Limestone, Goat Milk, and Desert Sunsets

Here's a quick story for you. Nothing serious tonight - there hasn't been a lot of good news to share lately and with the political world here in a sort of stalemate and cooperation largely suspended, it seems best not to drag out the discussion for the present.

So on to happier topics. On Saturday, I went on one my weekly rock-climbing expeditions to Ein Fara, a beautiful natural park inside of Wadi Qelt. The Wadi is a gorgeous valley carved through limestone cliffs, starting just inside the West Bank, straddled by a Palestinian town and a Jewish settlement, and cutting its way through the Judean Desert hills toward Nablus and Jordan in the distance. With the sun setting over the white cliffs and an evening haze hanging over the hills in the distance, the place is nothing short of magical. Peaceful and tactile, with goat flocks wandering the hillsides and monks emerging from their monastic dwellings carved into the rock, it can transport even the burliest secular climber into the pages of the Bible.

It was a beautiful way to spend a peaceful Shabbat. I was just clipping into the anchors on my last climb when I looked down and saw a shepard (Abbud I think his name was) talking to my climbing partner. He had been steering a massive heard of goats through the valley and had wondered over to ask Zac what we were up to. Zac lowered me to the ground, and we spent the night hour chatting with him in a combination of Abbud's shaky Hebrew and Zac's broken Arabic. He told us how his father and his father's father had lived in this valley. He was 28 years old and lived with his wife (his first) in the Palestinian village at the top of the Wadi, where his 14 brothers and sisters and father, mother and father's other wife and his extended family also lived. He had a cave too in the wadi where he often slept when he was out with his herd. He asked us if we were thirsty and pulling over one of the passing goats showed me how to milk it. We filled up one of my water bottles with the most delicious milk I have ever tasted, warm and sweet and frothy. We talked for a while, about our families and the comparative difficulties of having 2 brothers or 10, and how some people had become afraid to come to the Wadi, particularly down further into the West Bank and since the conflict of late had started. Abbud told us that some people are good and some are bad - it doesn't matter whether their Arab or Jewish, it's just how it is. Zac carved a kolrabi with his camping knife and we washed it down with goat's milk, talked until the sky started to grow dim, shook hands with our friend, and wandered out as the sun was setting.


So then, here is some evidence for you of peace and goat's milk in the Holy Land.

Israel Votes For ??????

I spent voting day with my professor Hagit's family in the town of Arad in the Negev Desert, on the road between Be'er Sheva and the Dead Sea. Voting day, as it turned out, was stormy in more ways than one. The first and long anticipated storm of the season descended on the Negev on voting day morning. As rains broke across Israel, the winds built in Arad, sending dust swirling into every corner of every house and rattling the pretty nectarine tree in Hagit's garden against her roof of her husband's photography studio. We watched the winds send clouds of swirling dust whirling through the wadi behind the house as we drove around the block to the local poll, established like many in a local kindergarten.

Ben-Gurion University was closed for the day, and most of the students had gone home to vote in the towns that they had grown up in -- Israeli being small enough that this is typically preferable to re-registering in a new locale, and absentee votes I believe can only be cast from overseas, by soldiers, or by those in the navy. The scene at the local poll was cordial and orderly. A few campaigners had set up around the corner from the kindergarten, barred from erecting their last ditch efforts to close to the voting station. Interestingly, most of the visible campaigning has come from the minor parties. Occasionally, a giant Livni face will appear on a poster hanging above a road. But generally, Likud, Labor (Avoda), and Kadima posters and campaigners have been relatively rare or at least very subdued. The most vocal and visible campaigning has come from parties that barely made it into the Knesset or failed to do so at all - the new Green Coalition for instance (which came just short of sending a member to parliament) and groups on the right like United Torah Judaism.

Inside the polling place, families line up quietly and look over a poster containing the tickets of the various parties -- squares with a letter or two or three symbolizing the party, with its name written out in smaller letters below. One party name had been crossed out in black marker, apparently barred from competing at the last minute. I watched Hagit and her husband and eldest son walk to the registration table, where volunteers checked their names off a list. They each picked up an envelop of party tickets and walked one by one behind a polling booth, sorted through the party tickets shielded from view, picked one, and dropped it in the box in front of the registration table. It's an interesting system, requiring hand counting and accomplished with strict rules and no ambiguity.

