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State of World Population 2010

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Chapter Seven

Imprisoned at home: life under occupation

In Gaza several years ago, when women in the town of Beit Hanoon were prevented from getting to hospitals by Israeli incursions and roadblocks, Fiza Shraim decided to create a temporary delivery room in a primary care clinic that women were able to reach.

A Palestinian woman and her baby pass through the Hawarra checkpoint, near the West Bank city of Nablus.
©Getty Images/Uriel Sinai

Shraim—a winner of the 2010 Americans for UNFPA Award for the Health and Dignity of Women—had seen a need around her and found a way to meet it. Gaza once had a 99 per cent rate of institutional births—favoured in poor countries where midwives may be in short supply and home births risky. With intermittent attacks, a blockade, and other disruptions, that percentage began to slip, and Shraim’s safe-delivery was a welcoming oasis.

Shraim had both a nursing diploma and a university degree, earned while she was raising 13 children. She had also qualified as a registered midwife, and had in an emergency delivered one of her own mother’s children, when she was only 12 years old. In 2008-2009, during the Israeli assault on Gaza, Shraim reopened the Beit Hanoon emergency delivery room she had created several years earlier, and offered both health and psychological services. Fifty-two women delivered babies during the 21-day assault on Gaza, as Shraim worked around the clock. On several nights, she was called to homes where pregnant women were trapped by shelling or lack of transportation, and she went out at great risk to deliver their babies.

“I faced a lot of challenges,” she wrote in an informal account of her life. “My family was big and I was the only supporter.” To ensure a continuing family income while her husband is unemployed, Shraim has a job at Balsam Hospital in Beit Hanoon. But her plan is to find a way to open centres and train midwives in more remote areas of Gaza, to make childbirth easier and safer and reduce the deaths of mothers and babies.

The economic situation Shraim faces at home because her husband cannot find work is pervasive in Gaza. Sabha Sarhan, a founder of income-generation education for women and small-scale community development in Gaza, who joined Shraim in a video teleconference to talk about life in the Occupied Palestinian Territory, said that young men especially suffer from being unemployed. “They go to university and then find no job,” she said. “They feel frustrated. The only work they can get is in the tunnels.” Those are the tunnels for smuggling goods into Gaza from Egypt, an illegal trade that nevertheless helps fill gaps caused by an Israeli blockade that has deprived the Gazans of many basic necessities, in particular material for reconstructing war-damaged buildings.

The boundaries of life never stop closing in on the Palestinians in territories occupied by Israel. In Gaza, they are blockaded to the east by the tightly restricted Israeli border. To the west, they face Israeli control of the Mediterranean seacoast and to the south, Egypt. In the West Bank, there are daily humiliations at checkpoints and the visible threat of Israelis moving in to encircle Palestinian cities with settlements that loom like fortifications on the surrounding hilltops. A gigantic concrete barrier wall to keep Palestinians out of Israel is matched in hostility by roads that local people may not use, connecting Israeli settlements on Palestinian land.

The total population in the Occupied Palestinian Territory, a designation that includes both the West Bank and Gaza, was about 3.94 million in 2009, according to the Palestinian Central Bureau of Statistics, which has been conducting its own censuses since 2007, with support from the United Nations Relief and Works Agency for Palestine Refugees in the Near East, known as UNRWA, and more recently from UNFPA. Of the total, about 2.45 million were in the West Bank and about 1.5 million in Gaza. UNRWA, established in 1949, provides assistance, protection and advocacy for some 4.7 million registered Palestinian refugees in Jordan, Lebanon and Syria as well as in the Occupied Palestinian Territory. Almost completely supported by voluntary contributions, UNRWA offers basic services such as education and health care around the region wherever Palestinian refugees are registered.

Curfews often made going out at night effectively impossible, even in medical emergencies.

In the West Bank and Gaza, two societies that differ in some ways are similarly never completely secure in the environment in which they live, with on-again, off-again conflict always a possibility. Palestinian women living in Israeli-occupied territories, and the men who support them, have been courageous, creative and resourceful in trying to alleviate hardship around them and make life safer for their families. One of the Palestinians’ most difficult challenges has been in providing reproductive health services. In both the West Bank and Gaza, nearly all births once took place in clinics or hospitals, the setting preferred by local reproductive health experts.

