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 cross checkpoints before even reaching your medical school? What happens if your city and school undergo continual bombardment for days?
Making the choice to study medicine in my homeland is a momentous undertaking, with a surrounding fragile health system deficient of medical supplies and in shortage 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 get dressed, throw on my stethoscope over my white coat. After packing a snack into my bag, I shut my apartment door behind me, ready to face the world outside those walls. This is how my daily ordeal to get to the hospital begins.
I walk to the bus and get on, knowing that we will have to stop soon at a checkpoint. The driver tells me, “We reached the checkpoint,” and suddenly we stop. I try to look from the window, and the driver remarks that he sees “a long, long line of cars and buses stopped at the checkpoint.” The driver decides we should wait … 15 minutes … 30 minutes … 45 minutes. All the while I am stressing about my clinical rotation and the fact that I should be at hospital by 8:30 a.m. 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 reach the hospital, rushing to the morning report hall, and see physicians leaving the hall. Ohh, I missed the morning report. I take a deep breath, and I tell myself, at least I arrived … Duha, begin your day.
The Palestinian health care system was founded in 1994 from the Oslo Accords and is currently a disjointed sector comprised of the Palestinian Ministry of Health (MoH), Non-governmental organizations (NGOs), United Nations Relief and Work Agency (UNRWA) and private services. Access inequality, overwhelmed by financial and other obstacles to care, such as inequitable health insurance coverage, has defined the Palestinian health care system since its beginning. An atmosphere of continual violence contributes to significant health disparities ranging from environmental health effects to lack of accessible,high-quality health services. As a result of a fragmented health care system with a scattered population, creating a well-organized and connected medical education system posed a significant challenge.
Despite these challenges, the Occupied Palestinian Territory (OPT) has seven medical schools, with two located in the Gaza strip (Islamic University of Gaza and Al- Azhar University) and the rest in the West Bank (An- Najah National University, Al-Quds University, Arab American University- Jenin, Hebron University and Palestine Polytechnic University). The first medical school opened in 1994 at the Abu-Dis, Al-Quds University. However, the complexities associated with health care delivery and ongoing geopolitical conflict make the study of medicine exceedingly difficult.
Military occupation has far-reaching impacts on the education and quality of life of Palestinian medical students. For medical students, one of the most immediate and physical barriers posed by the military occupation, especially in the West Bank, concerns restrictions on movement while traveling between cities to reach their medical schools and hospitals. These restrictions have a political-historical basis. Ever since the military occupation started in 1967, restrictions were put in place on movement from one place to another. As such, even mundane moments such as commuting to hospitals in the morning can have a significant impact on the medical student experience.
The occupied Palestinian territories (OPT) consist of 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 myself hold the West Bank ID and are prevented from entering Jerusalem without applying for special permission. Those with a Jerusalem identity reside in Jerusalem and are able to enter the West Bank. Finally, Palestinians holding the Gaza ID are unable to leave Gaza. ID status determines what hospitals medical students living in the West Bank are allowed access to. For instance, some students have to go through the arduous process of applying for a special permit to enter some hospitals such as Al- Makassed Hospital in Jerusalem.
Even when students acquire written permits, they may be refused access to the hospital seemingly without any obvious reason for refusal. Some students won’t be allowed in at all based on their ID, which means these students won’t have access to some clinical training opportunities and need to make up for them by other means.
ID status notwithstanding, travel itself is restricted within the West Bank by various obstacles. Physical barriers include roads forbidden to Palestinians and an eight-meter high, 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 within the West Bank, 59 permanent checkpoints located deep within the West Bank, 18 in Area H2 in the city of Hebron, where Israeli settlement enclaves have been established, 39 staffed checkpoints, and 2,941 flying checkpoints along West Bank roads (an average of 327 a month). My own morning commute requires going through one checkpoint daily, with wait times ranging from minutes to hours depending on the day. Some of my classmates are required to go through two or three checkpoints every morning.
As a medical student here, the consequences of these ID, checkpoint and physical barriers can be illustrated by my own and my colleagues’ morning commute and the effect these long commutes have on the rest of our day and studies. For example, for one of my classmates, the weekly journey of coming to and from Jerusalem can require taking up to six different buses or taxis to arrive at the hospital. Think of all the time you spend studying outside of school and then try to imagine spending several hours of time on transportation.
On top of losing time that we could spend studying, sleeping or socializing, my colleagues and I suffer from the stress this all imposes. Oftentimes, these barriers leave us feeling humiliated, intimidated and disrespected. Many students, especially in the West Bank, deal with restrictions on movement while traveling between cities to reach their medical school and hospital. All Palestinian students who have chosen to stay and study medicine in Palestine, at minimum, deal with the emotional and psychological effects permissions and checkpoints have on their clinical training.
To begin to understand what it is like being a medical student in Gaza, we must explore more than these restrictions on day to day travel. The Gaza strip has been under blockage for more than 15 years, with restrictions on traveling, exporting food and essential materials and specifically medical supplies and medicine. My next article will focus on studying medicine in Gaza.
Image credit: Photograph (“Way to school, everyday story”) used with permission from Wajed Nobani.