30 percent of vital medicines “at zero supply” in Gaza, says released doctor Tarek Loubani

Nora Barrows-Friedman The Electronic Intifada Podcast 12 November 2013

Gaza has “possibly the best indigenous medical system to be created within such a terrible siege,” says Dr. Tarek Loubani.

Ashraf Amra APA images

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US university to build “peace campus” in Palestinian Nazareth

by Patrick O. Strickland in Ramallah

Texas A&M University recently announced plans to establish an international campus in the Palestinian city of Nazareth, situated in the Galilee region of present-day Israel.

The plans were announced shortly after Texas Governor Rick Perry visited Israel late last month. Perry was accompanied by John Sharp, the chancellor of Texas A&M University. The two met Israeli President Shimon Peres, who The New York Times claims decided that the university ought to be located in Nazareth, the most populous Palestinian city in present-day Israel.

Perry’s visit was no surprise. Back in June, he told The Washington Times that he was “going to Israel to bring together Arabs, Christians and Jews in an educational forum.”

However, the plan was only recently announced when Governor Perry and John Sharp, the chancellor for Texas A&M University, visited Israel at the end of October. The new Texas A&M campus will take over the Nazareth Academic Institute, a privately-funded Palestinian school in Nazareth that has struggled to keep afloat due to Israel’s refusal to award it accreditation and state-funding.

Omar Barghouti of the Palestinian Campaign for Academic and Cultural Boycott of Israel sat down and spoke to The Electronic Intifada.

Barghouti:

From what’s been revealed so far it looks like an extremely dangerous, Zionist project that has several objectives. Our educated guess is that the main objective is to undermine the potential or the possibility of establishing an independent Palestinian university within the State of Israel, which has been the dream of Palestinian citizens of Israel for decades actually… and Israel has been thwarting that possibility for so long.

So bringing an American university to Nazareth would obviate the necessity for a Palestinian university, the argument goes. We think that the fact that Shimon Peres, Netanyahu, and leaders of the Christian fundamentalist Zionists in the US are proposing this, this cannot be innocent. This cannot be for the benefit of Nazareth. This must be serving the overall objective of the regime in Israel — the apartheid, occupation and colonization regime — to further Judaize the area, to further undermine the possibility of autonomy of Palestinians in Israel, and to spread their gospel, so to speak, of Christian Zionism among Christian communities in Nazareth, which is a real concern as well.

The new international branch — deemed a “peace campus” — is said to have the goal of providing education for Muslims, Christians, and Jews. Yet the names behind the project raise concerns about the real goals of putting an international university in Nazareth.

On top of Governor Perry’s history of staunchly supporting Israel, he is known for a number of racist remarks against Palestinians as well as his close ties to leaders in the Christian Zionist movement in the United States.

Among his close associates is John C. Hagee, a San Antonio-based evangelical mega-church preacher who is known for his apocalyptic Christian Zionism. Hagee, who is also the founder of Christians United for Israel, has been known to raise tens of millions of dollars for illegal Israeli settlements in occupied East Jerusalem and the broader West Bank.

Bishara Qattouf, who is president of the Nazareth Academic Institute, told The Electronic Intifada that they had not yet signed any agreement with Texas A&M, saying “we haven’t signed a single paper with them. We know nothing about it for the moment.”

Omar Barghouti confirmed that there has been consultation with the local Palestinian population in Nazareth about whether an international campus will address their educational needs.

Barghouti:

Who consulted with us? Or you decide in Texas our best interests? Or in Tel Aviv? That seems to be the case. They’ve consulted with Netanyahu and Shimon Peres and the lobby, and that’s as far as their academic consultation goes. So such projects are not welcome because they are only ostensibly educational projects whereas the real goal is a colonial goal to further Israeli apartheid.

These fears were reinforced by a statement from the Israeli Education Minister Shay Piron that the new Texas A&M campus would serve as “another important step in the integration of Israeli Arabs into Israeli society.”

Barghouti told The Electronic Intifada that another serious fear is that the establishment of an international university in the most populous Palestinian city in present-day Israel will lead to gentrification. In recent years, the indigenous Palestinian populations in cities like Yaffa and Akka have suffered from Israeli policies that aim to push them out and make way for Jewish development.