In the West Bank, that changed in 2002-2003 when Israel Defense Forces, in response to a series of Palestinian attacks, besieged several West Bank cities, including Ramallah, Jenin and Nablus, leaving many dead and considerable destruction in their wake. In succeeding years, access to medical care became very difficult for Palestinians, and there were many accounts of people in need of doctors or hospital care being held up or turned back at checkpoints. Curfews often made going out at night effectively impossible, even in medical emergencies. When active fighting ended, the obstacles remained in place for years.

A Palestinian woman walks along the Israeli barrier in al-Ram in the West Bank on the outskirts of Jerusalem.
©Reuters/Baz Ratner

The story of Samira, a woman in the village of Azoun Atmeh, near Qalqilia, has become symbolic among the Palestinians. In 2007, when conditions were supposedly getting better, the checkpoint controlling movement out of their village was, nonetheless, closed at night. “At that time, women in labour faced a problem,” said her daughter Hannan, as the women in the family gathered to talk about what happened. “Women had to leave the village several days early and stay with relatives to be near a hospital.” Regular reproductive health care during pregnancy had slipped generally, because women didn’t want to risk the x-ray screening at checkpoints, she added, and after-delivery care was lax. Thinking about these conditions, Hannan decided to study reproductive health and midwifery. It may have saved her mother’s life and that of her baby brother.

Before dawn on the morning when her mother went into labour, Hannan’s father was able to drive only as far as the closest checkpoint, where he was told he could not proceed. He pleaded with the Israeli soldiers to let him pass. They told him if he stepped forward they would kill him, Hannan said. Her mother called out to her husband to back away because he had to think of the nine people he was responsible for in the family, and should not risk his life. By the time her parents returned home, Hannan could see that the baby’s head was already visible. She delivered the baby in the car and then helped her mother into the house, where she found a razor blade and string to cut and tie the umbilical cord. Hannan is now a nurse, and a medical volunteer.

Ali Shaar, a physician who is the National Programme officer for reproductive health at UNFPA’s assistance programme for the Palestinians, said that in 2006, during the worst of the reproductive health crisis, about 1,400 Palestinian births a year were taking place at checkpoints or in cars on the way to the hospital. Even now, antenatal care is not as good as it could be and there are reports of preventable infant deaths. Faced with uncertainty about getting to a hospital, women are opting for more midwife-assisted deliveries or caesarian sections, which have increased to about 26 per cent in isolated areas of the Jordan Valley, Shaar said. “There is ease of movement now,” he said, “but all the checkpoint infrastructure is still there and the relaxation could be reversed in five minutes.”

Numerous self-help projects have sprung up by and for Palestinian women, not only in health but also in economic development. In Jericho, the YWCA offers classes in preparing professional-level food products at home to sell for income and to provide Palestinians alternatives to buying Israeli-produced goods. Palestinian farmers, often under pressure as their land is encroached on by Israeli settlements, produce high-quality dates, oranges, vegetables, honey and goat milk for cheeses. Women can also learn computer use and other skills at the YWCA. With many men out of work, women can put their vocational training to good use. In the city of Nablus, a new women’s centre is teaching the elements of finance and administration.

In Nablus, the movement of people is still restricted by checkpoints and bans on traveling through the closed areas reserved for Israeli settlers. Nablus residents acknowledge that Palestinian militants have operated from here, making the city a target of Israeli attacks. Nablus was badly damaged by Israeli raids in 2002, which largely destroyed its soap-making industry and other economic sectors, leaving the population in a prolonged commercial slump with high unemployment. People who find work outside Nablus, as far away as in Jerusalem, about 60 kilometres to the south, say that it can take hours to travel that distance on roads relatively free of heavy traffic because of unexpected delays at roadblocks. In that setting, rebuilding lives after attacks has been difficult, and physical destruction is still widespread in Nablus, a city that is among the world’s oldest urban centres.

