On November 18, 2003, the Palestine-Israel Journal held a roundtable discussion at the American Colony Hotel in Jerusalem on mental health in the Israeli and Palestinian societies. The participants were Professor Avi Bleich, president of the Israeli Psychicatric Association, Rana Nashashibi, director of the Palestinian Counselling Center (PCC) in Jerusalem, Professor Shmuel Tyano, president of the National Mental Health Council and Director of Geha Psychiatric Hospital, Rajiah Abu Sway, an expressive art therapist with the PCC, who also works with the WHO, and Dr Shafiq Masalha, a senior clinical psychologist and a lecturer at Tel Aviv University and the Hebrew University of Jerusalem, and an adviser to Palestinian mental health projects. The moderator was Dr Ambrogio Manenti, Head of the World Health Organization (WHO) in the West Bank and Gaza.

Dr Manenti: At the WHO we try to take advantage of the crises in countries with complex emergencies. We try to introduce changes to the health system to improve its effectiveness, compared to its pre-conflict state, based on principles of equity and sustainability. WHO activities do not specifically focus on dealing with the sufferng of people involved in a conflict. WHO's main efforts are directed to reorienting the general mental health policy and strategy towards a community-based approach (inclusion vs exclusion, intergration vs segregation). This includes the reorganization of mental health services so they can more effectively address the mental health problems of the general population, including those specifically related to the conflict.

Prof Tyano: My main interest is children and adolescents. I think the impact of social violence in general, and trauma specifically, starts from pregnancy. If it starts there, we have the first manifestations of traumatic symptoms in infants, and certainly later on in children and adolescents.
I see three different parts to our work - infants, children and adolescents - and three main axes. The first concerns the epidemiology of Post Traumatic Stress Disorders, PTSD. There are two main points about epidemiology. One concerns exposure to trauma. The second is clinical manifestations of PTSD. I have tried to summarize the works that were published over the last three years, the surveys done in Israel of the Israeli population. The first result is that the exposure of children to a traumatic event in Israel is around 45 percent. As we learned from the survey by Avi Bleich and Zahava Solomon, there is a big discrepancy between exposure and manifestation of PTSD clinically. We find the same percentage of PTSD symptoms in children as the percentage of exposure. This means between a 40 to 55 percent manifestation of traumatic symptoms, very parallel to the degree of exposure. This is one very interesting result we have seen over the last two years, which is different from adults.
We must realize, when we speak about epidemiology, that it is very difficult, even in Israel, to compare one research to another because the tools used are not always similar, resulting in very different percentages. The second problem is how we define PTSD. Today, at least in children, I wouldn't really speak about the criteria of DSM IV [Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition] or ICD X [International Classification of Diseases]. I would say that, today, we tend more and more to speak about a PTSD spectrum and not PTSD criteria. It's a spectrum of four, five or six criteria. If we take the whole spectrum, from anxiety and depression, up to full-blown PTSD syndrome, we see that it's something like 45 percent. If we go to PTSD according to criteria, it decreases to 15 percent. So there is a difference in what we call PTSD. Diagnosis is very important, and that's why I think it's difficult at the moment to even compare work done in different parts of the same country.
The third point, which I think is the most important one, is treatment. If you have one symptom, two symptoms, three symptoms, the whole syndrome, the most important question is how to treat these children.
I started to work on trauma and PTSD in 1974, after the 1973 war, and researched it until 1980. Our concepts at that time were very traditional. But today we realize that it's not what we thought. We have to do two things. First, we have to define risk factors for developing from the acute traumatic state to post-traumatic stress disorder. Which children are going to develop PTSD, if we start with a population of acute stress disorder?
I encounter these children after every traumatic event in Israel. In every emergency room you have a child psychiatrist, a psychologist and a social worker. What should be our approach to these children? It's crucial to initiate this first approach quickly, and to involve the family. In research at Ichilov Hospital published three months ago, when we compared children who got family support (the parents were also supported by the therapeutic team) to children who didn't get family support, there was a very big difference in the epidemiology, six months and twelve months later. It's very important to get the family into the therapy quickly. The third question is what kind of treatment should we do. Long-term? Short-term? At the moment, we believe - with children, at least - we can do short supporting psychotherapy to help them to repress. With those who cannot and who slowly develop post-traumatic stress disorder, then we have to think about adding supplemental therapy.
The last point concerns the environment of these children. What factors make children react? If it's what we call social violence, some environments are more violent, some less. Some are more exposed than others. It is also important to determine if we can still speak about an individual approach - what shall we do with this child or this adolescent - when we have a limited number of therapists for the large amount of children.
We might think about non-classical approaches. By that I mean an approach that is no longer treating the child individually - but an educational approach, a therapy approach thatwould be more systemic. If I have a few hundred children, I cannot even make a diagnosis. I know they are somewhere in school, on the street, but even if you develop a ten-year program to prepare enough people to approach them, I don't think we will be able to do it. That's why I think, today, with such a mass of children suffering from nightmares, anxiety and depression, that we should think about a social systemic approach rather than an individual approach.