Barghouti:

If you drive around the Galilee now, every Palestinian population center is surrounded by colonies that prevent the developments of the Palestinian villages or towns, that take the best lands away from them, and that make them so crowded. This is pure ethnic cleansing in much more urban development… under their urban development rubric. It’s an urban development for Jews only, of course, not for Palestinians. This is a core part of the Israeli apartheid regime against Palestinians in Israel.

So Texas A&M is coming in the middle of this context. This is yet another tool to further the continuous ethnic cleansing of Palestinians, and continuous suffocation of Palestinians within smaller and smaller and ever-shrinking areas.

This could be ostensibly a university for Nazareth, but it could be really just another Jewish-Israeli dominated institution that becomes a settlement within Nazareth, that becomes a foothold — yet another foothold — to Judaize the area and to start ethnically cleansing areas around it. Look at Hebrew University. The biggest gentrifying, colonizing power in occupied East Jerusalem aside from the Israeli state is Hebrew University. They grabbed private Palestinian lands as far back as 1968 right after the occupation. They confiscated that land with the help of the Israeli military authorities and they established Jewish only dorms initially. I mean, dorms for Israeli students, but we all know that Jewish students have the priority in such dorms. So basically the Hebrew University is not just complicit in the crime of settlement. It itself is a criminal. It itself is settling — not just helping the government to settle — Jewish settlers, academics and students, in occupied East Jerusalem.

Palestinian solidarity groups in Texas and elsewhere have taken a clear stance against the project. Aggies for Palestine, a student solidarity group at Texas A&M, told The Electronic Intifada that they oppose A&M’s plan. Spokesperson Jala Naguib said, “I believe it is a poor precedent to set in continuing to support a nation that has repeatedly violated human rights and has repeatedly pursued a policy of apartheid against the Palestinian people.”

Diane Wood of North Texas BDS — a group dedicated to promoting boycott, divestment, and sanctions against Israel until it complies with international law — also told The Electronic Intifada that A&M should not follow through with the project because Israel “continues spending billions of dollars to destroy a people both inside and outside its borders.”

Omar Barghouti said that as more information becomes public about the project and its backers, he expects more Palestinians and international solidarity activists to come out against it:

I think it has to start here with a clear Palestinian position against this project. And exposing this project as yet another colonial apartheid project – because that’s what it is. Once that is done, we expect from solidarity groups… we hope that solidarity groups, especially in Texas and in the US at large, to stand up to this by exposing it to Texan taxpayers. We understand that the university itself will not be using its own funds to fund this project in Israel. But just the very fact that an institution funded by taxpayers is being used or abused by the fundamentalist right-wing Christian Zionists and the state of Israel, which is led by a fascist-leaning government, to further colonize our existence within Israel… that should be exposed.

And I think many decent Americans will understand this for what it is and will stand against it… That this intervention of the worst type. We’re not giving people a chance at better education… We’re using education for a political agenda, that’s a very far-right racist agenda. Should a Texan institution that’s built through taxpayers’ money be used or abused in such a criminal way?

Though many will surely welcome Texas A&M’s plan to establish an international “peace campus” in Nazareth, all indicators suggest the project will meet significant resistance from Palestinians and solidarity activists across the world. As Barghouti concluded:

It’s another colonial project by Israel to further colonize our space, whatever is left of the Palestinian space within the state of Israel.

For The Electronic Intifada’s podcast, this is Patrick O. Strickland reporting from Ramallah in the occupied West Bank.

End transcript.

Dr. Tarek Loubani: Gaza medical supply shortage “is complete”

 

Dr. Tarek Loubani (Photo courtesy of TarekAndJohn.com)

The Electronic Intifada: How does it feel to be back home?

Tarek Loubani: Well, it feels great to be back home and I’m happy to be with my family. I’m happy to be back at my home, sleep in my bed. What I’m not happy with is that there are so many other people who I had shared a jail cell with who can’t do the same. Who were arbitrarily detained with us, but who were not arbitrarily released.

EI: And after you’ve gotten out of prison, how are you still keeping in touch with your fellow prisoners, what’s the situation like for them right now?

TL: So far we’ve been reluctant to make contact with the prisoners there directly, because the government certainly doesn’t hold us in the highest regard. And so we’re concerned that if we are in contact with the prisoners there, that would be a mark against them. So we’ve been generally keeping apprised of the situation through the lawyers of the group, but we haven’t been making any direct contact with some of the friends who we made while we were in there.

Certainly no direct contact because they’re in jail, but no direct contact with their families either.

