to include psychological servicesbecause “humanitarian aide does notaddress only physical needs. It mustrespond to humans in their complexi-ty and, even, their very essence.Restoring people to a state in whichthey can exercise choice, freedom andthe ability to act on the world is asessential as feeding them, keepingthem warm and nursing them”(Martin, 1995, p. 18). This suggeststhat by connecting and coordinatingwith other aid efforts, psychiatric inter-vention assumes its rightful role inhumanitarian response; its goal being:to care for human beings in their com-plexity. The four elements of a com-prehensive mental health program arecomforting, treating, witnessing andtraining.

Mental health care providersmust adopt new cultural perspectivesPsychiatry today plays an increasinglyimportant role in the field of humani-tarian medicine, with growing num-bers of psychologists and psychiatristsjoining health care teams respondingto humanitarian disasters. The majorNGOs are instituting mental healthprograms and developing techniquesfor psychological care. Psychologicaltrauma is not a new subject, but ittakes on new dimensions in programsthat assign health care providers –often young volunteers who want towork outside their own cultural set-tings – to conflict and catastrophesites. These psychiatric humanitarianaid workers often say they are inade-quately trained and prepared for suchwork. They want to be able to rely onwell-defined concepts of humanita-rian psychiatry, use specific tech-niques and evaluate results. Theywould also like to tailor their actionsto the contexts in which they interve-ne. To be able to modify their approa-ches they must understand the indivi-dual and collective experience of thepeople for whom they will be caring.This suggests why humanitarian psy-chiatry falls under the rubric of trans-cultural psychiatry. Individuals target-

ed for mental health services aremembers of groups and cultures.They have their own knowledge baseas well as their own social and culturalrepresentations of health, illness, trauma and family. When we workoutside our own culture we must beconscious of differences and familiarwith others’ collective responses. Toprovide humanitarian aid, partici-pants must undergo a process of per-sonal development and change. Thisextends well beyond the preparatory(and uneven) briefings that expatria-tes receive. They must develop theirown approach to adapting to theirnew work setting and to cultural andcurrent developments in the worldthat will be their temporary home.This involves, simultaneously, strug-gle and enrichment. Such a shift inperspective allows humanitarianmental health care providers to usetheir own emotions and internalconflicts as professional resources.Even as they struggle to hold ontotheir identity and knowledge base,humanitarian aid expatriates oftenface powerful forces pressing them tochange their habits, ideas and beliefs.In that sense, voluntary expatriationcan be seen as a form of humanmigration.

B Y C H R I S T I A N L A C H A L A N D M A R I E - R O S E M O R O

Psychiatry plays an increasing role in humanitarian aid. And mental health intervention occurs while traumatic events

are still underway.

Treatmentfor sorrow


Childrenof Hebron

Safouan, a 3 year-old boy4/30/01« Vrrr, vrrr, vrrr! »� This is the noise that 2 to 3year-olds make to imitate thesound of gunfire. Safouan livedthrough three weeks of Israeliincursions in his neighborhood,including bombings.

Marwan, a 5 year-old boy4/30/01“A bullet in the head.”� The house where Marwanlives was hit by bombing. His 13 year-old brother waswounded in the head. Marwandraws a gun with bullets shooting out of the barrel. As soon as he hears firing, hismother says, he lifts his handto his head.

Ali, an 11 year-old boy5/16/01“Jerusalem in danger.”� Ali lives in a neighborhood that was bombed bytanks. “An old man was hit in the head by a rocket.”(March 2001, incursion into the Territories.)

Aya, a 13 year-old girl5/02/01“A girl is wounded and tellsher mother.”� Aya lives in the old city.Her family has been harass-ed by soldiers and settlersfor a long time.

These drawings have been collected by Catherine Daubrège,psychologist with Médecins Sans Frontières.


Acknowledging emotionaltrauma and the role of the witnessSince its founding, Médecins sansFrontières has sought legitimacy frominternational public opinion, not fromnational governments. This is whereMSF breaks ranks with other interna-tional organizations like the Red Cross.Volunteers provide care and speak outabout what they have seen. They aregoing towards medias to make thepublic aware of the suffering of thepeople they are caring for. But it quick-ly became clear that the act of speak-ing out had to be distinguished fromsome humanitarian media circus strip-ped of ethical foundation. Bearing wit-ness means giving voice to the directexperience of the collective trauma ofspecific populations, like refugees orparticular ethnic groups. It also meansmeeting people face-to-face. In suchencounters, affected persons expresstheir anguish; an anguish felt collecti-vely as well as individually and withinthe family group. This testimony has aprofound effect on those who listen to and absorb it. They are moved torespond on a medical and materiallevel, as well as on an emotional level.One of the emotional responses is,clearly, the impulse to ease pain andrestore the full humanity of peoplewho have suffered violence’s dehuman-ising effects and other painful expe-riences. This calls for consolation in themost active sense of the word. Butalthough it may be a necessary action,it is not a sufficient response. Profoundtrauma and despair prevent manypeople from expressing themselves.Others – including children and babies– do not or can no longer speak. Theprocess of speaking out and bearingwitness requires that people be heard.It allows them to voice their despair andto imagine a kind of treatment thatwould meet not only their physicalneeds but restore their emotional capa-city as well. That capacity is clearlyaffected by the crises they have expe-rienced and continue to experience.Humanitarian aid settings are, first and foremost, emergency settings.Experience in managing emergencies(including natural catastrophes andwar) has led humanitarian aid organi-zations to develop specific expertise(including ready-to-use kits, protocols

and organizational structures) and hasput certain professionals, includinglogisticians, resuscitation specialists,surgeons and emergency care nurses,on the front lines. But this is the firsttime we have practiced real emergen-cy psychiatry; that is, intervening inthe midst of traumatic events.Previously we intervened to easeevents’ after-effects. Now we are therewith people as the trauma occurs andeven growing in intensity. We providepsychological care to strengthen theirdefenses and allow them to hold on inspite of everything.We address the effects of trauma oninfants, children, adolescents and theirfamilies. Many fields recognize thesignificance of this concept, whichnow extends well beyond the medicalsetting. As reflected in the term PTSD(Post-Traumatic Stress Disorders), thebroader concept has contributed to arecognition of suffering that is notlimited to the spontaneous empathy

expressed in cases of war, conflict, per-secution or catastrophe. Empathy, ourcapacity to put ourselves in another’splace, is an instantaneous mentalstate. It is emotionally-based and situa-tionally-dependent. Opinion is mobi-lized on the basis of empathy and ofinformation presented visually or inwriting. When attention wanes, thatshift is not caused by moral weaknessor laziness. Rather, empathy simplyevaporates. Compassion is ephemeral.Humanitarian workers in the field maythemselves sense empathy wax andwane. They may also feel its effects,which can both energize and paralyse.Naming and bearing witness is quitedifferent. This process allows everyone– those who experience suffering andthose who witness it – to identify andrepresent it in the psychological life ofthe individual and the group.

We can point to five levels forspecific intervention: accounts oftraumatic events by those whohave experienced them, indivi-dual traumatic experiences, col-lective and individual adaptivereactions and, lastly, the psycho-pathological level at which struc-tural, lasting and often majordisorders appear.

Accounts of traumatic eventsThis is the level of description providedby all who experienced traumaticevents like those Gaza Strip residentshave faced since the second Intifadabegan in September 2000. Descrip-tions of the events reveal people’s fearsand address the aggressive and dehu-manizing nature of Israeli Armyactions. These situations are obviouslytraumatic. Army actions include des-troying property using bulldozers,occupying houses, threatening resi-dents with tanks, rounding people up,

patrolling at night and setting upcheckpoints. Describing and docu-menting traumatic events, as well asdistinguishing factual accounts fromthose distorted or exaggerated byfear, is a useful part of the evidence-gathering process. It also allows thepsychologist to accurately representthe experiences of people she or he istreating. “I often treat people whowant to show me where an eventoccurred,” one psychologist said. “Ithink going there permits expressionand abreaction, an uncovering of thetrauma. It often allows a person toreturn to a place where he or she hasnot dared to go for a long time.” Themedia’s approach to telling stories oftraumatic events often overlaps withours. There are, however, multiple ver-sions of the same events. Ourapproach is a grassroots one. It allows

Humanitarian aid workers interveningoverseas must change their practices and

beliefs even as they maintain their identity.In that sense, voluntary expatriation can be

seen as a form of human migration.


Sahar, a 10 year-old girl10/16/01“The soldiers are occupyingmy school. They’re telling usto leave.”� Sahar had to leave herschool, which was occupiedby the Israeli army. On theway to her new school, shehas been subjected to moreattacks: teargas, firing bysoldiers, stone-throwing bysettlers.

Moataz, a 5 year-old boy11/05/01

“A girl who looked like scrambled eggs.”� Moataz saw two people mangledby a helicopter-launched bomb firednear his house. He found an ear near

the refrigerator in his kitchen. Thisoccurred in October 2001, during the

Israeli incursion and bombing.

Mohammed, a 6 year-old boy 10/15/01

“A tank is destroying trees. Soldiers are beating a boyand carrying him off. A boy is throwing stones at the

tanks. My sister, who is in prison because she tried to stab a soldier.”

� Mohammed’s sister, 14, presents with psycho-logical trauma linked to three violent

incidents: an attack by a settler’s dog in June, abeating by soldiers (for which she was hospitalized)

in July, and the death of a schoolmate who waskilled in August. Her attempted killing of the

Israeli soldier took place in September.


us to see events through the eyes ofthose who experienced and sufferedfrom them, as opposed to seeking afactual, “objective” account. Sharingtragic moments by listening to peoplerecount them may be the only way toprovide care, but it is significant. “Wetry to support the residents but reallyall we can do is be there,” a psycholo-gist in Gaza said in December 2000.“Our words seem pathetic. Theyalways say they were waiting for us.They talk about us with their neigh-bors and ask each other when we willbe there.”

Individual traumatic experiencesThis is the level of personal descriptionprovided by an individual who hasexperienced one or more traumaticevents. Gaining a complete grasp ofthe experience requires going beyondclichés. Little by little, the person willopen up and in the telling, begin to construct a specific and personalmeaning of events. The experience isnot solely negative but encompasses abroader, holistic awareness. Recount-ing the event in a therapeutic settingmay help to prevent the onset of futu-re psychological disorders. Peoplehave a tremendous need to tell theirstories of trauma and few have politi-cal goals for doing so. Rather by put-ting words to disturbing and disorga-nizing experiences, they seek reassu-rance and to restore their humanity.They want to communicate withsomeone who is close enough tounderstand what they have beenthrough, yet removed enough so thatthey are not just repeating their storyad nauseum. People will often talkrepeatedly among themselves aboutevents, though the consequences maybe negative as much as positive.Talking to a “health worker,” in thebroadest sense of the term, initiates atherapeutic interaction that can trans-form the traumatic experience, allow-ing the individual to move beyond itrather than remain imprisoned by it.

Collective adaptive reactionsA common example is the behavior ofpeople who remain in their homeseven when, for example, the buildingis the target of bullet or rocket fire orregularly attacked by groups of sol-

diers and even, in extreme cases,when soldiers have occupied the roof.Residents know their houses will berequisitioned or destroyed if they leaveso they stay on, living in fear. Even ifresistance is an individual action, inwhich an individual assumes all per-sonal and familial risk, the act is a col-lective adaptive reaction. Not all adap-tive reactions involve that level ofheroism. Others include regular, on-going conversations about the currentor prior days’ events. When a singlefamily member is designated as theone who is suffering and whoseresponses are judged abnormal, suchbehavior protects other family mem-bers from their own tendency to reactin inadaptive ways. On a collectivelevel, we observe reactions of fear,despair and revolt as well as rumors

and acts of solidarity. It is important tomonitor all these emotional shifts andsymbols (for example, martyrs and olivetrees in Gaza) because they changequickly and serve as indicators of thepopulation’s overall condition.

Individual adaptive reactionsThe reactions observed are the emo-tions visible in the face of danger andviolence, including the experience ofintense fear and its physical signs,including trembling, unsteadiness,involuntary urination, nervousnessand, sometimes, fainting. We nextobserve reactions that represent aneffort to master fear: denial, losingoneself in daily tasks, participating inthe confrontations. In many casespeople are virtually trapped and can-not remove themselves from the situa-tion. Take the example of housescaught under nighttime attack, withthe incessant, frightening noise oftanks rumbling by and children cryingand clinging. What are people to do?What is the appropriate adaptivebehavior? In such situations, indivi-

duals internalise their emotions in theform of future disorders that maymanifest physiologically, psychologi-cally or behaviorally. Prevalent war-time emotions also include rage andimpotent anger. But whatever the“quality” of emotions revealed at thetime, the challenge is reining in the“quantity” of emotions. If emotionscan be mastered and controlled earlyon, they may not emerge later as adisruptive, disorganizing flood.

Pathology with known disordersAcute states can be distinguished fromanxious states, which are more com-mon particularly among children.They may develop an excessiveattachment to the mother or an oldersibling, refuse to leave the house oreven a particular room or develop

sleep disorders and awaken screamingfrom nightmares. They can sleep onlywhen close to the mother. Sometimesthese children develop a state of per-manent, invasive fear with startle andhypervigilance responses. Amongadults, painful conditions like joint andlimb pain and headaches are com-mon. Some may develop genuinepsychosomatic pathologies like gastriculcers. True psychotic decompensa-tion may be observed, in which theperson shows transitory signs of insa-nity, thereby escaping an intolerablereality. Post-traumatic stress disordersappear later, affecting sleep and all major activities, including eating,learning and daily living tasks. The warcontext may revive prior states ofpsychological decompensation. Themost vulnerable individuals are atgreatest risk in such situations. Earlieremotional problems may, themselves,have resulted from prior trauma. Inextreme situations or immediately fol-lowing them, physiological com-plaints are often more common thanpsychological ones. This is particularly

Rather than seeking factual, “objective”accounts, our approach allows us to see

events through the eyes of those whoexperienced and suffered from them.


common in cultures that do not dis-tinguish between physical and emo-tional illnesses or, in the simplestterms, suffering. Sleep disorders areoften observed and are among therange of affected physical functionsincluding eating, sleeping, breathing,elimination and sexuality. Over-whelming fatigue is common. Physical

functions are disorganized and child-ren, in particular, manifest partialtransitory regression. For example,children who live with fear on a dailybasis can experience enuresis. Oftenpeople consume large amounts offood or conversely, may be unable toeat, complaining of problems swal-lowing. They may present with weightloss problems. (A common jokeamong MSF’s female team membersin Hebron, both expatriates andPalestinians, was that “fear and dan-ger have a silver lining – they keep youslim!”) If the mother-child relationshipis disrupted, especially if the mother

experiences post-traumatic problems,children may be particularly affected.Traumatic losses and bereavementsmay also generate medium-termpsychological consequences. Depres-sion may have long-term consequen-ces for child development and theparent-child bond. As events recede intime, a variety of symptoms may

appear: fears and phobias; behavioralproblems and disorders; aggressivi-ty and violence; learning disorders, language disorders; mother-infantrelationship disorders; avoidancebehaviors; blunted affect, inhibition,passivity and depressive states. Therelationship of events to the initialtrauma is obvious. The list can beexpanded to include the bitternessthat feeds hatred and is passed onfrom one generation to the next.Deeper understanding improves treat-ment and care. We must be willing toname the horror and speak theunspeakable if we are to keep hope

alive and hold onto the dreams neces-sary to work in these extreme circums-tances. We must do this to break thecycle and prevent trauma from recur-ring in successive generations. Wemust heal human suffering, evenwhen it is unspoken and its woundsinvisible. We must, therefore, begin byspeaking of it.

Christian Lachal andMarie-Rose Moro are child and adolescent psychiatrists.

Marie-Rose Moro is an ethnopsychiatrist, psychiatrist, and

psychoanalyst, and director of the Child and Adolescent Psychopathology

Department of the Avicenne de BobignyHospital, where she established a cross-

cultural practice. She is director of thereview L’Autre and organizes MSF’s

mental health missions.

Bibliography:Moro M. R. et Lebovici S. (Eds), Psychiatrie huma-nitaire en ex-Yougoslavie et en Arménie: face autraumatisme, PUF, 1995.Martin D., “Psychiatrie et catastrophes. Le pointde vue d’un humanitaire,” pp. 17-22, inPsychiatrie humanitaire en ex-Yougoslavie et enArménie: face au traumatisme.Lachal C., “Des adolescents en guerre”, inL’Autre, cliniques, cultures et sociétés, pp. 67-86,vol. 2, n° 1; Paris, éditions La Pensée sauvage,2001.Palestine-Israel Journal of Politics, Economics andCulture, n° 4, Jerusalem, autumn 1994.

Physiological complaints are morecommon than psychological ones.

This is particularly true in cultures that donot distinguish between physical and

emotional illnesses.

Sahar, a 10 year-old girl10/16/01“These are the soldiers who have taken over my school.Here, they ask us to leave it.”� This young girl had toleave her school, occupiedby the Israeli army. On herway to her new school, shehas been repeatedly assaulted: teargas, shotsfighted by soldiers, stones thrown at her by settlers.

17

InteriorG A Z A – H E B R O NN O V E M B E R 2 0 0 0 – O C T O B E R 2 0 0 1

Médecins Sans Frontières’ medical andpsychological teams tell the story of a yearspent working among the most vulnerable

sectors of the Palestinian population.

P a l e s t i n i a n C h r o n i c l e s – J U LY 2 0 0 2

Palestinian


Erez

Gaza

Beit LayiaBeit Hanoun

El Nuseirat

Deir el-Balah

ISRAEL

EGYPT

Netzarim

Kfar Darom

Khan Yunis

Rafah

Al Mawassi

2 km

Haifa

Nazareth

Netanya

Tel Aviv

Beersheba

Gaza

Jérusalem

ISRAELEGYPT

JORDAN

SYRIA

LEBANON

GAZA ��STRIP

Hebron

Jericho

Bethlehem

Ramallah

NablusTulkarem

Qalqiliya

Jenin

WEST BANK

Jerusalem

20 km

El Fawar

El Arroub

Qiryat Arb’a

Hébron

FragmentedTerritories

Access roads leading tothe settlements dividethe GAZA STRIP intothree sections. Thesedivisions have becomeinternal frontiers, whichthe Israeli army opensand closes at will anddepending on events.

18


Jérusalem

El FawarEl Fawar

El ArroubEl Arroub

Qiryat Arb’a

El Fawar

El Arroub

Qiryat ArbQiryat Arb’a

Hébronbron

Taffuh

Dura

Yatta

Bani Na'im

Sa'ir

Halhul

Kharas

Tarqumiya

Qiryat Arb'a

2 km

Area of Hebron �under Palestinian control

City of Hebron

Area of Hebron �under Israeli control

Hebron

The old city of HEBRONhas the distinctivefeature of being the onlyWest Bank Palestiniancommunity to beoccupied internally by250 settlers who areprotected by 2,000Israeli soldiers. The resultis extreme, ongoingtension between the twocommunities.

The Palestinian Territories’“patchwork quilt” design is visible on maps. Imposed bythe Israeli government in 2001,the fragmentation makes itincreasingly difficult for aidworkers to gain access to patients and deprivesPalestinians of freedom of movement.

