On July 5, 1948, at the height of the War of Independence, an unusual letter was sent to Dr. A. Katznelson, director general of the newly established state’s Health Ministry, by Dr. R. Pfilimin, a Red Cross representative. Pfilimin said 75 Jews were still hospitalized at a psychiatric hospital in Bethlehem, a city that had been in Jordanian hands for about six weeks. The hospital director, Dr. Mohammed Taha Dajani, sought to send them to Israel “as soon as possible.”
This was the first of several letters collected in a file at the Israel State Archives titled “Jewish psychiatric patients in Bethlehem.” It contains the unusual story of the dozens of Jewish patients who remained on the wrong side of the border, the treatment they received from Arab doctors, Israel’s indifference to their fate and, finally, their return to Israel thanks to international diplomatic efforts.
The file came to light thanks to an article published recently in the journal “History of Psychiatry” by Dr. Daniel Argo, a psychiatrist from the Jerusalem Mental Health Center, along with researchers Vladislav Fainstein and Edgar Jones.
The Bethlehem psychiatric hospital was built in 1928 and is still a main treatment center for psychiatric patients in the West Bank. Back then, it was the main psychiatric treatment center for British-ruled Mandatory Palestine, but it provided only a very limited solution to the enormous need for psychiatric beds for both Jewish and Arab patients. Two years after it opened, the article said, its waiting list numbered 88 Arabs and 67 Jews.
The hospital was run by British medical services, with a British director and Arab doctors. Its wards had both Arab and Jewish patients, and the kitchen was kosher.
Argo believes the hospital served only people whose families couldn’t afford either private hospitalization – which was common among Jews – or hospitalization in Lebanon, which was common among Arabs.
In May 1948, when the British left, the hospital was transferred to the Arab Medical Association and Dajani became its director. It had 75 Jewish patients at the time, most of them women. Their ages ranged from 24 to 74, but most were fairly young and of Eastern European origin. Most had been there for years, since the 1930s.
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Their names are blacked out in the archive file, but Argo posited that most of the patients were immigrants whose mental illness erupted due to their separation from their families and the difficult living conditions. There is no mention in the documents of any involvement of their families.
Another possibility raised by the researchers is that their illness is what prompted them to move to pre-state Israel to begin with.
“It’s a big question which came first,” Argo said.
Either way, the Jewish patients remained at the Bethlehem hospital even during the Arab riots of 1929, when their co-religionists in nearby Hebron were slaughtered; throughout the Arab Revolt of 1936-39; and even after the land was torn apart by the War of Independence.
In May 1948, Arab forces captured Gush Etzion and murdered the last of its Jewish defenders, thereby eliminating the last Jewish foothold in the West Bank. At the same time, hundreds of thousands of Palestinians were fleeing to the West Bank from areas captured by Israeli forces.
Argo speculated that their social classification as mentally ill protected the patients during thsse historic upheavals.
“To some extent, hospitals remained almost the only place where, throughout the decades prior to the state’s establishment, Jews and Arabs lived together, even during the tensest of times,” he said. “Today as well, Jews and Arabs continue living together all the time in psychiatric hospitals; it’s a kind of extraterritoriality.”
“Had they been regular patients at a regular hospital, it would presumably have ended less well,” he added. “There’s something that protected them in the fact that they were psychiatric patients – for better and for worse. For better, because nobody harmed them; for worse, because it was easy to forget them.”
And indeed, somebody evidently wanted to forget. There’s no evidence in the correspondence that Katznelson and the Israeli government saw any urgency about repatriating the Jewish patients. Only about six weeks after Pfilimin’s letter arrived did Health Minister Haim Moshe Shapira hold a first meeting about it.
The psychiatric patients in Bethlehem were the meeting’s fourth agenda item. Health-care officials proposed exchanging the Jewish patients for Arab patients housed in the psychiatric ward of Acre Prison, and the final decision was to ask the Red Cross to arrange such a trade.
