grassroots medical peace building: training palestinian physicians in israel
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Grassroots medical peacebuilding: training Palestinianphysicians in IsraelChen Kertchera
a Herzl Institute, University of Haifa, IsraelPublished online: 11 Jun 2014.
To cite this article: Chen Kertcher (2014) Grassroots medical peace building: trainingPalestinian physicians in Israel, Medicine, Conflict and Survival, 30:3, 190-212, DOI:10.1080/13623699.2014.926444
To link to this article: http://dx.doi.org/10.1080/13623699.2014.926444
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Grassroots medical peace building: training Palestinianphysicians in Israel
Chen Kertcher*
Herzl Institute, University of Haifa, Israel
(Accepted 13 May 2013)
Based on new scholarship on the importance of health in times of conflict,this paper examines the training of Palestinian physicians in Israel fromthe 1990s to 2010 as a test case for the theory. It shows that althoughIsraeli governments have adopted a passive policy towards such training,and the Palestinian Authority is officially against such cooperation; in prac-tice, individuals and hospitals on both sides work at the grassroots levelwith the aid of several NGOs to increase cooperation. Thus, grassrootsactivities are leading to better cooperation between Jewish and Palestinianhealth professionals, improving Palestinian health capabilities and estab-lishing a bridgehead for better professional cooperation when a peace set-tlement is achieved. Health, like other social areas, is part of theexplanation why the conflict remains stable and how mutual beneficialcooperation has planted the seeds for future cooperation.
Keywords: Israel–Palestinian; medical peace building; conflict resolution;health
Introduction
The prevailing literature on the Israeli–Palestinian conflict focuses on difficul-ties in finding common ground due to the depth of the contested issues onmatters such as security, return of refugees and the final status of Jerusalem.According to such literature the Israelis and Palestinians are embroiled in anintractable conflict with no clear conditions for the cessation of hostilities andwithout a prospect for a comprehensive peace settlement (Bar-Siman-Tob2010; Bar-Tal 2013; Bercovitch 2003). In this paper, I offer to turn the focusof Israeli–Palestinian relations towards routine activities such as health. I arguethat pointing at routine activities may open new avenues of understanding whyconflicts remain and how societies and institutions may create the conditionsfor cooperation between the societies, not only in post-conflict environmentsbut also during conflict.
The history of health in the area west of the Jordan River shows constantimprovement, but also that the different political leaderships endeavoured to
*Email: [email protected]
© 2014 Taylor & Francis
Medicine, Conflict and Survival, 2014
Vol. 30, No. 3, 190–212, http://dx.doi.org/10.1080/13623699.2014.926444
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improve the health systems without encouraging cooperation (Kertcher 2013,31–47). This policy contradicts the global thinking that gained momentum afterthe Cold War, which emphasized the need for strategies that would influence thetransformation of war-torn societies in political, economic and cultural spheres(Dobbins et al. 2007; Paris 2004). One of the issues which gains dominancedeals with health. The health system – the generic term for the people, building,machines, administration, regulations and financing involved in the health proce-dures – is one of the conditions for maintaining a stable civil society. Therefore,it is not surprising that writing on health and conflict resolution use titles such asPeace through Health (PtH), Health as a Bridge to Peace, Multi-track Peace,Medical Peace Work and Medical Peace Building (hereinafter MPB). The writerson MPB underline the positive contribution of MPB before, during and after aconflict. According to different writers, the people who work in the health systemare better agents for reconciliation and cooperation. They can cooperate with thelocal government because their main goal is to heal. In that respect, they standopposite security forces whose job demands that they inflict damage. A function-ing health system also prevents the spread of contagious diseases; it also symbol-izes the potential of a stable society for development; finally, the people in thehealth system are usually part of the civil society which has an interest in thepreservation of peace (Arya and Santa Barbara 2008; MacQueen and SantaBarbara 2008; Rushton 2008).
While several academic works point at achievements in the field of healthin the Israeli–Palestinian context (Barnea and Husseini 2002; Kitts 2008;Rubenstein and Kohli 2010), a close examination show discrepancies betweenthe theory and its practice. MPB scholars recommend training physicians onlyafter the cessation of hostilities and the signing of a peace agreement(MacQueen and Santa Barbara 2008). In practice, however, the training of Pal-estinian physicians in Israel has taken place in the past two decades duringperiods of increased violence. A second contradiction relates to the agents whoimplement the MPB. The theory encourages the intervention of third parties inthe conflicted region. It also encourages full cooperation with local govern-ments. In the Israeli–Palestinian case, the practitioners of MPB are usuallyJews who are part of the same socio-political apparatuses that sustain the con-flict in the first place. A third problem with the implementation of MPB theoryin the Israeli–Palestinian conflict is its disregard of the definition of the ‘object’or ‘other’. We don’t know who the objects of change are. Are they the stateapparatus, a hospital, the health personnel or the patients? Each of these targetgroups has its own concerns, ambitions, resources and reacts differently withregard to the conflict. Finally, health systems are open systems. They aspire toattain sustainable development, but are affected by many variables. Thus,development of a health system is always accompanied by tensions betweenpeople with different goals and the strategies to achieve them. For example,the goal to develop tertiary capabilities is conditioned by the availability oflarge sums of money, establishment of good electricity, availability of water
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supply, building services and above all the availability of highly trained medi-cal staff. If these conditions are not met, there is a danger that the system willdeteriorate and even collapse. Therefore, policy-makers may prefer to invest inprimary care to make the health system more equitable and available to mostof the population, thus preferring quantity to quality. This poses a challengefor MPB experts: When to intervene in a conflict? What are the alternatives tothe development of a health system and what to recommend to the localgovernment?
To settle the discrepancies between MPB theory and its practice in the con-text of the Israelis and Palestinians, this paper analyses the evolution of rela-tions between two levels of agents in the context of the training of Palestinianphysicians in Israel. The first agent examined is the Israeli and Palestinian gov-ernmental and ministerial level. The paper will show how the two adjacenthealth systems evolved in the past two decades and how they established strat-egies for or against the training of Palestinian physicians. This part will alsoshed light on the role of the donor community, a third party to the conflict,which, with its political and financial assets, can induce or discourage suchcooperation. The second level to be examined is the grassroots level whichincludes mainly high ranking personnel in Israeli and Palestinians hospitalsand Non Governmental Organizations (NGOs) as well as private physicians.Combined, these two agencies present us with in-depth knowledge of how thetraining of Palestinian physicians has affected both Israelis and Palestinians inthe past two decades in relation to MPB theory. The questions raised abovewere confronted by the adoption of a combination of methodologies such asin-depth interviews of 40 Israelis and Palestinians involved at different levelsof interaction; primary governmental, hospital, and NGO publications and doc-uments. The majority of Israelis agreed to reveal their identities. On the otherhand, almost all Palestinians refused to disclose their identity for fear ofnegative repercussions.