Jérusalem

El Fawar

El Arroub

Qiryat Arb’a

Hébron

Palestinian area

Israeli settlement

Zone under Palestinian Authority control

Zone under Israeli control

Zone under Israeli forces’ fire (destroyed or annexed sincethe beginning of the Intifada)

© M

AP

S M

SF


SUNDAY, NOVEMBER 12, 2000

R A F A H

Life undergunfire

Visit to the Salah’edine district.We’ve come back to see an 8 year-old boy who’s had problems sincethe floor of the house where hewas sleeping with his brothers was

destroyed. He’s a little better since our last visitbut is still fragile. He keeps saying he is afraidand anxious. His family finds him changed.They say he is worried now, not cheerful likehe was before.We hear gunfire overhead. We talk with theboy and his older brother (The child did notwant to be alone with us.). We help him toexpress his feelings and to tell us what heexperienced when the house was attacked.The street is very exposed and we see a houseriddled with bullet holes. We ask people onthe street if it is occupied. An older, childlesscouple live there. The husband is a formerEnglish teacher. They invite us in and seemvery willing to talk. Since the Intifada, theyhave been living under constant stress. Theirhouse is within firing range of an Israeli milita-ry post just opposite. Bullets have been firedseveral times through their living room, rightwhere we are sitting and talking. The couplehas moved their living quarters to the backroom of the house. They leave by the backdoor to visit their neighbors but don’t go farfor fear that a fire may break out when theyare gone.They can’t sleep any more and eat little ornothing because it is difficult to take in food.The man, 58, complains of joint and musclepains while his wife, 37, complains of constantfear. Still, they speak with a certain sense ofhumor, thanking God they have no children.Given what’s happening to young peopleright now, their lives would be much worse.Despite their casual comments, we sense amuted anguish below the surface in their bit-ter comments about the Palestinian Authority.“They’ve lined their pockets and we don’ttrust them.” They feel isolated, abandoned,and gripped by deep pessimism.

20

2000September 28

Ariel Sharon

visits the Al-Aqsa

mosque in

Jerusalem,

sparking

Palestinian

uprisings. The

second Intifada,

known as the

Al-Aqsa Intifada,

begins.

September 30

Fourteen

Palestinians are

killed by Israeli

fire, including a

12 year-old boy,

Mohammed al-

Durra. Filmed by

the French 2

television news

team, footage

of his death

is broadcast

around the

world.

MSF psycho-medical team in Gaza

A man stands in front of the house across thestreet from theirs, right next to the Israeli mili-tary station. We see women and children atthe windows. The man lives here with hisfamily and invites us in. To enter, we have togo around the corner where the confronta-tions occur. People have been wounded andkilled right here. As we climb the stairs, wehave to duck as we pass openings – bulletholes and gaps in the walls the size of a hand.Two stories, two families; one of which has leftto take refuge somewhere else. While we talkin a closed-off room, we can hear firing closeby and our eyes begin to sting from the tear-gas. The children are calm and quiet. Theirexpressions are serious as they listen to theirfather. Every night they leave with theirmother to sleep somewhere else. The fatherreturns alone to keep watch over the house.He, too fears that a fire could break out. The15 year-old boy has not joined the confronta-tions. Or so he says in front of his father. Thefather has tried to talk the young people outof participating because he cannot bear to seethem injured anymore. He can’t stand thatthis is happening so close to his house but herealizes he’s powerless to stop them.

K H A N Y U N I S

She wants toknock over thetelevision

Arefugee camp borders the outskirts of asettlement area on the western edge oftown. It is an enclave within a zone

completely controlled by the Israeli army. Thefurthest houses are exposed to daily confronta-tions. The multi-story apartment buildingstowering over the houses, now empty, areriddled with bullet marks.We visit two families living in the two houses atthe end of the alleyway, barely 20 metersacross from the military installations.Confrontations have taken place here since thebeginning of the Intifada. In the last two days,the clashes have moved 100 meters away.They still occur close by, but the extra distanceis enough to restore a bit of calm for thesefamilies.Nearly all the families have left the district, atleast at night. The father speaks. He is very ner-vous and his words rush out. He has sevenchildren, ages 2 to 14. He fears for their livesand their health. He no longer works and is


very worried. He describes the family’s earliertragedies before the war. His oldest daughter,8, was killed in 1993. On the day of her death,she was wearing T-shirt with a picture ofSaddam Hussein. Two of his brothers were alsokilled, one in 1976 and the other in 1991during the confrontations. A few days ago, asshe watched images of the Intifada, his 7 year-old daughter wanted to knock over the televi-sion. He is under permanent stress, doesn’tsleep and has seen youths wounded. He speaksof his impotence in the face of events. “WePalestinians are educated and intelligent, butwe don’t have a chance. Your visit brings us alittle comfort.”

MONDAY, NOVEMBER 13

E R E Z

The fear of teargas

This Bedouin village is located across froma spot where clashes occur daily. Wemeet people who are worn out by the

situation. They live near the road, with militaryinstallations facing them and the Beit Hanoundistrict behind. Gunfire passes overhead andalongside them. The camp is fairly poor andnearly all the men work in Israel. We sat firstin the courtyard of one of the houses to talkwith the people there – men, women andvery young children. Most of the houses arebuilt of sheetmetal. Some have real walls butare still not very solid and offer no protectionagainst gunfire or teargas. Countless bulletholes pock the “walls” of these homes. IsraeliDefense Force installations loom over thevillage. The soldiers are invisible behindcamouflage nets, but you can sense their pre-sence and their weapons, permanently aimedand at the ready. The threat is invisible butomnipresent.Today, and for the first time since the Intifadabegan, there have been no confrontations. It is1 p.m. Yesterday at this time we couldn’t havegotten in here. And what about tomorrow?We’d be better off returning earlier in the day.People suffer from the effects of teargas. Theycan no longer protect themselves and theirchildren from the new teargas grenades, whichcontain more concentrated gas. They holdonions under their noses, but this remedydoesn’t work anymore.A man reported that young people werewounded in the confrontations. They hid in

the village to get away from the shooting andfind help. He saw wounded and one dead.They had to drag them across the sand toreach the ambulance. They had been hit inthe leg and there was a lot of blood. He can-not stop thinking about the young people hesaw suffering in front of him. He knows thattwo had to have limbs amputated. These ima-ges of death will not leave him. Later, he tells usabout other problems, which suggest severeanxiety. He asks us to come back so that hecan speak to us privately, which we do.The others point out another, younger manwhom they said was in very bad shape.“Yesterday, he was like a crazy man.” The manexplained that about a month ago, around thetime the Intifada began, his father, an elderlyman, suffocated during a teargas attack.Seeing his father in difficulty, the young manrushed to help him and both were exposed.The man confided that he’d had difficulty res-training his fear. He carried his father, who hadlost consciousness, outside the range of fire.Yesterday he panicked during another teargasattack. He burst into hisneighbor’s house through awindow, seeking safety therefor himself, his pregnant wifeand their two young children.He lost control of himself andtoday his wife is in bed, ill.We visited her. Her problemsare the result of stress. Wewere able to speak with herand she responded positively.We will see her again tomor-row with the doctor for aphysical examination which can be very usefulin such cases, given her physical symptoms.We will continue to provide follow-up psycho-logical care.Everyone expresses recurring worries aboutexposure to teargas. They are all afraid thatmen could become sterile and that illnessesthat may appear 20 years later. After the doc-tor visits one woman, a man wonders, “She’sbetter today, but what will happen to herbaby?”The feeling of suffocation following teargasinhalation provokes a sense of imminentdeath, aggravated by the belief that the sub-stance is a chemical toxin. We were not fami-liar with the new teargas canisters. Theycontain concentrated gas released in greaterquantities than the grenades used before,which were made of black rubber and could begripped and thrown into the distance. Thenew ones are metal. They spin and becomevery hot, making it impossible to grip them.

As we talk, we can hear

shooting close by. The gas

begins to sting our eyes.


N E T Z A R I M

The tanks keeppassing, backand forth

Four houses occupy the same patch of landnear this settlement. The houses are justbehind two buildings the IDF dynamited

to clear the area at the junction leading to theNetzarim settlement (This is the spot where theyoung boy, Mohammed al-Durra, was killedand his father wounded.).Four brothers and their families live there, alongwith their many children. They are former refu-

gees and built here in 1990. Wesit in the largest room. Theyunderstood why we had come.Only one of the fathers is pre-sent, along with two motherswho are worried about theirdaughters. One of them keepsasking to leave this place.Although the walls are sturdy,they don’t seem to offer muchprotection any more. Severalpeople speak at once, tellingthe story of that endless nightwhen the buildings were blown

up. “We didn’t think we’d get out alive.” A girlwho was frightened speaks up, encouraged byher more talkative cousin. The grandmotherjoins us and described her fear as she hid underthe staircase. She wonders if she ought to takedrugs to sleep. Outside, we heard the tanks roll-ing back and forth, a reminder of the constantmilitary presence that no one here can forget.Accompanied by their parents, the childrenleave only to attend school.

TUESDAY, NOVEMBER 14

E R E Z

Regression

We came back to the village to see theyoung pregnant women. We areasked to visit a woman and child in

another house. Soon, more women and youngchildren arrive and the house quickly resem-bles a little improvised family health clinic. Twochildren present with stress-related symptoms.A two year-old girl who was toilet-trained hasbegun to wet herself again (enuresis). A slight-ly older child shows with the same symptoms.

We talked with the mothers and children toexplain the link between fear and regressionsthat may follow. This is a normal reaction to anabnormal situation. Reassure, comfort, protectand cuddle – how can you do this for three orfour children who are all asking for the sameattention? We will return to the village to care for thesefamilies and help them care for the little ones,who flee the house to take shelter in the gar-den during every confrontation and threat.

WEDNESDAY, NOVEMBER 15

K H A N Y U N I S

Laughter, criesand stones

This time we visited the other part of therefugee camp. It is very close to the mili-tary post and is exposed to gunfire. Many

youth come here daily. Several have been killedsince the confrontations began.It’s clear that these people live with permanentstress. The atmosphere is highly-charged.Everyone wants to speak at the same time.Everyone calls for the doctor.People are in a state I would describe as hypo-manic. They laugh and cry; the children areover-excited children; small rocks are thrown.But they are happy to welcome us and toexplain what they are going through. Thosewho have somewhere else to go do not sleephere. Every house has a sealed room to protectagainst teargas.During this first visit, we also saw mothersconcerned about their children, a baby whowas failing to thrive and a child who presentedwith enuresis.

THURSDAY, NOVEMBER 16

K H A N Y U N I S

Eleven years oldand at war

We had a long interview with awoman with a 7 month-old baby,which allowed us to discuss a pro-

blem that was both troubling and shameful to her. Three months ago her baby stoppedgaining weight. Despite that, the baby pre-sented with normal psychomotor develop-

People are in ahypomanic state.They laugh andcry; the childrenare over-excited;small rocks are

thrown.


October 12

Three Israeli

soldiers are

lynched in

Ramallah. The

Israeli army

retaliates.

November 9

The head of

Fatah’s armed

wing for the

southern West

Bank is killed in

his car by a

missile. He is the

first victim of

Israel’s strategy

of targeting and

eliminating

Palestinian

activists.

ment, interacts with others and appears lively.Above all, it’s the mother’s anxiety that needsto be relieved.Another mother, whom we had met yester-day, came to talk to us about her 5 year-oldson’s enuresis. We were able to give her someadvice and speak to the boy, who yesterdaywas behaving like a “tough guy.”The baby’s older brother is 11, his eyes spar-kling with intelligence. He told us that heknew the boy who was killed yesterday notlong after our visit. They were in the sameclass. He’d just come back from the funeral,which we had passed. He was proud to speakand his tone of voice was almost arrogant ashe told us that he goes to the confrontations,too. He says he’s not afraid and that anyonewho doesn’t go after school is a coward.

Everyone goes, it’s impossible not to. Then headds that the dead boy, the “chahid” (mar-tyr), was “majnoun” (crazy) and that he pro-voked the Israeli soldiers by yelling insults andexposing his genitals. According to this boy,the soldiers had aimed at the child. The boyhid behind a cement block, stuck out his headand was shot in the forehead. Trying to im-press us, he spoke without showing sorrow asif to say, “no one can say I was afraid.” Hisexpression troubled the Palestinian psycholo-gist who was with me.The young people were gathering at theregular place where clashes take place andteargas bombs were fired. We could not stay.We left the camp without being able to noti-fy the people waiting to see the doctor or totell them when we would visit next. A bit fur-ther along we were stopped and surroundedby dozens of young people, mostly girls whohad come close to the IDF stations and hadbeen teargassed. A sense of collective hyste-ria was in the air, reminding us again of thetense atmosphere here. One of the girls yell-ed out, “Why do you want to kill us?” TheFrench-speaking Palestinian psychologistwho was with us told her that we wereFrench and had come to help. The girl didnot listen. It’s all the same, she said. We left,confused and pensive.

An Israeli army armored bulldozer again piles cement blocks at the entrance to the Hebron market in December 2001.


SATURDAY, NOVEMBER 18

N E T Z A R I M

The bulldozersattack

While the Netzarim junction was beingcleared (buildings destroyed and treesuprooted), confrontations broke out

at the next intersection in the Al Muragah neigh-borhood, alongside a little mosque where an IDFJeep is stationed permanently. One or moretanks patrolled the road taken by the settlers.This Saturday is unusually quiet. People haven’texperienced calm here for days, especially sinceThursday night when bulldozers resumed theirclean-up operations. Now there’s enough roomto build a four-lane road.We go from house to house. There’s no militarypresence until 3 p.m. We’ll leave the district ataround 4 p.m., after seeing demoralized peoplewho are still experiencing shock and are visiblyexhausted by sleepless nights. Their anxiety isrelentless; it is seen, heard and spoken.A young woman with first aid training offers totake us to the houses where the residents aremost affected. She is very concerned about thepopulation’s suffering. We identified at least twopeople who need individual care: a 27 year-oldman whose mother came to talk to us and ahousewife who lives in one of the houses alongthe road. During the night, the family saw thebulldozer roll up to their house and stop a fewmeters away after having smashed the fence andthe well at the entrance to the house. The womanasked for help, unable to cope any longer.Two weeks ago, another family watched itshome turned into a firing base. Israeli soldierscordoned off the empty house to set up opera-tions and shoot. One of the little girls is visiblyvery frightened (we would return later to seeher) because the family had just moved back intothe house today.In another house, owned by the sheikh andacross from the mosque, a young woman had amiscarriage a few days earlier. A month ago, her18 month-old baby daughter died from a tear-gas attack. (She was hospitalized but could notbe saved.)Large bullet holes are visible at another housewhere the family is on constant alert, watchingand waiting. The father and son, a pharmacist,are solid and steady. Four days ago, anotherwoman in another house had a miscarriage. Shesays she is fine, strong and unafraid of the sol-diers. She and her husband would be run overby the bulldozers before they would leave.

As we leave, we pass the youths headed towardthe junction where the confrontations takeplace. “We haven’t even started!” they say.

SUNDAY, NOVEMBER 19

E R E Z

Vulnerable, lonelyand helpless

We visit this IDF-controlled coastal zoneto the far north of the Gaza Strip,where the Alai Sina and Nevetz Sala

settlements are located. People in this agricultu-ral region live surrounded by two Israeli settle-ments. There have been no clashes but fear gripsthe farmers. The majority no longer sleep here,returning instead to the seaside camp wherethey are from. They come here to work duringthe day. Only a few families live here full-time but they do not sleep soundly.Several Bedouin families live here, too. Theymoved in when the Palestinian Authority arrivedand are scattered throughout the zone. Theirway of life is very traditional and clannish, unlikethose we saw at Erez, who are more settled.We visited one of these families, particularlyexposed to gunfire from tanks and the advancedIDF station positioned at the settlement’s entran-ce, some 100 meters away. The family feelsextremely vulnerable, isolated and helpless.When night falls, they are unable to sleep fromanxiety. They moved to this region six years agobecause they liked the area. (They came fromthe south.) Since then it has become a night-mare and they dream of safety that does notnow exist. One of the men who greeted us isasthmatic. His asthma attacks have becomemore frequent since the events began. We offerto return as soon as possible with a doctor whocan provide appropriate care for the entire fami-ly. We did not see the women or all the children.

MONDAY, NOVEMBER 20

E R E Z

The pastresurfaces

Third visit to the Bedouin village of Erez.We are scheduled to conduct a personalinterview with a 39 year-old man about

problems he’s had for three years but which

November 20

Israeli naval and

aerial forces bomb

official Palestinian

buildings in Gaza

following a bomb

attack on a bus

carrying settler

children.

November 24

Houses are

destroyed and

trees uprooted

along the

perimeter of the

Gaza settlements.

December 9

Ehud Barak resigns

as prime minister

and elections are

scheduled for

February 6, 2001.

December 20

According to press

reports, more

deaths occurred

during two weeks

of the Intifada

– 344, including

292 Palestinians –

than during

all of 1987.


have been revived by the current situation.The long, in-depth interview revealed that hesuffers from post-traumatic stress resultingfrom past experiences, some of which certain-ly date to his childhood and which may ormay not be related to the political situation.His condition is not acute but he experiencespersistent anxiety that presents in both hisphysical and emotional status.

TUESDAY, NOVEMBER 21

D E I R E L - B A L A H

The day afterthe bombings

Last night, Gaza was bombed from 6 p.m.until 8:45 p.m. We had planned to go thesouth of the Gaza Strip to meet the fami-

lies previously seen on November 12. Amongthem was a little boy we’d seen twice before.But we were stopped at the Kissufim roadblock,which is closed to Palestinians. Our car was notadequately identified so we gave up for today.In light of the night’s bombings, we had alsoplanned to visit families living near a bombedbase at Deir el-Balah, located before the turn-off for Kissufim. We headed towards the threehouses closest to the bombed site and werewelcomed by the family living there. The father,mother and children are there. Not many child-ren are going to school this morning as no one got much sleep the night before. Aftera few moments, the other family members arrived.A 9 year-old boy spent the night in a state ofacute stress. The family spent two full hours inthe garden for protection in case of renewedfiring on the base. The boy could not calmdown. His mother says he wouldn’t leave herfor a second and went to the bathroom cons-tantly. He couldn’t sleep in his room with hisbrothers and stayed with his parents, prayingfor daybreak. Only then did he begin to calmdown. He was here during our visit and said hefelt better. He thinks things will be all right now.This is the first time that anything has hap-pened in this seaside district. There have beenno clashes here since the current events beganand there were no serious situations evenduring the first Intifada.We are asked our advice about two members ofthe family for problems unrelated to the night’sevents. Both are present: a 7 year-old boy, the youngest son of the man of the house, and a 32 year-old man, married and a father.

He is one of the four brothers living here.When I asked the youngest his name and howhe felt, his father answered for him, explainingthat the child stutters as a result of a traumaticexperience when he was 5. He was alone in acar waiting for his father. Suddenly, a huge,vicious, barking dog appeared, circling the carand terrorizing the child, who screamed until hisfather returned. This took place in Saudi Arabia,where the family was living at the time. Sincethen, the boy has stuttered. He has received no treatment. I turned to speak to himand asked him to explain the experience. Herelated what happened and his eyes filled withtears. He was very touching and we weremoved. He is very intelligent, does well at schooland is very open to how we might help him. Hewould like to be treated. I mentioned thePalestinian organizations and suggested that wecontact them to arrange psychological care. Thefather agreed.The second patient is a man with visible pro-blems. His face is contorted and he twists hisfingers compulsively. His older brother explainshis situation. The man has severe attacks, including catatonic states in which his body stiffens, he pulls his hair and hits his headagainst the wall. His throat closes up and he caneat only yogurt. He does not sleep. This began10 years ago. The problems occur intermittent-ly and the brothers agree that they increasewhen he is faced with difficulties as he is now,given the events.The young man was seriously mistreatedduring the Intifada, when he was 22. He wasarrested and beaten by theIDF. His problems apparentlybegan following this abuse.The description suggestsPTSD (Post-Traumatic StressDisorders) with psychotic fea-tures. The brothers cannotrecall similar episodes beforehis arrest. He is the third offour brothers and receives tre-mendous support from them.He was treated in Jordan andanother Gulf country wherehe had wanted to study. Hehas been seen everywherepossible, including the Gaza psychiatric hospi-tal and the Gaza Community Mental HealthProgram (GCMHP) where he saw a physician.The prescribed treatment was helpful but theresults did not last. Apparently, this man hasnot been able to undertake psychotherapy. Ifthere is still time, it could be useful to sug-gest. We must still confirm that there are nounderlying psychotic problems.