Hagit and her husband had voted for the Labor party, which was expecting a particularly poor turnout, due in part to a general shift to the right in Israeli politics and in part to more left-wing voters consolidating behind Kadima to elect Tzipi PM over Netanyahu. Hagit's son claimed to have voted for the Green Leaf (pro-marijuana) party, which had interestingly joined forces with the Holocaust Survivors to try to garner votes. While many of the young or politically seem to say that they're voting Green Leaf, it's questionable how many actually do, as the party has still failed to put a representative in the Knesset.

We returned to Hagit's house in time for the storm to hit and spent the afternoon huddled inside working as the rains raged around us, gushing through the wadi behind the house and darkening the desert skies. By five o'clock, the rains had knocked out the power, and we spent the evening eating and talking by candlelight. Flood warnings had shut down many of the streets, so I spent the night in Hagit's comfortable little family home, getting Hebrew lessons from her sons, political lessons from her, and photography lessons from her husband. The first poll-based election results were due to come in at 10pm and initial counts just after midnight. We sat in the dark as the first results hit the tv's, unable to check the news and not wanting to call others to ask. It was a rather beautiful moment, the political fate of the country still undecided. We expected the worst (which for us meant a rightward political shift), but for the moment, anything was still possible and we quietly hoped (though did not expect) that we might yet still wake to world that would surprise us.

And the morning results -- decidedly undecided. Kadima (Livni's party) had won 28 seats over Likud's (Netanyahu's party's) 27. Kadima's shaky victory had surprised many, though what it means is yet to be decided. First, while 99% of the votes have been counting, the 1 remaining % will come from soldiers and electing the remaining 4 or so Knesset seats. While the majority of these soldiers are between the ages of 18 and 22, they're still soldiers afterall and tend to vote to the right of center. So whether Kadima will maintain its lead in the final count is questionable. Secondly, voting day had brought out a decided rightward shift in Israeli politics. Most of the left-wing parties have come out with disappointing losses. Meretz, a smaller though very popular leftwing party, had lost about half its previous seats and its party head, claiming responsibility for the poor showing, had turned in its resignation. Hadash, the joint Arab-Jewish party, came out with 4 seats, and labor fell to a rather tragic fourth place, with 13 seats compared to Yisrael Beitenu's 15 (Lieberman's far-right nationalistic party).

The results have left both Livni and Bibi scrambling to put together coalitions with the 60 plus ministers that will give them the necessary majority in the Knesset. Whoever manages to form a coalition and gain the approval of the majority of the elected ministers will receive the nod from President Peres to act as Prime Minister. So while Israelis have elected their ministers, the meaning of the government that they have put into power as well as its principle leadership is still far from clear. Both Livni and Bibi are courting Lieberman's party (Lieberman claims to have made up his mind but isn't telling), and Labor has committed firmly to being part of the opposition, where it can try to regain some of its previous strength. Likud has turned down a rotating PM option - a power-sharing deal between Bibi and Livni, which has occured in the past -- saying that the electorate has given a clear mandate for the right to lead the government. With both Bibi and Livni claiming victory and ultra-nationalist parties like Lieberman's and Shas looking like they will be part of coalitions formed, the only clear result is the rightward political shift.

Not a happy day for the Liberals but not so suprising to anyone. It's a subdued time in Israeli politics, with a rather depressing lack of leadership and a poor voter turnout reflecting the general malaise. I couldn't tell you the number of times I've heard people wishing they had an Obama. Someone who could actually unite across the deep social rifts rather than just say the words and court the votes. Several months ago I stood in a bar at 5am, surrounding by weeping expats as Obama's victory became clear. This week, I sat with an Israeli family in the dark, not really wanting to see the results that the light would bring in.

The schisms are widening in Israel, from within and from without. And the struggle to define what this country means and what its future will look like drags on.

Israel Hits the Polls

Tomorrow, Israelis head to the polls to elect their new Prime Minister and Knesset (Israeli parliament representatives). There's been quite a bit of political engagement here, and the currently very quiet Ben-Gurion University of the Negev (where I am working this week) along with most institutions in Israel, will be closed for national voting day (a lesson that the U.S. would do well to learn, in my opinion). In Israel, voters cast their ballots (that is, they lick and seal and envelop with the party emblem of their choice inside) for a party rather than a candidate, electing the PM and Knesset ministers at the same time. Israel tried direct elections for about five years under Rabin but did away with them after it seemed that they were accentuating rather than alleviating the divisiveness within Israeli politcs.

