What are the general repercussions of the conflict for mental
health?
I think we have to start with the original sin: the expulsion of
Palestinians from Palestine in 1948. Part of the definition of
being a Palestinian is being a refugee, living in exile, having
your home destroyed, having your belongings destroyed, having to
leave your land. I still remember - and I'm not strictly a refugee
because my family originally comes from Gaza, but I was born in
Be'er Sheeva - at the time of 1948, when we had to leave. I
remember a very hazy vision of my mother trying to bring her sewing
machine from the house. She was pulling it to the truck waiting for
us. My father told her to leave it. Later, I asked my father if
that had happened and he said: "Yes. Your mother was trying to
bring the sewing machine, and I said it was only two weeks and
we'll go back to Be'er Sheeva." It was so painful, especially in
the first few years, that, though she had more sewing machines,
whenever she sat at another machine she started crying. She always
wanted that sewing machine. Of course, this is only a little thing,
it's not about the house or the land. But, even then, there's a
deep sense of grievance in every Palestinian, whether you are a
refugee or not, there is something that is so unjust that you can't
accept it. And I think this is basically the problem of the
Palestinians. So they are defiant, they feel helpless and they feel
demoralized.
Second to exile is the occupation. This has affected the
Palestinians very harshly. In the last few years of the Intifada,
the Palestinians have been exposed to a situation that turned their
villages into prisons, but prisons without roofs, still exposed to
bombings and with no escape. There is no way of telling where the
next strike will be. And when the Israelis strike, usually they
fill the streets with panic because nobody knows where to hide.
There is nowhere to hide. Total exposure and vulnerability have
resulted in intense fear that is translated to the children through
the behavior of their parents. And the children perceive parents as
being helpless. They perceive their father in the first Intifada as
being impotent. Some of the children identified even with the
Israeli soldier, the new replacement of the symbol of power. You
know our children play the famous game, Arabs and Israelis? Many
children prefer to play the role of the Israeli because he is
powerful. With this Intifada, again the father is being seen as
helpless [and] unable to protect their children. And of course the
impact was due particularly to that scene of Muhammad Dura being
killed in the arms of his father.
The other serious trauma that has affected people is the
destruction of the home. It's as if the Israeli military government
always tries to force us to relive the original trauma so
psychologically we realize we have no place here. This is exactly
what happens. We relive the experience every day, and every day we
ask ourselves if tomorrow we will still have a home. We did a study
on children and the worst kind of trauma, after losing the mother,
is losing the home. Of course, there are different serious kinds of
trauma, for instance the impact of torture. Israel has jailed
nearly 25 percent of the adult population and some 70 percent of
them were tortured. That has an impact on Palestinian society. It's
like putting 20 million Americans in prison and torturing them. And
the impact is far-reaching here, because violence goes from one
person to another, from one generation to another, from one nation
to another. And the trauma and the violence of the Palestinians who
were tortured has resulted in at least some of them expressing
their anger and hostility against others in their family. Some of
them became security officers. So they adopted the same techniques,
in a process that we call identification with the aggressor, and
they became torturers themselves against other Palestinians.
What specific mental health problem do you see as the most
pronounced or the most worrying?
Well, the most worrying for me is that we did a study on children
of 12, and we found that 24 percent of them claim the best thing in
life is to die at 18 as a martyr. This is very serious. Of course,
this again is an expression of the identification with power,
because power for them is to be able to fight best, and to really
conquer your fears through dying. And, of course, to be glorified.
This is a society that glorifies. Many of the suicide bombers of
today are the children of the first Intifada, who witnessed the
beating of their fathers and their humiliation. The bottom line is
that this is an expression of despair. Despair is expressed in the
sense of impotence, despair is expressed in depression. We see it
all the time. We have children who are unable to smile, "smileless"
children. It's not easy for them to enjoy life. Thirteen percent of
our children up to the age of 15 have problems with bedwetting at
night. Many of them have problems at school, because they can't
concentrate. Some cannot go to school because they fear that there
will be some bombing and when they go home their parents will have
died. In the areas of the West Bank of intensive violence by the
Israelis, nearly thirty percent of them [children] have developed a
picture of Post Traumatic Stress Disorder (PTSD), which is a
collection of symptoms.
What are the effects of the occupation on physical health, the
family structure and drug use?
Ofcourse, the physical is a complex story, because you have
nutritional concerns, particularly for children. And now you see
children who are really looking stunted in their growth. You ask a
child, "how old are you?" and he says 12 but he looks 8. Sometimes,
signs of different kinds of anemia can be diagnosed from the face,
from the way they look. I know that also - I don't know what the
percentage is - many women suffer from anemia when they are
pregnant and that affects the children.