Ms Nashashibi: My work in mental health has changed over the years. In the beginning, I thought about empowering mental health professionals who work in the Palestinian context. It's important to be able to have an effect on society, whether it is remedial or preventive, especially since, in our society, this is a relatively new field. Previously, people manifested their stress in psychosomatic or physical ways. Only lately have we begun to see people becoming more able to talk about their pain psychologically. Even so, we don't have enough people trained in this area to be able to provide this service to our society.
Lately, I've been working with the center to study how the occupation is affecting people on a long and short-term basis. Long-term we see that something is happening to people's psyche, especially children, and that the manifestation now is not as dangerous as it will be in a few years. I'm talking about the developmental aspect, whether on the emotional or cognitive level. Our preoccupation is to try to explain these implications, to study them thoroughly, and to caution people about how to organize the educational system and the health system, to decrease the implications and improve children's lives.
Let me explain what I mean by that. The Palestinians' ability to resist has always been through their will power, the belief in the justice of their cause. Because of that, there has been a systematic targeting of this will power as a way to defeat people who resist the occupation. There are many aspects, but I would concentrate on two. One is the checkpoints, the way they are set up and the way people are treated there. The other thing now is the wall, and the ways that communities living beside the wall are being affected. We have been conducting two separate researches, one in the Qalqilya area, seeing the psychological effect of the wall on the community there, and we are also trying to do something about systematic humiliation at checkpoints and its long-term effects.
These are important issues because we are not seeing as much clinical manifestation as one would expect. Where is the anger? The frustration? In a way, we are seeing that people cannot relax enough to show their symptoms. We don't see this wide spectrum of PTSD because we are not in the post trauma stage. This situation does not fit the traditional classification. A major concern at the moment is how we can upgrade our abilities to serve the community to decrease the implications of this situation.

Prof. Bleich: Talk about the Palestinian-Israeli mental health issue is clearly trauma-related. According to WHO and other data, one in four people around the world is going to have some clinical psychiatric disorder during their life, and around ten percent of people globally are currently suffering from some psychiatric disorder. Under the stress of major conflicts, classical psychiatric psychopathologies are put aside. Fewer people come to the ER for treatment. Clearly, we are in the midst of such a situation. It's traumatic, it's post-traumatic, and sadly, it's also pre-traumatic trauma.
Last August, in the Journal of the American Medical Association, we published a major study on 20 months of the second Intifada and its effect on a representative sample of the Israeli adult population. We may assume some of the findings are also true for the Palestinian society, and in an even more severe manner. Around 16 percent of Israeli citizens reported being directly exposed to traumatic events, which seems a huge number. But, from the start of the second Intifada, there were more than 10,000 terror events. To this you may add secondary circles of exposure - relatives, friends, bereavement - of more than 30 percent. So nearly 50 percent of the entire population is exposed to trauma.
At this point, I may assume that, in Palestinian society, the percentage may be much higher in terms of exposure. With regard to traumatic, stress-related symptoms, we are experiencing the traumatic event, reading about it, nightmares, etc., and on the other hand, avoiding everything reminiscent of the trauma. A huge percentage of the population may have this, but that's normal. I don't expect any one of us here not to have some trauma-related symptoms.
When we came to speak about clinically-defined PTSD, which means a set of symptoms with subjective distress and a report of malfunctioning - which are two basic criteria for having a psychiatric disorder - we came to less than ten percent of the overall population. We were amazed. Why? We didn't have pre-Intifada data. We can only compare it to data in the US after September 11. They found huge percentages of PTSD over the whole of the US. So we thought to ourselves, what's going on? Where are all the emotions and the complaints? Rana, you mentioned the same phenomenon with the Palestinians.
The second thing is that women are much more vulnerable to PTSD. This data was confirmed in other studies showing that women are much more vulnerable to post-traumatic disorder, usually in a ratio of one to two. We found one in five. Also, in Israel of May 2002, you did not have to be directly exposed to an event to suffer PTSD. The feeling of being threatened is all around, through the media. You don't have to be exposed directly to have it. We interpreted our data, and I say very carefully that it is probably much more severe on the Palestinian side. Wherever you look, both societies reflect the problems of the other, and we came to the conclusion that the lower percentage of PTSD, trauma-related psychopathologies, probably relates to the strong processes of adaptation. What can we conclude from this? That people are adjusting as well. They feel they are in for a very long struggle.
The other possibility would be that we don't have enough facilities, enough agencies, enough knowledge, to treat trauma. One of the answers would be moving the traditional treatment of psychiatry from mental health hospitals to the community. This is not a total reform because the very hard cases still have to be treated in hospital. I think about how community centers can raise awareness of stress-related problems and supply services in the near-site communities in terms of primary and secondary prevention, teaching empowerment of secondary agents - family physicians, teachers, counselors, etc. Only a minority of the people will have to be treated in the more conventional ways, either alone or in groups. If we are willing to overcome this bloody situation, we may try to think about seeing our mutual trauma as a bridge. For this, we need a common understanding and mutual projects.

