Border Control / 'The Best Doctors Are Moving to the West'

Palestinian Health Minister Fathi Abu Moghli speaks softly, but his message is clear: Israel and Hamas are causing immediate and long-term damage to the health of his people Dr. Fathi Abu Moghli is detached from all the pomp and circumstance usually associated with being a government minister.

Palestinian Health Minister Fathi Abu Moghli speaks softly, but his message is clear: Israel and Hamas are causing immediate and long-term damage to the health of his people Dr. Fathi Abu Moghli is detached from all the pomp and circumstance usually associated with being a government minister. The new Palestinian minister of health in the West Bank-based government, headed by Salam Fayad, arrived for this interview without an aide or spokesperson. Former colleagues at the World Health Organization made available to him the modest conference room at the representative office in East Jerusalem.

Even though he is responsible for matters of life and death, the Palestinian minister in the gray suit speaks calmly, almost shyly. Even when he complains that the Israeli minister of ealth and his director-general ignore his existence and the existence of severe health problems across the road, Abu Moghli chooses diplomatic phrasing such as, "If they see us as partners and neighbors, why don't they invite me? We have many common problems and five joint committees established by the Oslo Accords that are not functioning, including a committee to deal with epidemics."

Abu Moghli was born in Nablus not long after his parents fled there in 1948. His father, a native of Nablus, worked at the time in Haifa, together with Abu Moghli's mother, a native of Acre. From the West Bank, the family traveled to Jordan, where it spent most of his early years. Abu Moghli completed his medical studies and internship in Greece. Nine years ago, he closed a circle in his life by returning to the West Bank in order to set up a network of clinics in the territories. During the four years that he headed the Palestinian Health Ministry's projects department, he promoted the establishment of 34 health centers and updated the "basket of medicine." During most of the intifada, he held a senior position at the WHO office for the West Bank and Gaza.

In order to arrive on time at its offices in Jerusalem, Abu Moghli used to leave his Ramallah home early in the morning. He had an opportunity to see first-hand the long lines of patients waiting at the checkpoints at the entrance to the city.

The budget of the Palestinian Authority's Ministry of Health last year amounted to $145 million, which included payments for medical treatments in Israel, Egypt and Jordan. There are 13,000 salaried employees, including physicians and social workers at 22 government-run hospitals.

How does the crisis in the relationship with Hamas affect the health of the Palestinian public?

"Since the first moment after the revolution - excuse me, the revolt - we have been determined to disengage health services from politics. Unfortunately, Hamas decided to act otherwise. It intervenes in the management of hospitals and dismisses workers in order to make jobs available to its loyalists. This affects the medical teams and makes it hard for us to run the system. When I entered this job, 128 medications were missing in the territories. I managed to reduce this to 50-55. But the economic siege imposed on the Gaza Strip since last June makes the supply of medications very difficult. As far as I'm concerned, there's no difference between a hospital and a patient in Gaza and a hospital and a patient in the West Bank."

You claim that the Israel Defense Forces' policy in the territories - for example, with regard to checkpoints - is destroying Palestinians' health?

"Absolutely. The limitations on movement and the closures cause poverty in the territories to intensify. Poverty goes hand-in-hand with illness and illiteracy. Despite the fact that health and education are provided free, or almost free, too many children do not get to the clinics and the schools. Either they don't have a permit to cross through the checkpoint, or they don't have money for a bus ticket, or both. Poverty also leads to a decline in nutrition levels and the children are the first to pay the price. They don't get nutritious and healthy food and instead of vegetables and meat, they eat mainly carbohydrates. We see the results: More and more children are suffering from obesity and anemia.

"Since the establishment of the Palestinian Authority in 1994, we have managed to reduce infant mortality each year. From 37,000 infants, we reached 24,000. We hoped to get closer to you (infant mortality in Israel is less than 7 per thousand), but over the last five years, the downward trend stopped. Because of the restrictions on movement, there was a sharp decline in the number of deliveries in hospitals and maternity centers. We had brought the number of births at home down to 6 percent, but in the last year, the rate has increased to 20 percent."

Are the phenomena you describe also typical in the area of mental health?

"As a result of the ongoing economic and political pressure, along with the absence of personal security, a generation of mentally and physically ill people is growing up among us. In recent years, we have witnessed a huge increase in the rate of mental disorders and phenomena such as bed-wetting among children. This is reflected in the number of people referred to mental health centers: This number is increasing tenfold. The lack of hope for change and the political violence have also lead to an increase in domestic violence. I'm convinced that this phenomenon stems from the political-socio-economic situation, and not from Palestinian culture. You should realize that more frustrated and mentally disturbed people means more hatred and more violence.

"Unfortunately, in recent years, there has been an ongoing deterioration in the level of the psychiatric hospitals. If until 1967, the mental hospital in Bethlehem was considered one of the best in the region and admitted patients from Jordan and East Jerusalem, the situation is not as good today as it was then. Most of the time, the physicians and medical staff are busy diagnosing ailments caused by external factors and attempt to improvise solutions for them. There is no better cure than peace between the two countries, Israel and Palestine. But even after we build up peace, you will have to help us close the gap."

How does the situation affect the level of physicians in the territories?

"As could have been expected, the inability to pay physicians' salaries led to a brain drain to Arab countries and to the West. For a long time now, there has not been a single senior gynecologist in Ramallah. A severe shortage of pathologists makes it very difficult to diagnose blood ailments and cancer. A pathologist who goes to Jordan can earn a salary five times as high [as what he would earn in the territories]. We also have a problem with training physicians. According to an arrangement determined many years ago, the only medical faculty is the one at Al Quds University. Because of the break between the territories and Jerusalem, it was decided to open a program of basic medical studies, the first two years, at An-Najah University in Nablus and Al-Azhar University in Gaza as well. We had hoped that the situation would improve and the students would continue their studies at Al Quds. As you know, the situation did not change and they continue to study in Nablus and Gaza. The result will be a surplus of physicians and more unemployed."

A few days ago, there was a report in Haaretz about a Bethlehem youth who died in an ambulance after being delayed at the Bethlehem checkpoint en route to Hadassah Hospital. Human rights organizations blamed the Civil Administration, while on the other hand, Israeli security officials argued that ambulances are used to smuggle in terrorists.

"I have no complaints against health coordinator Dalia Basa, who is responsible for arranging the passage of patients into Israel. Dalia is only one of the instruments of the occupation. Dalia is a nice woman and does her job in the best possible way. The day will come when the occupation ends and the Israelis and Palestinians realize that they must establish neighborly relations; we will even be able to be friends and visit each other. "Hospitals such as Ichilov [in Tel Aviv], treat our ill and injured, but the Israeli security officials make it difficult to obtain transit permits. Lucky patients who receive a permit must wait to cross the long tunnel at the Erez checkpoint. How can it be possible to do that to cancer patients? I see no reason why a Palestinian ambulance cannot cross freely from the West Bank or Gaza to hospitals in East Jerusalem and why we should have to transfer patients back-to-back. Apart from that, Magen David Adom charges one thousand shekels or more, and many patients cannot allow themselves to pay these sums. I don't believe that our ambulances have been used negatively. Those are fictitious stories."