However, some officials at the meeting wondered whether conditions at Acre Prison would be suitable for the Jewish patients, so a Dr. Lichtag was assigned to study this issue. A handwritten note in the archives file sheds light on the problem: “Dr. Lichtag already said that the conditions in Acre are not suitable for Jewish patients,” it noted.
Further correspondence reveals the Health Ministry’s desire to get rid of the Arab patients in Acre. In a letter to I. Golan of the Jewish Agency regarding “support for the psychiatric patients at the Bethlehem hospital,” an aide to Katznelson wrote, “I’ve been asked to inform you that we’ll pay 1,340 Israeli pounds to maintain the Jewish patients at the psychiatric hospital in Bethlehem. But we ask you to tell the Red Cross to inform the Arab authorities of the fact that the Israeli government is supporting 45 patients in Acre at its expense. Therefore, the Red Cross should ask the Arab authorities to pay the Israeli government for maintaining these 45 patients.”
On September 1, almost two months after Pfilimin first wrote, the Israeli government sent the Red Cross a check for 1,350 pounds. The researchers concluded that this sum, which had been requested by the hospital, was low compared to the cost of treatment in those days. Meanwhile, in both typed and handwritten correspondence, Israel continued to press for an exchange of the Jewish and Arab patients.
Later, another check was sent, but the Red Cross had already left Jerusalem, so it’s not clear if the money ever arrived. The file contains dozens of letters about the payment, which was discussed by the Health Ministry, the Foreign Ministry, the army and other agencies.
In October, the Arab Medical Association wrote that it could no longer afford to continue supporting the Jewish patients. This letter spurred the Israeli government to find a place to put them. One possibility considered was an abandoned military prison in Jerusalem.
Meanwhile, Dajani’s pleas grew more urgent. In a letter to the UN observer on December 11, he wrote, “I am sorry to trouble you, but it seems to me that people do not understand that mental patients need bread to eat and cannot be maintained by letters or discussions ... I ask you in the name of humanity to come and see these invalid patients, I cannot get them any funds from any place to save them from starvation.”
Dajani’s letter – and, even more, the death of three patients – finally got the Israeli government moving. The medical documents show that two of the patients died of “heart failure” and one of “heart failure due to general weakness”; Argo interprets this as dying of hunger. To this day, the patients’ burial site remains unknown.
Finally, on January 24, 1949, more than six months after the correspondence began, the patients were moved to Israel. The documents say 69 of them were transferred via the Mandelbaum Gate, the only transit point between the Jordanian and Israeli sectors of Jerusalem; it’s not clear what happened to the other three.
Jordan’s Arab Legion guarded the transfer, the Egyptian army provided the ambulances and Arab Medical Association members accompanied the patients to the border. The patients were then sent to several Israeli psychiatric hospitals.
A front-page article in the now-defunct daily Davar heralded their arrival. “The patients were transferred one by one from the Arab cars to Jewish ones, with the help of Jewish and Arab nurses and caregivers,” it said. “The patients all wore gray hospital robes and slippers. It’s evident that their treatment was generally satisfactory ... Dr. Katznelson asked the Arab doctor accompanying them to express his appreciation to Dr. Dajani, the director of the Bethlehem hospital, for the patients’ treatment.”
Another paper, Herut, headlined its article “Hysterical scenes during the psychiatric patients’ transfer” and described the “strange scenes” its reporter witnessed: “While some of the patients went wild in frenzied joy, other women burst into hysterical tears, and one woman parted from her Arab doctor, Dr. Hadad, with bitter tears and cries of ‘my darling.’ In general, the patients’ appearances were shocking.”
Three days later, Moshe Zaimin, an official from the Health Ministry’s Jerusalem office, wrote to the director of the ministry’s warehouses. “Please inform me as soon as possible if we have any clothing for patients, stockings and slippers in our warehouses that could be used for the patients transferred from Bethlehem to Jerusalem,” he wrote. “I’m especially interested in warm winter clothing. Please view this as urgent.”
“In the end,” Argo said, “medical personnel on both sides overcame even the crisis we described in our article. They worked successfully to return the patients to their own borders – and perhaps that’s also a reason why this story has been forgotten.”