Being a medical student where I live is totally different from any other place in this big world. What does it take to be a medical student living under occupation? How does it feel to need permits and checkpoints before you even reach your medical school? What if your city and your school suffer continuous bombardment for days?
Choosing to study medicine in my native country is a capital undertaking, with a surrounding fragile healthcare system, deficient in medical supplies and in short supply of expertise. Through this series of articles, I will share my experiences and perspectives on being a medical student in Palestine.
This morning, I woke up at 5 a.m. I got dressed, put on my stethoscope over my white coat. After packing a snack into my bag, I closed the door to my apartment behind me, ready to face the world outside those walls. This is how my daily ordeal begins to get to the hospital.
I walk to the bus and get on, knowing that we will soon have to stop at a checkpoint. The driver says to me: “We have reached the checkpoint”, and suddenly we stop. I try to look out the window, and the driver remarks that he sees “a long, long line of cars and buses stopped at the checkpoint.” The driver decides to wait… 15 minutes… 30 minutes… 45 minutes. All the while, I’m stressing about my clinical placement and the fact that I should be in the hospital by 8:30 at the latest. We are still waiting an hour later when the soldier asks me for my ID, which I keep in my wallet for quick and easy access.
I finally arrive at the hospital, rushing to the morning orderly room, and see doctors leaving the room. Ohh, I missed the morning report. I take a deep breath and say to myself, at least I arrived… Duha, start your day.
The palestinian health system was founded in 1994 from the Oslo Accords and is currently a disjoint sector consisting of the Palestinian Ministry of Health (MoH), Non-Governmental Organizations (NGOs), United Nations Relief and Works Agency ( UNRWA) and private services. Inequality of access, overtaken by financial and other barriers to care, such as unfair health insurance coverage, has defined the Palestinian healthcare system since its inception. An atmosphere of ongoing violence contributes to significant health disparities ranging from the effects of the environment on health to the lack of accessible and high-quality health services. Due to a fragmented healthcare system with a dispersed population, creating a well-organized and connected medical education system has posed a daunting challenge.
Despite these challenges, the Occupied Palestinian Territory (OPT) has seven medical schools, two of which are located in the Gaza Strip (Islamic University of Gaza and Al Azhar University) and the rest in the West Bank (An-Najah National UniversityAl Quds University, Arab American University – Jenin, Hebron University and Palestine Polytechnic University). The first medical school opened in 1994 at Abu-Dis University, Al-Quds. However, the complexities associated with health care delivery and ongoing geopolitical conflicts make the study of medicine extremely difficult.
The military occupation has significant impacts on the education and quality of life of Palestinian medical students. For medical students, one of the most immediate physical obstacles posed by the military occupation, particularly in the West Bank, is movement restrictions when traveling between cities to their medical schools and hospitals. These restrictions have a political-historical basis. Since the beginning of the military occupation in 1967, restrictions have been put in place on movement from one place to another. So even mundane moments like going to the hospital in the morning can have a significant impact on the medical student experience.
The Occupied Palestinian Territories (OPT) includes the West Bank, East Jerusalem and the Gaza Strip. Individuals in the OPT carry one of 3 identities, each of which reflects where they are free to travel. Palestinians like me hold the West Bank identity card and are prevented from entering Jerusalem without asking for special permission. Those with a Jerusalem identity reside in Jerusalem and can enter the West Bank. Finally, Palestinians with Gaza ID cards cannot leave Gaza. Identity status determines which hospitals medical students living in the West Bank are allowed to access. For example, some students have to go through the arduous process to apply for a special permit to enter certain hospitals such as Al-Makassed Hospital in Jerusalem.
Even when students obtain written permits, they may be denied access to the hospital for seemingly no obvious reason for denial. some students will not be allowed entry on the basis of their ID at all, which means that these students will not have access to certain clinical training opportunities and will have to make up for it in other ways.
Identity status notwithstanding, movement itself is limited in the West Bank by various obstacles. The physical barriers include roads prohibited to Palestinians and a height of eight meters, 700 km long concrete separation wall that separates the West Bank from Jerusalem and Israel. There are also military checkpoints; In September 2017, there were 98 military checkpoints in the West Bank, 59 permanent checkpoints located deep in the West Bank, 18 in the H2 area of the city of Hebron, where Israeli settlement enclaves were established, 39 manned checkpoints and 2,941 flying checkpoints along West Bank roads (327 on average per month). My own morning commute requires passing through one checkpoint per day, with wait times ranging from a few minutes to several hours depending on the day. Some of my classmates have to go through two or three checkpoints every morning.
As a medical student here, the consequences of these identification, control and physical barriers can be illustrated by my own morning commutes and those of my colleagues and the effect of these long commutes on the rest of our day and our studies. For example, for one of my classmates, the weekly commute to and from Jerusalem may require taking up to six different buses or taxis to get to the hospital. Think about all the time you spend studying outside of school, then try to imagine spending several hours commuting.
In addition to wasting time that we could spend studying, sleeping or socializing, my colleagues and I suffer from the stress that all this imposes. Often these barriers leave us feeling humiliated, intimidated and disrespected. Many students, especially in the West Bank, face movement restrictions when traveling between cities to get to their medical school and hospital. All Palestinian students who have chosen to stay and study medicine in Palestine, at a minimum, face the emotional and psychological effects that clearances and checkpoints have on their clinical training.
To begin to understand what it is like to be a medical student in Gaza, we need to explore more than these restrictions on daily travel. The Gaza Strip has been blocked for more than 15 years, with travel restrictions, the export of foodstuffs and essential equipment, in particular medical supplies and medicines. My next article will be about studying medicine in Gaza.
Image (“The Way to School, Everyday Story”) used with permission by Wajed Nobani