Ms Abu Sway: I've been working with adolescents in group therapy using psychodrama, painting and movement. These adolescents were born under occupation, they were children during the first Intifada, and are now adolescents in the second Intifada. The problems most of them have relate to their daily experiences. They cannot move from place to place - everybody is under siege in their small towns. I want to connect this with their developmental stage. They want to be independent, to build their personalities, to make their own decisions. From my experience, they are having serious problems expressing themselves. They have no future, no interest in doing things. When I work with them in relaxation or breathing, most of them cannot breathe properly. They cry when they close their eyes.
On the Palestinian side, during the first Intifada, there wasn't much interest in psychological treatment. Now, in this Intifada, we are getting help, in conjunction with the international community. And people are more aware of what is going on because they're seeing symptoms of aggression in their children. We have the Palestinian Authority, we have Ministries, but ultimately, we don't have a state, we don't have a health service, and we don't have institutions that can intervene here. The Israeli state is 50 years old. It has a health service and institutions that can intervene and do research. On the Palestinian side, we have some NGO's here, some researchers there, nothing systematic. As a result, it's difficult to study the symptoms and crises affecting people.
Now we are trying to go from mental health hospitals to community centers to remove the stigma. We have to work within the cultural context. If you go to a mental health hospital here, you are crazy, and we shouldn't speak to you or your family. Different NGO's and UN agencies are now working with the Ministry of Health to develop community-based centers and run mental health campaigns. We have thousands of traumatized children and adults. How can we deal with them through therapy? We can't do it. We have to go into schools and use media campaigns. We have to develop educational programs that can help families understand how to help their children deal with these traumatic events.

Dr Masalha: My contact with trauma and children has been mainly through research that I have been conducting for the last 15 years on children's dreams. Dreams avoid the reporting symptomatology and pathology, which, as you mentioned earlier, do not always reflect the inner world of the child. The dreams, during the first and second Intifada, show post-traumatic stress, in terms of symptomatology and diagnosis, and correlate with studies conducted by other researchers using interviewing methodology.
But the research on dreams tested other arenas, for instance, issues like threat or being preoccupied with suicide. Some children reported that in their dreams they were willing to blow themselves up or do something very extreme in terms of ending their lives. This research also highlighted other issues, such as children reporting that their movement was limited during the dream, which reflects their experience of checkpoints and curfews. We know that children talk a lot in their dreams about journeys, about going outside in their normal life. Here we see that, when they record their dreams, the children's movement was interrupted by soldiers. Or the journey - that was supposed to be good - was interrupted and ended badly.
What I wonder is how what happens in the dream influences the child in his world? In the dreams I see a lot of humiliation - witnessing parents being beaten, captured or in a state of helplessness or worthlessness. I'm talking here not about the pathology of post-traumatic disorder, but the larger psychological inner world of the child. These things are being experienced, right now, by a large percentage of Palestinians, and a certain percentage of Israelis. But for Palestinian children, it is very close to their daily lives. There is no place where a Palestinian child can feel safe. A child is supposed to feel protected at home and in school. In many areas, these places are really not secure for Palestinian children. I see this also among the Israeli children. But again, it's not surprising that the amount, in terms of symptomatology, is less than half.
Once, in Nablus, I was giving a workshop. It was after the first violation of the hudna [ceasefire], and the Israeli Army bombed a three-story building. There were about three to ten families in that building, some whom were attending my workshop. Imagine how many families are in one attack, and how many children are affected, even if they don't show evidence of trauma. All of a sudden, their homes and personal items are completely destroyed. It's very human to think that these people would need to be counseled, but the Palestinians do not have the capacity, the organizations, that can take care of this affected population through emergency intervention. In Israel, it is much more organized and more of this assistance is provided. Loss must be addressed regardless of the symptomatology. We don't have to wait until a child manifests behaviorally to know it needs help.
I join my colleagues in thinking we should address other populations more than we do, in particular through the education system, school staff, first aid providers, nurses, doctors, etc. I believe that Israeli and Palestinian professionals should join efforts to be creative about ideas for collaboration. We know that this kind of meeting is not a regular thing, and it's not by chance that the American Colony Hotel was chosen as a venue. It's a neutral place.