The governmental level
The Declaration of Principles signed on September 13, 1993 called for theestablishment of the Palestinian Authority (PA) as an interim arrangement untilthe parties reached a comprehensive agreement. The agreement emphasized theseparation of the two polities on the basis of two states for two people. From1 December 1994, the Israelis referred all the authorities concerned with healthto the PA (Barnea and Abdeen 2002).
In congruence with MPB theory we could have expected that both sidesdevelop post-conflict strategies concerning health. This expectation is sup-ported by the fact that both nations form one epidemiological family due togeographical proximity and the daily interaction of the people. Therefore, thissection analyses the health strategies of each of the nations’ high governmentallevels concerning the training of Palestinian physicians in Israel and the role of
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the donor community in encouraging the development of the Palestinian healthsystem.
One explanation for the training of Palestinian physicians in Israel has itstraces in a change of policy by the Israelis in the mid-1980s. At the timeIsraeli governments thought that they should support local Palestinian institu-tions so that when Israel left, these institutions could form independent stateinstitutions. These activities were controlled by Haminhal Ha’Ezrahi (CivilianAdministration), the body that Israel created in 1981 to supervise the WestBank and Gaza Strip.1 The director of Haminhal Ha’Ezrahi from 1985 to1987, Brigadier General Dr Ephraim Sneh, decided to develop the Palestinianhospitals to better prepare them to work under an independent Palestinian gov-ernment. During these years several dozen Palestinian physicians received brieftraining in different health fields. Thus, the training of the Palestinian physi-cians was considered a part of a future disengagement policy and not in orderfor future cooperation (Israel Ministry of Health 1993; Sever and Peterburg2002; Sneh 2002).
Another explanation for the training of Palestinian physicians lies in the con-fidence of the Israelis in their health system. The Israeli health system is rankednear the top in the world World Health Organization (WHO 2000). There areseveral explanations for this. Israel has a universal and compulsory health careinsurance system. It has a mixture of public, private, and semi-private health careproviders. The health care system is one of the biggest employers in the countrywith approximately 170,000 employees (Israel Ministry of Health 2010). In thetwentieth century,the Jewish community enjoyed massive immigration of trainedJewish physicians. Israel enjoys a high ratio of physicians to the population, esti-mated to be 3.3 physicians to 1000 people. The health care system is aided byIsrael’s stable economic growth, ranked high according to the human develop-ment indices United Nations Development Programme (UNDP 2013).2 Thus,high ranking officials in the Israeli Ministry of Health think that their health caresystem should also be a global centre to train foreigners – mainly from lessdeveloped countries – among them Palestine. According to this perspective,Palestinians and other foreigners should train under the same criteria (Shanon2006).3 From the late 1990s until today, the policy of training Palestinian physi-cians has been monitored by Dr Amir Shanon, director of the Department ofMedical Professions, Israel Ministry of Health. Shanon claims that his depart-ment treats Palestinian physicians as any other foreign national physician.Although his department doesn’t have statistics on the issue, he estimates thatthere has been a constant increase in the number of Palestinian and foreign physi-cians being trained in Israel since the beginning of the twenty-first century.Shanon recalls that in the 1990s, there were only a few dozen physicians a yearin Israel in comparison to 400–500 foreign physicians a year in the past years,many of them Palestinians.4
The two explanations given above by Israeli Health Ministry officials fortraining Palestinian physicians in Israel ignore the difficulties that the Israelis
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place on Palestinian physicians who want to do their medical fellowships orresidency in Israel. The facade of an Israeli technical rubber stamp thatapproves Palestinian applications ignores the fact that any Palestinian physicianwho wants to enter Israel must receive a special permit from HaminhalHa’Ezrahi.5 In many instances, the Israeli government ministries create bureau-cratic obstacles in the issuance of work permits, study visas or in the paymentof salaries to Palestinian physicians. Many of the physicians who arrive fromtheir homes in the West Bank are checked at and delayed by Israeli militaryroadblocks – scattered in the West Bank – in disregard of their obligations toIsraeli hospitals. A special problem occurs in East Jerusalem. For thePalestinians, East Jerusalem is their intended capital. Therefore, they considerthe Palestinian population and health institutions there as a part of their futurecountry. Officially, the Israelis claim that the entire city is their capital. Theyeven passed the ‘Jerusalem Law’ that emphasizes that the city is united underIsrael rule. Because Israel is the de facto administrator of East Jerusalem, theIsraeli Health Ministry sometimes refuses to give work permits to Palestinianphysicians who work in the best Palestinian hospitals in East Jerusalem. Theyalso refuse to let the medical graduates of Al Quds University work in Israelihospitals. They claim that the university is part of its territorial claims butoperates without Israel Council of Higher Education guidance. According to aprominent Israeli hospital official: ‘The Ministry of Health put them against awall. Thus, to the frustration of the (Israeli) hospital staff, the physicians fromrelatively better hospitals such as “St. Joseph” and “Al-Makased” (in EastJerusalem), are prevented from application for residency’.6
From the above analysis, we can assume that for the past three decades,Israeli government policy towards the training of Palestinian physicians inIsrael can be explained as a passive MPB rather than part of a comprehensivestrategy towards the Palestinians. It wants to improve Israel’s image in theworld in general and towards the Palestinians in particular. It wants to increaseits prestige as a leading health care provider (Israel Ministry of Foreign Affairs2013). More rarely some officials claim that they also have a positive effect onthe viability of the Palestinian health care system. In fact, the entire healthcoordination is part of this passive strategy of tolerance to other initiatives onthis issue while maintaining no interest in it, as long as it does not pose athreat – to Israel’s policies and health care system. The training of Palestiniansis not considered as supportive for the development of the Israeli health caresystem or for the improvement of relations between the two peoples either(Kertcher 2013, 49–82).