Political engagement in Jerusalem has been quite interesting. It often takes the form of a car or two parading through the streets, covered in posters and streaming signs behind, blaring political slogans as loudly as its loudspeakers will permit. Othertimes, a group of generally young Israelis claim a street corner or roadside and make as much noise and as much of a scene with their political posters as possible. One of the more interesting party demonstrations I have seen was by a group from representing the Green Movement, possibly Israel's newest party and, confusingly, one of several "green" parties (including the "Green Party" and the "Green Leaf Party" -- whose platform includes almost exclusively the legalization of marijuana). I am attaching a few pictures from this bicycle demonstration below -- a group of young Green Movement affiliates, along with one of their founders, Gershon Basin (with the red backpack), took over a Critical Mass bike protest, a monthly gathering to promote bicycling in Jerusalem. The event turned into a raucous Green Movement display, with stump speaches, loud streetside arguments with passersby, and traffick-stopping party affiliaties.







The most interesting political demonstrations in Jerusalem tend to take place at night, however. For the last week and a half or so, walking around Jerusalem after midnight on almost any given night, one can hardly enter a bar or walk through the streets without getting accosted by one to a hord of campaigners foistering their little leaflets and reasons on you. One night, my friends and I were stopped by several groups of Green Movement campaigners who, when we remained skeptical of their platform, routed us to a local bar outside of which the heads of the party were gathered. The party's PM candidate put his hand around my friend's shoulder and took him on a 20 minute stroll to explain his candidacy. I'm not sure that my friend was convinced, but I was rather bemused by the spectical. The thought of Obama or Clinton or McCain buddying up to students unannounced and unphotographed in a NYC bar is hard to conjure, but in Israel, particularly among leaders of the smaller parties, it's an every-night occurance during election season. The night before the local Jerusalem mayoral elections, I found myself drinking beer with the wild-haired Green Leaf party candidate, who was stumping his way around the local bars that night. In this small, word-of-mouth based society, being able to present yourself as that "chill guy I had a beer with at the Sira the other night" can be a pretty effective way to gain a network of votes.

Bibi (Benjamin Netanyahu, head of the right of center Likud party) looks poised to win PM tomorrow, though Tzipi Livni (head of centrist Kadima) may yet put up a tough fight. Ehud Barak (Labor) has been making noises about turning down another term as Defense Minister if Labor is not adequately represented in the new Knesset. Meanwhile, Lieberman's far-right and controversial Israel Beiteinu party has been polling disturbingly strong, given that they are currently most likely to be associated with recent overturned efforts to block Israeli Arab parties from participating in the general elections. On the left, the joint Jewish-Arab Hadash party (formerly Communist Party) will likely gain several seats (helped out by a number of my friends). The new and innovative Green Movement (seems to be strong among young voters) may turn out to be stronger than expected. While opinion seems to be that the generally popular young Left-Wing party Meretz has been declining in strength and popularity, due perhaps to lack of leadership, it may gain several seats as well. Word on the street has it that Green Leaf voters, for some hard to fathom reason, often forget to show up at the polls.

In general, most voters seem to feel that despite the array of options, there is a lack of real, strong leadership in Israel these days. None of the leading candidates seem to represent particularly compelling options, and while many of the smaller parties have innovative ideas and platforms, they don't have popularity and they, along with the bigger parties, don't seem to be putting forward the kind of compelling, rising star, Rabin-esque figure that this area needs.

So tomorrow, Israelis will drop their envelopes (no hanging chads here), even if for "the better of the bad." We'll see what happens...

The Politics of Health Care

The New York Times published a troubling article this morning: "Palestinians Pull Patients from Israeli Hospitals." http://www.nytimes.com/2009/02/10/world/middleeast/10patients.html?hp

This article profiles a rather dramatic shift in the policy of the Palestinian Authority, which has previously supported Palestinian patients seeking care in Israeli institutions.