EI: You’re a physician and you’ve done extensive work in the field, treating people, casualties of wars and occupations and conflict. Talk about the conditions inside the prison, and really what you learned as a physician, new skills you picked up and what the conditions were like treating people inside jail.

TL: Well, basically, medicine in general is an endeavor in which you’re trying to put together the best available information, the best available resources, and the best available set-up of the patient. So in terms of our training, especially in emergency medicine, we don’t talk about actually what those things are — we talk about these axes, and how we can try to bring them together.

How can we try to make our equipment the most useful possible? How can we try to make the information as accurate as possible, and how can we put the patient into a situation that’s the best possible? So from that sense, I guess emergency was the best training for what I found myself in in Tora.

In Tora, the equipment was terrible. Knowledge wasn’t really available, I couldn’t look it up — it was only what I knew. And patients were essentially impossible to optimize. What does that mean, like functionally what does that mean?

Well, I needed — for example, I had a patient with an abscess. That’s a collection of infection that manifests as pus. The treatment for which is opening the collection. When I had a patient with an abscess, all I could do was take apart a sheared tuna can, and use that as a knife — to incise it, to open that particular collection of pus. I can’t imagine what any practicing Canadian or western physician would think about such a thing.

When our patients ran into situations where all I needed to do was to change where they were — so, for example, I had patients who were heat-stroked. In the west, or anywhere in the world, it’s a very easy solution: take them out of the hot place. Suddenly when we were in this transport vehicle outside of Tora prison, we were not allowed to take the people out of the situation that was harming them.

So I learned a lot about being humble and taking the things that I did have and trying to maximize them. You kind of wish you had McGyver [a fictional television character] by your side, really, a lot of the time. Because there just were so many compromises that had to be made. And these compromises were always at the cost of the patient.

EI: Talk also about the wounds that you were treating while you were in the square, hours before you were arrested. What kinds of injuries were you treating, and why is it significant to talk about the kinds of injuries that were being inflicted by this legion of snipers?

TL: Well, there’s a narrative that is contradicted by the facts. The narrative that the Egyptian government presents is that in fact this particular police station was being attacked by armed, pro-Brotherhood thugs, and that they shot back because they had to. Well, in those cases, you expect certain injury patterns. I’m not a military strategist, so I guess maybe they have a little bit more to contribute, but I have seen a lot of people get killed in a lot of different situations.

As a general rule, when people are getting shot by snipers, this is relatively cold, relatively calculated, and not usually defensive. So what was happening, and what we witnessed in Ramses [square] was very difficult to actually understand from on the ground until I saw video later.

We saw tens of sniped patients — well, let’s not say sniped, because that’s a conclusion. Rather, what were the facts? The facts were that people were coming in, with head and neck wounds that were very small. Small caliber. Small caliber bullets are the bullets that snipers use because they stay more true over time and over distance.

So small caliber head and neck. These are sniper shots, that’s the inevitable conclusion that I or any doctor with my experience and with knowledge of these facts would come to.

But what didn’t make sense is that they were coming in the tens. Usually, most of these situations have just a couple of snipers, and it takes time for them to re-load, to pick new targets and to shoot. And what I only understood once I started reviewing the video after our release is that they had snipers lined up, almost shoulder to shoulder, sniping on these protesters.

The protesters — I looked at a lot of video. These protesters were unarmed, nonviolent. In fact, they were nonviolent to a fault. When one of the protesters would fall, they would simply close the line and keep marching. It really was something that you’d have to understand the Islamists, or the Islamist mentality to know. They really thought that they’d be protected by God.

And they really believed that what would happen to them was meant to happen to them. And it was certainly not what I would consider tactical, the way that they approached that particular situation. But back to your original point — talking about the wounds is to expose the fact that people were being massacred, rather than the assertion that the Egyptian government came up with — that there was this act of self-defense against armed shooters.

EI: Tarek, you’ve worked in South America, you’ve worked in Iraq, you’ve worked in south Lebanon, and of course in Gaza. How was the situation in Ramses square that day different, or similar, to situations that you’ve worked in before?

TL: Well, there a lots of similarities that exist in all of these situations. The main similarity is that that it is a heavily-armed, well-trained force versus a civilian population that is generally nonviolent, generally believes in peaceful protest, and generally unarmed.