These conclusions are supported by the health coordinator in HaminhalHa’Ezrahi for the West Bank, Ms Dalia Basa, who has served in this rolesince 1995. She claims that her recurrent requests in the past two decades forincreased manpower to deal with the issuance of permits to Palestinians arebeing declined. Her suggestions to high ranking officers in the Israeli militaryto discuss the development of the Palestinian health care system and also for
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the training of Palestinian physicians are ignored. Frustrated, she compensatesfor these shortcomings by personally engaging with Israelis and Palestinian24/7.7
The Palestinian health care system that emerged in late 1994, after thesigning of the Declaration of Principles, was very fragile. The Palestinianhealth care system is divided into four medical providers: the governmentalPA, the non-governmental, UNRWA and private entities. Each medical pro-vider aspires to increase its assets and capabilities but does not necessarilycoordinate its activities with government strategies. This problem of coordina-tion was increased after the Hamas military coup in the Gaza Strip in June2007 resulting in the creation of two separate political units. Thus, while onpaper, the PA governs 25 hospitals, in practice 13 of them are in the GazaStrip, under Hamas control (Mataria et al. 2009). Israel’s continued control ofPalestinian assets, the limitations on the movement of Palestinians by theIsraeli Defence Forces (IDF) and their influence on the imports and exports ofassets make the PA dependent on the Israelis. The Palestinian health care sys-tem is also faced with a constant lack of funding. Part of this challenge is dueto military flare-ups with Israel, which slowed its limited economic growth. In2011, its GDP was estimated at less than 8 billion dollars. Therefore, the PAdepends on foreign economic aid to ensure its functioning. In the first decadeof the twenty-first century, it received approximately 1 billion dollars from thedonor community (Palestinian Ministry of Health 2010a; World Bank 2012,2013). Economic difficulties are constantly growing due to the demographicchallenge. In 1967, there were less than one million people in the Palestinianterritories. In 2010, it was estimated that the population reached approximatelyfour million (Palestinian Central Bureau of Statistics 2010). Finally, the PA isoften accused of mismanagement and corruption (WHO 2006). Thus, up to thelate 1990s, Palestinian physicians were trained according to Jordanian orEgyptian laws and practices. The PA formally legalized the work of thePalestine Medical Council (PMC) in 2006. The training of specialists waslegalized in December 2008 (PMC 2011; Schoenbaum, Afifi, and Deckelbaum2005, 42–45).
The difficulties described above did not prevent the development of thePalestinian health care system. The number of hospitals in the West Bank andGaza Strip increased from 28 in 1992 to 76 in 2010. The Palestinian healthindicators such as life expectancy, child mortality and the ratio of physiciansper thousand people are similar to neighbouring Arab countries such as Egypt,Jordan and Syria before the civil war (Giacaman et al. 2009). Moreover, thePA is ranked in the middle echelon of developing countries together with othercountries such as Bolivia, China, Egypt and Paraguay (UNDP 2013).
In spite of its ability to maintain continued development in the health sec-tor, according to the World Bank: ‘Allocations of resources within this sectorare still primarily emergency and humanitarian assistance … The projectsdefined under health quality and health care programs are critical in helping to
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move back to a development agenda within the health sector’ (World Bank2008, 8). The international report is in congruence with the Palestinian officialpolicies on the development of the health care system in which the training ofPalestinian physician is crucial Palestinian National Authority (PNA 2009, 26).
One of the major challenges in creating a sustainable health care system isthe quantity and quality of the physicians available in proportion to the generalpopulation. After signing the Declaration of Principles, in 1994, the Palestiniansestablished their first medical school in Al-Quds University, in East Jerusalem. Itis estimated that up to 2011 this institution trained approximately 500 physicians.Later on, the Palestinians established two new schools, in Nablus and the GazaStrip. The entire yearly increase in general physicians stands at best at 120.8 In1994, the Palestinian health care system had 1575 general and specialist physi-cians. By 2010, this number had increased to 8093. (Palestinian Ministry ofHealth 2004, 2011). Most of the physicians were trained in hundreds of medicalinstitutions in dozens of countries with different curricula(PMC 2011). In spiteof the rise in the total number of physicians, the total number of Palestiniansspecialists in 2010 was only 2166. The need for specialists is great and it is esti-mated that by 2015 the Palestinian health care system will have a shortage of3317 specialists (Palestinian Ministry of Health 2008, 99). In the past twodecades, the majority of the specialists worked in non-governmental hospitals inthe West Bank and in East Jerusalem. The shortage in specialists who can trainothers and their concentration in a few hospitals create difficulties for generalphysicians who aspire to be trained as specialists. For example, due to the Israeliblockade policy, a general physician in Gaza has almost no chance to be trainedas a specialist. Other physicians are being prevented from entering EastJerusalem’s main Palestinian hospitals such as Al-Makassed, Augusta Victoria,St. Joseph and St. John due to Israel’s barriers and permits policy.
The shortage in specialists is also one of the explanations for the PA’sdifficulty in developing tertiary medical centres (Palestinian Ministry of Health2010b). Up to 2010, only two NGO hospitals in East Jerusalem, AugustaVictoria and Al-Makassed hospital, had professional residency programmes(Bernhart 2010, 12).
The lack of quality tertiary medical centres forces the Palestinian healthcare system to send thousands of patients abroad for treatment. In 2005,approximately 42% of the Ministry of Health budget was allocated fortreatment outside its medical centres. This trend has decreased but it is still aburden on the health care system.9 The Palestinian authorities are aware of thedire need for specialists. Although the PA does not control most of the hospi-tals in the West Bank and in Gaza Strip, it operates as a regulator. In its work,it also benefits from the support given to it by the donor community, whichinvest tens of millions of dollars each year to create a sustainable Palestinianhealth care system. The utility of the development programmes, however, isdoubtful. Many of the development projects emphasize construction ofinfrastructures rather than the training of specialists. For example, the 86
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million dollar American ‘Flagship Project’ which operated from 2008 to 2012allocated very little for the training of Palestinian physicians (PalestinianMinistry of Health 2012). According to a Palestinian professor, critical ofAmerican aid policy in the health sector: ‘By the time they finish, they areexperts on US regulations and what it takes to follow the USAID guidelines.Alas, what about the different Palestinian health service systems? They [theAmericans] are more process-oriented than outcome oriented!’10