Prof Tyano: I would like to know what you mean by school invasion?

Dr Masalha: It appears in the dreams. For example, "While we were in school, we saw airplanes bombing the camp."

Prof Tyano: You meant just from dreams you got material of invasion of home and school?

Ms Abu Sway: Incidents have happened in different schools in different areas - there were shootings in the schools, or the army went into the school, sometimes arresting students or shelling inside.

Ms Nashashibi: One aspect we also have to take into consideration is that we allow each other our own narrative. In trauma, it is very important how we explain what happened to us and how we allow the child or the adult to say what happened to them. The repression of this important aspect has allowed the appearance of a lot of frustration and psychological problems. If Israeli and Palestinian psychologists consider what is happening to both our societies, we have to be very clear that we don't censor what can and cannot be said, and what is and is not allowed to be researched. At the end of the day, we are destined to be neighbors, so whether we like it or not, how we deal with each other is very important. Not only what solution will take place politically, but how we relate to each other as human beings.

Prof Tyano: You have raised a very important question concerning our professional attitude. Professionally speaking, what is treatment? Treatment is helping somebody adjust to reality. With this kind of conflict, the main question is, what does it mean "adjust to the situation"? To which situation do you want to adjust? If you say to the actual situation, which means not to resist what is happening, this is a political issue. So how do you manage to keep the ideology and, at the same time, aid adjustment to reality? As a professional, I think this is a very difficult question.

Dr Manenti: You said there is a higher than expected adaptation to trauma, so people don't show many manifestations. But they also have to cope with the features of a fifty-year conflict, and these relate to some kind of fear overwhelming all our thoughts. In the Balkan war, we saw things that created an atmosphere of war - polarization, selective communication, stereotyping. This is a way to be indifferent to life and not be influenced by rational argument, because you are basing your way of thinking on prejudice toward the other. Stereotyping is very much against adaptation and is part of the atmosphere of war - where you start to discriminate and create an artificial barrier between you and the other. There is a social and cultural atmosphere that takes over the majority of society in such a conflict. Do you think that you should be engaged in working against some of these features of conflict?
Secondly, many of you have mentioned a shift from the hospital or from an individual approach to a community or collective approach. Do you think the effort to develop reform in mental health - trying to promote values like integration of the mentally ill patient within the community - can also help to become more open towards any minority, more open as a society in general? Could reforms in mental health lead to more tolerance and more openness?

Prof Bleich: Let me try to answer you and elaborate on other questions discussed earlier. I would like to refer to the remarks about street aggression in the Palestinian Authority, which were related to the non-structural status of the non-nation of Palestinians. We in Israel also see a rise in violence, murders and aggression, so this does not necessarily have to be related to a non-structural status. It can be related to the stressful traumatic conflict we have now.
Second, there is a debate among mental health professionals about how to treat trauma. The traditional way is to explore, to bring in history, hidden material. But some may prefer to repress this. A few months ago, we published a prospective study on myocardial infarction patients with PTSD, showing that those who managed to repress had a much better prognosis. The Americans made it a central issue in the New York Times, debating the proper way to treat the post-traumatic stress victims of New York. They said, "See, the Israelis found that repression is okay. Why are we treating everybody?" We, as professionals, have to do be a role model for the public, starting with our ability to empathize, our people to yours and your people to mine. People need a much more existential approach. It's time to focus on the here and now, to take responsibility for change, to take on the burden of change. It's not so natural to go looking for archetypes. Trying to measure who is more right, who is the greater victim, etc., will not help the public at large constructively.
I believe that groups of professionals must begin the dialogue, aiming to identify the problems and start work on community centers that will take stress-related, trauma-related problems as an example for treatment. There is one model in Israel called The National Center for Terror Victims. It has a hotline to answer calls, clinicians and community intervention teams. As the director of a hospital that also serves Arab-Israeli areas - for example, the clinic in Taibeh - Israeli Arabs avoid using community services too. They will not come to the clinic, never mind the hospital. So it's not as simple as offering community services. You have to re-educate.