So that’s what I saw when I was in the West Bank during Operation Defensive Shield [in 2002], that’s what I saw when I was in Iraq and saw Iraqi protesters go down by the tens, that’s what I saw when I was really in Gaza, seeing civilians being shot by drones. And that’s what I saw in Ramses.

The protesters were people who very much were out there with the belief that peaceful protest and democratic movement were the way to make change. And the armies in all of these cases, and certainly the Egyptian army that day, was pretty keen on proving them wrong.

EI: Let’s talk about what you were in Cairo to do that day, you were basically there on a stopover on your way to the Gaza Strip. As you mentioned, you’ve been in Gaza before. Talk about the work that you’ve done in Palestine, and specifically in Gaza, and what you were on your way there to do this time.

TL: Well, of course it was a stopover in Cairo — I would take a direct flight into Gaza City if I could, but unfortunately the reality is that the armed Israeli occupation does not allow that. Simply does not allow me to go to Gaza where I want and need to be. Instead, it forces us to go through the only small window in this brutal siege on Gaza which is the Rafah border [between Egypt and Gaza].

When we talk about what the work is in Palestine, and what the work is in Gaza, really it’s very simple — I’m a doctor, I care about health. I want to make sure that everybody gets the care that they need. And when I went to Gaza the first time, my intention was to become part of this indigenous movement that was going on. To try to educate Palestinian doctors, and to make sure that Palestinian patients got the best care possible.

I don’t go to Gaza to tell them what to do. I go to Gaza and I’m asked or told what the Palestinian plan is. It’s a plan that I happen to agree with, so that’s nice. And I do it. It’s about training physicians, it’s about advocating for patients, it’s about getting the resources that are necessary. It is the same thing I do there that would need to happen in Canada. Just on a different scale.

In Canada, we advocate in small ways, because the foundations are there. We don’t need to demand clean water. In Gaza, there’s often not clean water in the hospital. We don’t need to demand electricity. In Gaza, there’s often not electricity. We don’t need to ensure that people are able to train without getting shot at. In Gaza, that’s the case. I don’t need to make sure in Canada that my paramedics are not killed. In Gaza, paramedics are killed every year.

So it’s one of those things where all we’re trying to do in Gaza is really the same thing that we’d be trying to do in any country in the world — bring appropriate medical care to the population. They way we’re doing that is largely through education and trying to find ways to get supplies in. For a while, that was smuggling. So we had helped organize ways to smuggle in basic medical supplies that we couldn’t get in any other way.

EI: During times of extreme, aggressive assault on Gaza, such as during Operation Cast Lead several years ago, there were new weapons that were essentially being tested on the people inside the Gaza Strip by the Israeli military — weapons such as DIME bombs, white phosphorus, of course. When there’s already a lack or a diminished amount of medicines and medical supplies to treat patients across the Gaza Strip because of the Israeli siege, when you are treating patients who are coming in with these specific kinds — these new kinds — of wounds, how do physicians in Gaza deal with that?

TL: Physicians in Gaza are also people, and one of the things that I had seen and observed and witnessed was these people — whose families are also under fire by these new weapons, and weird weapons, whose friends were also getting killed by them — they very often would have these moments in which they would sort of break, cry. Weep.

I think it’s the main effect of these new weapons — white phosphorus being a key example — is to psychologically devastate everybody around.

There are lots of good ways to kill people. White phosphorus is not one of them. White phosphorus is a good way to maim people, both psychologically and physically. And this seems to be the main recipe for most of the weaponry that’s coming out.

I will give credit to the Israelis — we have seen new weaponry that actually seems remarkably good at killing within a very small radius, so small-kill radius. Over the last year we’ve noticed bombs that were launched from drones that had a kill radius of about three meters, which is remarkable. They kill everybody within a three-meter radius, and nobody five meters away. So I think there’s lots of reasons why these weapons come out. Some of them are, in fact, minimizing unnecessary civilian casualties, or, let’s say, untargeted civilian casualties. But the vast majority of these weapons in fact aim at one thing, which is to psychologically maim as much as physically maim.

When we see these new weapons in Gaza, we’re very very aware of what weaponry looks like. We know what normal bombs look like, in terms of their injury patterns. We know what incendiary bombs look like, we know what white phosphorus looks like. So when we see something new, the doctors there are usually quite aware that something new is being used.

And what we do is what any good scientist would do — we compartmentalize, we document and we try to figure out how we can best treat this new kind of patient.