In spite of the tremendous challenges to their health care system, the offi-cial stance of the Palestinian Health Ministers rejects training of Palestinianphysicians in Israel. It seems that in the past two decades none of the Palestin-ian Health Ministers approached his Israeli counterpart with such a programme.Israelis complained that even in the heyday of cooperation during the 1990s,the first Palestinian Health Minister, Dr Riad Al-Zanoun (1994–2002), rebuffedinitiatives for cooperation and issued anti-Israel statements.11 For example, dur-ing the 1990s, following the signing of the Oslo Accords, efforts to develop anoncology hospital in the Gaza Strip with the large Sourasky Medical Centre inTel Aviv, Israel, failed to materialize in spite the fact that the Israelis promisedto provide the funds and the knowledge and to train Palestinian physicians.12
The official policy against the training of Palestinian physicians in Israel alsocontinued in the tenure of Dr Fathi Abu Moughli as the Palestinian HealthMinister from 2007 to 2012. Abu-Moughli was considered bipartisan by manyPalestinians because he worked for many years in the WHO, and was not partof the inner Palestinian politics. After becoming a Minister he adopted an anti-cooperation policy with Israel. In one instance, a Palestinian representativecame forward to Abu-Moughli with a proposal that an Israeli specialist trainPalestinian physicians without charge and in return receive free medical sup-plies from a medical corporation. Abu-Moughli turned it down and accusedthe Palestinian physician of cooperation with the Israelis.13
There are several explanations for the official Palestinian moratorium onthe training of Palestinian physicians in Israel. For Palestinian authorities whoare being screened by the public eye, MPB strategies without a peace treaty isanathema. For them, the dire needs of their health care system and peopleshould be sacrificed to a higher political goal of participating in the campaignfor self-determination. Cooperation can also weaken the delegitimization policyof Israel activities. Thus, the Palestinian position against cooperation rejectsthe aspirations ascribed above to Israeli Ministry of Health and Foreign Officeofficials. The denouncement of MPB between Israelis and Palestinians is alsobeing fuelled by Arab health societies and professional unions around theMiddle East, who have no interest in cooperation with the Israelis andtherefore are at ease with sabotaging such initiatives by threatening to boycotthigh-ranking Palestinians who consider such cooperation.14 For the committedDr Dan Shanit, who headed the Medicine & Health Care Division in the PeresCentre for Peace from 1996 to 2010, and who tried to develop such formalcooperation from the 1990s this was a puzzle. ‘The Palestinian Minister of
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Health decided one day that he didn’t need it. It doesn’t matter if he needed itor not: the calculations were political’.15
From the Palestinian perspective, the armed struggle with the Israelis alsomade it more difficult to cooperate with them. The Second Intifada from2000; Operation Defensive Shield during 2002 in the West Bank; OperationCast Lead in Gaza Strip 2008–2009 and other small-scale operations as wellas routine targeted killings all made it difficult to continue formal cooperationwith Israeli agents on health issues (while ignoring the Palestinian sufferingimposed by Israelis). Moreover, the Hamas military takeover in the Gaza Stripin June of 2007 weakened the chances for cooperation as the Hamas andFatah movements struggle for the support of their people. Thus, in severalincidents Palestinians who were supposed to reach out to the Israeli side fortraining or for medical treatment were prevented from it by Hamas securityforces.16
The only formal Palestinian exception to cooperation with the Israelis is onhumanitarian aid. Ever since its inception, the PA sends thousands of patientsto Israel, Jordan and Egypt. As mentioned above, this eats a large amount ofthe Health Ministry budget. As the Palestinians fear, this is being used by theIsraeli Foreign Ministry to improve Israel’s public image (Israel Ministry ofForeign Affairs 2013).
Side by side with the political explanations given opposing cooperationwith the Israelis, there are more concrete professional arguments against thetraining of Palestinian physicians in Israel. Palestinians claim that the millionsof dollars spent on these programmes could also have been spent directly intraining Palestinian physicians in their Palestinian hospitals or in other places.Sometimes, the Palestinians suspect that big Israeli NGOs receive high over-head financing for their operations. Another argument is that the Israeli pro-grammes concentrate on visibility rather than on analysis of Palestiniantraining needs. One example of this is that most of the training programmesfor Palestinian physicians are short term, from six months to two years, insteadof full-five year residency programmes. The programmes usually do not pro-vide for close orientation programmes to assist the integration of the Palestin-ian physicians into the Israeli health system and thus may create negativefeelings. A high level of training in Israel together with the unstable politicaland economic environment in the West Bank and Gaza Strip may encourage abrain drain of the local health care system, since Palestinian specialists couldleave the area for better and more stable health care systems abroad. Finally,the continuous training of Palestinians in Israel may continue the dependencyof the health care system on the more developed Israeli system which willencourage the treatment of Palestinian patients in Israel without the creation ofa large medical corps and with continued high costs to the Palestinians.17
Interim conclusions on the evolution of both the Israeli and the Palestinianhealth care systems in the past two decades, from the governmental perspec-tive, emphasizes that the directors of these systems navigated them away from
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and contrary to MPB doctrine. Israeli health officials are more passive observ-ers than players in the process. They don’t see the need to encourage coopera-tion to form a basis for future institutionalized cooperation that can in turnsolidify a future peace agreement. The commitment of Ms Basa, the healthcoordinator in Haminhal Ha’Ezrahi, to encourage such cooperation is theexception to the rule. The official Palestinian – stance is anti-cooperation withthe Israelis for the training of their physicians. They prefer to receive aid fromthe donor community, while denouncing Israel with disregard for the potentialbenefits of such cooperation. The passive and even hostile standing of theIsraeli and Palestinian officials on the issue of training stands in contradictionto actual events. From the mid 1990s hundreds of Palestinian physicianstrained in Israel in short and long programmes. In spite of recurrent cycles ofviolence, the overall number is on the rise.
The grassroots level
MPB theory generally mentions the involvement of health professionals mainlyfrom outside countries which have no direct interest in the conflict. In practice,any health issue has its own professional demands and internal circumstancesthat are most influential in the evolution of MPB. In this paper, the main healthprofessionals identified as crucial for training from the Israeli perspective arethe hospital directors, heads of hospital departments and directors of NGO pro-grammes. From the Palestinian perspective, the influence of the hospital direc-tors is as important as the personal needs and rational decision-making byhundreds of individual Palestinian physicians. As shown below, this group isresponsible for the increase in the number of Palestinian physicians who aretraining in Israel and for their effect on the quality of Palestinian health care.