Women in Nablus, working through community initiatives, with support from the city’s municipal government, have in recent years established a network of assistance. Sixty women trained in psychosocial work help traumatized or injured women, guiding them when necessary to professional services offered by relevant municipal government departments. In 2010, the network opened a new headquarters, the Women’s Corner, above a shopping centre in downtown Nablus.

In the Women’s Corner, a cheerful place, women can seek counselling in a programme coordinated by Rafif Mahlas, who directs psychosocial work. There is also training in income-generating activities and a small shop that displays women’s craftwork. The products on display, for which women are paid, include beadwork, embroidery, olive oil soaps and processed foods. The new Women’s Corner programmes in finance and administration are designed to help women move from being merely small-scale producers to becoming entrepreneurs who understand how to market goods and handle money. The Women’s Corner also urges municipal departments and services to mainstream gender and gender budgeting into their work.

Raeda Freitekh, who came to the Women’s Corner to talk about her life as a victim of Israeli attacks and her long years of rehabilitation, has in her own way become a model of determination and persistence for many others in Nablus. In 2002, her home was hit by Israeli bombing. “Two of my aunts were killed,” she said. “I was buried under the rubble for nine hours. After three days, I woke up in the hospital.” Whether from the collapse of her home or the hasty efforts by passers-by to rescue her, she was left completely paralysed; nothing moved, not even her hands. “I can’t remember anything that happened, but what people told me was that somebody walking past heard me under the rubble. Maybe they pulled me out in the wrong way, just because they wanted to save my life and were not thinking of anything else. At that time the situation was very, very bad. Many people were killed and many houses were destroyed, and nobody could understand what was happening. All people were feeling that maybe the city would be completely destroyed over our heads.”

“I did not care what happened to me,” she said. “I was thinking about my family. Where were they? The doctors would tell me nothing. I stayed in the hospital for three months, and then I learned the truth. I would never be able to regain movement. My aunts were dead and my house destroyed. I realized that this was the reality now.” Freitekh went through several operations, including one in Jordan. “Three months after coming back, my brother was killed. There was nothing left for me.”

“I was 27, in my first year in university at the time of the bombing,” she said. “Before this happened, I had been married and had a son and a daughter. But I was separated from my husband and had gone back to my family’s house. After this injury, my husband found it very easy to say, ‘You are handicapped, you are not suitable as a wife anymore; you are divorced.’ He found a very easy way to say goodbye.” A well known Palestinian feminist, Rawda Baseir, who had known one of her aunts and had heard the story of the family’s tragedy, stepped in to save Freitekh from depression and suicidal thoughts. “She told me, ‘It is up to you to choose whether to die here on your bed or to continue your life.’” Baseir had organized a support group for women who lost loved ones in the attacks and urged Freitekh to join. She remembers the first, disastrous meeting: “I attended only one session, but felt inside that I wasn’t ready to listen or participate. All I did was cry. I was ashamed of being in a wheelchair. Only a few months ago, I was walking and strong. And now I was not moving anymore.”

Under Baseir’s consistent prodding and with her financial support, Freitekh returned to An-Najah National University in Nablus to study psychology, hoping to use the knowledge to help others. By then, physical therapy had helped her regain movement in her upper body, but her legs did not respond. “Studying at the university was very difficult for me using a wheelchair. Getting to classes was horrible. Because it was an old university, there was no handicap access. My friends in the university helped me a lot by carrying me up stairs to lecture rooms. Sometimes lecturers switched their rooms to the ground floor just because of me. I was the only person in the university with a wheel chair. Now there are six disabled people studying there, and the university has more access. Thank God my friends and my teachers were very supportive.”

With her degree, Freitekh was able to find part-time work on a psychosocial project for the city government. This year, she moved to her first fulltime job as a psychosocial counselor in the Nablus centre for mental health. She was told that she got the job because she had been through everything—psychosocial and physical—and she knew how to provide support for others. “Within that centre, I feel I exist,” she said. “I have found something I can do.” Her story has inspired her own children—her son is now 17 and her daughter 13—and they visit her frequently. They continue to live with their father, while she lives in a brother’s home adapted for her wheelchair. “Now my kids are very proud of me,” she said. “They see and hear people say that, hey, you have a strong mother.” Yes, she says, but it took a community and the support of strong women to make it all possible.

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