The child couldn’tsleep with hisbrothers. He

stayed with hisparents, praying

for daybreak. Only then did he

calm down.

N E T Z A R I M

Sore throat

In the Al Muragah district, a young man of 27invited us to his home. His mother was pre-sent during the interview. He explained what

had happened to him two weeks ago as he wasreturning from his daily job at a restaurant inGaza. (He comes home late at night.) At thecrossing in front of the IDFJeep, he was arrested androughed up by the military.They struck him in the sidewith their rifle butts, took hisdocuments, told him to waitand then left. He was veryfrightened because of thewait and also because he hadbeen detained previously (for6 months in 1991 after parti-cipating in a demonstrationin Gaza). He feared the sol-diers were checking his iden-tity by computer and that hewas in danger. The wait lastedtwo hours, during which timehe spoke with other youthsnearby. When the Jeep came back, he retrievedhis documents and was told – firmly but withoutphysical violence – to return home.Ever since, he has been unable to return towork, feels extremely fatigued, asthenic,anxious and ill (a sore throat). He is in a state ofpersistent anxiety, cannot think, speaks littleand is unable to relax. He must go back to workbecause he is the only one of the brothers work-ing right now. (The others are unemployedbecause they work in Israel.) Their father waskilled in an accident in 1998. He is also veryworried because with his mother’s help, it tookhim four years to recover after his release fromprison. He recent experience has triggered arevival of his earlier fragile state and he is afraidthat he will relapse. He is a newlywed, marriedjust two months ago. We sense this is contribut-


ing to his anxiety as at this point in his life hemust take on new responsibilities vis à vis hisyoung wife. His current stress could compromi-se his ability to meet those responsibilities. Hecan’t answer her questions. She is aware that heis not well but he does not tell her what iswrong.

WEDNESDAY, NOVEMBER 22

N E T Z A R I M

“What about thechildren if I die?”

It is still impossible to visit Rafah or KhanYunis. Since the last attacks in the Rafahregion the Israeli Army has, in effect, divid-

ed the Gaza Strip in two and imposed strictcontrols on travel between north and south.It is currently impossible for us to reach thesouthern region.We returned to Al Muragah and met a woman in her forties who was visiblyexhausted and troubled by persistent anxietysince the first day of the events. The family’shouse, riddled in places by bullet holes, is onthe road leading to the Netzarim settlementin the 70-meter strip where buildings tallerthan one story are prohibited. Their houses isof light but durable construction, with seve-ral rooms. Our patient is in a state of extremeasthenia and stress. She no longer sleeps andeats very little. Her expression is sorrowfuland her exhaustion shows. She only sleepswhen the family visits relatives but despitefrequent pleas from one of her daughters,10, they go only rarely because they fear thehouse will be destroyed if they leave.“What will happen to the children if I die?”We listen to the woman, spend a long timecomforting her, and plan to visit again.We visit a neighboring home. The youngmother came looking for us at the previousfamily’s home. We find her alone with threeyoung children in a sheet metal hut. She saysher husband has been gone since the firstdays of the confrontation. He had said thathe couldn’t stay any longer, that it was toodangerous and that he was afraid. He has notreturned since.The 18 month-old boy has a huge burn onhis buttocks. Two days ago, he fell into thefire when teargas bombs were fired into the house and everyone was blinded. Themother took him to the health clinic for treat-ment and is supposed to return daily to have

The man is a newly-wed,

married just twomonths ago. The

stress he facesmakes it difficult

for him to take onthese new

responsibilities,which increases

his suffering.


the bandage changed. The fee is two Israelishekels but she has no more money. This isboth a social service and family matter. Whatcan be done?In speaking with the neighbors present, onethinks the husband left and abandoned his fami-ly because he was traumatized. As he has beenseen in the neighborhood, we suggest sendinghim a message that we will return here onSunday. We should try to speak with him.Another mother asks us to help her 9 year-oldson who has become enuretic since the events.We offer to see him on our next visit.

G A Z A C I T Y

Collateral damage

Visit to the district where the bomb fell “bymistake.” It is in the Beach Camp, not farfrom us. People were watching the roc-

kets launched from the sea fly overhead whensuddenly one fell in the middle of a group ofhouses in a small alley. One house was badlydamaged. Several others had part of their metalroofs blown off and a young girl received frag-ment wounds in the abdomen.

A father asks us to see his 9 year-old son who,two days later, has not recovered from the inci-dent. We speak with the child on the patio of theneighboring house. He talks about his fear andhis feelings. He’s feeling a bit better than yester-day but still can’t think of anything else. He’s asomewhat shy and reserved. His father comfortshim as best he can, although he is worried aboutwhere he will find the money to repair his house.The Palestinian police arrived just after the bom-bing to reassure the people.


N U S E I R AT

A drawing toshow the wholeworld

Visit to the women’s center. There are noclashes in the Nuseirat camp. Instead,the youth go to Netzarim and Kfar

Darom to participate in the confrontationsthere. We met some of them as they were

December 28

Two Israeli

soldiers are

killed during a

bomb attack

carried out

against army

patrols in the

southern Gaza

Strip. That day,

the Sharm al-

Sheikh peace

summit is

canceled.

At the Kalandia checkpoint between Ramallah and East Jerusalem, only people with Jerusalem residence permits may pass.

drawing and setting up a puppet show. Veryinteresting discussion in which these fifteenyear-olds – who look younger – shared theirdetermination to “defend their people,” inspite of everything. They hide their activitiesfrom their parents and scorn the coordinator’sadvice not to go. (He is a young man of 22who was hit twice in the leg during theconfrontations.) They aren’t afraid becausethey can “hear the bullets coming and dodgethem.” They carry the wounded and don’tthink of the danger. The speakers leave nodoubt as to their determination. They areproud of what they do. They are sweet,endearing kids. One has gathered all the ele-ments of the situation in a single drawing:trees uprooted, bombings, a martyr, tanks,settlements, houses destroyed, people fleeing.He wishes the whole world could see it.

SATURDAY, NOVEMBER 25

R A F A H

For thephotographers

We can finally head out for Rafah. Wehoped this Shabbat Saturday wouldmake it easier to get through at the

Kissufim checkpoint (no settler traffic today) andwe planned for every contingency: a white car,driven by an expatriate, with MSF identificationand flag and a second car, yellow, with aPalestinian driver.The checkpoint finally opens at 10 a.m. Thingsmove slowly because the passage is narrow andcrowded with pedestrians, cars and trucks.After a week of intensified confrontations, visit-ing Rafah was a priority but we had been unable to go because of strict travel restrictions. In the Salah’edine district, we find peopleexhausted, intimidated and demoralized by the worsening situation. Incessant gunfire pla-gues the area.The English teacher we met does not hold backhimself as he expresses his anger and despair. Heis extremely upset. His wife is not as agitated anddescribes his exhaustion during a long interviewI have with her. The conversation calms and reas-sures her. She insists that our visits are necessaryand comforting. A cousin of her husband’s, a man in his fifties, was killed three days agoreturning from prayer. He was shot in the headaround 300 meters from the scene of the clashes. No more good humor in their words,only anger and fear.


The father of the family in the house across thestreet is equally distraught. His face is drawn, hespeaks angrily and as he expressed his exhaus-tion, we sensed that he might burst into tearsat the end of every sentence. He has moved his

family into a garage on theground floor of the house.We have a conversation withhis wife, who is holding upbut is very worried about thechildren. We are in the housewhen violent gunfire breaksout. (The photographershave just arrived and theyouth want to show whatthey’re capable of!) The IDFresponds immediately, withresounding gunfire. This is

intended to sound like the real thing and tofrighten and warn people before the real shoot-ing begins. We’re not used to it and it’s quiteupsetting.Next we visit the little boy again. Paradoxically,he seems better. We meet with him in the MSFcar so we can have a quiet place to talk. Besides,teargas has just been fired and his house is filledwith fumes. No one can breathe there. He’shappy with this arrangement and the other kidsare jealous. He feels safe now because he and hisfamily will sleep somewhere else.In this district there are around 25 families at risk and another eight at very great risk.We return to Rafah and find a place to see ourpatients in the calm and shelter of the MSF bus.We can’t provide treatment or support in houseswhere there’s a risk of being attacked and wherewe, too, become stressed.

SUNDAY, NOVEMBER 26

N E T Z A R I M

Massage with oiland relaxationtechniques

We have an appointment with apatient in Al Muragah. He is waitingfor us because he’s been told that we

will visit. We find a worried man who has diffi-culty explaining his situation. He’s the one whoabandoned his home out of fear. He shows ustwo gunshot holes in the fence around hishouse. He hid to protect himself and then, pa-nicked, fled to his parents’ home 1.5 km away.He had decided not to spend a minute longer

Unlike during ourprior visits, thereis no more goodhumor in their

words, only angerand fear.


in that hell. His wife and children were not inthe house that day so he left without them.Ever since, his wife has been alone there withthe children. He has been living next door tohis brother’s house. The situation has becomeunbearable for him since the incident. To makematters worse, he lost his job and has no moremoney. Our visit comforts him. He wants ourhelp, feels guilty and needs support. This morning his wife left with the children for thefuneral of her father, an elderly man who diedyesterday of old age. This could be a chance forher to rest as she had told us that her parentslive near Karni in a quiet area.We will return to see him when his wife comesback to try to help them find a solution acceptable to all. He says he has nightmaresand can’t sleep anymore. He seems quite dis-traught.Next we visit a patient we’ve been caring for totell her that we will return with the doctor theday after tomorrow. She is weak enough that itis cause for concern. She says she can no longertake care of her children and seems to have nomore strength. In spite of the situation, she saysshe can only rest at her own home. At her sister’s house, 2 km away, where she goes occa-sionally, the children fight (there are many ofthem) because they are over-excited. The spaceis small and it’s almost worse than being athome. I suggested that we also see her hus-band (he comes home fromwork at 3 p.m.) who, she says,is “even more frightened atnight than I am.”During the conversation, weget news about the familiesliving in the houses near themosque. We meet with seve-ral people; in particular, agroup of women who havecome together to supporteach other. The conversationis animated and wide-rang-ing. Each woman shares herfeelings and her personalrecipe for fighting off fear (including massa-ges with oil to ease painful joints and relaxa-tion techniques). One of them laughs. Shefinds this treatment approach a bit out-dated!An IDF tank is parked along the road. Fromtime to time we hear gunfire in the distance,but this is relatively calm and peaceful, com-pared to what happens every afternoon from 3 or 4 p.m. and during the night. Is this harassment, “psychological warfare?” Yes, noquestion about it.On our last visit of the day, we stop at another

family’s home. This is the tallest house and shows evidence of repeated gunfire (many visi-ble large bullet holes). The children are at school.We will come back after 1:30 p.m. and see themon another day. I realize that I haven’t writtendown the sentence that people, especially theelderly, repeat often: “They are going to kill us,we are all going to die.”Our patients also voice the hope that we willbear witness to what we see and hear. Clearly,the Palestinians feel abandoned and forgotten.“Do people where you live really know whatwe’re going through?”


N E A R T H ES E T T L E M E N T S

Fortress towns

Every day we see the situation in the districtsnear the settlements deteriorate. Increasingnumbers of families are affected; houses are

destroyed, occupied and riddled with gunfire.Families are living in tents or with relativeswithout any hope of reclaiming their requisi-tioned property; farm animals are butcheredsavagely. Fear has become part of daily life inthese isolated districts and villages. Some remainout of reach of any humanitarian aid because no one can guarantee acceptable levels of secu-rity (Mawassi, Swidi).Our regular visits with these families allow usto observe how the conflict has escalated. ThePalestinians live in fear of Israeli Army repri-sals. Israeli restrictions hamper freedom ofmovement within the Gaza Strip. The onlyauthorized crossing point between north andsouth is the country road which passes by theKissufim junction. The regular four-lane road,linking the southern and northern towns, hasbeen cut off above Deir el-Balah because itruns for some distance alongside the KfarDarom settlement.The settlements have become fortified townswhere the Israeli Army sanctions every man’sright to carry a weapon. The IDF soldiers pro-tecting the settlements can take advantage ofthe settlers’ logistical and moral support.There is no possible comparison with thePalestinian civilian population, which for themost part avoids having anything to do with Palestinian military operations for fear ofreprisals.

Patients hope thatwe talk aboutthem: “Do the

people where youlive really know

what we’re goingthrough?”


MONDAY, DECEMBER 4

K H A N Y U N I S

I thought myheart would stop

The bulldozers have continued their work atthe Kissufim junction, destroying whatevervegetation remains. Two tanks block the

road, stopping traffic. Warning shots convincedthose trying to move forward to turn back.At Khan Yunis, the situation seems to be stabi-lized. Despite the lull, residents are still verymuch in a state of shock. After fasting is over andthey have eaten (at home so as not to be anextra burden on their host family), everyone lea-ves to take refuge in the center of town. Bulletmarks and holes scar the houses. Parents descri-be disturbing scenes of panic. When the firingbegins, they must flee their houses. The childrencry and scream. Everyone rushes into the smallalleyways to find shelter elsewhere. Someparents appear very demoralized and resigned.They no longer have hope. Others announcethey cannot fight because of the children. All suf-fer from feelings of insecurity.We understand that the Israeli army apparentlywants to move some these of families out of theirhomes so that the army can occupy their houses.A woman followed by her children called out tome. She showed us one of the children, sayinghe had problems and needed help. I went withher and spoke with the child. He is 10 years oldand explained that after being at home when hishouse was bombed and shot, he has had panicattacks every day at the same time, re-experienc-ing the terror he’d felt at that moment. He cries,trembles and screams to be taken to his grand-father’s house.His father, who joins us later, confirms that hisson is unable to get over this fear. Not knowingwhat to do, he gives the boy tranquilizers, keepshim at home and forces him to eat. I advise himto be patient and to respect his son’s fear. Theboy must decide for himself if he wants to stay inthe house. I promised the child that I wouldcome back to see him.We also met the director and teachers fromthe Netzarim elementary school. They needsomeone to listen to and advise them. Whilewe were talking, a burst of gunfire broke out.I thought my heart would stop on the spot.The children, as well as the school personnel,live with this every day. I don’t know howthey manage. But judging from the teachers’reactions, I don’t believe they have gottenused to it!

WEDNESDAY, DECEMBER 6

R A F A H

Fear in thefamily

The street is reminiscent of Beirut or Kabul.Families cling to the ruins, living in terror.Where are they to go? So they stay. With

fear in the pit of their stomachs. Praying that abulldozer won’t come to tear down their house.We cross into the Israeli-controlled zone to visit ashantytown of Bedouin refugees who haven’tseen a doctor for months. We are still in PalestineAutonomous Territory, but given the camp’s pro-ximity to Israeli settlements, it is cut off from therest of the world. The settlements resembleislands of prosperity, entrenched behind electricgates or huge concrete walls, with observationtowers and surveillance cameras. They are pro-tected by tanks and fixed airships providingground surveillance and, at sea, by militarypatrol boats. The concrete walls are made ofmovable blocks.In the Gaza Strip, some 5,000 Israeli settlers, pro-tected by thousands of soldiers, control 40 per-cent of a territory with a total population of onemillion. We are shown the Kfar Darom settlement, home to a couple with two children,around twenty soldiers and some dogs.Occasionally the dogs get out and bite Palestinianchildren. A population living in terror and miserysurrounds this armed camp. The Palestiniansserve as cheap manual labor on Israeli farms.They are prohibited from traveling on the roadsused by the Israelis. The zone’s main roadway is made up of two parallel roads, so each com-munity has its own buses, taxis and schools. Thetwo communities are totally separated.We went into the Rafah district called al-Brasil.There we observed that two Palestinian familieswere at risk of being fired on by the IDF. Situatednext to the border, this district is caught in thecrossfire between two positions: one, along theborder with tank support; the other, level withSalah’edine, where an Israeli army watchtower islocated. The apartment of the family we visitedhas been pierced through with gunfire comingfrom both directions simultaneously. Only thekitchen is unscathed.When I meet this family, none of them is able toadmit feeling fear. They introduce the youngestchild, explaining that he has become fearful and that no one understands him any longer.Only after we talk further does each person ack-nowledge fear, even the older brother who saysthat he no longer had feeling in his legs during

2001January 4

Negotiations

resume in

Washington.

Clinton, soon to

leave office, fails

in his efforts.

January 8

More than

100,000 Israelis

demonstrate

against the

division of

Jerusalem.

January 21-27

The Taba peace

talks in Egypt

end without an

accord.

February 6

Likud wins 62.5

percent of the

votes and Ariel

Sharon becomes

prime minister.


the shooting. The little one narrowly escapeddeath when a bullet passed between him and hisbrother. Ever since, he has been unable to tole-rate the noise of tanks and wants to take shelterat his uncle’s to sleep. He says he doesn’t feel safethere either but at least he can sleep. Three ofthe four brothers speak of their fear. The fourthclaims not to be afraid. I explain to the familythat everyone has his own threshold of resistan-ce and each person’s fear must be respected. Ibelieve that for the first time, the members ofthis family have been able to articulate, in frontof others, feelings that until now they could notadmit to having.It seems to me that each member of them istrying to conquer his or her fear and fight theurge to flee, which would be seen as proof ofcowardice as the family’s duty is to protect thehouse. One suppresses all emotion, anotherwants to become a soldier, a third wants to leavefor the U.S. All are obliged toremain in this house, transfer-ring their anxiety, in a way, tothe youngest, whose own fear– which none of the others can admit to – then becomesincomprehensible. This is thefirst time that I have observedthis family phenomenon soclearly.Another phenomenon seemsto be present here. Despite thelull, it appears that many peo-ple find it difficult to relax andresume a normal life. Perhapsthis is the precursor to full-fledged trauma. If thatis the case, we can expect to observe the symp-toms soon. I will wait to gather more data on thissubject before venturing an opinion. But fornow, we can say that in spite of the rapidly-changing situation, the mood here remainsgloomy. Fear remains uppermost in people’sminds and still affects their physical state.