The directors and department heads in Israeli hospitals did not approachthe training of Palestinians in their hospitals with knowledge in MPB theory.For some hospital directors and department heads such training in their depart-ments may also have a negative impact. For them, training non-Palestinianphysicians is easier because it does not create political tension amidst the med-ical staff or patients. Another advantage when working with non-Palestinianphysicians lies in the fact that they will not be detained at roadblocks or haveother security issues. Finally, the presence of Palestinian residents (sometimeswith Israeli Arabs) along with Palestinian patients may induce tension amidstthe large Jewish population, who may view the hospital as less than loyal toits original goal of serving them.18
In spite of their fears, the Israeli hospital directors and department headsclaim that for two decades they have supported such endeavours for severalreasons. First, they see a direct link between humanitarian aid (treatment ofPalestinian patients) and the training of Palestinian physicians. In that aspectthey are committed to providing medical care to Palestinian patients who donot receive proper care in their hospitals. Second, they see eye to eye with the
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officials in the Ministries of Foreign Affairs and Health who claim that itimproves Israel’s image in the world. Some of them hope that a constantincrease in the number of Palestinians trained in their departments will supporta viable Palestinian medical system which is in dire need of specialists.19
Finally, those interviewed showed confidence that their treatment of Palestinianphysicians will increase the trust between the two peoples, Jews andPalestinians. For Prof Eitan Kerem, Chairman, Department of Paediatrics,Hadassah hospital ‘In the Mount Scopus department there is a physician whosesister was killed in a terror attack on a bus. There is a physician who wasbadly wounded in another terror attack. She and her husband were in intensivecare for two weeks … there are not a few who live in settlements [in the WestBank] … yet the atmosphere is wonderful’.20
Most Israelis also admit that the training is not only a philanthropicendeavour or part of planned national strategy. They identify a need in theIsraeli hospitals for such activities. Israeli hospitals suffer from a shortage ofcheap trained available physicians. The presence of Palestinians and othertrainees from countries such as China, Cyprus and Georgia help to fill theshortage in manpower. The presence of Palestinian physicians also assists theIsraeli medical system in dealing with the Arab minority which comprisesapproximately 20% of the country’s population. Finally, in one particular case,MPB theory was part of a strategy by the Wolfson Hospital management inthe late 1990s to justify the development of a new cardiovascular departmentto treat children from outside of Israel, many of whom are Palestinians. In thisdepartment, they also train Palestinian physicians. To summarize, a mixture ofideological, political and professional calculations are pushing the scaletowards acceptance of Palestinian physicians in Israeli hospitals. In most cases,however, the Israeli hospital department heads admit that they were not activein the recruiting stage of Palestinian physicians. With the exception ofHadassah Hospital in Jerusalem, no other Israeli hospitals have permanentprogrammes for recruiting Palestinian physicians.
From the 1990s, NGOs have been the second crucial agent involved in thetraining of Palestinians physicians. The Palestinian Israeli Peace NGO Forumrecorded more than a hundred Israeli and Palestinian organizations whichmaintain constant cooperation in different fields. From the late 1980s and espe-cially since the signing of the Framework Agreement, three NGOs have beeninvolved in the work of training Palestinian physicians in Israeli hospitals: theSwiss Karl Kahane Foundation, the Peres Centre for Peace and Save a Child’sHeart (SACH). These organizations raise funds and have special divisions forthe sole purpose of training Palestinian physicians in Israel. They maintaincontact with Israeli hospitals and induce them to accept Palestinian physiciansfor training. They also engage with Palestinians to encourage them to apply forpositions in Israeli hospitals.
The Karl Kahane Foundation is Swiss. It was the dominant programme fortraining Palestinians physicians in the 1990s. The Foundation funds full
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residency in Hadassah hospital in Jerusalem (one of the top secondary andtertiary medical centres in Israel). The Kahane Foundation estimates that from1987 to 2013 they have been responsible for the full training of close to 50Palestinian physicians. Their work is held in high regard by Israelis andPalestinians alike.21
The second NGO with the largest turnover activity in this respect is thePeres Centre for Peace. The Peres Centre, established in 1996, is committed tothe promotion of cooperation with the Palestinians on economic, cultural,social and medical levels. The Centre is known mainly for its support forhumanitarian aid for the treatment of thousands of Palestinian children inIsrael. From 1999, however, it has also developed a unique programme for thetraining of Palestinian physicians with French and Danish funding.22 Unlikethe Kahane Foundation, the Centre’s programme provides financial support fora fellowship of one to two years, but not a full residency. Since the IsraeliMinistry of Health allows the trainees to do medical shifts for a salary afteronly a year of training, trainees can fund their own stay in Israel by workingin the departments. This strategy was successful in terms of quantitativemeasures and since its inception the Centre receives dozens of Palestinianapplications each year. In the Peres Centre, they say that their strategy createda win-win situation for Israelis and Palestinians. The Palestinians receive atleast minimal quality training; even the small Israel hospital salaries are betterthan the small salaries from the PA governmental hospitals; since Israeli hospi-tals are short of trained physicians, they tend to welcome these trainees; thePalestinians hope that the various department directors will take an interest inthem and support their applications for full residency.
Based on the Peres Centre model, SACH – founded in 1995 and committedto heart treatment for children in developing countries – developed a specialtraining programme for Palestinians in the last decade. Their programme worksonly with the medium size Wolfson Medical Centre (400–600 beds) on paediat-ric cardiology, cardiac surgery, anaesthesia and paediatric intensive care. Theyadopted the Peres Centre model and are being funded by private, EuropeanUnion funds and sometime by the Peres Centre. In recent years, however, theyhave begun training for full residency.
Unlike the directors and heads of departments in Israeli hospitals, the direc-tors in the Peres Centre for Peace and SACH are well informed in MPB the-ory. Dr Ron Pundak was in the team that drafted the Oslo Accords byemploying ‘Track-II diplomacy’; Dr Dan Shanit founded the health division inthe Peres Centre and is committed to improve cooperation between the twopeoples; the executive director of SACH, Simon Fisher, is a lawyer by trainingwho says that he learned of MPB by experience. Pundak, Shanit, and Fishercriticize the governments of all sides. They criticize the lack of Israeli govern-ment support for development of the Palestinian health system. They also criti-cize the Palestinians for preferring narrow political gains rather than improvingtheir health care system. They reject the accusations that the funds for training
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could have gone directly to Palestinians. They show that these programmes arebeing funded mainly by wealthy Jews or by European and American pro-grammes such as ‘people to people’ funds for the specific objective of promot-ing cooperation. They also show that they are working against the threat of aPalestinian brain drain. To achieve this goal, they developed a unique systemin the Peres Centre for Peace that was later adopted by SACH. In this system,a Palestinian trainee must bring an official commitment from the PA Ministryof Health that it is willing to employ him in a government hospital after thetraining period. On his part, the trainee must sign a document in which hepromises to work in the government hospital for several years. The short pro-gramme prevents the trainee from receiving a specialist certificate, thus makingit difficult for him to look for work in Western countries. Moreover, becausehe was trained in Israel, the trainee sometimes find it difficult to work in Arabcountries. Therefore, the training programme creates a ‘professional trap’which induces the Palestinian physician to remain a part of the localPalestinian health system.