EI: What kinds of medicines and supplies are still in scarce quantities and supply across the Gaza Strip hospitals, maybe specifically at al-Shifa hospital?

TL: So the main things that … basically, a bunch of people have gotten together and written up lists of what they consider critically-short medications. We’re not talking here about luxury medications — and by luxury I mean medications that will treat conditions that will kill you in five years or ten years. We’re talking about essential medication.

And in terms of essential medications, by some estimates, 30 percent of all essential medications are at zero supply. By other estimates, for example, Medecins Sans Frontieres have done their own estimates, and they estimate that it’s over 40 percent of essential medications at zero stock in Gaza.

So I can’t list for you one or two; this is about half of our arsenal of essential medications. I can tell you within the emergency [department] at Shifa, I have no access, nor is anybody trying to get me access, to medications that I would use to paralyze patients when I’m trying to intubate them. This is an essential part of not traumatizing a patient who needs to be intubated. Or sedatives, so that they don’t remember what’s happening while very important procedures are happening.

We’re using medications that my colleagues in Canada have only used if they’ve been in practice since the ’60s. So yes, we have a deep and desperate shortage there. The shortages of medications, the shortages of supplies — especially what we would call “consumables.”

I rarely have the sutures that I want available for the patients when I need them. I rarely have the correct-sized chest tubes. Sutures are how you sew people up together, chest tubes are the things that you put into peoples’ chests when they’ve been shot in the chest or when they’re bleeding in the chest or when there’s water, air in the chest for other reasons.

I don’t know how best to describe it other than to say that the shortage is complete. It is everything. It is medications, it is supplies, it is consumables, it is everything.

EI: And of course, this is because of Israel’s ongoing blockade, this is because of Israel’s ongoing occupation, this is because of the fact that Gaza is a hermetically-sealed, open-air prison. What kind of message does that send to Palestinian physicians, Palestinian civilians, that if they get shot and need to be intubated, that they will have to feel as much pain as possible? What’s the direct impact of that, psychologically, and what kind of symbolic message does that send?

TL: Well, the siege is by Israel and its junior partner, Egypt. If Egypt didn’t participate, for sure the siege wouldn’t survive. The message that it sends, basically, or that the Israelis want to send, is that you are alone.

The message is well-received by Palestinians, but not in the ways that Israel would intend.

Israelis intend for the isolation to be debilitating. They intend for the isolation to be destructive. But what the Palestinians in Gaza have done is they’ve turned that isolation into their own kind of empowerment.

You’re talking now about possibly the best indigenous medical system to be created within such a terrible siege. The next most comparable siege is really on Cuba, and Gaza, within probably ten years, is going to have, I expect, a better medical system than Cuba. And when that system comes, the Palestinians will rightfully be able to say “we did it ourselves.”

The Palestinians right now are not counting on the outside world, because they can’t. They’re not counting on other Arabs, because they can’t. They’re not counting on Muslims, because they can’t. These traditional pillars that the Palestinians thought they could count on, they now know they can’t.

And instead of being debilitated, like was the intention, they’ve become empowered. They’ve burrowed tunnels. And it’s good to remember — not just the Egyptians who are being sort of touted as incompetent; they’ve burrowed tunnels into Israel too. And quite a few of them, quite embarrassing for the Israelis as the recent tunnel shows.

The Palestinians have put holes into the siege, and holes into the occupation — and we’re talking both literally and metaphorically, and in every possible way. And what I think it will result in, not to be too triumphalist about it, is a genuinely indigenous system that is genuinely resilient, and doesn’t depend on the Israelis’ generosity in opening the border today or tomorrow, or the Egyptians’ political situation opening the border today or tomorrow.

EI: Tarek, what can you tell me about how Palestinian medical workers, either physicians or physiotherapists, are being trained in Gaza, and what the challenges are in that field?

TL: Medical training in Gaza is currently a solitary sport. In any other country in the world, there is a significant element of cross-pollination. So for example, for me, when I want to figure out what my colleagues are doing, what the state of the art is, I go into conferences, internationally, all over the world. I talk to colleagues; I read medical journals. These are the ways that I learn. Medical school is easy, you can throw a medical textbook at almost anybody and have them learn what is in medical school.

But true medicine is about continuity of education. The fact is, lots of what I learned in medical school is no longer applicable. And that’s true for doctors trained in Gaza. So for them to be good physicians and provide good care, which they want to do, they need not just a good medical education but a continuous medical education.