THURSDAY, FEBRUARY 15, 2001

Two inches fromdeath

In the district between Haret Al-Sheikh, hometo Palestinians, and Daboïa, home to settlers,we visited a little boy who’s almost 3. Since I

arrived in January, I have seen him on a regular

basis for post-traumatic stress problems. Theytriggered a trauma that occurred a year agowhen he had a serious fall from a balcony at thetime his brother was born. Last week I waited tomeet him but he never came. When I arrive thistime, I find his mother lying down. Her arm is ina cast, she has a wound on her leg and she isclearly very shaken. She explained that she hadgone to the roof to check the water supplies.Frightened by the shooting, she fell two storiesinto the interior courtyard. A tree branch brokeher fall and saved her life.Four months pregnant, she is especially frighten-ed for the baby she’s carrying. She went to thehospital and received an ultrasound and medicaltreatment which reassured her, but she is still ina state of shock. Her skin is yellow and her eyeshave deep circles. She cries every night. She wasso frightened and the fall seemed so long. Thewhole family talks about their fear. They believeshe was deliberately targeted because at themoment she fell, everything was calm. No onethought there was any risk. The mother-in-lawtakes me to the roof to show me the bulletmarks. She, too, is very upset. Two years ago, shewas shot in the leg. The scar continues to giveher pain.When we return to the mother’s bedside, her husband speaks to us sadly of his condition. Hehas been in the room all along but remained silentand withdrawn. He spent five years in prison andhas never recovered. Solitary confinement was theworst. He is overcome for a moment as he recallsthis memory. The youngest child wakes up andjoins his brother on a rocking horse. Both smile forthe picture they insist we take. The father smiles,too, and says he would like to talk about this past“that destroyed me.”A few houses away, I meet Leila, a 14 year-oldgirl, at her grandmother’s house. I have been following the older woman to support herthrough the mourning for her husband, whodied six months ago. During my last visit, onlyafter the woman described her sorrow and lone-liness and spoke of the couple’s last wonderfulmoments together did she show me the recentbullet holes in a room facing a building wheresettlers live, as well as in the doorframe of thebedroom, the door through which she was walking at that moment. She had been twoinches from death, but she would have passedover the experience if I hadn’t been there tofocus the conversation on it for a moment. Shesays she feels better today.She’d like me to talk with her granddaughter,who was wounded on December 31. Leilaexplains that there were many clashes that day.Her brothers had told her to go to her grand-mother’s for safety. When things calmed down

MSF psycho-medical team in Hebron

Each member ofthe family is

trying to conquerhis or her fear andfight the urge toflee. Their duty

is to protect the house.

in the district, she wanted to get her chickensfrom the roof because she was afraid they would

be killed. As she came down-stairs, carrying the chickens in acardboard box, a bullet struckher in the abdomen. She canstill hear the sound. “I didn’tlose consciousness,” she says. “Icame downstairs quickly, scream-ing.”Today the event is engraved inher memory. “Now, before I goto sleep I remember everythingthat happened that day. Mybrother’s friend, Gassan, died.He was 12. He was hit whenmissiles exploded as he wascoming home from prayer. Atnight, I cry for him and I alwaysthink, ‘What if I were dead?’

What frightens me is that a piece of the bulletis still in my stomach. They can’t get it out.What if I can’t have children?” She would’vebeen pleased to be a “martyr,” but perhapsshe’ll manage to become a doctor. Her teach-ers are helping her to catch up with her studies.


SUNDAY, FEBRUARY 25

“When a martyrdies, I cry”

On this home visit in the Jabel Jawhar dis-trict, near the Qiryat Arb’a settlement,we meet a 10 year-old child who com-

plains that she can’t breath and has chestpains. The mother quickly tells us of the preced-ing days’ problems. There has been a lot ofgunfire close by and children have been thro-wing stones. Her daughter was unable to gethome from school and had to take shelter withher cousins at a neighbor’s house. The little sis-ter, 6, who was playing a game of buildinghouses in the courtyard, inhaled teargas whena bomb fell close by. She tried to get back tothe house but fainted and fell. The 10 year-oldgirl made a drawing showing a house, a “mar-tyr” prone on the threshold, the barrel of a gunpointed at his chest and a soldier holding the weapon in his outstretched arm. “When amartyr dies, I cry and my chest hurts.” Themother listens to her daughter and then tellsus about her cousin’s death a few weeks ago.

In a valley near Hebron, this house, which Elias built in anticipation of his marriage, was bombed during the night.

The grandmotherhad a close brushwith death, butshe would havepassed over theexperience if I

hadn’t been thereto focus the

conversation on itfor a moment.


THURSDAY, MARCH 1

Demanding,aggressive, violent

At our doctor’s request, I make my first visitto a 15 year-old boy. In May 2000, he hadbeen shot twice while climbing up to the

roof to see what was happening that day. A stri-ke was underway and there had been some kindof activity a few streets away. He was climbingthe ladder and was shot in the arm. He didn’tfeel the injury and as he continued climbing, wasshot in the stomach. Severely wounded, hespent six months in the hospital close to death.Having received considerable attention and sup-port early on from his family, journalists and localorganizations, he now finds himself alone andfacing major physical disabilities which seriouslylimit his daily life. (He suffered kidney, stomachand intestinal injuries.) People describe him asdemanding, aggressive and violent. His motherand brothers no longer recognize the boy, whowas calm and gentle before the accident. Theyfind it difficult to cope with him and don’tunderstand his psychological distress eventhough they had given him so much support. Hesays he feels nothing – just like when he was hitfirst in the arm – and that his family mistreatshim, especially his older brother who, when hewas first hospitalized, had spent every day andnight at his bedside.The same day, I make another first visit, this oneto the home of a 9 year-old child who is unableto sleep, cries out for his mother at night and hasbecome agitated. His mother doesn’t know howto calm him. She welcomes us with a thin smileon her drawn, sad face. She immediately descri-bes the nightmare she has been living for the lastfive months. Her house is occupied and Israelisoldiers are stationed on her roof. When we arrived, we noticed weapons standing betweensandbags.When there is shooting, everything shakes andlizards scurry along the walls. The roof is consi-dered a military zone and access is prohibited.The family is only permitted to go there every 10days to perform essential tasks. Two shifts of sol-diers take turns day and night, coming andgoing by the only door to the house. When itrains, the soldiers set up in the hallway and theinhabitants must leave their bedroom doorsopen at night.“In the beginning, we were terrorized and wecouldn’t sleep,” the mother says. “Then wearranged things so that one of us stayed awake

while the others slept. The soldiers leave theirmess behind, they urinate in front of our win-dows; some are more disgusting than others andeven expose themselves in front of our daughter,harassing and upsetting her.”Her son, who was living there with his wife,chose to leave because thewife couldn’t take it any long-er. She no longer goes out.The son was once locked outfor four hours because the sol-diers had bolted the door. Herhusband, now retired, does allthe shopping even during cur-few. The woman describes her fatigue, headaches andexhaustion. Why not leave?That would mean losing thehouse and besides, wherewould they go? Her relativesno longer come to visit. The soldiers keep watchon all visitors.Only her neighbor dares to visit occasionally. Shehas come today and tells us that her water tanksand solar panels have been broken several times.At the beginning, she fixed them but whybother? It just keeps happening. Hopeless anddemoralized, she says, “It was never like thisbefore, even during the other Intifada. They fireheavily now, whenever they want, just like that,to play games, for nothing. We don’t know wha-t’s going to happen.” And of course her com-plaints go unanswered.

MONDAY, MARCH 12

“I want to leaveeverything,school, Hebron”

Ihad a hard time finding this family, which hadleft the house where they used to live near thecheckpoint next to the Abraham mosque.

Their son’s severe stress reaction after experien-cing shooting convinced them to move.I came to see him today and met the whole fami-ly. They had had to huddle in a corner to protectthemselves. The last time, this child remainedfixed at the same spot, “all yellow, and he trem-bled, trembled, he couldn’t stop.” He hasn’twanted to go out since then. His older brother,16, has quit school. “It’s pointless to go when wemiss so many days.” He prefers to help his fatherand works as a mechanic. The older daughterarrives home from school. This is her first dayback after 10 days under curfew. She immedia-

The mother can’ttake the presenceof soldiers on theroof any longer.“They leave their

filth and urinate infront of thewindows.”

tely tells her mother that she arrived at schoollate because of a half-hour delay at the check-point. Yes, she’s stopped most of the time, oftenby different soldiers. They want to see what she’scarrying and they drag things out. They’re ofteninsulting and crude. She doesn’t want to do herschoolwork anymore. She had wanted to beco-me a doctor but she’s discouraged now. “I justwant to leave everything – school, Hebron…”She feels oppressed and her hair is falling out.The youngest boy has not recovered from theshock he experienced when seven of his friendswere burned by a sound bomb, launched by sol-diers into the schoolyard. He hardly talks aboutit, his eyes distant, staring off towards theAbousnina hill. Through the window of the newhouse, he saw the bombs falling there, red tracesin the night sky, as if he were watching a televi-sion screen.

TUESDAY, MARCH 13

A dove and a sunthat weeps

Amother has come for a consultation withher 9 year-old daughter. They are fromJabal Jawhar, a more distant district where

I visited the family at home several times. Themother is out of breath, moves heavily and hasdifficulty breathing. In the taxi, she suddenlysmelled teargas but the driver told her nothingwas wrong. A few weeks ago, a teargas bombfell in her courtyard. She rushed to find her children, who are sent home from school whenthere are clashes. But she fainted and fell, had tobe hospitalized and remained in intensive care.Her current fragile state has triggered long-agotraumas, including the death of a baby eightyears ago – for which her in-laws blamed her –and her father’s death, when she was 6. Hermother was accused and then imprisoned.Meanwhile, the child is drawing and describingher fear when she saw her mother faint. Shethought the woman was dead. She is afraid of


teargas, too, of children who throw stones andsoldiers who shoot. She fell when she was run-ning to take shelter in a neighbor’s house. Shewas so frightened she couldn’t manage to reachthe house. She was with a little friend, her neigh-bor. She is most frightened of being shot, ston-ed, being ill, dying. Luckily, she can go into anyof the neighbors’ houses. She has difficulty sleep-ing, fears getting up at night to go to thebathroom and is afraid on the road on the wayto school. “But I like going to school,” she says.She made some drawings at school. Her motherwrote a play about the Intifada that the childrenperformed but she can’t show me anythingtoday because the school is closed and soldiershave occupied it. She drew a house being hit byrockets, a “martyr” and the soldier who has justkilled him holding a gun, a dove and a sun thatweeps. In Arabic, she writes that Palestine haslost its rights for all eternity.

WEDNESDAY, MARCH 21

Attacked by thesettlers

This is my first visit following the request ofa father who called out to me in the streetto come see his children. I discover a little

family in great distress; fragile and on the vergeof collapse. The mother has just recovered from giving birth a month ago. I can sense thefather’s acute tension. He shows me the shat-tered glass in the front door, the kitchen windowthat he’s just sealed up, the solar panels he’salready repaired and the low wall he’s rebuiltseveral times.Every week over the last few months this house,located along the route that takes the settlersfrom their district (Daboïa, just across the way) tosynagogue, has been the object of stone-throw-ing attacks. Only the son remains in the familyhome. His parents, as well as most of the neigh-bors, preferred to leave. Only one neighbor is stillhere; an elderly woman, tired but still firm. She’slived there all her life. The father wasn’t ready toleave the house where he was born either, but hehas stomach problems, can’t sleep and is extre-mely tired and overwhelmed. He shows us thelegal complaint he’s filed but the procedures takea long time and he can’t spend his days there.He manages to work a bit in his shoe store andleaves now to return there. After he’s gone, hiswife explains that the children are always afraid.They don’t dare go outside anymore. She can’tplay with them on the patio, as her husbandrecommends. She’s afraid to talk to him about it.

February 14

Eight Israelis are

killed by a

Palestinian who

drives his bus

into a group of

civilians and

soldiers near Tel

Aviv.

Israel imposes a

total blockade

of the

territories.

March 4

A suicide bomb

attack kills four

and wounds 45

in Netanya, a

beach resort

frequented by

Jewish tourists.

March 11

Ramallah is

completely

sealed off.

March 13

Israeli bulldozers

destroy houses

near Hebron.


The prisoners of the Al Mawassi community

The 3,000 Palestinians living in this Gaza Strip enclave cannot travelfreely. Israeli soldiers even prevent them from seeking medical care.

Al Mawassi, alsoknown as GushKatif, is a communi-ty in the southwest-

ern Gaza Strip. Surrounded by settlers,some 3,000Palestinianslive on thispiece of annexed land, com-pletely under Israeli control.They could benefit from socialand health care services butsuch programs are few, sothey have to leave the enclaveto travel to Palestinian-control-led zones. To get out, they arerequired to show pieces ofidentification that aredistributed – at random – bythe Israeli army. Few peoplehave the official documentsthat allow them to moveabout. The others are stoppedat roadblocks, sometimes fordays. Access to health care iscomplicated if not impossible.For example, a pregnantwoman who needed prenatalcare was unable to wait forlong periods at the check-point and finally turned back.The day we went to theMawassi roadblock, nearly 50angry people had been wait-ing for three days for permis-sion to enter. Most hadshown their identificationcards to the soldiers, postedsome 200 meters (220 yards)away, but had been ignored.One family that we treatedtold us that the soldiers hadannounced, without warning,

that people would have toproduce different identifica-tion cards.The same family told us ofanother incident that had

taken place in the enclaveseveral days ago. A little boyhad been seriously injuredwhen a settler’s German she-

pherd bit him in the leg. Thechild’s family was in a rush toleave Al Mawassi to get himto the hospital. The soldiers atthe roadblock would not let

them pass.The familyspent thewhole night

waiting, in vain, for the sol-diers to show some flexibility.The little boy died the nextmorning.

A little boy had been seriously injured when asettler’s German shepherd bit him in the leg.

Like her, the children jump at the least noise.Mostly she feels very alone. No one comes to thehouse anymore. She has only her sisters for sup-port but can communicate with them only bytelephone. How long can they go on like this?

THURSDAY, MARCH 22

“Tar, tar, tar”

We conduct a visit in the Abu Sneina dis-trict, located on a hillside facing theQiryat Arb’a settlement, which was

rocked several days ago by violent bombing andstrafing. Bullets and missiles woke the family inthe middle of the night, breaking windows, tear-ing through walls, leaving holes in furniture andin clothes in the closets. The mother describedthe horrible night during which they were allpinned to the bedroom floor, terrorized andwaiting to die. A 12 year-old was wounded inthe head and lost a lot of blood. The child him-self removed the metal fragment from thewound. They couldn’t call an ambulance.Crying, her legs shaking, the mother had to givefirst aid. The other children sobbed next to her,the 2 and 5 year-old clinging tightly to her.They’re both here today. They’ve never drawnbut respond to my offer when I give themcrayons and show them the house I’ve sketchedon a piece of paper. The 2 year-old girl fills inwith heavy marks, saying over and over, “tar, tar,tar,” (the sound of gunfire) and the little boykeeps coloring a red spot, while his mother talksabout the wound that terrified them.The same day, we made our first visit to a familywho learned of our work from a neighbor. Themother is waiting for me with her 12 year-oldson. He doesn’t want to go to school anymore.Wadia is very welcoming and explains that thesoldiers stop him constantly. He describes hisupsetting experience. Three soldiers stoppedhim, took a pencil from his bag and pointing it athis face, pretended they were going to put outhis eye. He was very frightened and broke free.The soldiers called him back and ordered him toget his pencil. Ever since, he dreams that soldiersare following him and he can’t get away. Hismother worries that he’s not the same anymore.He has become aggressive and disobedient. Untilthen everyone always said he was a pleasant, kindchild. When he grows up he wants to be a warpilot to fight the soldiers. His house, along withseveral others, is located in an area of greenerywith gardens and olive trees, surrounded by twosettlements, a military camp and Israeli police station. The ruins of a leveled house mark theentrance to the area.


SATURDAY, MARCH 24

A family withproblems

Gassan, a 10 year-old boy, has come aloneto find us in the street to ask us to “comesee his family, which has problems.”

Their many problems are indeed evident as soonas we enter. The older brother is disabled, thefather is ill and the mother is depressed. Shewants her son to return to school so that he willcontinue to learn but also to distance him fromthe dangers on the street. But Gassan doesn’twant to learn. “He’s afraid of the soldiers,” hisolder brothers say.A poor student from the time he started school,Gassan is proud to show us the large platter heputs on his head, filled with sweets he sells afterthe muezzin’s first call. That’s how he earnsmoney to give to his mother. But he smokes “likethe big guys” and throws stones at soldiers’ cars.When he came for a consultation, Gassan spokeonly about his cousin who was arrested by sol-diers at the house. He was struck and wounded.Gassan saw the blood and describes the sceneseveral times. His cousin is now in a prison camp.It’s true he’s afraid of the soldiers but he doesn’twant to go back to school.The same day, in the street, two little girls, 8 and10, stop us. They go to school and want to tellus what is happening now: the school is closed,soldiers have come, there’s teargas. We talkabout school and what they will do when theygrow up. “I’ll be killed,” one of them says.

WEDNESDAY, MARCH 28

Sweeps

The old town is inaccessible. We call thefamilies most at risk to learn their news.Considerable distress. During the night,

the settlers conducted “sweeps.” Shops and carswere burned and there was shooting, bullets androckets. The families stayed awake, frightened bywhat might happen to them.

THURSDAY, MARCH 29

“God’s Wisdom”

This is our second home visit to two girls, 9and 14, as well as a youth of 18 who isunder psychiatric care. The younger of the

two children has large patches of alopecia on her

March 17

For the first time

since 1967, three

mortar shells are

fired from the

Gaza Strip onto

Israeli territory

at the Nahal Oz

kibbutz.

March 26

Shalevet Pass,

the infant

daughter of an

Israeli settler

family, is killed

by a Palestinian

sniper in Hebron.

March 29

Clashes in Gaza

kill two

Palestinian

teenagers.

March 30

Six of the

Palestinian

demonstrators

commemorating

“Palestine Land

Day” are killed.


scalp and the older has recently become enure-tic. The third has not yet agreed to meet us.The adjoining building is occupied by settlersand guarded by an impressive militaryforce. The apartment where we meet isentirely closed off. The soldiers haveordered that all windows be blocked.Only one room gets daylight throughgrated openings in the ceiling. Themother summarizes the situation in a sin-gle word, the first she speaks: torture.They don’t dare leave anymore, turn thepages of the newspaper or even breathefor fear of calling attention to their pre-sence. Their only escape is the television –when the electricity isn’t cut, which itoften is.The daughters describe the recent bomb-ing at school. They lay pinned to the floorfor 1 hours, holding hands. They thoughtthe soldiers were going to invade theschool. They were afraid that they wouldnever see their mother again and weregoing to die. The older one tells us ofbeing harassed as she passes through the Jewishneighborhood on her way to school (when notunder curfew). She mentions the day when abag of sand “fell” from a rooftop as she passedbelow and the soldier who told her, “Go homeor tomorrow you’ll be on the front page of thenewspaper” – meaning she would be killed. Shetalks about the settlers who throw stones.The little sister wants to study and stay at the topof her class. She would like to become a doctor.She’s thinking of leaving school because it’s hardto do her work, “although it’s my duty to stayand protect the school.” She reads us a poemshe wrote in which she asks why there are mar-tyrs, why houses burn and why women cry overwounded children. It ends with the words, “It iswritten, it is God’s wisdom, but one day we willwin.”Same day in the old town. We have beencoming to see this family regularly since the endof January. Their problems are multiple: econo-mic, family and educational. The neighborhoodis often the scene of gunfire. The wife describesthe recent night of horror and terror. One of thechildren began to scream when, out the win-dow, he saw a friend’s house burn. Flames,smoke, screams. She wanted to leave the houseto strangle and kill the settlers.“It’s not fair. It’s because I hold back my angerthat I feel I’m suffocating.” She has no one to talkto, so she cries for comfort. The father arrives. Hewasn’t there when it happened, but he saw thefire. He screamed; screamed out of fear, power-lessness and rage. Then he tells his own story. Hewas a baby during the “first invasion” (the Six-

Day War). Seven family members disappearedthen. He doesn’t know whether they were killedor imprisoned. Since he was little, he’s unders-

tood that you’ve got to “watch out for theJews. They talk peace but you can’t trustthem.” He is tense, and he hits and argueswith family members. Patience and reli-gion are his only consolation. He would’-ve liked to build airplanes but works as anauto mechanic. He’s had lots of jobs. “Ifwe had a Palestinian state, we would dowhat you’re doing, helping people,” hesays. “When I was young, my father mademe leave school to earn money for mybrothers.”“Just like me,” says his son, Aïd, 11. Threemonths ago the boy left school to sellsnacks and earn a little money. A few dayslater, Aïd comes alone to meet us. He’svery chatty and carries a lovely coffeepot.He would like to go back to school. Hehopes that I will convince his father to lethim return and has come to offer us cof-fee. This was to be the source of his day’s

earnings but we are not even allowed to think ofpaying. This is a gift.