The joint work by the Israeli agents creates the basic organizational andprofessional platform for the training of Palestinian physicians in Israel. TheIsraelis believe that the advantages of such programmes overcome the disad-vantages on their side. Thus, they ignore that most of the time their pro-grammes work without a real assessment of the needs of the Palestinian healthcare system. Part of the reason is that they do not initiate studies to examinewhat the needs of that system are. Another reason is that most trainees areaccepted after sending a short letter of application, a CV and being interviewedby an NGO representative and an Israeli hospital department head. Most of thetime, the Israelis have no problem with this mode of work because they cancontinue in their programmes as long as they can convince the Western donorcommunity and wealthy Jews that such endeavours are beneficial to coopera-tion and to improvement of the Palestinian medical capabilities. Not all Israeliagents, however, are content with the two decades of cooperation. They sharetheir concerns that in the long run, the Palestinians will be less inclinedtowards such cooperation. Although the number of Palestinian trainees is onthe rise, there is no permanent mechanism to maintain cooperation in the longrun. A look at the Palestinians reveals a mixture of interests regarding thetraining in Israeli hospitals. The average Palestinian physician is a product ofdozens of countries’ medical schools. Of the 959 physicians who were recog-nized as specialists by the PMC from 2000 to 2010, only twelve graduatedfrom a Palestinian medical school. The main six countries for training werefrom Russia (167), Egypt (97), Romania (94), Israel (91), Ukraine (75), Jordan(71) (PMC 2011, 102–103).23 There are several explanations to the wide diver-sity in the education of Palestinian physicians. First, as mentioned above, thereare only three medical schools in the West Bank and Gaza Strip. The admis-sions requirements are strict and tuition high. The Israeli Defence Force (IDF)roadblocks in the West Bank and the periodic fighting as well as high
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unemployment make it difficult to sustain studies in these schools for six years.Finally, the main and best medical training centres to practice in their finallearning stages are situated in East Jerusalem under Israeli control. Therefore,in many instances, going abroad is easier. The large Palestinian diaspora some-times provides a global network of support. Many teaching universities in EastEurope are cheaper than the Palestinians ones. They also provide more possi-bilities for future work. This trend encourages a Palestinian brain drain.
After graduation, a new challenge is presented to the average Palestinianphysician who aspires for specialization in Palestine. As mentioned above, theregulation of the specialization process was decided only in December 2008.Palestinian and Israeli interviewees suggested that the specialization pro-grammes are not recognized or supervised by top Western medical authorities.There is lack of congruence between the local curriculum of training and thehighest Western standards. Moreover the locally trained Palestinian specialistlacks in knowledge and skill to train new physicians in comparison to a spe-cialist from the Western hemisphere. In the words of a Palestinian professor,‘We have only one properly trained neurologist. We have people who callthemselves neurologists but they are not properly trained.’24
A second problem is that there are only few good places to specialize inthe West Bank. Many Palestinians mentioned that the main hospital for Pales-tinian training is Al-Makassed in East Jerusalem which is under Israeli control.Because Israel’s Health Ministry supervises the Palestinian hospitals in EastJerusalem, it refuses to allow Palestinian physicians from Al-Quds Universityto be trained in these hospitals since it doesn’t supervise the university’s curric-ulum. Other physicians are also under scrutiny. This is explained by Israelihealth officials as a necessity to ensure a suitable level of health care. It is lessunderstood by Palestinian physicians and hospital directors in East Jerusalemwho sees it as a way to politicize and control training.25 In order to bypassthese difficulties the Palestinian Medical Council encourages applying for shortfellowships or to try and establish a full residency by creating a conglomerateof hospitals in the West Bank that together could offer a better residencyprogramme.
The alternative for such programmes is to initiate periodic visits by foreignspecialists to the Palestinian hospitals. The idea’s rationale is that resident phy-sicians can learn from them. These specialists, however, are expensive andthey arrive for short periods, while full residents need constant supervisionthroughout their training.
None of these improvised solutions are available to the Palestinian physi-cian in the Gaza Strip which has been subjected to an Israeli blockade sinceHamas usurped the PA institutions. According to the current Minister ofHealth, Prof Hani Al-Abdeen, the Palestinian trained in Gaza ‘is at a dead end[…]. He has to leave Gaza. They don’t train postgraduates in Gaza […] So,when he finishes his sixth year he has to leave Gaza and train outside’.
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Other specialization alternatives are also scarce. In Western countries andespecially the United States, there are more limitations on the issuance of visasto Palestinians. The competition for residency programmes in Western coun-tries is much tougher. Moreover, these programmes are very expensive. Thereare similar problems in advanced health care systems in rich Arab countries.Finally, the search for better training encourages the local Palestinian to emi-grate from the Palestinian territories. A clear exception to this situation wasQatar’s financing a full residency programme with a cost of three million dol-lars for 10 Palestinian physicians from 2005 to 2009 Qatar News Agency(QNA 2009). While being supportive of the Qatar model, the Palestinian Min-istry of Health is reluctant to encourage the specialization of Palestiniansabroad from the simple fear that it will encourage the constant brain drain. Itcannot, however, resist the temptation of such prestigious residencyprogrammes if offered. In this case, it is clear that the Qatar offer was anexception.
Therefore, in many instances, Israeli fellowships or residency programmesare very attractive to Palestinian physicians. These programmes are cost free.Even if most of these programmes are short, they allow the Palestinian physi-cians to gain experience by training in Israeli hospitals which work under Wes-tern regulations. Moreover, all the interviews pointed to the high regardPalestinians feel towards the Israeli medical capabilities (Abuelaish 2011).Some of the Palestinians hope that even a short fellowship will give them anedge in their career. After six months of work in an Israeli hospital, they canbe part of the department rotation and earn approximately 1300 dollars permonth. This salary is similar to the average salaries in governmental hospitals.For others, the prospect of full residency is a ticket to ensure their careers inPalestinian hospitals. The geographic proximity offers other advantages. Itallows the physician to keep in contact with his family. It is also a guaranteethat in later years, he will be able to bring his patients for consultation withIsraeli colleagues.
The argument above explains why in spite of the official Palestinian stanceagainst cooperation, for hundreds of Palestinians physicians training in Israel isa positive career move. For the Palestinian physicians, the Israeli training pro-gramme increases their status in their government’s hospitals and in their soci-ety. After completion of the residency programme and receiving thespecialization credit from the PMC, they will not have to do duty roster in thegovernment hospitals. Their work hours will decrease from the morning tonoon and their chances to be appointed as department heads increase. Theycan also open private clinics that will dramatically increase their basicgovernment salaries.
From the above analysis, it seems that in the past two decades the trainingof Palestinian physicians in Israel has implemented MPB theory duringconflict. Palestinian physicians, however, still confront many challenges. Forlack of funds, many Palestinians are being turned down for such programmes.