That’s what we lack in Gaza right now. And when there’s no continuous medical education for the elders, that means that the medical education for the younger goes away.

Our focus in Gaza, the health ministry’s focus in Gaza as well, has been on getting every physician up to the standards, the best world standards, so that they can then turn around and educate the medical students who come after them.

The way we’re trying to do that right now is by bringing in some people with international training so that they can help train the local doctors in a way that creates and stands up that indigenous medical system.

We’re not yet there — emergency medicine is about to graduate its first resident, well, he’s a resident now, he will be a consultant next year; and his training is patchy but good. And with time, hopefully we’ll get it better. And we’ll be able to keep training more doctors. Just as we’ve done for emergency, we plan on doing for other projects. Right now, nephrology is the next big collaboration that we’re doing. And we expect that they’ll be able to train a significant number of pediatric and adult nephrologists. Nephrology are the people who deal with the kidneys, they’re the people who run dialysis units — which Gaza didn’t have before the siege started.

EI: Tarek, one of the projects you’ve been working on in London, Ontario, has to do with toy helicopters. Can you explain how — you’ve described yourself as a tinkerer and a geek, and you’ve developed these modifications to remote-control helicopters in order to help serve the needs of medical workers and of clinics where you work, and you were bringing that technology to Gaza. Can you talk a little bit about these helicopters, and what they were going to be used for in Gaza?

TL: So, the idea of these quadcopters is — it’s a bigger idea than just the quadcopters. It’s the idea that Gaza has this tremendous need, and we’ve got this incredible reserve of technologies that we use to play around that might be beneficial.

I wanted to bring into Gaza 3-D printers and quadcopters, and any other technology — you described me as a tinkerer, and I described myself as such, and I’m also a geek of course, and I think the other term that’s commonly being used nowadays is a “maker” — and I want that value to go out to the Palestinians. I can’t possibly have all of the ideas in mind. Instead, I can give people the tools.

Quadcopters are an incredible tool. I have some ideas, I think good ideas, for what it is that they can do. For example, transporting medical samples or small, light medical supplies. Or rare medications, or things like that that are needed emergently in one place or another. That maybe those ideas are terrible ideas; maybe once we test them in Gaza they don’t work.

I can guarantee though that there will come good ideas if you leave the technology in the hands of doctors and nurses and physiotherapists and dentists and all these people in Gaza, they’ll come up with good ideas for these quadcopters. And it might be something like transporting supplies, it might be something like helping patients in this way or that way; and obviously if I knew everything they could do then I would tell you. But I was really looking forward to the creativity of my colleagues and seeing what they could do. And by the way, that’s kind of the way we do it in London, too.

I never thought about transporting medical supplies — I came with this thing to my colleagues. I said to them, look at this really cool thing! I made this, and it costs only $500, and I don’t know what to do with it, I just know it’s really cool and it has lots of potential. And so they suggested, well, you know when we’re on disaster sites, we can’t tell what’s going on and it would be really great to have a bird’s-eye view. So we flew them in disasters.

And they told me, wow, well, you know it takes us four hours to transport medical samples from one of our hospitals to another. So we started flying medical samples — it was their creativity, not mine. In that case, I’m very much an enabler. I’m a tech geek, not a visionary.

So I let them do the visionary stuff, I just try make it happen. I couldn’t wait to see what my colleagues in Gaza could come up with that we could do.

EI: I love this idea of this marriage of being a maker, a tinkerer, using your hands physically to make solutions for problems, and then also applying those skills and creativity to field work and to emergency medicine. Is that just an essential nature of who you are as a human being, as a physician? Explain your process a little bit.

TL: I don’t really know that I could really put my finger on it. These are just things I enjoy, and things I’m passionate about, and things I care about. So why not put them together?

Ever since I was five years old I’ve been taking things apart. My parents used to have a hell of a time keeping toys together. So when you can take these things you enjoy and apply them in a way that makes sense, well, why wouldn’t I do that? I love doing that.

So the technologies — when I see them, I inevitably start thinking about all the applications in all the parts of my world. And so the first thing I made with my 3-D printer were fixes for my broken plastic things. And when I saw a need I started to meet it. So when I’m in Gaza, I’m thinking, oh my God. This particular need could be met.

So, for example, the first thing I designed with a 3-D printer was a way to look at people’s vocal chords. Because that’s very important in emergency medicine — if you can see their vocal chords, you can put tubes between the vocal chords and then you can actually intubate people. So we couldn’t get these special kinds of intubation tools in Gaza, so I said hey, why don’t I print my own? And we started doing that.