WEDNESDAY, JANUARY 3, 2001

D U G I T

Bulldozer,donkey andpotatoes

Today we went to the northern Gaza Strip,near the Dugit settlement. Along the way,we encountered a Palestinian military

roadblock and were not allowed to pass becausea man was killed yesterday. We left the car andcontinued on foot. A road leads to a house, butwe hesitate about approaching it. It is about 20 km from the fencing surrounding the settle-ment. A small, reinforced outpost installed toprotect the Israeli buildings stands about 50meters away. The resident warns us that it is verydangerous to be there because the Israeli soldiersrecognize everyone and quickly identify stran-gers. We set up outside, across from the station.It’s close enough that we can hear the radios.While we are talking, I see a Jeep go by. A soldier


The old city isinaccessible. Wecall the families

who are exposedto danger. There

were fires,shooting androckets during

the night… Thenext morning,we resume our

visits andconsultations.

gets out and stares at us through binoculars. Hewatches for a good minute, then turns away,obviously having concluded that we pose nothreat. The residents of the house know they arenot at risk as long as they don’t go near the settlement or protest when the bulldozer tearsup their land. Since a new fence was built, theiracreage has shrunk to almost nothing.They point to a spot where we can go to watchthe bulldozer at work. We can hear it movingbehind the trees. As we walk, we meet several farmers, including one who, enraged, tells usthey are tearing down his greenhouses. Everyoneknows they are going to lose years of work. Wecontinue walking and meet a woman who saysthe bulldozer is just passing by her house. Herfather is in the hospital and she is trying to keephim from learning what is happening. She holdsa baby in her arms and her tears fall on him. Shegrew up here, worked this land and knows everyone of the trees that she “nursed like a baby.”We continue to walk along the tree-lined road.We meet a group of farmers waiting for the bull-dozers to finish their job. They usually work herebut have been chased away. They explain thatthey were threatened and had to abandon theirgreenhouses. As they watch the bulldozer in thedistance, the machine goes back and forth, backand forth.


Next we meet a man and woman, each leadinga donkey hitched to a wagon filled with crates ofpotatoes. The woman has tears in her eyes.Crying out, she tells us that everything is goingto disappear. The Israelis have given them per-mission only to gather the vegetables lying onthe ground. At first, the man says nothing butthen begins to explain that they received nowarning. Their wells and pumps have been des-troyed. His anger rises and gives way to despairand tears. He lashes the animal and walks on.We walk further on to the last house. The bull-dozer is there, about 100 meters away. It is hugeand armor-plated. It moves forward and back,uprooting trees in its path. It sees us, stops for afew moments and then resumes its ruinous

March 31

Some 100

soldiers from

Israeli army

special units

capture six

Palestinian

militants during

the night, north

of Ramallah.

Five of them

belong to Yasser

Arafat’s

personal

bodyguards.

Zina had the misfortune to live near the Netzarim settlement. Her house, along with those of her neighbors, was torn down.


work. There are no soldiers around so I take apicture, but I’m frightened. Everyone is fright-ened. With a terrifying boom, an airplane breaksthe sound barrier. A little furtheraway, we see cars driving by.The IDF is building a road in thearea around the settlement.New electric fences appear asthe development expands.All those who’ve worked thisland for decades are watchingtheir years of work wiped out.They stand by powerless astheir source of sustenance isdestroyed. A father explainsthat his children will cry whenhe returns home tonight andtells his them there is nothingleft. He brings us some straw-berries and tells us to enjoy them becausetomorrow there may be none. We leave withheavy hearts. When we come back, the landsca-pe will be changed.

SATURDAY, JANUARY 6

D U G I T

“I feel like tar”

This morning we tried to get through theroadblock at the Netzarim junction. TheIsraeli soldiers open it precisely from 9:30

to 11 a.m. The first MSF car was able to passand is now in Khan Yunis. When our turn camewe were stopped so we turned around andwent to work in the northern Gaza Strip. Ireturned to the place we visited on Wednesdaywhere I took the picture of the bulldozer. Thehouse is gone and we met the family that livedthere. They describe their distress at what hashappened to them. They understand what theloss of land and home can mean for their emo-tional health. It’s as if they’ve lost a part of them-selves. They grew up here and their father caredfor each tree. Now nothing remains but torn-upland, strewn with dead rabbits run over by themachines.I ask the owner of the house, a 75 year-old manwho has just left the hospital, how he feels. “Liketar,” he says. His son is giving him Valium to easethe shock. We walk across a sand dune wheretheir house stood only days ago. Several peopleare digging in the sand, looking for financialrecords and, in particular, the 5,000 Jordaniandinars (7,500 euros) the father had hidden there.He seems to be moving in a fog, walking slowlyand carefully. I advise the son to reduce the dose

of Valium and to stay with his father. He is veryworried about the old man who worked here for40 years and now has nothing but the clothes onhis back. Having worked his whole life so that hecould be independent, it’s even harder for a manof his age to have to rely on his children.All they have left is to come back to the site oftheir former home. They are in mourning, tryingto accept “the way things are now.” The objectsuncovered here, connected to some moment oftheir lives, are like memories rising to the surface.A smashed wood-burning oven reminds them ofthe barbecues they used to have during the sum-mer.I am very worried about the people living nearthe Netzarim settlement. Most of them haven’tleft their houses in four days. I don’t know whatkind of shape they’ll be in when we find them.Their life is hell right now. The tanks prevent peo-ple from moving around. Their living conditionsare extremely precarious but they are complete-ly cut-off and inaccessible. A visiting medicalteam would pose no security problem but there’s only the tank here, no military post andso no one to talk to.I’m very concerned about a patient whosehouse is located at the junction but I’m afraid togo there. There’s no movement. I don’t evenknow if the family is still there or if they’ve left,abandoning this young man with serious beha-vior disorders. He must be in a terrible state bynow.

FRIDAY, JANUARY 12

D E I R E L - B A L A H

Two Intifadas,two traumas

In the area near the road leading to GushKatif, a young man asks to see me. He has hada problem ever since the Israeli soldiers took

him away. We sit down. He is very nervous. Hisspeech is rapid and he can’t sit still. I suspect hisproblem may predate that incident. He explainsthat he is Bedouin and has lived in the area fora long time. His family owns land here.Although he wanted to see me about a recentexperience, I begin by asking him about hispast. He describes how during the first Intifada,he had gone to throw stones at the soldiers.He’d been considered the leader of his littlegroup of friends. When he came home one day,he found what looked like a little bomb.Curious, the other children sent him to pick itup. He pulled the pin and it exploded. Luckily, it

The bulldozer isthere, about

100 meters (110yards) away. It ishuge and fully

armored. It movesforward and back

as it tears out the trees.

was just a noise bomb but his hand was bloodyand he thought he’d lost his thumb. He couldsee the bone, which upset him deeply. He fainted in the ambulance on the way to thehospital. The finger was sutured, he didn’t losehis thumb, and his hand is normal today. Evenso, he had been deeply frightened and thoughthe was going to die. He says he had no after-effects and resumed a normal life. I asked if hehad nightmares, but he said no.Next we talked about the recent event. His fami-ly owns a small house on their field near thebypass road. He used to go there in the mor-ning and meet his brother. One day, he foundthe house locked. He called out to his brotherwho did not answer, so he decided to climbover the wall. When he got into the house, aman stronger than he pinned him to the floorand tied his hands behind his back. He was sur-prised – he’d thought they were Palestinian sol-diers but they turned out to be Israeli military.He saw his brother sitting there, tied up. He wasafraid they were going to kill him. After a fewmoments, he was taken in a Jeep with a teen-ager and was struck several times. When theygot to the Israeli Army station, he was interro-gated and an intelligence officer checked hisbackground. Knowing there was no file on him,he was reassured and could breathe a bit easier.Then the soldiers took him back to the houseand released both him and the teenager. Hehasn’t been the same since that day. His friendstell him he’s changed and that he talks too fast.He offers to take us to the spot. We agree becau-se I think it is helpful to go back the place whereno one has dared go for a long time. He says hewouldn’t be able to make this visit without usbut it turns out that we can’t even get close tothe house. Everything nearby has been torndown and we hear firing. There is a watchtowerin the distance. We make a U-turn. The youngman seems calmer.I advise him to reduce his dose of chlorpromazi-ne. He says it helps him calm down. Still, he isunable to concentrate and it’s difficult to studyfor his high school graduation examinations. Iexplain what’s happening to him and that


symptoms that develop after a trauma. Heseems to understand that talking can provide arelease after a psychological shock.This 20 year-old young man has experiencedsevere shock. In my opinion, he’s suffered twotraumas although he is unaware of the impactthe first one had on him.

FRIDAY, JANUARY 19

E L M O U N TA R

Silent angel

Iam surprised to see a little blond girl. Themen in the family explain that their grand-father, whose family was blond, married a

dark-skinned Palestinian woman. The familyname is Malaka, which means angel. The dis-trict, near El Mountar, has the same name.Unfortunately, this sweet story doesn’t describewhat is happening to the people who live herein several houses crowded together near thebypass road linking Netzarim and Karni. Thebulldozer did its demolition work and nothingremains between the road and the houses. TheIsraeli army is occupying a house on the otherside of the bypass. Everyone in the family mustask the soldiers for permission to go out. Theylive in extreme isolation.One girl tells me that she lost her voice for twodays after a tank attack. That night, a powerfailure had plunged the house into darkness.Everyone was in bed when the tank fired onthem. The girl was afraid of losing her father.His bedroom had been hit by gunfire. Panicked,she managed to find her way to his room andhelp him get out. The whole family wentdownstairs to wait for daybreak. At thatmoment she realized she could no longerspeak. She says she felt like she didn’t knowhow to use her vocal cords any longer. Onlywhen she and her father went to see his room,riddled with gunshot holes, and he told her shehad saved his life that her voice began to comeback, little by little, first sounds and then words.I asked her what her first words were. “Ahmdolelah,” she says, “Thanks be to God.”The grandmother, an elderly woman, faintedwhen the night before, the tank rolled up tothe houses. She tells me she lived through thetwo Intifadas and had seen all the fields flat-tened and Israeli soldiers move in. She’d neverbeen afraid. She would always say, “It’s notimportant, we can replant.” But that night, atthe window of the other house, she saw thetanks came close to the house where her children and grandchildren were sleeping. She

April 3

The Jewish

settlement of

Atsmona (Gaza)

is hit by mortar

fire. A mother

and child are

struck. Israel

sends in

helicopters and

armored tanks.

More than 60

Palestinians are

wounded.

April 14

Hezbollah

attacks an Israeli

position in the

southern

Lebanon hamlets

of Shebaa. An

Israeli soldier is

killed.


screamed, felt something leave her body andfainted. She speaks calmly, fatigue and tensionvisible on her face and body. She hasn’t slept,has eaten nothing and appears very weak.After our conversation, I advise her to lie downfor a bit and eat something, without forcingherself.We meet the family’s children, some of whom arebuilding tanks out of clay. Their models are sur-prisingly well-made and they’ve developed atechnique that allows the tank’s turret to pivot.The models are very like the real thing and showthat the children have masteredconstruction techniques. Thechildren are proud to showthem to us. Christine, our doc-tor, explained to the skepticalparents that such games allowchildren to gain control overoverwhelming situations.This family has been deeplyaffected by the events. Their iso-lation further increases theiranxiety and sense of insecurity.The soldiers have already comeinto the house. They are allafraid of the occupation and the destruction ofhouses. It is unusual to see so many traumaswithin a single family.

THURSDAY, FEBRUARY 8

T U F A H

An eye for thecause

We had met Ibrahim for the first time atthe Khan Yunis hospital, where welearned that he’d been struck by Israeli

soldiers. He was confined to his hospital bed, suf-fering from multiple contusions. He had a hardtime sitting up in bed to greet us. Ibrahim hasonly one eye. He lost the other during the firstIntifada. He told us about his capture near theTufah checkpoint. Six soldiers attacked himwhen he was brought into the settlement. Later,he was released and taken to the hospital.Ibrahim had told us that he wasn’t afraid andthat as soon as he felt better he would return tothe checkpoint.He’s not talking like that today. He is experienc-ing post-traumatic stress and does nothing all day long. He remains in bed, smoking andthinking about how he will get revenge. He stillsuffers from the blows he received but also hassymptoms linked to the psychological trauma.He feels week and has headaches. He says

Tufah, April 2002. Israeli army builds a wall and cuts off Al Mawassi and Khan Yunis.

The children maketanks out of clay.They look like thereal thing and arebuilt to allow thetanks’ turrets to

pivot.

he will never forget the people who struck him.He explains that because of his one eye, he wasrejected when he applied to become a police offi-cer. As a result, he had to work in the settlementsand, thus, for the Israelis. He believes his friendsconsider him a traitor. His sense of injustice is alsofanned by a relationship that ended badly.Ibrahim can no longer bear to listen to televisionreports about people who’ve been wounded orbeaten. Those images are constantly in his mind.He is nervous and becomes irritated easily. Atnight, he argues with his friends and feelsexcluded from their group. He’s hurt when peo-ple stare at him but today he points to his losteye as proof of his commitment to “the cause.”At the end of our conversation, he seems a littlecalmer and asks if we are coming back. Thatreassures him a bit. A few days ago, he wentback to the checkpoint with some journalists. Hebecame agitated and wanted to fight the sol-diers. He hasn’t gone back, but I’m afraid he will.He has no hopes for the future and his friendsonly remind him of his problems.That same day we met Mahmoud, 11, who livesin Tufah. He was struck in the head by a rubberbullet. Since the incident, his mother tells us hehas become aggressive. She’s afraid somethingwill happen to him. He lost a bit of his skull anda pulsing blood vessel is visible underneath.Mahmoud says he often thinks about what hap-pened to him. He tells me about a dream inwhich he is trapped beneath an Israeli jeep. Asoldier climbs down from the vehicle and shootshim. One of Mahmoud’s friends is shot, too. Athird youngster, Ahmed, intervenes and saves histwo friends but he is shot twice, once in the armand again in the leg. They are all taken to thehospital. Ahmed remains while Mahmoud isreleased.Mahmoud is mixing dream and reality as he was,indeed, taken to the Shifa hospital. Ahmed hasbecome a hero who haunts his dreams. Severelywounded, Ahmed remains in the hospital andwill be disabled when he leaves. Mahmoudcontinues to explain how the “chebabs” (youngfighters) threw Molotov cocktails during anencounter with armed settlers. He relates all thisin a monotone, barely stopping between sen-tences. Now he lives in a world filled with violentmemories. Images and dreams remind himconstantly of what he has been through.A little while ago, I met another adolescent whowas hit by two bullets. One remains in his bodynear his hip. I saw him again today and after lis-tening to his mother, I’m still very worried abouthim. Apparently he trapped a child, locked himin a room and beat him. When asked why, hesaid he doesn’t know and that the child hadn’tdone anything. He can no longer control him-


self. He still has severe pain in his leg. In his pre-sence, his mother tells us that it will be difficult tofind a wife for him. He was fine before but nowhe is weak and thin. I intend to see him for a longer visit and to work with him on thosemoments when he lost control and let himself byoverwhelmed by violence.These accounts capture the violence spilling overin Tufah. Firing has continued incessantly formore than four months. Every family has some-one who’s been wounded or traumatized.

SATURDAY, MARCH 3

T U F A H

Thinking aboutbullets

Today in Tufah I met three people woundedby gunshots and another hit by a rubberbullet. Hania’s mother calls out to me in

the street and asks me to visit her 14 year-olddaughter who “hasn’t been the same” since theevents. At that point, I didn’t know that the girlhad been shot in the spine. Hania is confined tobed. She smiles frequently but twists her handsnervously. At the beginning of each interview, Iintroduce myself and ask the interpreter to do thesame. I have a world map so I can show Haniawhere France is in relation to Palestine. She does-n’t know how to read or write but she seems tounderstand my explanation. I show her Palestine,Algeria and other countries, explaining that eachhas its own language. Then I try to explain whata psychologist is. I ask her if she understands whyher mother has asked me to come see her.She says that the bullet remaining in her bodybothers her a lot. The doctors have not been ableto remove it. She had been in front of her housewhen she was suddenly racked by pain. Her sisterasked what had happened and saw Hania bleed-ing. The two girls ran to an ambulance nearby.Hania was treated at hospitals in Khan Yunis,Gaza, Amman and Saudi Arabia. Every doctorrefused to operate, saying she would not survive.Finally, one physician explained that the bulletwas serving as a bandage and must not bemoved out of place. Hania, who wanted to beco-me a housewife, can no longer perform house-hold tasks.She is very anxious today. Gunfire never frigh-tened her before but she now can’t cope withthe noise. This feeling upsets her and she is asha-med. She often recalls images from the day shewas shot and they make her tense. Her friendscome to see her every day to cheer her up but

April 17

For the first time

since its 1994

retreat, the Israeli

army reoccupies

territories in the

northern Gaza

Strip. Armored

tanks that had

taken up

positions in Beit

Hanoun withdraw

under US

pressure.

April 18

In spite of

everything, Israeli

incursions into

Gaza continue.

April 21

An Israeli-

Palestinian

meeting on

security takes

place at the Erez

checkpoint. From

the Israeli side,

cooperation on

security matters

appears to be

ongoing.


nothing is the same. I ask her if it’s because shefeels different. She answers that she can’t playany more for fear of dislodging the bullet. Andnow she’s afraid to leave her house. She goes outas little as possible. She thinks the Israeli soldiersmight find her, wherever she is.I try to return to her feelings and thoughts fromthe time when the doctors told her she wasgoing to die. She had been struck by the ideathat she had not yet had a chance to do any-thing good in life. This is very painful for her andI prefer not to dwell on it. Hania lives constantlywith the idea that if the bullet moves and nolonger serves its role as a bandage, she will die.As a result, she cannot overcome the experiencethat almost killed her.Next I meet Farid, 16. I have to explain to himwhat France is. He’s never heard of the UnitedStates or Bill Clinton. He understands, feels hecan trust us and tells us that he was shot in theknee and the pelvis. The second bullet remainslodged there. Farid was coming from AlMawassi when he was shot. He had been pick-ing tomatoes for the settlers. He fainted imme-diately and woke up an hour later in the hospi-tal, where he learned that he had been shottwice. He panicked. His knee was very painfuland he couldn’t sleep or walk. Like Hania, hefeels that his body is not as strong as it used to

be. He has no appetite, no longer sleeps anddoesn’t play sports or work anymore. He does-n’t want to go back to Al Mawassi. He thinks theIsraeli soldiers have his picture and will try to killhim. He even dreams that they capture him andshoot him in the throat. This idea torments him.I point out to him that he can’t remember any-thing because he had fainted. He agrees, butafter he learned he’d beenhurt, he thought that the sol-diers had wanted to kill him.Like Hania, he is no longer asactive as before. He doesn’trecognize his own body any-more. He can’t handle frustra-tion and breaks objects thatannoy him.The third adolescent is namedNidal. She was hit in the skullby a rubber bullet. At the hospi-tal, the doctor removed thebullet and closed the injury with wound clips. Herfriends tell her she isn’t as smart as she was. Shedoes have a lot of difficulty concentrating and nolonger does as well at school as before. She feelsas if a bit of metal remains in her head and shedoesn’t want to have the clips removed becauseshe is afraid her skull might split open. In psycho-logical terms, Nidal is less affected than her

Funeral services at the martyrs’ cemetery of Hebron in April 2002. Eight people, including three fighters, were killed a day earlier.