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Others have to learn the language and culture quickly to be part of the staff.The Peres Centre sponsors short courses in Hebrew. These activities, however,are not sufficient to ensure acceptance in the Israeli health care system. Dailyroutine forces the physicians to deal with Israeli society which is sometimeshostile. Moreover, most of the information they have on Israel comes fromtheir direct experience, their families, the PA official statements and from Pal-estinian news agencies. The Israeli hospitals do not have special departmentsto ease the transition phase. As a result, sometimes the trainees may feel iso-lated. Short-term fellows are more likely to feel unequal and frustrated. Fur-thermore, because the first year is the toughest, there is the danger thatPalestinian trainees will transfer professional for political criticism. In two inci-dents, Palestinian physicians were frustrated at being posted to provincialIsraeli hospitals. Finally, even when they work in Israeli hospitals, they see thatthey are still being treated as regular Palestinians. Thus, they must leave carsat the IDF’s roadblocks and then take several buses to the hospital. Many timesthey have to stand in long lines early in the morning. The physicians also fearthat their decisions may turn their own society against them. In this study, itwas clear that Gaza physicians are more afraid than their counterparts fromEast Jerusalem or Ramallah. Several trainees feared that because they have bet-ter training, sometimes even in comparison to Palestinian specialists, the politi-cal card will be played against them by the Ministry of Health representatives,in the Palestine board exams, and in the hospitals. In spite of all the difficul-ties, the number of Palestinian applications in Israel is constantly on the rise.
Taken by itself, it is hard to bridge the gap between the individual will tobe trained in Israel and the official PA government’s hostile position towardsmedical cooperation with the Israelis. From the study it is clear, however, thatseveral hospital directors and mid-ranking officials in the Palestinian HealthMinistry support cooperation with the Israelis and oppose the official PAstance. The explanation for this is that the training of Palestinian physicians inIsrael is a political as well as a professional decision. Thus, some intervieweespointed out that several directors in East Jerusalem hospitals are politicized –meaning that they oppose cooperation with Israelis. In contrast, others point tothe fact that it is difficult to know who is supportive because all directors areunder constant pressure from the PA, public opinion, and the JordanianMedical Association, which works closely with Palestinian hospitals in theWest Bank. For example, this kind of pressure forced the termination of jointseminars held by Al-Makassed hospital and the esteemed Israeli HadassahUniversity Hospital in Jerusalem.
In several cases in the West Bank, government hospital directors encour-aged Palestinian trainees to go and train in Israel, promising to give them posi-tions upon their return. In one specific instance, it is clear that a governmenthospital director in the West Bank paid full salaries for trainees in the Israelihospital by funnelling funds received from both Israeli and foreign donors. Hisgoal is to train full medical teams by giving them full residency and make
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them come back to the Palestinian hospital. This will allow him to open newspecialized departments in the hospital. This training is not being publicized inorder not to aggravate high-ranking officials in the Ministry of Health or thepublic.
A good example of the potential and problem of medical training can beseen in Augusta Victoria hospital in East Jerusalem, run by the Lutheran WorldFederation. From the 1950s, this hospital specialized in treating Palestinian ref-ugees. During the 1990s, however, UNRWA, the international authority respon-sible for the treatment of Palestinian refugees, decreased the number ofpatients due to the high cost of treatment. Moreover, the collapse of the OsloAccords and the rising violence between Palestinians and Israel security forcesencouraged the building of a security fence and roadblocks, which made it dif-ficult for Palestinians to reach the hospital. As a response to these challengesthe hospital’s CEO, Dr Tawfiq Nasser, developed the most advanced cancercentre in the West Bank. The Palestinian Ministry of Health, which claimssovereignty in East Jerusalem, did not take part in this important health project.The Israeli Ministry of Health, which is the de facto regulator, baulked at au-thorising the programme until it was certain that other Israeli hospitals wouldnot follow suit and request new cancer treatment centres for medical tourism.The main funds came from the Lutheran World Federation and other EU coun-tries and American support. The Peres Peace Centre provided important logis-tic support. It also created the connections between Dr Nasser and Hadassah’sdepartment heads who treated cancer patients in order to encourage full resi-dency programmes for Palestinian physicians. Some of the physicians contin-ued to work in the hospital and maintain contact with Israeli hospitals in WestJerusalem. Others, who were not qualified to work in the field or were bitterwith Palestinian management, left the field. This successful example wasachieved without the support of the Palestinian or Israeli Ministries of Health.It was initiated due to economic necessity, the vision of a Palestinian directorwho saw the benefits of working with Israelis and foreign financial support.Finally, Israelis and Palestinians are cooperating on a permanent professionalbasis (Lutheran World Federation Jerusalem Programme 2011).26
Conclusion
During the twentieth century medical cooperation between Jews and Arabs inthe territory of west of the Jordan River was limited. Health became anotherfield of contention between the two peoples. The Framework Agreement from1993 promised to settle the protracted conflict by advancing separation of thetwo nationalities. Unfortunately, the tensions, suspicions and cycles of violencecontinued. Both parties’ governmental representatives were reluctant to cooper-ate and didn’t show understanding of the other side’s needs. They usually per-ceive the ‘other’ as an enemy. By doing this, they are expanding the fields ofconflict to health and failing to build bridges for future cooperation. This
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conclusion should also be a warning sign against the simplistic execution ofMPB theory. As was shown in this paper, any medical action such as humani-tarian aid, movement of medical staff or the work of Palestinian physicians inEast Jerusalem becomes a contested action.
In spite of these grim findings, many Israelis and Palestinians who wereinterviewed agree on an ideal model that should be advanced as part of otherdevelopment programmes of the health sector in the Palestinian territories.They claim that the cooperation should result in the training of Palestinianmedical teams for periods of 5–10 years. The teams should include full resi-dency programmes in various department specializations, for technicians andnurses as well. They see this as a better model for several reasons: the hospi-tals are relatively close, it will increase the total number of trainees; it willassimilate the most advanced working norms practiced in Israel and modelledto the norms of Western hospitals in the Palestinian medical core; it willencourage long-term consultation between professionals and with it the build-ing of trust between all participants on more equal terms; the team could thentrain other teams and increase the overall professional level in Palestinian hos-pitals and thus create advanced secondary and tertiary medical centres whichin turn could provide employment for thousands of Palestinians and become asymbol of development for the society.
The gap between the ideal training model and the uncooperative stance ofthe two governments was not dominated by political estrangement. WhileMPB theory insists on government involvement, it is clear that many of theachievements made by Palestinians training in Israel in the past two decadesare due to local needs and necessities as well as positive perceptions of theother by thousands of individuals.
This article shows that mutual beneficial cooperation has planted the seedsfor future cooperation. Moreover, future studies should also examine howhealth and other social areas, perhaps provide parts of the explanation why thisspecific protracted conflict remains stable.
The incentives for such cooperation are different. For the Israelis, coopera-tion is something to be done while making sure that it will not force them tomake too many concessions. Hundreds of people involved in the training ofPalestinians see political, professional and moral benefits in this practice. Forthem this action is a vote of confidence in their system and in the possibilityof a future of professional cooperation with Palestinians, as they work withother counterparts around the globe.