Generally speaking, there is a very bad environment for children in
terms of hygiene, food - balanced nutrition, and so on. Poverty, of
course, is the main reason and the lack of resources and care.
Israel has also killed so many and injured thousands and these
people will suffer, some of them for life. Mental problems are
expressed in our society in physical complaints. In my clinic I
have seen something like 15,000 cases. None of them said: "I am
depressed." Ninety-nine percent of them were depressed. But they
express it in terms of headaches, chest pains, and joint pains.
It's all psychological. Stress and psychological problems here are
expressed through the body. It's not denial. We have denial in
other areas. We deny loss and we deny death. But the question of
psychological pain is very recent in Arab societies, so we don't
have the vocabulary to express ourselves. As for the family, the
father... we give the children a picture and we tell them to tell
us a story, and in the picture there's a father and mother and a
little child. And they say the father is sitting, doing nothing,
reading the paper. The mother is doing everything and the child is
trying to find a game to play. Sometimes they think their father is
the representation of the Palestinian Authority, even Yasser
Arafat, sitting there doing nothing. Helpless. The mother has
become more powerful and the women here are more radicalized than
men. Religion has also affected them, in the sense that it is the
last resort. It is the force of God that is protecting us and there
is a kind of fatalistic resignation.
But, of course, there is a conflict. The dynamics of the family
change all the time. There is an influence of the Israeli
occupation causing people to come together, but there is also a
process from within for individualization, liberty, women's
liberation, which goes against that unity in a sense.
I expect there will be a greater use of drugs once there is some
peace and tranquility, because usually this is the case when there
is no outside enemy. The enemy becomes within. Tension is not
resolved. [If] the anger and hostility is not resolved against the
outside enemy, then it will be destructive inside. And this is what
I expect, because we don't have the leadership that can lead us
through a process of reconciliation, so I expect more trouble for
the future.
Does Gaza exhibit unique characteristics, as opposed to the West
Bank?
Gaza has been at the crossroads for centuries. If you read the
history of Gaza, you know that everyone was here. You find that
there is some kind of isolation that has really chronically
affected Gaza. Even in the cities. In cities like Ramallah you feel
like you are part of the world. Of course, Ramallah is not under
siege. But in Gaza you don't have that feeling. You feel you are
isolated from the rest of the world. And it is, it has been
isolated for many centuries. Isolation brings a sense of paranoia,
that we are let down by the rest of the world. Nobody cares about
us. And the harsh reality is the poverty. The poverty, if you
compare it to the West Bank, is worse here. Of course, there is
also an overwhelming impression you get here of crowdedness. It's
so full. When people are allowed to move out, in the streets or on
the beaches, the place is full. Overcrowdedness at home, in the
camp, in the village, affects people profoundly.
What are the coping mechanisms?
The tribal structure is one. It's a kind of moral duty that people
come together. Money goes in circles. Somebody is employed in the
family and he gives to others, and they, in turn, give to others.
So the tribal structure gives you a sense of belonging and a sense
of security. In the absence of a functioning state and the rule of
law, there is no security except the tribe. I think the tribal
structure and tribal ethics have really [enabled] the Palestinian
people to survive for centuries under oppression, occupation and
invaders. Mothers are very important in this also, because the
mothers are at the center of the family. Although on the face of
things men are the ones who are in control, the real control is in
the hands of the mothers. I think the mothers have really helped in
keeping society going.
Another thing that is very important for the Palestinians is the
struggle. Compare the Kuwaitis and us. The Kuwaitis are now a
demoralized society, where drugs are everywhere. It's a society
with broken dignity. In Palestine, we don't have that. On the
contrary, we have a very astute and acute sense of dignity, because
we struggled against the enemy. The Kuwaitis did not resist. The
resistance by the Palestinians against the Israelis has given them
a sense of purpose, a sense of self-respect and a heightened
self-esteem. And this self-esteem is very important for people to
be able to carry on their daily lives. These are the main reasons
that enabled us to cope. And that is in the absence of any form of
leadership.
How popular or successful could nonviolent methods of resistance
be?
I was one of the people, and I still believe, that no one has the
right to kill any person for any reason. I believe nonviolent
struggle is the best way of achieving justice even against, and
particularly against, the overwhelming forces of the Israeli
occupying forces. But it has no impact on this culture, because
this culture is physical and tribal. Tribal means revenge. And
revenge, if it is physical, has to be an eye for an eye. It is very
difficult to influence people with ideas of nonviolence when they
are subjected to this form of violence on a daily basis. So it has
no basis, sadly, I think. Politically, violence by the Palestinians
is counter-productive, and I don't believe people have the right to
kill. I don't give this right to the Israelis, I should not give it
to myself.