Hania still has abullet in her back.She thinks Israelisoldiers might beable to find her,wherever she is.


After the last Israeliarmy incursion inRafah, we went to theYebna district where

we were able to assess theextent of the destruction. Some40 houses had been destroyed,leaving more than 200 peoplehomeless. Men, women, child-ren, and elderly people werepreparing to set up tents, which had been distributed bythe ICRC, next to those of theirformer neighbors whose homeshad been torn down twomonths earlier. Drained of ener-gy and resources, the PalestinianAuthority has not found hous-ing for these families who losteverything in the space of a fewhours. The situation is evenmore worrisome because winterhas begun, and with it, coldand rain. Nothing remains ofthe destroyed houses. We arewalking through rubble.Amid the debris we notice tra-ces of daily life, interrupted andbroken off suddenly: a shoehere, a sweater there, a casse-role, and a toy. As we learn thecircumstances of the tragedy,the scenario, although terri-fying, sounds typical of manyothers. Several tanks appearedsuddenly and fired. Panicked,residents fled without beingable to grab anything. Thenarmy bulldozers began to des-troy the buildings. There’s nopoint in trying to recovermementos, papers, or clothingfrom what remains of thehouse. Over the loudspeaker,

a threat is issued fromthe nearby watch-tower. “If you’re notgone by the count ofthree, I’m firing.”Two months earlier,we noticed that notall soldiers bother toissue similar warnings.Without notice, tworounds of M16 machi-ne-gun fire aimed atthe ground burst fromthat same watchtower, splittinga crowd of “undesirables” intotwo distinct groups; one to theright of the shots, the other tothe left. No one is likely to comeback there! We are very careful not to moveout of the watchtower’s blindspot. As we continue throughthe desolate surroundings, acold January rain beats down.No one speaks. Faces areserious. Some people stare with

empty expressions. A manexplains why the Palestinianpolice, who were present at thetime, did not shoot. “If theyhad, it would’ve been worse,”he says.Another man shows us whatremains of his house. He hasnothing. When we ask himwhat he and his family aregoing to do, he raises his eyes

slowly towards the sky and, in awhisper, says, “Wait for God totake pity on us.”In silence, we return to our car,which is parked a few streetsaway. As we make our waythrough the narrow alleys wethink about the emotionalwounds that have just beeninflicted. How many people willfind a way out without sufferingsevere psychological damage?Will it be this cold tomorrow?

Will it still be raining? And willthe tents be distributed today?We finally reach the car.Coughing, the engine starts upas rain pelts the windshield.After a few seconds of silence,we turn to our translator. “Are you all right?” His dignityrequires that he smile, sadly.“Chouaia, chouaia,” he answers. “It’s O.K., it’s O.K.”

“Desolate surroundings, pounded by a cold January rain”

In early 2001, an MSF team discovers the extent of destruction after an Israeli army operation in the Rafah district.

It is impossible to pull mementos, papers or objects from the debris. Soldiers stationedat a watchtower threaten to fire if anyone

approaches.

April 22

A bomb attack

near a bus stop

in the center of

Kfar Saba (Tel

Aviv) kills two

and injures 39.

Hamas claims

responsibility.

April 23

A Palestinian

child is killed in

the southern

Gaza Strip.

May 2

With Ariel

Sharon

presiding, the

Israeli Security

Cabinet meets in

the Jewish

settlement of

Ofra.

Simultaneously,

armored tanks

and bulldozers

carry out a

nighttime

incursion into

the Rafah

refugee camp.


friends, even if her obsession prevents her fromfeeling at ease. I suggest that she go to the doctorand let him remove the clips.In each of these stories, the body has been violated and penetrated. That penetration pro-duces genuine psychological after-effects thatchange the person’s relationship to his or herphysical self. The body has become weak andnow carries within it the death that these ado-lescents have seen close-up.

WEDNESDAY, MARCH 23

G A Z A

Spots on his legs

Ahmed is an 11 year-old boy whose familyhome is occupied by Israeli soldiers. Hismother and grandmother bring him to us

because spots appeared on his skin after he hada severe fright. Our doctor, Hélène, examineshim and observes depigmentation on both tibia,his feet and a round area on his buttocks. He tellsus what happened. Unaware that Israeli soldiershad occupied the roof of his grandmother’shouse, he had decided to visit his relatives to tellthem his mother had come home after a tripabroad with his sister, who had an operation.He took the usual route, passing in front of thePalestinian station on his way to the bypassroad that he had to cross to reach the house. Ashe crossed, he was suddenly caught in Israelisoldiers’ gunfire. Ahmed explains in great detailthat he was next to an electricity pole but didnot see camouflage on the roof. I asked him totell me exactly what he had heard. I imitate thesound of shooting that he makes repeatedly –it’s bursts of gunfire. He heard a bullet whistlepast his ear and thought he had been hit. Hefelt as if someone was pulling his hair. His legshurt and shook. His head felt hot. He staggeredand fell in a faint. The last thing he saw was thecolor orange, which seemed to fill his visualfield.Ahmed describes a sharp pain in his back duringthe brief moment between the onset of firingand when he fainted. “It’s as if someone werethrowing stones at me.” He knew that he waswounded. His brother was hit in the hand. Heunderstands you can die from being shot in theheart or the head. I ask him if he knows whatdeath is. Yes, he says. “It’s like when someone isasleep except that he doesn’t move when youtry to wake him up.”The soldiers were firing over his head to frigh-ten him. Ahmed doesn’t know for certain thatthey really wanted to kill him. When he regain-

ed consciousness, his head and legs hurt. Hisgrandmother massaged him. The next mor-ning, his mother noticed that he had spots onhis legs.– What do you think these spots mean?– They’re from being scared.– Does that worry you?– Yes, I’m afraid of dying.– Dying? Why?– Because of the operation.– What operation?– The operation for the spots.Ahmed often dreams about what happened. Hesees himself approaching his grandmother’shouse and coming under fire. He can’t sleep.

SUNDAY, APRIL 8

A L M U R A G A H

“Like an animalcircling a post”

The Al Muragah mosque stands out in thedistance. As we move up the road, we seeOuad’s house next to it. He joins us in his

neighbor’s garden in the middle of orange gro-ves. We hold the consultation out of view in thecourtyard. We are not authorized to go to hishouse, which is located near the bypass roadleading to Netzarim. The tank moves forward tosignal us to stay away. Only Ouad and his twowives are authorized to cross a small road thatcuts through the fields of orange trees that havebeen uprooted and destroyed. The destructionwas so violent that it is hard to imagine the for-mer 20 hectares of orange trees. (It took 40 wor-kers more than a week to harvest the 600 tons.)No one comes to pick the oranges any more sothey rot silently in the fields. Ouad’s fields are alittle further away towards the Netzarim settle-ment but there is no more access to them. Andwhat would he do there? The 3,400 feet of vinesthat made him the region’s largest grower havebeen uprooted.Even after more than 15 years in Israeli prisons,Ouad feels differently about this latest depri-vation of liberty. He circles his house “like an ani-mal circling a post.” He has nothing left and issupported by his brothers. He feels like he is inprison. The worst is that his earlier success allow-ed him to help his family, while now he needshelp to survive.Mohand’s family has lived along the road lead-ing to the Netzarim settlement for years. Motherand four sons live there in four houses they builtfor their families. The houses are still standing,

May 5

“The

Independent”

newspaper

publishes

extracts of the

preliminary

report of the

international

commission on

violence in Israel.

The report calls

on Israel to end

its “settlement

activity” and

“use of rubber

bullets”.

although the building next door has been des-troyed, like many others in the district.For more than three months, Israeli army soldiershave been using the roof of the tallest house as astrategic lookout. Life has become difficult. Thetanks’ comings and goings along the road raise apermanent dust that covers everything. To pro-tect themselves and avoid respiratory problems,the family has no choice but to stay closed insidethe house. The movements of the heavy vehiclescreate vibrations and make noises which frightenthe children. As they go between the houses,family members move slowly and deliberately soas not to create suspicion in the soldiers’ minds.The soldiers have authorized the family to workand leave the house, but they must still notify thesoldiers when they go and are required to beback inside before the middle of the afternoon.The oldest of the four brothers feels like he’s ahuman shield protecting the others from the sol-diers upstairs. His wife struggles to maintain aminimum of intimacy within the family. Thedoor leading to the staircase remains closed asmuch as possible and the soldiers are billetedupstairs. Early on, the soldiers slept in the sameapartment as the family.This is a difficult situation. The adults have beco-me weak and the main question is, How longwill this go on?


TUESDAY, APRIL 10

J O H O R E L D I Q

“Dialogue ofdeaf-mutes”

To reach a group of houses sheltering thislarge family, we must cross the road leading to the Netzarim settlement. We

had already come in March. Gaining access tothis house is an ongoing battle, although theIsraeli army never puts its refusal in writing,which would make the denial official. Althoughwe planned today’s visit a week in advance, ourefforts are fruitless. Two Jeeps stop along theroad. We manage to establish contact with thesoldiers but they tell us to leave. After phonenegotiations with various parties, the soldiersbreak off our conversation and threaten to shootif we stay in the no man’s land on both sides ofthe road. We turn around and wait for newsfrom the Israeli army, which never comes.But more troubling than this unfortunate episo-de is the life that this family of 30 people hasbeen living since December. The house, which isin a strategic position, provides the military anideal checkpoint. A dozen soldiers occupy it.

The beach at Gaza on a Friday in July 2001. It is the only open space available to most of the territory’s residents.


Only clearly-identified family members mayenter the no man’s land. Their life has been turn-ed upside down. They haven’t had water for along time and their wells have been destroyed.Rain is the only source of water but their reservesare dwindling and the water quality is declining.The situation is tragic for everyone in the family,but especially for the children and the oldest ofthe three brothers. The Israeli soldiers are hold-ing him hostage in his own house and usinghim as a human shield against possible attacks.

WEDNESDAY, APRIL 11

T U F A H

Like an enormousearthquake

While en route, we learn from our doc-tor, Hélène, that property has beendestroyed in Tufah. We arrive in Khan

Yunis and find lots of people there. We hadexpected to find that a few houses had beentorn down but we were wrong. We’ve beencoming to this district for more than four monthsbut it’s unrecognizable now. Rubble is piled onboth sides of the road for a distance of some 50meters. The area looks as if a huge earthquakehad hit. Only one house remains standing in themidst of the ruins. But the state of the groundfloor suggests that a bulldozer has attacked it.We don’t recognize anything. The holes in thefaçades of the houses still standing speak to theviolence of the firing.I am very worried as I search for Abu’s house. Wehave been treating him for several months.Maybe it wasn’t touched. The interpreter and Iclimb over rubble that was once the walls ofhouses. We have to take another street as piles ofdebris block our way. Abu’s house is almost enti-rely destroyed. The whole family is there inshock, looking at the damage. The grandmotherwelcomes us with tears in her eyes. She leansagainst the only remaining piece of furniture andseems not to believe what she is looking at. Abu’ssister recognizes us and comes over, smiling. Sheacts as if nothing has happened and apologizesthat she can’t offer us a chair. Maybe she’s happyabout leaving this house that’s become a hellsince the Intifada began. I don’t know what tosay to this family that has just lost everything.Luckily, they all left the house yesterday, whenthe firing began. Next we look for Ahmed’shouse, which we know is among those closest tothe settlement. Climbing over the rubble, wewalk in what we think is the right direction. The

road and the landmarks are gone. Ahmed isthere, sitting on the ground under a makeshiftshelter made of a piece of fabric held up by fourbits of wood. His house is next to him. “Luckily,”it’s only half-destroyed. He welcomes us with hisusual smile. He livens up and finds – I have noidea where – two chairs.He, too, had to flee last night although he hadresisted since the Intifada began. He tells us thattwo tanks and a helicopter fired more violentlythan ever before. Then the bulldozers startedworking. They kept up all night.Ahmed used to hold forth about peace. Now this man whose house is riddled with bullets and whose son is an Israeli prisoner no longerbelieves in peace. A month ago, the Israeli armyprohibited him from visiting his son. For the firsttime I saw him and his wife demoralized. No oneoffered any explanation for the prohibition andthe Red Cross couldn’t help. That was the firsttime I sensed their resolve weaken and theirhopes for peace give way. ButAhmed is holding up and hasbegun building a tent in theplace where fifty years ago, as arefugee, he’d hoped to start amore tranquil life. In thosedays, the Neve Dekalim settle-ment didn’t yet extend to hishouse.A man is erecting a tent on apile of rubble. We approach tospeak to him. After I introducemyself, his rage against theWestern nations bursts forth.“They let the Israelis do whatthey want while no one takes our side.” Likemany Palestinians, the sense of having beenabandoned is very strong.After calming down, he explains how the bull-dozers came to his house. The tanks were firingconstantly. Hidden in a bedroom with his child-ren, he saw the engine attack the front rooms.He tells us that the children were crying as themachine headed toward the neighbor’s house.I ask him why he is raising his tent on the ruins,exposed to gunfire. Now that part of Tufah hasbeen leveled, everyone is exposed to firing, espe-cially those who face the settlement. “Where willI go?” he answers. It’s difficult enough to live ina house in Tufah. Living in a tent on this spot issuicidal. We hear gunfire as we’re talking and thecrowd starts to run. He doesn’t move. He’s seenand heard too much.Next we go to Um Yousouf’s house. Her daugh-ter is disabled. We know Um Yousouf can’t fleequickly because of her baby and this little girlwho can’t walk. Indeed, the entire family stayedthrough the night, terrorized by the gunfire. The

I am very worriedas I look for Abu’shouse. We have

been treating himfor several

months. Perhapsthe house wasn’t

damaged.

resin roof tiles have cracked from the blast. UmYousouf will leave the house tonight, hoping thebulldozers won’t destroy it. Everyone who liveshere is sure of one thing: the army will return.I know Tufah well and can say that large familieslived in all these houses. If Gaza is known as the region with the world’s highest populationdensity, Tufah is certainly the most densely-populated area in the Gaza Strip.

MONDAY, APRIL 16

R A F A H

No right to beweak

The bulldozers came as far as Tarek’s house.His situation has not improved. For sixmonths, he, his wife and their seven child-

ren have been living in the storeroom on theground floor of their house. The house faces theIsraeli army watchtower located along theEgyptian frontier. Riddled with gunshot, thehouse has become so dangerous that we can nolonger enter.Tarek has collapsed. Last week, he was so agitat-ed he fainted and had to be hospitalized. He tellsus that he’s barely alive any more. He can’t standthe continual gunfire that tortures his days andhaunts his nights. How can you sleep underthese conditions when, at any moment, yourchildren could be shot? One day he tried to spend some time with friendsoutside the district. But the sound of gunfirebrought them back. That’s what happens to mostpeople in this situation. If they manage to getaway, the shooting drives them back. Their fearfor their families and their houses is stronger thanthe fear of dying.Tarek would like to sleep, even if only for onenight. He complains of the changes he senses inhimself. Before, he thought of himself as a calmperson who maintained good relationships withhis neighbors. Now he becomes agitated easily,can’t tolerate the children’s noise and feels verydistant from his neighbors who he thinks do notunderstand his situation. He says it’s the same withthe Palestinian Authority, which has never cometo help or support him. His feelings of abandon-ment and danger suck all his strength.He is still in shock today. Not a single houseremains standing to the right of his. A wide swathof debris is all that’s left. Tarek invites us to sitdown. He needs to talk and express what is tortur-ing him. His hands tremble as he recounts howbulldozers came in the middle of the night. He


had only a few minutes to flee, taking his wife andchildren.While we are talking, several gawkers come to seewhat happened last night. Tarek and his neighbortry to make them leave. They remain calm. Firmly,they say there is nothing to see and that it’s dan-gerous to be here. Tarek knows the Israeli armywould destroy his house at the least provocation.He’s never made any problems, he says, no onehas ever come to shoot or throw a stone from hishouse. Suddenly, a group of determined youngpeople approach. They’ve come to fight the army.Tarek rises, followed by his neighbors, one ofwhom has picked up a stick. They won’t let theseyoung people pass. They respect their fight butdon’t want to pay the consequences. Tarek has toprotect his family and his house. Voices are raised,but the young people end up turning around.They return to apologize.Tarek is unaware of his role in the family. Hemakes it possible for them to stay together.Unemployed since the Intifada began, he feelshe can’t guarantee his children’s safety. He seeshimself as a bad father. Today this house, whichhe spent his life building, is worthless and couldbe destroyed tomorrow.A noose is tightening around him. He can’t makeup his mind to leave, so he is putting himself indanger. He wants to defend the house but hestops the young people who want to take on theIsraeli army. He can’t work but he must still provi-de for his family. It’s easy to see how hard it mustbe for him to remain calm. In spite of that noose,he doesn’t have the right to be weak.

TUESDAY, APRIL 17

B E I T H A N O U N

“Cut in half”

Beit Hanoun is a region in the northern GazaStrip at the Israeli frontier. The Red Crosshad notified us about a family there and

we went to see them a while ago.

May 13

Israel defends its

harsh policy of

“liquidating”

Palestinian

activists and the

“natural growth

of settlements.”

May 15

Fifty-third

anniversary of

the founding of

the State of

Israel. Four

protesting

Palestinians are

killed and more

than 200 are

wounded. In the

West Bank, an

Israeli woman is

killed in her car,

targeted by

Palestinians.

May 18

At Netanya, a

Hamas suicide

bomber blows

himself up at the

entrance to a

shopping mall.

Five people die

and more than

70 are wounded.


Last night, bombings followed mortar fire fromthe direction of Sderot (Israel), a town near BeitHanoun. The family we know lived next to thefrontier and had to leave after an Israeli militaryoperation. Today they live witha relative a little further away.The “hajj,” the leader of thefamily, comes to meet us. He isvery upset and seems to be inshock. His hands tremble andhis voice catches. He tells usabout the night he’s just expe-rienced. With each explosion,the house seemed to leap fromits foundations and then fallback down. He hasn’t slept.This morning, he learned that ayouth from the district was lite-rally cut in half by a missile. Hekeeps repeating, “cut in half.”He says that since the Israelisstole his land and his house, he’s lost his dignity.As a refugee, he remembers being one of thefirst to arrive here. Little by little, the Israelis havemoved closer to his house and now he’s beenchased out. Tears come to his eyes.Next I speak with his grandchildren in a group.We talk about their fears and dreams. Ibrahim

wasn’t there during our first visit. I ask him whathe feels when he’s afraid. He says that he trem-bles, his legs hurt and that the pain comes backwhenever he hears gunfire. Rami tells us that heis cold and tries to get warm by going under thecovers. Since the army leveled everythingaround his house, he has had the same night-mare in which soldiers arrive with dogs that traphim and tear his clothes. Radir dreams that he hishouse is bombed while he is inside with his bro-thers and sisters. The little girl, Kifah, sees soldiersarrive and take the men of the family (her fatherand uncles). I ask her where she got this idea.She says it already happened. During the firstIntifada, soldiers entered the house and shut thechildren up in a bedroom. Then they separatedthe men and women.Moaz asks me why his brother urinates when hehears gunfire. Assem, 12, is very upset. I explainthat each person expresses fear in his own way.Some tremble, others feel cold or have pains intheir legs or stomach and others urinate. It’s notthe least bit abnormal.Then I ask the youngest children if they thinkgrown-ups could be scared, too. “Yes,” theyanswer. Everyone is afraid. Especially yesterday.We thought the Israeli tanks and bulldozerswould have been the most terrifying experience

“On Monday they came at 1:00 in the morning… At 4:00, we came back. Some of our neighbors didn’t have houses anymore.”