Ms Nashashibi: I agree that existential issues have to be targeted. But it's hard to talk to people when there are urgent issue to deal with in their own lives - unemployment, poverty, immobility and so on. At the same time, I believe the deeper issues cannot be ignored. Let's look at the Palestinian paradigm. What can Palestinians look at in their society and feel proud of, feel good about? After years of humiliation and oppression, there is a sense of unworthiness.
Whether we like it or not, if we talk about power in the sense of literal control, Palestinians do not have control over their lives, over change. So what is the basis to go on from our side? What constitutes a good basis for mental well-being for a person to start from now and go ahead in the future? Treating trauma at this level is very practical. But at the same time - and of course, we don't want to talk about political issues - to build this empathy, people have to start from a position where they feel good about themselves.

Prof Bleich: What will make you feel good about yourself?

Ms Nashashibi: To feel good a person needs to feel in control. Living in a state of unpredictability is exhausting. We have to get to a point where we can look at times when we were in control and think of how to regain it. I realize that the issues prevailing at the moment are not going to be the same forever, and this connects with what Dr Tyano was saying about adjustment. But for me, treatment is our ability to help the other person consolidate their power. How they want to consolidate their power, their strength, is as important as looking at how that person will use their strength. And it doesn't have to only be to accept what is happening.

Prof Tyano: You said that it's very important to feel good and to have control. I think you're right. But the reality is different today. The Palestinian people are going through very difficult times where they don't have control. When I spoke about adjustment, I don't see myself as having any role in politics. Unfortunately, I don't think that I can do anything to bring any control or sense of well-being to the Palestinian people. But the question you raised is important. What can we do? Maybe, at the moment, the transmission should be of values, of culture, tradition and religion. I would focus on that. That's how we [the Jewish people] did it for many hundreds of years.
How can I transmit to the next generation, to children, to adolescents, my values, my ideology, my identity, although I know that in this current situation I don't have freedom, I don't have power, I don't have space, I don't have transparency. I don't think we, as professionals, should focus on things we know we cannot give because reality is not in our hands. If we do that, we put ourselves in the politicians' role. I cannot try to give an ideal, because then I transmit impotence. We should have power, we should feel good, we should have these things, but we don't. Which means that you, as somebody I want to identify with, as a therapist, as a leader, you know you cannot bring it to me. You know that, tomorrow as yesterday, as a result of the situation, you cannot change today.
So what should I identify with? With your inability to change reality? Maybe what I call 'adapting' sounds difficult, but we are going through a very difficult period. So I ask myself, what issue should I base it on. I think transmission is the most important one, transmission of what I would call positive values. That is crucial, and the only thing I can say to my ministers and politicians is, "Please try to transmit positive values, not hatred of the other, not the aggressive part of the conflict. Let's try to transmit the positive issues of our identity, of our culture, of what we believe in, of what I got from my parents that I want to give to you."
This trans-generational transmission is important today. I want to identify with something I can do rather than with something I cannot do. Existentially speaking, I think that today, in Gaza, Jenin, Ramallah, Bethlehem, if I were to get a grant, I wouldn't go and train ten, twenty or fifty more psychologists or psychiatrists. I would try to find out who are the people in the community I can train to help me go to all the teachers, the directors, the educators and the social welfare people, to try to educate them in my profession.
One last point about research that Israel does or doesn't have. The Palestinians have very good researchers. You have very good published, well-founded and evidence-based research. The question is how much to invest in this research. Some people do invest in research, and I think we should encourage other people to do the same. You have the tools. You have the samples. You have the opportunity to do it. So I think it's good to encourage more people to do this.
Ms Abu Sway: I want to comment on adjusting the client to reality. It has raised a lot of questions because I am working with people and what am I doing with them? Am I adjusting them to reality? Is this my role? And what is the reality? What is the Palestinian reality? Are these people coming to me for me to tell them, "You live in Ramallah and you can't leave your homes and you have checkpoints and you need permits and there are curfews and incursions and shelling." I don't think this is my job. That feels like telling them to be passive.
From my experience, what they need is to express themselves. They want somebody to listen to them. They want attention. They want to express their feelings. Nobody is listening to them, either because of political oppression or social oppression. That, I think, is the answer. They need to feel human. Lots of times, standing at a checkpoint I feel dehumanized because the soldiers control me. One of them is in a bad mood, closes the checkpoint and now we can't cross to the other side. It's humiliating. Lots of times, when we use psychodrama, many people want to express the feelings they have standing at the checkpoint and they cannot say no to the soldier. In these sessions, they have the opportunity to say no and I feel this helps.

