May 30, 2012

MSF is running a program in the West Bank to provide psychological and social support as well as medical care to the victims of the conflict. 



Occupied Palestinian Territories © Juan-Carlos Tomasi

An MSF staff member runs a counseling session in Hebron.

Doctors Without Borders/Médecins Sans Frontières (MSF) runs mental health programs in the West Bank aimed to alleviate the impact of trauma, stress, and pervasive and often targeted violence, offering psychological and social support as well as medical care to the victims of violence caused by  Israeli forces and settlers and intra-Palestinian disputes. Here, Manuel López Iglesias, head of mission for MSF in the Occupied Palestinian Territories, talks about the situation in the region and explains MSF's work.

Why is MSF working in the West Bank and what are the needs of the people our teams assist?

MSF has been working in the West Bank since the first Intifada as a consequence of all the violence associated with the conflict. At the beginning of the second Intifada our teams observed that there were not only patients who were experiencing problems of access to the health structures, but also a lot of people with trauma associated with the violence they had lived through [and] who needed mental health care and psychosocial attention. That was the reason why we started a mental health care project in the governorate of Hebron in 2000, to provide much-needed psychosocial care to the victims of violence. MSF teams focus on people in psychological distress (depression and anxiety disorders such as acute stress and post-traumatic syndromes) caused by violent incidents involving Israeli settlers and Israeli Army, but also due to the intra-Palestinian conflict.

Also, in 2011, we started a very similar program in East Jerusalem, in the part of the city occupied by Israel in 1967, and especially in Shufat Refugee Camp and in Silwan, where violence, exclusion, and political tension are more prevalent and problems of access to the health care services in general and services of mental health care in particular are more acute.

What is the level of mental health care services provided in the West Bank?

Generally, in Israel, the level of mental health care services is quite high. But access to these services for the Palestinian population is very limited. In Israel-controlled areas, there is a clear discrimination in the quantity and the quality of services provided to the Israeli part of the population, and in the area of the West Bank controlled by the Palestinian Authority and in Gaza, controlled by Hamas, health care services are insufficient, especially mental health care services. The proportion of government expenditure on mental health care tends to be low in relation to general health care expenditure, with less than 2 percent of the national health budget devoted to mental health services, and approximately 90 percent of that spent on tertiary-level care (psychiatric hospitalization) largely confined to urban areas.

For these reasons, MSF has chosen to provide mental health care as well as medical and social support to the people living in the Occupied Palestinian Territories who suffer from trauma—direct and indirect victims of the conflict alike. MSF has been providing these services not only in Hebron and East Jerusalem but also in the area of Nablus including Qalquilya and Tubas refugee camp and in all the districts of Gaza.

What kind of violent incidents are MSF patients exposed to?

Most of our patients report that they have suffered arrests and detentions, either by the Israeli security forces or by the Palestinian Authority, or that they have been subject to violence in their neighborhood in their daily life and interaction with the settlers, or that they have suffered an incursion by the Israeli armed forces in their own houses. These incursions are usually search operations by the armed forces of the Israeli Defense Forces, who often enter Palestinian homes at night in search of alleged terrorists or activists, in order to detain them. The way these searches are conducted can be very violent and traumatic. These operations are usually conducted with a large number of soldiers heavily equipped with guns, noise bombs, tear gas bombs, and dogs—in other words they are meant to be very intimidating. 

According to witnesses and victims, violence is common, including destruction of furniture and goods, beatings, and verbal abuse, et cetera. Children and elders are not spared from witnessing this violence and sometimes they are victims themselves. Many of our patients are children that have witnessed these incursions and have seen how the soldiers have treated the members of their family. Many times they see their fathers or brothers beaten up and taken away by the soldiers. This type of experience often results in trauma, especially for children—these things are very difficult to handle and manage without psychological support.

What are the challenges that MSF faces working in the Occupied Palestinian Territories?

The work of MSF in the Occupied Palestinian Territories is very challenging because of the complex characteristics of the conflict. MSF strives to maintain a position of absolute neutrality and independence between all the parties to the conflict. It's not just Israelis against Palestinians, it's also the violence among different Palestinian factions and all the long-term consequences of the conflict, the lack of access to education, the lack of access to jobs, the lack of access to health services, et cetera. In this setting MSF teams try to provide the much-needed psychosocial support to the people who have been affected by this violence, always following the principles of humanitarian action: independence, impartiality, and neutrality—focusing on the people and not on the politics.