What can Palestinians do to change the situation?
Being tribal means we are hostage to a system in which the father
figure is very important. And the father figure today is Yasser
Arafat and what he represents. It's difficult for the Palestinians,
and the Arabs in general, to challenge their leaders, because they
take on this image of being the father figure, plus [for the
Palestinians] there is an outside aggression, which makes people
come together and protect each other and express solidarity. These
two elements prevent the Palestinians today from changing at the
grass-roots level or other levels.
The situation today is catastrophic for Palestinians, because just
as the patriarchal system is working against the freedom of the
individual and the freedom of the nation, the Israeli aggression
only helps to strengthen the tribal system and the father figure.
Every time they say they want to attack Yasser Arafat, he becomes
even stronger. Every time they send bombs against us, we become
more tribal. It's a vicious circle. It's impossible to remove the
element of tribalism without removing the element of the Israelis'
aggression. We have to remove that outside element first. If you
remove that, then the Palestinian dynamics become different. I
believe the Palestinians are more prepared than any Arab nation for
democratization. But as long as there is an outside enemy that
strengthens tribalism and the patriarchal system, there will be no
change. There will be no change from within the Palestinian
society, unfortunately, because Arafat and Fateh are in control,
and they are in constant struggle with Hamas. Between the two
forces, the majority of the people are the silent majority. They
are intimidated into silence.
What can Israelis do?
The Israelis can do a lot. At least the Israeli government is very
sensitive to public opinion. Each extreme group feeds the other. In
order for [Ariel] Sharon to control his people, he needs Hamas to
intimidate these people and to frighten them. Israel has become a
culture of fear, which is dominated by the military. It has always
been a military regime. And this fear is fed by suicide
bombings.
As long as there are suicide bombings, Sharon will be in control.
So what the Israelis need to do, from their side, is to try to
pressure their government to stop this campaign of violence against
the Palestinians, so at least the Palestinians will stop using
suicide bombings against the Israelis. And the Israelis should
respond by pressuring the Israeli government, by making the rest of
the society aware that the way out of this mess, for Israel to stay
as a state, particularly as a Jewish state, is for them to withdraw
from the West Bank and Gaza as soon as possible. The next round
will be for a one-state solution, where there will be no Jewish
masters and Arab slaves. It will be a struggle for equality and a
struggle against racism. If Jews want to have a Jewish state, it is
now or never.
How do you rate Abu Ala's chances of getting something positive
done?
I think he has the will, but I don't think he has the power. It's a
very complex story. On the one hand we have Arafat, and we have
[George W.] Bush and we have Sharon. These three are not really
working for peace. As long as they are together - I know Arafat
wants a solution - but the other two are doing everything possible
not to have peace, supported by the extreme right in Israel and by
the extreme right in Palestine. So Abu Ala'a will be in the middle
of this. What chances will he have? Very slim chances. I think that
there is a possibility, positively speaking, of him being able to
do something, because Hamas is ready to stop suicide bombings
inside Israel. That is very good, because that will allow him the
chance to maneuver without having to confront Hamas, which would be
a huge task and could lead to civil war. He can contain them and
handle them in a way that would not mean confrontation.
The other major task is to give the Palestinians a sense of
purpose, a sense of hope, a sense of security. But that will not
happen without an Israeli government that is really interested.
This Israeli government, I believe, is not interested in peace,
because peace, as far as Sharon is concerned, is a danger to Israel
because it means giving up the land, and land is more important
than peace. Land is more important to Sharon than Jewish blood. So
that is another difficulty. So I think that as long as Sharon is in
power, as long as Bush is in power - with this kind of policy...
maybe they will change. If they change, good. But I don't believe
that Bush or Sharon will change.
If they did change their policies tomorrow, how much support
will there be for a political solution?
Huge support. Everybody is waiting for a solution. The Palestinians
have had enough and the Israelis have had enough. And we know what
the solution is, and the question is how many people have to be
killed before the solution is implemented. Although the solution is
unjust for us - because Israel will take more land than was decided
in the [1947 UN] partition plan - still, I think that the majority
of Palestinians will accept it, if it happens today and if there
are no settlements. The Geneva Declaration, for example, I think
would be accepted by the majority of Palestinians because there
would be no settlements, [a return to the] 1967 borders, and it
will give the refugees the chance to be resettled, either in
Palestine or third countries or in Israel, according to
negotiations. The majority of the Palestinians and the majority of
Israelis will be in support of a political solution.
Dr Sarraj was interviewed in Gaza by Omar Karmi from the
PIJ.