Tarek has nevermade any trouble.No one has everthrown a stone

from his house. Hesupports the

Intifada but he’sgot to think of his

family.


Mohammed is a retired English

teacher. He proudlyshows these pictures

of Arafat, standing a few yards from Israeli

positions.


for the children. “No,” they say. “The bombingslast night were awful.” Moaz describes how themissiles were fired toward Gaza from the otherside of the border. Unfortunately, the housewhere they are staying is very isolated and couldbe an easy target. The children know that. Theyexpect the Israeli army to appear.I ask the children what they think about the futu-re. Hoacim says it would be better to die than seeall this. He thinks the soldiers willcontinue to advance, pull uptrees and destroy houses. Moazwould rather that the Israelisoccupy Gaza. He thinks that waythey would stop tearing every-thing down and shooting every-one.We think the bombing will resu-me tonight. I tell them and askwhat it’s like on a day when youknow the coming night will beviolent. “I’m afraid this could be my last night,”they say.After last night’s bombing, we learn that theGaza Strip has again been cut in three. Israeli for-ces have imposed travel restrictions, just as theydid two months ago. We take the coast roadnear the Netzarim settlement, which does notintersect any Israeli roads.Today, few people are taking the coast road toget to the central zone. We’re surprised to learnthat a child has gone ahead of us on the road.The Palestinian soldiers confirm that we can getthrough. Only fear holds people back. Step bystep, we move ahead. The road is noticeablycalm. A slow-moving ambulance passes us andstops four hundred meters ahead. When wecatch up, we realize why it’s physically impossibleto move on. At around 3 a.m., bulldozers cameand dug out four sections of the road to a depthof more than a meter.Blocking the coast road is equivalent to blockingPalestinians’ lives. It is a collective punishment.Whether this road is open or closed will notaffect security at the Netzarim settlement.

SATURDAY, JULY 21, 2001

Pregnant andstopped at theroadblock

On our way to visit to a family, we noticedthat two soldiers had stopped a womenat the checkpoint and would not let her

continue. We waited to see what would happenand spoke with the woman. She explained thatthe soldiers would not allow her to cross to go toa doctor’s appointment.We spoke to the soldiers. They told us that therewas a curfew and that Palestinians were not allowed on the streets. We explained that shewas going to see a doctor and she showed thesoldiers her swollen hand. After some discussion,they finally allowed her to cross and see her doc-tor. We then visited a woman who had been 8months pregnant. At 10 p.m., she began havingcontractions. She called the Red Cross ambu-lance but the soldiers at the Karantina check-point refused to let it pass. They didn’t want toauthorize the ambulance to cross and pick upthe woman. The ambulance spent about anhour trying to get in. Finally the woman mana-ged to find a car and get to the Al Ahli hospital.She came alone and her husband remained athome with their children. She gave birth and the baby is healthy.

TUESDAY, AUGUST 14

Anger at leaving

Igreet the father and mother of a family of eightchildren who live across from the Harcina settlement. They are moving to Jerusalem and

have come to say goodbye. Their home has beenhit frequently by gunfire and attacked by tankincursions. The environment has had seriousconsequences for several family members. Two ofthe young men were wounded within one year.The 14 year-old daughter suffers from acutestress and the 2 year-old’s language developmenthas stopped progressing. I treated them for twomonths and we were to have continued ourwork. But economic difficulties have pushedthem to leave. Those are even more difficult to

I ask the littleones if they thinkgrown-ups could

be scared too.“Yes,” they

answer.

MSF psycho-medical team in Hebron


July 2001 – We are in theheart of the Gaza Strip in aPalestinian house close to the Jewish settlement of

Netzarim. A family of nine liveshere, including a newborn, thehead of the family, his wife, andthe grandmother. The roof oftheir home has been occupiedfor several months by Israeli sol-diers who’ve turned it into amilitary post. The house over-looks the bypass road that thesettlers use to travel among theJewish settlements in Gaza.Camouflage nets are stretchedacross the roof and between thesandbags; you can sometimesmake out a soldier’s shadow.The house stands alone, isolated.Since the Intifada began inSeptember 2000, the orchardshave been destroyed, the fruittrees – the pride of the

Palestinians – torn up, green-houses demolished, and neigh-bors’ houses flattened like hund-reds of others in the Gaza Strip.It has become almost impossi-ble to reach the family’s house.You have to climb over piles ofdirt and straddle branches of fell-ed trees. Israeli army bulldozershave devastated the landscape.Despite several attempts overthe last four months, the MSFmedical team has been unableto visit this family. The lastattempt ended when Israeli sol-diers posted on the roof of thehouse fired warning shots. Theteam realized it had to leave.Now it is 9:00 a.m. and theMSF team once again makes itsway across the battered, pock-marked road. We see the grand-mother coming toward us andwe decide to move ahead,

openly. We call the head of thefamily in the house on our cell-phone to make sure that thesoldiers won’t fire on us. Severalminutes later, an army Jeepstops on the road in front of thehouse. A soldier signals us toapproach. He checks our docu-ments and searches our bags,which contain medicines, aswell as food and cooking oil.We will have to wait severalminutes to receive authorizationto continue.When we finally reach thehouse, the soldiers are watch-ing. But the children quickly surround us. The grandmotherhugs us and welcomes us intothe second-floor apartment.There is a strange commotion.Soldiers are talking outside thefront door. Inside, children arecrying, laughing, or watching

We meet with a family whose roof has become a permanent base for Israeli soldiers. Despite the humiliations of the situation,

the father refuses to abandon the house.

“If you want to leave, you can leave…”


us silently. Conversation beginseasily, without any delay.Overnight, this Palestinian familyfound itself hostage to the Israelisoldiers occupying its house.“When the soldiers arrived,there was nothing we could do.A captain told us they were herefor security reasons. Ever since,we’ve been human shields.”The grandmother explains theirliving conditions. “The soldiersonly let the children play outsideone at a time,” she says. “Theyfrighten them and sometimeshit them. We have to ask per-mission to enter the house. Wehave to ask permission to leave.Four family members must beinside the house at all times.When my son got permission togo to Gaza to look for food, hecould only bring back two plas-tic bags’ worth and no more.We are prisoners with our child-ren. This is no way to live.”While we are talking, we hearthe soldiers walking and speak-ing above us.The mother, who seems sub-dued, speaks up. “The soldiershumiliate us,” she says. “Theythrow their filth and their dirtywater off the roof. A week ago,while the children were playingoutside, a sandbag fell from theroof. The children screamed andI thought they were hurt. Butthe soldiers wouldn’t let me goout to see what happened.”Continuing, she sighs. “It’s evenworse at night. The soldiersbang on the walls. They makenoise and sometimes theyshoot. Then the house shakes.The children cry. It’s impossiblefor us to sleep.”In spite of the circumstances,this family refuses to leave theirancestors’ land, even if it meansliving with Israeli soldiers upstairsand in the hallways. “The sol-diers have done everything tomake us leave but I’m still here,”

the father says, proudly. “Theytold me, ‘If you want to leave,you can leave.’ You know, I’mno superman. I’m afraid, but myfear of losing my house is stron-ger. Leaving means death, but ifI’m killed, that’s unimportant.”The father had several brusheswith death when shots werefired into the room where wasstanding. He shows us where abullet hit the window and main-tains that it came from Israeliarmy gunfire. Another smallmilitary fort, a few hundredmeters away, is visible throughthe window. The grandmotherexplains that they have livedthrough shooting several timessince the Intifada began.The father turns to the MSFpsychologist whom he knows,and says, “You know, it’s not ourthe material problems thatworry me, but our emotionalsituation. The children fight, yell,and are aggressive toward each

other. The littlest one cries whenhe has to leave the house. He’safraid of soldiers. We don’t sleepvery much. The confinement isdriving us mad.” His eyes arered and he is on the verge oftears. “Sometimes I’m violent,too. Sometimes I want to throwmyself at the soldiers… I can’ttake any more.” The grandmo-ther serves us orange juice. Thefather says that no one has beenable to reach the house. TheMSF medical team’s visit is thefirst in four months. “It’s impor-tant that you’re here,” he says.“We know you try to come andthat brings us some comfort.The children need you. And you

need to show the Israeli soldiersthat we haven’t been forgotten,that people from abroad arepaying attention to us. Everyoneneeds to know what is happen-ing here.” Continuing, he says,“This is my home. But they’vestolen my life and my dignity.The soldiers say they’re here toprotect the settlers. But whatabout me? Who is protectingme?”In spite of himself, the head ofthe family has become a stan-dard bearer. “If we leave, they’lldestroy the house and the landwill belong to them forever,” hesays. “Where do I get mystrength? From my childhoodmemories, my memories of thisplace.I won’t have my childrenask me one day why I left.”While he is talking to us, theMSF psychologist takes thechildren and the mother else-where. Watching them leave,the father says, “This was a

paradise here. We’ve got to giveour children a chance. We’velost too much time. Israel mustleave the Palestinian territories.”September 2001 – The Israeliarmy has ended its occupationof this Palestinian family’s house.The soldiers have left and set upcamp in a small, concrete, rapid-ly built fort, about 50 meters(55 yards) away. The residentsof the house are still exposed,subject to reprisals and humilia-tion. Their movements outsidethe house are still limited andthe Israeli soldiers can withdrawpermission to move about atwill. The MSF team continues tovisit the family.

“The soldiers only let the children playoutside one at a time. They frighten them

and sometimes hit them. We have to ask permission if we want

to enter or leave the house.”

deal with than violence at their door – and theyhaven’t been spared the latter, either.The man describes his anger while his wifeweeps silently. They have no choice. He hasn’tworked for seven months, which translates intoseven months of boredom at home as he beco-mes impatient and depressed. It’s hard for him,too, but he doesn’t cry. His voice is strained. Heis overwhelmed by mounting debts and humi-liations which eat away at him. He can’t go onlike this so has chosen to live in Jerusalem wherehe will be five minutes from work. His boss isholding his job because he likes him. But to leavea house where he’s lived for 25 years; to leave alife and his mother here. When he was a child, heand his family had had to leave everything. Hedeveloped psychiatric problems then and hasbeen taking medication ever since.

WEDNESDAY, AUGUST 22

Family implosion

In early February, I treated a 9 year-old girl whowas enuretic and suffered from nightmaresand anxiety. She has had to rush home from

school several times. She was terrified of the sol-


diers, the bullets that could injure or kill her andteargas bombs that could suffocate her and hermother.On my second home visit, I met her father. Helooked sad and demoralized. He told me that hehad lost his job at the beginning of the Intifada.He used to go to Qiryat Arb’a every day wherehe worked as a cook in a restaurant. Before that,he went to Jerusalem to earn a living to supporthis family of six children. But one day there wasa curfew and he couldn’t get back. The baby,their first son, died. He and his wife have neverrecovered from the loss and he doesn’t want tobe away from home any more.That’s why he was working in the settlementnear his home. He has friends there but they’vetold him it is too dangerous for him to go therenow. They call to stay in touch but he cannot seethem anymore, which has affected him deeply. Itell him how sorry I am. My own emotion relea-ses his and he starts to cry. He has set up a fala-fel stand downstairs in his house. It’s not much ofa business and doesn’t provide enough income.Their savings are dwindling and they’ve had togive up on the idea of building a house. Thatdream had made it bearable to stay in this tiny,makeshift place which serves as their shelter,except when it rains. In the months that follo-

This mother has just learned of the death of her 23 year-old son, a Hamas activist killed deliberately in Hebron by the Israeli army.


wed, I rarely saw this father. He was going toHebron in search of a job that would pay betterthan his miserable falafel business.Today, August 22, he tells me that he has collap-sed. In spite of the risks, he had wanted to returnto Qiryat Arb’a but was arrested by Israeli sol-diers. He and several other Palestinian workerswere all guilty of having wanted to work duringthe curfew. He spent two days in jail and had topay to get out. Their employer, a settler, was alsojailed, but just for one day. He was not mistrea-ted but was not able to speak to his family. Thatwas the hardest. He feels tense and anxious andloses patience with his children. That’s why hesays he is depressed. His expression and behaviorreveal what his words can’t articulate. He asks usto come to the house to see his family and insiststhat we have cookies and juice before leaving.His wife and children describe the anguish ofthat night and the two horrible days that follow-ed. The little girl tells us she is always afraid thatthe soldiers will arrest her father again.I saw the 11 year-old boy who had brought mecoffee again. He had gone to work selling cof-fee to help his family. He had told that he wan-ted to return to school. Although the last fewweeks have been difficult and conditions havenot improved at home, he has returned.I had spoken with his father for the first time inApril. The man had told me that he was hisson’s age when he started working. He’d hadto resign himself to a career as an auto mecha-nic even though he’d dreamed of working onairplanes. At that time, he told me that hecould no longer go to Jerusalem to buy autoparts and that it was becoming difficult to feedhis family of two wives and nine children.Nonetheless, this family did not want to relyon charity and as the father said, he was holding on to his patience and faith. He stillwanted to believe that peace would come oneday even if the Israelis didn’t seem to reallywant it. He would continue to bow and scrapeand, preferring to borrow money from hismother, hoped to earn some small amountsfrom a small itinerant drink business. I wasthere in mid-April when they launched thebusiness. The entire family was helping outand this mini-enterprise had animated them.I’d seen them here and there, at the corner ofthe market, on the street and at the drawingstudio at the house.Two days ago, I stopped at the house andfound the father having coffee outside with hisneighbor. His expression was downcast and heseemed at loose ends. He grabbed me and tookme inside the house to see the damage.Windows, walls (exterior as well as interior), clo-sets and clothes all pock-marked with holes. A

fire had started and each hole was charred.With the children and adults, I followed the bul-lets’ path through the rooms. Crawling on handsand knees, they’d fled the parents’ room. My fingers catch on sharp bits of metal stuck in thewalls. These are exploding bullets that releasedreadful mini-projectiles which kill and wound.They escaped this time, even though a piece ofthe weapon had landed in the room wherethey’d all crowded together to take shelter. Thechildren show me the little bits of metal theygathered inside the house. Still very shaken afterthis hellish night, they are agitated and excited.They fight among themselves. The littlest oneswhine and cling to one of the mother’s skirts.Tired and in shock, she is unable to control them.The second wife can’t cope any more and hasgone to her family to rest. The father is veryanger, completely heartsick. He had supportedpeace and the two-state proposal but no more.He says he’s ready for anything. Last summer, heabandoned his business. With competition, hecouldn’t make any money and so decided toaccept Red Cross help. The agency was suppos-ed to bring food last week but no one has comeyet. He hasn’t yet gone to the Social ServicesMinistry to apply for health insurance for familiesin which the father has been unemployed sincethe Intifada began. He feels discouraged,powerless, aggressive and at the end of hisrope. These are the words he uses to describe hisdepression. The family is imploding. This is hardto take. How can I help them? The children askme to say a little longer. They want to draw withme. They want me to come back soon if I can’tstay today. The father will be there with them totalk a bit. Yes, he would like to bear witness.

EARLY SEPTEMBER

It’s more thanjust four walls,it’s a battle

To leave your house and land – the essenceof your identity – after years of resistance isthe equivalent of committing suicide. The

first time I visited this family at home in mid-April, the father showed me the results of theharassment from settlers who pass his house ontheir way to synagogue every Saturday: solarpanels broken, walls collapsed, kitchen windowsshattered. Tirelessly and relentlessly, he repairsthe damage although the situation has triggeredlong-standing stomach pains that seem to resistall treatment. Worn down, he tells me “the doc-tors say it’s psychological.” His wife, who had just

July 13

A new escalation

of violence in

the territories.

Since the

ceasefire was

declared one

month earlier, an

average of one

person a day has

died.

August 9

Seventeen are

dead and 90

wounded in East

Jerusalem.

Islamic Jihad

claims

responsibility for

this suicide

attack.

given birth to their third child, spoke of theirfears and weariness. “He doesn’t sleep anymore.I’m afraid to play with the children on the patio.The 4 year-old is afraid to go to school. She

always says her legs hurt. She’safraid to go to sleep because ofnightmares.”In July, this father, who’d cometo the house for our consulta-tion, told us that he was findingit harder and harder to stand byhis decision to stay in the housewhatever the cost. “It’s worseand worse.” He told us aboutthe night in September 2000, amonth before the Intifada,when the soldiers swept insideto take a position on the rooffrom where they had fired. Theunforgettable night of terror

had deeply marked the entire family. After that,he began thinking about leaving. But it is hisfather’s house and he was born there. His inde-cision tormented him. He knew he was havinga difficult time, but it was even worse for hiswife and children. He added safety measuresaround the house. He accompanied his daugh-ter every day as she went to school. He would


leave work to check on the house. He smiles,but can’t mask his fatigue. His eyes are red fromlack of sleep and his nervousness shows in theanxiety that gnaws at his stomach.In early September, he came back to the office toask for an appointment. The school year hadbegun. To drive his daughter to school, he toldus, he had to take a road around the checkpointmanned by soldiers who monitor the area sur-rounding the nearby settlement. He was wound-ed in the foot as he jumped over a wall. With acynical smile, he said the situation was unlikely tocontinue because the director expected that theschool would close. That same day, settlers threwrocks, striking his wife. The couple had begun tofight. She couldn’t stand the nightly bombingsand the harassment, which were sure to increa-se. She wanted to live with her parents.Finally, last night he took a mattress and blanketsand decided to sleep in a corner of his brother’sstore in the non-occupied zone. But he couldn’tsleep out of worry about what might happen attheir house. He developed an allergic reaction toa mosquito bite. He doesn’t want to return. Thatday, Ranine’s father describes his childhoodhome to me as the child begins to play for thefirst time today while listening to the conversa-tion. He tells me about his grandparents who

Hebron, June 2001. The cordoning-off and curfews remain the most serious problems, worse even than the danger from shootings and bombings.

For the first time,Ranine’s fatherdescribes his

childhood home,the get-togethers

and the plants thatwere his

grandmother’spride and joy.


gave parties there and about the garden thatwas his grandmother’s pride and joy. He alsospeaks of the time when, seated at the doorway,he physically resisted the soldiers’ entrance. Hisresistance is passive and determined. This houseisn’t just four walls. It represents a battle. But ifthings get worse, he’ll leave. The frank smile hasdisappeared from his face.

SATURDAY, SEPTEMBER 8

Stopped at thecheckpoint

We meet with the leader of a non-vio-lent movement established in 1986.As we discuss daily events from our

different perspectives – his of 15 years andmine of 8 months – I get a phone call. Amother is in distress because she’s afraid shewon’t be able to get back to her children. Shelives alone with her children at the border ofthe occupied zone near the checkpoint. Even iflife hasn’t always been easy, the soldiers havealways allowed her to circulate. But today,contrary to past practice they will not permither to return home. She works in thePalestinian zone, where her children also go toschool. To avoid the soldiers and their sarcasticcomments, the children typically climb overrooftops to get home. She is afraid they willreturn before she does and that she will notable to get back. She is panicked and asks forhelp. The response? It’s IDF orders. Luckily, thechildren haven’t yet gotten back home andthey find each other. What a relief. But theycannot reach their house. They had to go toher sister’s home in a village neighboringHebron. She’s still worried about the house.Last night, the stores next to their home burned. Their house was spared. The familyreturned but the mother is afraid to leave andwonders if she should quit her job. Two dayslater, when we go to see her, soldiers stop usfor the first time during our consultation.