For the Palestinians, training in Israel is a professional opportunity thatsolves individual career needs and helps to create and sustain new tertiarycapabilities. What is clear is that in spite of the many difficulties facing Pales-tinians trained in Israel, the number of Palestinians turning to Israel for trainingis constantly on the rise.
This grassroots action is under constant threat by the political level whichis present usually as an obstructive element. Therefore, most people
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interviewed for this study hoped that the shadow of politics on health wouldbe removed, so that cooperation, development, and trust will become a jointstrategy for both parties on all levels.
AcknowledgementThis article is part of a research project that was funded by the Tami Steinmetz Centerfor Peace Research in Tel Aviv University. I am grateful for Mottie Tamarkin, EphraimLavie and the anonymous reviewers for their useful comments.
Notes1. Haminhal Ha’Ezrahi is subordinated to the The Coordinator of Government
Activities in the Territories (COGAT) which is a unit in the Israeli Ministry ofDefence which responsible for coordination of civilian issues between the Israeligovernment offices, international organizations, foreign governments and the PA.
2. The Israeli health system confronts several challenges that may change its policyin future years. The ratio of trained physician is in decline in comparison to popu-lation growth. There is growing shortage in several fields such as anaesthesia,intensive care, pathology and geriatrics. Due to low salaries to young physicians,there is a constant brain drain. All in all, the Israel Medical Association officialdocuments warn that the Israeli health system will deteriorate during the secondand third decades of the twenty-first century.
3. Prof Alex Leventhal, Director of the Department of International Relations, IsraelMinistry of Health, Telephone interview by the author, 10 April 2011.
4. Dr Amir Shanon, Director, Department of Medical Professions, Israel Ministry ofHealth, Interview by the author, Tel Aviv, 25 March 2011.
5. Brigadier General Yoav Mordechai, Chief of Civilian Administration, COGAT,Interview with the author, Tel Aviv, 19 December 2010.
6. An undisclosed high ranking official in an Israeli hospital in Jerusalem, Interviewwith the author, Jerusalem, 30 June 2011.
7. Ms Dalia Basa, Health Coordinator, Civilian Administration, Interview with theauthor, Jerusalem, 26 April 2011. Palestinians who were interviewed for this studyconfirmed her unique efforts to help them.
8. Undisclosed Palestinian official, interview with Author, Jerusalem, 23 March 2011.9. PNA, Ministry of Health, Palestinian National Health Strategy 2011–2013, Setting
Direction Getting Results (Ramallah: PNA-MH, 2010).10. Undisclosed Palestinian Physician, interview with author, Jerusalem, 24 March
2011.11. Ms Tamara Barnea, Director of the JDC’s Unit for Disabilities and Rehabilitation
Israel, Interview with the author, Tel Aviv, 28 September 2010; Prof Shaul Harel,retired paediatric neurologist at theTel-Aviv Medical Centre, interview with author,Tel Aviv, 5 August 2010.
12. Prof Shlomi Constantini, director of the Department of Paediatric Neurosurgery attheTel-Aviv Medical Centre, Interview with the author , Tel Aviv, 31 August 2010;Prof Harel, interview; Dr Dan Shanit, former Director of the Medicine & Mealth-care Department, The Peres Centre for Peace, Interview with the author, Tel Aviv,31 August 2010.
13. This line of criticism was raised by Palestinian and Israeli physicians.
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14. Several high-ranking Israelis and Palestinian government officials and physicianspointed on this issue. They also demanded that their name will be omitted for fearof negative repercussion.
15. Dr Shanit, interview.16. Ms Rachel Harari, Director of the Medicine & Mealthcare Department, The Peres
Centre for Peace, Interview with the author, Tel Aviv, 5 April 2011; Dr RonLobel, Depurty Director at Barzilai Hospital, Interview with the author, Ashkelon,8 October 2010; Undisclosed Palestinian Physician, interview with author, TelAviv, 8 March 2011.
17. These arguments were raised by several Palestinians who were interviewed. Itseems that the higher the rank of the Palestinian medical personal there was also arise in the suspicion towards Israeli initiatives.
18. The danger in Palestinian medical tourism – from the perspective of Israelis – wasmentioned also in several interviews especially in the context of the work of twochildren’s medical centre, Schneider and Safra, in the centre of Israel. See also:Linder-Ganz, Roni, ‘This is How medical tourists put Israeli patients in danger inthe hospitals,’ The marker, 15 November 2011. http://www.themarker.com/consumer/health/1.1566547.
19. Dr Gil Fire, Deputy Director, The Tel Aviv Sourasky Medical Centre, Interviewwith the author , Tel Aviv, 17 May 2011; Prof Eitan Kerem, Chairman,Department of Paediatrics, Hadassah Ein Karem, Interview with the author,Jerusalem, 11 April 2011.
20. Prof Eitan Kerem, Chairman, Department of Paediatrics, Hadassah Ein Karem,Interview with the author, Jerusalem, 11 April 2011.
21. Personal document received from the Foundation, 6 May 2011; see also the officialsite of the foundations www.karlkahanefoundation.org. All Israeli and Palestinianphysicians who work in Hadassa and Dalia Bassa praised this programme.
22. Ms Gitte Hundahl, Deputy to the Denmark Ambassador to Israel, Interview withthe author, Tel Aviv, 17 March 2011; Dr Ron Pundak, Director of Peres Centrefor Peace, Interview with the author, Tel Aviv, 5 April 2011; Shanit, Interview.
23. PMC, Palestine Medical Council Guide: Laws-Bylaws-Rules (Ramallah: PMC2011), 102–103.
24. Undisclosed Palestinian Physician, interview with author, Jerusalem, 24 March2011. This statement received support by other Israeli and Palestinian physicianswho claimed that in many instances there is a gap between the Western criteriafor specialists and Palestinian criteria.
25. Dr Amir Shanon, Interview; Undisclosed Palestinian Physician, interview withauthor, Jerusalem, 4 April 2011.
26. Shanit, Interview; Prof Michael Weintraub, Chairman of the Paediatric Hemato-Oncology, Hadassa Hospital, 13 March 2011; Undisclosed Palestinian physician,interview with the author, 28 February 2011.
Notes on contributorChen Kertcher received his PhD from Tel Aviv University in 2010 for his dissertation.The United Nations and Peacekeeping in Cambodia, Former Yugoslavia and Somalia,1988–1995. During 2010–2013, he was a research fellow in the Tami Steinmetz Centrefor Peace Research in Tel Aviv University. From 2013, he is a research fellow in the HerzlInstitute in Haifa University for his research on the United Nations, Israel and the war onterror. He lectures on global history, conflict resolution, peace building and peacekeepingoperations in Tel Aviv University, Haifa University and the Interdisciplinary Centre inHerzliya (IDC).
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