Dr Masalha: The last part of the discussion has been fascinating because it combines theoretical attitudes and practical behavioral responses to specific events. The way I understand Rana's idea is that psychological empowerment of people comes through giving them a feeling of power and control over their lives. Prof. Tyano was leaning more towards empowerment that comes through admitting reality, but also empowerment through humanistic values, which in turn empower me to face this harsh reality. Those humanistic values are, for instance, not being aggressive toward others, believing in my right to live and be respected.
The difference may be between feeling this externally or internally. When you stand in front of a soldier, although you may not have external control, internally you feel that you are right and that you are human. This feeling gives you the power to stand and look him in the eye and feel that, although he has a rifle, you are still more powerful than he is. Maybe I need to clarify this by one event I witnessed in Jenin. During that week we were allowed to get into the camp, I was asked to observe a counselor talking to school kids. He was saying to the kids, "You know, we are strong and we have to be strong and we have to cope with reality." What you are saying, Dr. Tyano, is that this is not the right thing to do because you are distorting reality. They are not strong, in the real military sense. So you would recommend counselors say this is the reality and we have to cope with it within our own values. Others should not be violent to us and we should not be violent to them, we have the right to live in our land with respect. I think that the attitude of the counselor correlates with the tragedy of the struggle that is going on now. When I listen to Hamas leaders, I think they have the attitude that they have to be powerful by showing the Israelis and the world that they are not impotent; "We are able to struggle and kill, the way they do to us. We are equal in terms of power, and only in this way can we sit and negotiate and be equal around the negotiations table."
I think this is the philosophy that leads to what happens in the field. If we take the other attitude, the strategy would be completely different. We would say, "Listen, they do this to us but we don't do this to them, and our power comes from the value of being human, and we want to implement our values of non-aggression, to feel empowered."

Dr Manenti: If I can conclude with a few words, values arising in an atmosphere of war are opposed to our values as professionals. If we are working on including the mentally ill into society, we are working towards the promotion of patients' human rights. War is exactly the opposite. From your own reality as a psychiatric psychologist, you can start to promote positive values. When training the community, I'm not thinking about training the community in techniques, but training the community in acceptance of diversity. They are not mutually exclusive but the second is more cultural, and there is space in Israeli society for this kind of work.

Ms Nashashibi: We're talking about a normal reaction to an abnormal situation. We're not really talking about people who have disorders.

Prof Bleich: Another thing is that Israeli professionals, at least as it refers to Dr Tyano, myself and other colleagues, we are not sparing ourselves from emphasizing the psychological consequences to politicians. We are speaking to them. I would like to see you speaking to your leaders as well. We emphasize it in newspapers, on TV. I believe that all normal people in both societies know how this is going to end up - with an argument over two or three percent of the land. Do both societies have to go up this Via Dolorosa again and again, even though we know the final solution? We have to put it on the agenda, to the people, to patients, to the leadership as well. This is one of our duties, I believe.

Ms Nashashibi: We are doing it. I think that the IDF specifically has to be reoriented in their attitudes. And that is something the Israelis have to be very careful about. The only people our children are exposed to right now from Israel are the IDF, and so however they behave at checkpoints or in house searches, this is these kids' image of the Israeli, and that is very dangerous. The settlers are the other image the Palestinians have of Israelis. They're not seeing you, unfortunately. They're not even hearing you on the television.

Dr Manenti: Thanks to the Palestine-Israel Journal for this opportunity. I hope that this will allow us to know each other better and that we can continue the dialogue in other contexts.