MID-SEPTEMBER

Under pressurefrom soldiers

For the first time since we began treating herdaughter, this mother comes to see me atthe office. I usually meet her at the house,

whose front door adjoins the soldiers’ check-point guarding the entrance to the Jewish district

of Babzoaouia. She’s come to tell me that she leftbecause it was no longer possible to live there.The last time we went to her house, we sensedthe tension oppressing her family. The neighborshad all fled and they were the only ones living inthe building. They remained at the mercy of sol-diers installed downstairs who still take up posi-tions on the roof after occupying it for severalmonths. Every time she opens the door she hasto reassure the family. During our visit, the child-ren go back and forth to the window, wherethey watch what’s going on downstairs. Today, aloud burst of gunfire and a fleeting red glimmerof light outside the window made us jump. Achild rushed to close the shutters. We had toleave the occupied zone immediately, as we’vehad to do often in the last five weeks.This mother, alone with her children, just cameback from several days with her parents inJerusalem. They haven’t yet put their belongingsaway. Far away from this hell, they rested andappear to be much calmer than during our pre-vious visit at the end of the school year. The children are better, she said, but she already feelsdiscouraged. It’s nerve-wracking to come back,but all the other families have left the building. Ifshe leaves, the settlers will move into her home.And then there’s the children’s school. It wasAugust 27.On September 10, she had to flee. For twoweeks, the soldiers had practically prevented herfrom leaving at all. She hasn’t had any appetiteduring that time. She feels like vomiting andfears for her children. She is staying with her sis-ter but feels she is a burden. She is looking foranother house.

MID-SEPTEMBER

New house, newhope

For three weeks I’ve been visiting anotherfamily near the Harcina settlement whose 5year-old daughter who wakes up screaming

and is agitated and cranky all day. Her mother,holding her youngest child, a month-old infant,tells me the behavior began when the girl saw abulldozer tear down their house. The three olderchildren quarrel over the baby and try to kiss andhold her. Their new house is on a hillside acrossfrom a settlement. They’ve had offers to buy itbut they’ve turned them down. Now shots arebeing fired at the house.The land belongs to both families. The parentsand grandparents live nearby. This couple wasborn and grew up here and built their first house

August 10

Incursion of

Israeli special

forces into the

offices of the

Palestinian

Authority.

August 14

The Israeli Army

enters Jenin, a

city under

Palestinian

control.

August 27

In Ramallah, Abu

Ali Moustafa,

leader of the

PFLP (Popular

Front for the

Liberation of

Palestine) is

killed by two

missiles.


with their own children. The house is now only apile of rubble. I walk across it to reach them. Theaccess road is blocked by a pile of dirt.On the day the house was destroyed, the garden– trees and crops – had just been torn out andthe mother was beaten by soldiers and taken tothe hospital. She escaped and ran back to thehouse, which she found demolished. Her hus-band had been jailed and family members hadtaken in the children. The 2 year-old wanted todie and burn her clothes. She remained upset fora long time and was treated by a doctor fornutritional problems.“When I was 7, my older daughter’s age, I alsosaw my parents’ house destroyed,” the mothersays. “That was in 1967. I’ve been fighting eversince. I rebuilt the house with my brothers. I’vealso done everything like the men. I smoke, too.A year ago, when our first house was demo-lished, we lived in a tent with my husband, there,on our land. And we built this one with the children.”In Palestine, the whole family, from the youngestto the oldest, builds a house together. The fami-ly organizes and structures itself around thehouse. “This new house is built on hope,” thefather says.But they talk about the conflicts every day. Giventhe soldiers’ regular incursions, they are unlikelyto forget them. The latest threat is that the hou-se’s strategic location may result in the roofbeing turned into a military base. Many foreignorganizations are helping and a lawyer from theIsraeli group, Peace Now, is defending them.The children see the ruins of their first houseevery day. The older one remembers the goodtimes there. They continue to water the plantsthey planted, now near the rubble. Gatheredaround the newest child, their “ray of sunshine,”the family continues to resist.

OCTOBER

Gunshots in amedical office

When I came back from my vacation inearly August, I found my visiting roomriddled with bullet holes. There were

fifteen holes in the window on the western sidefrom which I used enjoy the sunsets and the soothing light. It’s difficult to leave this place. Ihad thought this burst of gunfire, coming froma house newly-occupied by the Israeli army, wasonly an accident. It occurred at night and notduring working hours. I had hoped to stay herefor a while longer. But two weeks ago, the office

was hit again. I had to close it. Patients used totell me they could breathe calmly here. Now thispeaceful haven is no more.

MONDAY, AUGUST 13, 2001

B E I T L AY I A

An open-airprison

Today we visited the zone called Seafa,north of the Gaza Strip, between theDugit and Elie settlements. Since June, the

residents of this sector have been completely cutoff from the rest of the area.Before the Intifada, 125 families, including morethan 600 people, lived there. The land and houseshave been destroyed and many of the residentshave left. Life has become impossible since the zonewas surrounded. The Israeli army has created anenclave. We already tried to visit the area but thearmy refused to let us enter for “security reasons.”The two square meter area is now surrounded bysand dunes built by bulldozers and it bristles withbarbed wire. A tower, metal detector and gatehave been installed at the entrance to the zone.The Israeli army opens the checkpoint for an hourevery day, but sometimes they don’t. It’s becomeimpossible for people working in the city to leavehome in the morning and get to work on time.Most people in that situation have had to leave sothat they can meet their commitments.Most of the zone’s residents are farmers. The soilis good but it’s difficult to find fuel for the irriga-tion pumps and almost impossible for water tan-kers to get in. Even if the fruits and vegetables areharvested properly, they may sit at the checkpointfor several days. Many people have abandonedbringing in the crops. How can they pay workersif they can’t get their products out of the zone?What’s true for fruits and vegetables is also true forstudents. School will start again in a few days.Most families have decided to send their childrento relatives living outside the area.Yesterday the Palestinians finally rebuilt the roaddestroyed by the Israeli army. They used a bulldo-zer authorized to enter the zone.Access to health care is a serious problem. Fromtime to time, a group of doctors from the HealthMinistry makes the rounds in the zone, as we do.In case of emergency, patients face huge obstaclesto leave the zone for treatment.

August 29

Israel seizes

several sectors of

Beit Jala, which

have been under

Palestinian

control since

1995. The

international

community

condemns the

incursion.

September 4

After 11 months

of the Al-Aqsa

Intifada, at least

554 Palestinians

and 157 Israelis

have been killed.

Twenty-four days

later, on

September 28,

the Intifada’s

anniversary, the

statistics are 629

Palestinian and

169 Israeli

deaths.



Salah‘edine Street in Jerusalem:

war destroys more than bodies. It also killshope, career plans, and

dreams of marriage.


WEDNESDAY, AUGUST 15, 2001

G A Z A

The soldiers haveleft!

We were on our way to a house we knowwell in the Murlaga region. Israeli sol-diers have occupied it for months. As

we headed out, we discovered that a rumor we’dheard the night before was true: the soldiers haveleft the roof!The family is finally free of the soldiers’ presenceand their daily, irritating restraints.When we arrive, the family is waiting for us in front of

the house. The atmosphere haschanged. Everyone is there! Forthe first time in many longmonths, they can enjoy the openspace in front of the house. Theyrejoice in this change and welco-me us.A few days later, the grandmo-ther of the family visits us in theGaza office. She explains thatthings are different now for thefamily. Yes, the soldiers are nolonger on the roof but thesituation may be more dange-rous. The Israeli station repre-sents a certain threat. Questions

mount within the family. “Will they shoot uswhen we cross the road?” “Now that they’vebuilt that tower, will they demolish the house?”

TUESDAY, SEPTEMBER 11

R A F A H

Rafah meansresistance

Our visit to Rafah (in the Salah’edine dis-trict) is part of our commitment to bearwitness to these events. With two jour-

nalists, we visit Ibrahim and his family. The report-ers are interested in the psychological aspects ofthe Palestinian people’s suffering.The house is across the street from the Israeli sta-tion monitoring the frontier between Egypt andPalestine. Like everyone who ventures to the endof Salah’edine street, my companions today areworried as they come face to face with theimmensity of the chaos and sea of ruins. As we sitdrinking coffee, they ask, “Why do you stay

here?” His answer is clear. “I don’t know whereelse to go. I don’t have another house.” Firingbegins while we are visiting the house.We also visit Mohammed, whom we call “theEnglish professor” out of respect for his teachingcareer. The discussion always turns to the eventsthat began almost a year ago. They can’t changethe situation. The only thing left to them is theirdetermination to stay here and face the threathead-on. This is a supreme act of resistance,which consists of living one’s life with as muchdignity as possible.As we return to the car, several youths are walkingup the street. They are visibly determined to takeaction against the Israeli station. From his window,a neighbor calls out to them, forbidding themto go further. The people on the street know that these isolated actions prompt the soldiers toshoot toward their houses and their families.

SATURDAY, OCTOBER 6

R A F A H

Destruction onthe frontier

This is the first time I’ve gone back to visitIbrahim and his family in the Salah’edinedistrict since the demolition of the night of

September 27. From the beginning, Ibrahim hadbeen prepared for confrontations and suspectedthat in the end, something would happen.The tanks opened fire in the middle of the nightand everyone fled. They sought refuge and waited a few dozen meters away. “The explosionwas awful,” Ibrahim says. The house next to hishas collapsed. The skeleton of his own house isstill standing. The downstairs walls are gone andonly supporting beams seem to be left. Theupstairs walls are cracked and entire sectionshave fallen in. The doors of the house flew offand landed a few meters away.Unable to flee in time, one man was sent flyinginto his neighbor’s house by the force of theexplosion. The neighbor was the first to find hisbody and the sight was traumatizing. The bodywas unrecognizable and only the man’s clothingmade it possible to identify him with certainty.The families have fled this place to take shelterfurther away on the same street. They may be fur-ther from the Israeli position, but they are closerto the frontier and are sure to be within the zonewhere the next round of destruction occurs.Families want to leave this desolate place andmove away from the noise of shooting andmovement of tanks.

Having lost theirpossessions, the

families fled a bitfarther away, buteven there theyare likely to bewithin the next

area targeted fordestruction.


PARIS, December 15, 2001 – MSF doc-tors and psychologists in the field areseeing an increasing number ofPalestinian families who have beenexposed to violence and are lackingaccess to regular medical care. Isolationand daily violence provoke depressivesyndromes and post-traumatic shockamong both adults and children.The daily reality of civilians confrontedby violence is very troubling. Obstaclesto medical care are increasing. Becauseof travel limitations imposed by theIsraeli army for security reasons, some families areunable to reach Palestinian medical facilities orgain access to doctors. Palestinian health care pro-viders also face serious obstacles in reaching medi-cal facilities, and ambulances are not allowed tocirculate freely. Recent Israeli army military opera-tions in the “A” Zones (areas that are supposed tobe under the exclusive control of the PalestinianAuthority) in Ramallah, Jenin, Nablus, Tulkarem,Qalquilya, Hebron, and Bethlehem have been

extremely violent. Physical and psychological pro-blems already manifested in patients over the last14 months have increased. These problems inclu-de chronic or pre-existing conditions intensified bystress, acute depression, anger, anxiety, and sleepand eating difficulties. Continued violence and theclimate of terror provoke intense stress and panic.This leads to a build-up of trauma and endlesscycles of therapy.Terror comes at night to the houses borderingJewish settlements or along roads used exclusivelyby settlers. Under security pretexts, entire neigh-borhoods are riddled with gunfire and then syste-matically bulldozed. Families who refuse to leavefind themselves hemmed in. Their movements arelimited and they are cut off from social networks.Every day they worry their turn will come.MSF is troubled by the continued decline in livingconditions of Palestinian families in the West Bankand Gaza Strip areas most exposed to violence. Asthe conflict continues, recurs, and intensifies, thisworsening of conditions contributes to families’insecurity and despair.

M S F P R E S S R E L E A S E S

JERUSALEM, January 10, 2002 – Following theIsraeli army’s latest incursion in Rafah, in thesouthern Gaza Strip, MSF’s emergency mentalhealth intervention team went to Yebna’s “BlockO” area. The breadth of the day’s destruction wasglaring. Some 40 houses were destroyed andmore than 200 people are now homeless. Men,women, children, and elderly people are prepa-ring to set up tents, distributed by the ICRC, nextto those of their former neighbors whose homeswere torn down two months earlier. Drained ofenergy and resources, the Palestinian Authorityhas not been able to find housing for these fami-lies, who have lost everything in the space of a fewhours. With the onset of winter’s cold and rain, thesituation is even more troubling.Nothing remains of the destroyed houses. Only afew traces of daily life, interrupted and broken offsuddenly, are visible: a shoe here, a sweater there,a casserole, and a toy. As we learn about the tra-gedy, the scenario – although terrifying – begins

to sound familiar. Several tanks appea-red suddenly and began firing.Panicked residents fled without beingable to grab anything. Then army bull-dozers began to knock down the build-ings. There is no question of trying torecover mementos, papers, or clothingfrom the debris. “If you’re not gone bythe count of three, I’m firing,” says avoice over a loudspeaker from the near-by watchtower.MSF condemns the mass destruction ofcivilian homes during winter. We have

been working in Gaza since the beginning of theAl-Aqsa Intifada and are concerned about both the medical and psychological consequences forthe affected families, who are at risk for post-traumatic stress, depression, and phobic disor-ders. MSF’s joint mental medical team has inter-vened to help these 200 newly homeless peopleovercome the catastrophe.

With palestiniancivilians trapped, MSFcontinues itsmissions

MSF comes to victims’ aid when

40 houses are destroyed

in Yebna


JERUSALEM, March 11, 2002 – Beginning inNovember 2000, MSF launched two medical andmental health programs in the AutonomousPalestinian Territories of the West Bank. These pro-grams are intended to benefit residents of regionsmost exposed to violence, including people livingnear confrontation sites, army installations, andIsraeli settlements. Since early March 2002, wehave witnessed an unprecedented escalation ofviolence. The last few days have been the deadliestin 14 years. Israeli Defense Force attacks againstthe Autonomous Palestinian Territories are con-tinuing and widening.During the first week of March, close to 100Palestinians civilians and children were killedduring air strikes and tank invasions in refugeecamps near Jenin, Nablus, Bethlehem, and Gaza.The city of Hebron, where MSF’s medical teamlives and works, was also subjected to heavy firingfrom machine guns and tanks. Emergency respon-se services and health care providers have beenattacked, preventing them from providing emer-gency care to the wounded. The most recent vic-

tims were the head of emergency servi-ces for Jenin, a UN nurse in Tulkarem, anambulance driver, a first aid provider,and a medical worker in Gaza. Severalambulances were crushed, flattened,and shot at during the attacks. Duringthe past 17 months, the Israeli armykilled 15 members of the medical corpsand wounded many others. The Al-Mezzan hospital in Hebron has beenshelled repeatedly, damaging thepathology department and the patient

cafeteria. These attacks are very alarming and arein obvious violation of international law.The Geneva Convention and international huma-nitarian law expressly protect medical services andthe wounded during conflict. Belligerents arerequired to provide care for the wounded andensure safe access to medical staff. MSF condemnsthese attacks and calls on Israeli authorities to takeimmediate measures to protect medical staff, gua-ranteeing them access to the wounded as well asto the most needy.

JERUSALEM, April 4, 2002 –Blocking of medical care toPalestinian civilians in the OccupiedTerritories has reached alarminglevels. At a time when ordinaryPalestinians are subjected to intensemilitary pressure, MSF’s ability reachthe most isolated families is beingseverely restricted. Even in Hebronand the Gaza Strip, where MSF hasbeen working and where the army is not concen-trating its attacks, access to medical care is underserious threat.A particularly disturbing incident occurred on themorning of April 2. An MSF team composed of adoctor, translator, and driver went to Um Amer, avillage in the Hebron district, to conduct medicalconsultations with Palestinian families living inremote areas. MSF’s car was clearly identified withbumper stickers bearing the MSF logo and a flag.Each member of the team wore an MSF jacket.Along the way, the team reached two militarycheckpoints and, after showing MSF identitycards, was authorized to continue. At the thirdcheckpoint, three Israeli soldiers jumped out frombehind trees and, pointing their weapons at thecar, forced it to stop. The team was authorized topass only after clearly explaining the medical natu-re of its mission. As the car neared the village, it

was stopped again by two men in plain clothescarrying automatic weapons. The men, who woreno distinguishing signs, were clearly securityguards from the neighboring settlement. Whileverifying the team’s identification, they confis-cated the keys to the car. The team was thusdelayed for more than half an hour without anyexplanation.This last incident illustrates the continuing obsta-cles faced by MSF teams in carrying out their workand seeking to exercise their right of free access tocivilians. These obstacles also contradict the Israeliarmy’s guarantees that MSF teams working in theOccupied Territories are free to move around. Inthe past, we have requested and received the rightto move freely to conduct our medical work. Asthe situation deteriorates, we can no longer relyon these commitments. Even when we receiveauthorization, we are increasingly denied the rightof passage.MSF considers these restrictions a violation of ourright to access victims of this conflict, as well as aviolation of civilians’ right to access medical facili-ties. MSF is very concerned about the Israeli army’sapparent indifference to this situation. This indiffe-rence encompasses both Israeli soldiers’ attitudesat checkpoints and the fact that the Israeli armyauthorizes independent militias and armies tointerfere, at will, with our work.

MSFcondemns

israeli attackson medical

services

MSF protestsabout controls by armed militias

AustraliaDoctors Without BordersSuite C, Level 1, 263 Broadway Glebe, NSW 2037Postal address :PO Box 847, Broadway, NSW 2007Tel. : + 61 (2) 9552 4933Telec. : + 61 (2) 9552 6539www.msf.org.au

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HollandArtsen Zonder GrenzenMax Euweplein 40, Postbus 100141001 EA AmsterdamTel. : + 31(20) 520 87 00Telec. : + 31 (20) 620 51 70www.artsenzondergrenzen.nl

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SpainMédicos Sin FronterasNou de la Rambla, 2608001 BarcelonaTel. : + 34 (93)3 046 100Telec. : + 34 (93)3 046 102www.msf.es

SwedenLäkare Utan GränserHögbergsgatan 59B, Box 4262 10266 StockholmTel. : + 46 (8) 55 60 98 00Telec. : + 46 (8) 55 60 98 01www.stockholm.msf.org

SwitzerlandMédecins Sans Frontières / Ärtze Ohne Grenzen12, rue du Lac, 1207 GenèvePostal address : Case postale 6090, 1211 Genève 6 /Postfach 6090, 1211 Genf 6Tel. : + 41 (22) 849 84 84Telec. : + 41 (22) 849 84 88www.msf.ch

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United States of AmericaDoctors Without Borders6 East 39th Street, 8th FloorNew York, NY 10016Tel. : + 1 (212) 679 6800Telec. : + 1 (212) 679 7016www.doctorswithoutborders.org

Others offices

Médecins Sans FrontièresInternationalRue de la Tourelle 39, 1040 BrusselsBelgiumTel. : + 32 (2) 280 1881Telec. : + 32 (2) 280 0173www.msf.org

UN Liaison Office – GenevaCase postale 6090, 1211 Geneva 6,SwitzerlandTel. : + 41 (22) 849 84 00Telec. : + 41 (22) 849 84 04

UN Liaison Office – New York6 East 39th Street, 8th FloorNew York, NY 10016USATel. : + 1 (212) 655 3777or + 1 (212) 679 6800Telec. : + 1 (212) 679 7016

Documents

Trapped by War - Ärzte ohne Grenzen€¦ · PALESTINIAN CHRONICLES Trapped by War Since the beginning of the second Intifada, in September 2000, MSF’s physician-psychologist teams