Médecins Sans Frontières aims to “help Palestinians survive mentally”

Originally published in Palestine Times, April 5, 2007 (Health and Environment page).

by Asa Winstanley

“Our objective is to provide psychological and medical support to the victims of violence. To help people to survive — more psychologically than medically in Palestine — but to be able to survive and continue to have normal socioeconomic activities.”

Laura Brav is Head of Mission for Médecins Sans Frontières (MSF — Doctors Without Borders) in Jerusalem. Originally from France, she has been based here for almost two years and has worked with MSF for more than nine years around the world in places like Southern Sudan, Congo, Ivory Coast and Sierra Leone.

Active in more than 80 countries, the MSF movement usually intervenes in countries suffering from conflicts, epidemics or natural disasters. “We have projects focusing on HIV/AIDS, for example, in countries like Kenya and Guatemala where there is no conflict. We consider the AIDS epidemic to be quite serious.”

The medical NGO has been involved with different projects in Palestine since 1989, though its current projects began in 2000 at the beginning of the second intifada. With its head office in Beit Hannouna, MSF has offices in Nablus, Hebron and the Gaza Strip, and the main focus of its current projects is mental health issues. “Usually [for MSF around the world] psychotherapy is a smaller part of a larger medical project. Here it’s the main part of our project.”

Brav says there is little need for her group to focus on more traditional emergency medicine here since “the basic medical needs are covered by the [Palestinian Authority’s] Ministry of Health.” The size of MSF in Palestine is about 65, she says. They are a mix of volunteers and paid staff, 14 internationals and “about 45 Palestinian staff.” International volunteers eventually move up to salaried positions and “of course all the Palestinians are paid employees” — doctors, social workers and one clinical psychologist.

Apart from in Gaza — where the withdrawal of Israeli settlements has eased internal travel somewhat — the small NGO does not have its own clinics or consultation rooms. Teams made up of psychologists, doctors and social workers make home visits instead. Brav says this practice began because “when we started in 2000 the closures caused by [Israeli] settlements, checkpoints and so on made it almost impossible for people to come to a fixed center — so we went to them.”

Even MSF themselves are sometimes subject to movement restrictions at Israeli checkpoints. “In Hebron district in the last six weeks, we have had a lot of problems. Both in accessing villages and accessing H2 [the section of Hebron formally controlled by Israel]. These have been really huge delays… and occasionally there are incidents with settlers too.” The organization holds a general staff meeting in Jerusalem every six weeks. “This is a nightmare — for some of the staff in the West Bank it’s impossible to get more than a 24 hour permit and sometimes we can’t get them at all.”

She says that aside from the more recent international boycott of the PA, any gaps in medical services that occur are usually caused by Israel. “[Gaps] are linked to access problems, because of the [Israeli army] closures, not because of a gap in services.” Although, she notes that the international boycott of the PA is small change compared to the tax funds Israel is withholding: “It was the main source they used to pay salaries. This money belongs to the PA.”

In Sept. 2006, MSF issued a press release out of Jerusalem saying that sanctions against the Palestinian Authority since the January 2006 Hamas election victory have caused “serious deterioration in access to health care.”

But MSF is in a somewhat favorable position compared to other NGOs. “In Palestine, we’re on entirely private MSF funds” — that is funds from MSF in Europe, who in turn get the vast majority of their funding from “millions of donors everywhere in the world sending checks… of 30 or 50 euros, apart from a few rich people who write big checks! For us it’s key, particularly here in Palestine, to be as independent as we can so there is no political or economic agenda that affects our work.”

This means that unlike many international NGOs who get their funding from Western governments, “we are completely independent and free to interact with anyone and provide the services we think are needed.” Both before and after the Hamas elections victory, many NGOs, such as those funded by USAID, were barred from working with anyone related to Hamas.

After the international boycott of the Palestinian Authority begun, MSF was “obliged to make donations to Ministry of Health medical structures, to help alleviate shortages they’ve faced… When Hamas came to power, funding was frozen. The pharmaceutical companies also froze their deliveries because they wouldn’t be paid.” The donations exclusively took the form of medicines and disposables, never funds.

In any case, Brav says MSF would prefer not to have to make such donations. “Certain pieces of the puzzle are being donated by NGOs or the ICRC or the WHO, but the Ministry of Health has no control over the full puzzle so there are gaps since each one is making their own decisions. This is not what the MoH needs. They need to be able to manage their own budget, to pay their staff and to buy medicines.”

Last year, after funding cuts to the PA, many international donors continued to spend money on Palestine, but they gave money to international NGOs instead of directly to the Ministry of Health. Brav says this has led to medicines being both under and over stocked — or issued to clinics without health workers qualified to prescribe them.

“Since the beginning of the year, all the international donors have announced how much money they spent on Palestine last year to show that although there was an embargo against the PA, there was not an embargo against the Palestinian people, because ‘look how much money they spent.'” But on the ground, because of the boycott of the PA’s Ministry of Health, much-needed medicines are not getting to where they are needed, she says.

Many Palestinian health workers and academics are critical of the role some international NGOs play. They say the groups have a role in indirectly maintaining the Israeli occupation, in “picking up the pieces.” Israel bombs a bridge in Gaza? No problem — we’ll rebuild it.

“For sure [NGOs] make the occupation easier, because normally Israel as the occupying power should be providing needed services,” Brav acknowledges. “[In a way] NGOs are helping relieve the burden of the occupation for Israel.”

Brav says this is a risk all NGOs take in any conflict region. She points out that MSF always evaluates the situation beforehand. “Is there more damage done by providing these services, knowing it means the war can probably last longer? At which point is it acceptable to abandon a population? It is something we are aware of and are constantly measuring.”

On their website MSF says that part of what they do is to “speak out against the causes of suffering.” But Brav says that this is done by MSF “mainly when no one else is talking about what is happening. We haven’t put out a lot of reports [on Palestine] in recent years because we consider that there is excellent coverage of the conflict, and we don’t want to duplicate information already out there.”

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