Every day, hundreds of Palestinians cross the border into Israel with special permits granting them day and sometimes overnight access to an Israeli hospital. In 2006, according to the WHO, tens of thousands of permits, averaging 200 patients per day, were issued to Palestinians, allowing them to cross the border from the West Bank or Gaza and be treated within an Israeli health facility. Approximately 60,000 Palestinians from the West Bank were treated in Israeli, 2/3 of whom received received ambulatory care and 1/3 of whom were hospitalized. 2500 of these patients were children. Patients crossing the border are generally looking for specialized care for a condition such as cancer or diabetes, for which expertise in terms of both human resources and specialized facilities is generally lacking in the Palestinian Territories.

For a range of reasons, related in large part to the history of the development of the Palestinian health system when health care in the Territories was administered by Israel, the Palestinian health system is built predominantly around primary care and community health services. While access to these services can be quite good, secondary and tertiary health care services are largely lacking in the Palestinian Territories. While the Palestinian Al-Quds University Medical School in East Jerusalem trains Palestinian physicians, Palestinian health facilities generally do not have the capacity to offer specialized residencies. And while Israeli hospitals are open to Palestinians seeking residencies and fellowships, these training positions are often too lengthy, inadequately funded, or unattractive for Palestinian applicants. Furthermore, given the already competitive and squeazed Isreali medical education system, the few positions available to Palestinian applicants fall far short of what would be required to truly build capacity in a systematic way. Palestinian students can also look for training in Jordan and elsewhere abroad, but again barriers abound.

What's left is a situation which, for better or worse, demands cooperation and requires codependence. At the time being, the Palestinian Territories do not have the facilities and expertise to provide treatment to most of the patients being seen in Israeli hospitals, the majority of whom are there because those institutions offer best-in-the-world specialized care for a complicated longterm health condition. Withdrawing these patients as a political statement may indeed sacrifice their lives to politics. And as usually occurs, it will be the children and the most vulnerable who suffer the most.

The Palestinian Ministry of Health does spend about 16% of its budget in paying for the treatment of Palestinian patients in foreign institutions, including those in Jordan, Egypt, and primarily Israel. For a cash-strapped heath system, this amount is not insignificant and the expense of treatment in foreign facility may contribute to slowing the development of a self-sufficient Palestinian health system. Yet, it is also true that Israel subsidizes much of the care for these patients. Often Israeli hospitals themselves soak up much of the cost of treatment for Palestinian patients. In many cases, their care is subsidized by an Israeli NGO such as the Peres Center for Peace or Save a Child's Heart. Call it what you will, these cooperative efforts save lives. That these lives are Palestinian or Israeli is unimportant. Talk to any physician, for instance, at Israel's Hadassah Hospital in Jerusalem and they will tell you that when a person enters that hospital they are no longer Palestinian or Israeli or anthing else. They are a person in need of care, and they will be given the best care possible. Politics stop at the door.

I know Dr. Fathi Abu-Moghli, the Palestinian Minister of Health, and I know that he is a good man who cares deeply about the people for whose health he is charged. I hope that the way forward beyond this controversy can result in a new kind of cooperation -- cooperation in building a sustainable, independent health system for Palestine, the kind of institutions and resources that will be required in order for a two-state solution to be viable. The peace process is also an institution-building process: a two-state solution means that each must have institutions and systems that can stand on their own two feet and operate independently, though with some necessary ties. My experience has shown me the benefits of Israeli-Palestinian cooperation in health, medicine, science, and academia for both sides. These cooperative efforts build trust and bonds of mutual respect while benefiting both sides involved. They also increase capacity and create the civil society ties that two states living side-by-side in peace will require. I beleive that this kind of cooperation can encompass the politics that Dr. Fathi is expressing here rather than fall victim to it. The goal of building a Palestinian health system that is strong, advanced, and independent is a extremely worthy and viable one. Cooperation with Israel, as well as the neighboring Arabic nations, can and should help it get there.

Peace Now in the Holy Land -- An Obama-Era Possibility?

Almost two weeks ago, I stood below the steps of the U.S. Capitol and watched Barack Obama take an oath, sworn in as an embodiment of change in American democracy. The shouts, the chants, the tear-filled eyes and genuine exhilaration in the air had transported me a lifetime away from my world of only several days before. As I huddled in a stairwell in Be’er Sheva, in the Negev Desert in Israel, the explosions I had heard came from Hamas rockets rather than fireworks and the tears were those of fear and pain rather than hope and pride. With violence now threatening to reignite conflict in the region, we in Israel and Palestine need the weight of American diplomacy and Obama-era diplomatic rhetoric to maintain peace on both sides.

Whether or not Israel and Hamas achieved their stated aims during the war in Gaza is questionable. Israel has not ended its blockade of Gaza, for which Hamas broke the ceasefire with Israel in December. Hamas’ hold among the Palestinian people and authority over Gaza does not seem to have been weakened by the Israeli offensive. While the Qassams have thankfully stopped falling, their infrastructure isn’t only material. It is also rooted in the will of a people who elected them in large part because they promised to provide services, like health care and food supply, which are severely needed in the area and which Fatah failed to deliver.

A large part of the professed Israeli strategy in the war was to inflict sufficient damage on Hamas in order to teach the people of Gaza a lesson. The Israeli campaign was meant not only to destroy the infrastructure for rocket launching and supply tunnels from the Sinai but to show Palestinians in Gaza that the policies they supported through voting in the Hamas leadership have brought about too painful consequences and thereby to turn the Palestinian people away from Hamas leaders. Though the jury is still out, it appears that this strategy has not succeeded. Rather, the common perception in Gaza appears to be that Israel was waging an offensive not solely against Hamas but against the population of Gaza for the crime of being Palestinian.

If there is anything that the past month has taught, it is that a violent response to violence is an ineffective strategic solution and a disastrous humanitarian policy. Far too much of the political rhetoric surrounding the offensive on both sides has an eye-for-an-eye flavor too it. One side promising to avenge the sins of the other. And everyone living in fear, insecurity, and under the shroud of violence as a result. On the strategic front, Israel has not succeeded in uprooting Hamas leadership. On the humanitarian front, the IDF has brought relative quiet to the South of Israel but has not entirely lifted the insecurity that hangs over the region. Relationships between the local Jewish population and Israeli-Arabs, including the Negev Bedouin, who are caught in the middle of the conflict, have also grown more tense. Meanwhile, the humanitarian toll on the Gazan side is beginning to surface as foreign journalists enter the Strip and document the “collateral consequences” of warfare.

As a Fulbright Scholar working in Be’er Sheva and Jerusalem on joint Palestinian-Israeli public health interventions, my primary concern is for the health and welfare of people in the region, regardless of their racial, cultural or national identity. Blockades limiting the flow of urgently needed medical supplies into Gaza and restrictions on the passage of Palestinian patients into Israel, where infrastructure and will exists to treat them, raise glaring red flags about the kind of moral and ethical example Israel wishes to represent in the region and its attitude toward the right to health of the Palestinian people. Health care is a privileged sector through which Palestinians and Israelis have always interacted on positive terms, in which concerns over physical welfare have superceded mistrust and overridden barriers to interaction. This is one area which both sides should be encouraging, and it is extremely unsettling to see joint efforts faltering because of mistrust and lack of institutional support. As we move forward beyond the violence, narratives of the many powerful joint Palestinian-Israeli efforts, particularly in health and medicine, need to be brought out and encouraged more than ever.

As in the days and weeks following September 11th, violence in the region has succeeded in opening up an opportunity for a different kind of path to be taken. The election of Obama, the appointment of Middle East envoy George Mitchell, and Mitchell’s early trip to the region signal a different level of engagement in the Palestinian-Israeli peace process by the U.S. Presidency, which for at least the past eight years has taken a better late than never kind of approach. Obama’s commitment to diplomacy, rhetorically and already in practice, needs to be translated into helping actors in this region wage a different kind of negotiation strategy. Rockets and bombs do not change hearts and minds, if they were ever intended to. They only feed a cycle of hatred, violence, and mistrust, and their harshest consequences are always felt by those least deserving – families and children on both sides whose lives become shaped around conflict.

Since its founding, Israel has represented a remarkable new kind of democracy in the region, a bastion for free speech, intellectual fervor, gender equality, law and justice. It is strong enough to defend itself, act on its ideals, and withstand criticism. As a true lover of Israel, a Jewish student and public health academic who has chosen for myself to live in the country, I feel an obligation to bring out my voice in the public debate about the actions of the country that has impassioned me. This, I believe is democratic patriotism, as Americans and Israelis have always understood it. Israel should be the “Light Among Nations” that it was founded to be by working with the full force of its strength toward peace.