We can get plastic pellets in Gaza — they’re not easy but it’s possible to get them. And so you can actually start generating ideas anywhere in the world, transporting them and printing them out there. It’s not quite there yet, but it’s the closest thing we have now — also as a Star Trek geek — it’s the closest thing we have now to the Replicator.

I just love these ideas, I guess.

TL: When I met you in Toronto, three days after you had gotten back, you were talking about how you couldn’t wait to get back to work. I, along with probably everyone else you had said that to, was shocked. You had just gone through this two-month ordeal in prison, you were on a hunger strike for weeks, it was very uncertain about what was going to happen to you. And you said something like, “I’ve been resting for two months, I want to get back to work.” You love what you do.

TL: Well, you know, firstly, I really do love medicine. And I’m really in love, even, with medicine. It gives me such joy, such unadulterated pleasure to practice medicine that of course I considered it, if nothing else, part of my therapy.

But it comes also to another point about what is jail. And jail has two parts — it has the physical part, and undoubtedly I was in physical jail. And it has the psychological part. And yes, sometimes I was in psychological jail too. But by and large, I succeeded at never allowing myself to be in that psychological jail.

And so one of the things that was important to me was self-improvement. I thought a lot, read a lot, wrote a lot, exercised a lot and really tried to become a better person. And part of that was resting as much as I could. And coming out with the idea that once I get out, I am going to go full-steam at life.

There’s two months now that I’ve lost, that I was supposed to be in Gaza. That I was supposed to be teaching. I need to make that time up. Two months out of my life that were on hold, I need to make that time up.

So when I came out, I had a list of all the things that needed doing in the first 48 hours after I came out. Sleep wasn’t on that list, so for the first 48 hours I didn’t sleep. But that was fine, because I had been sleeping very well for eight weeks before. And that list — there was a 48-hour part to the list, and then there was a six-month and a two-year part to that list. And I need to do those things now.

I need to figure out a way to continue this work. Which isn’t my work, it’s the work of the Gazans. And I was supposed to do it, and in a sense I feel like I betrayed them. I said I’d be there on Saturday, and I didn’t show up on Saturday.

It’s not how you do things. You tell somebody you’re going to be somewhere, you should be somewhere. And I want to make it up to them, and I want to go back when it’s safe to do so, and I want to make sure whether I’m involved or not personally, that the education continues and that Palestinian citizens and patients get the best care possible, so that they can have the best lives possible.

End transcript.

“Anti-Triggers”: Memoir by Nour Joudah

From Joudah’s blog, isdoud.wordpress.com.

Trauma introduces therapy in the day to day.
The long walk
Underwater swims
Train rides and buses to them
Memories turned short stories
And therapy introduces trauma to the same.
The paralyzing song
The suffocating scent
Worst case scenario daydreams

And what’s strange is that though I see Palestine everywhere, around every corner, the sounds don’t match. I hear Tennessee and a woman named Delilah, up at the altar of my favorite black church, singing “Walkin’ in Memphis,” pickin’ and flickin’ the salt out of my wounds.

The chorus comes again, and she asks me “But do I really feel the way I feel?”

And when around the corners, I see just Chocolate City streets, with Palestine nowhere to be found, Delilah is silent, and I hear dabke beats with every step on the sidewalk. I’m suddenly Walkin in Ramallah all through my new/old city — pounding Dal’ona and Jafra and Zareef il-Tool on my long walk of therapy.

But under the water, there is no noise; no one sings to me. There is pure submersion, only exhales, no intake of air, complete protection from memory. And I want to put off coming up for air for as long as possible. I want to hold my breath until I can feel my lungs beg. Pound. And beg. Hurry for life to the surface. Feel a drop of water fall off my eyelashes and hit my cheek. Hear a stray noise from the above-water crowd. Hurry back underwater for quiet as quickly as I came up for oxygen to satisfy silly organs that don’t know what they really need.

And in motion, on buses and trains and planes leaving the city, it’s the comfort of transition and hope of a healing arrival that momentarily expunges the trauma. It’s the moment before stagnant presence reminds you nothing has been solved.

And I never sleep in motion. I savor transportation of bodies, of worries, of love, of inexplicable fear running from itself, looking for new space to occupy, to colonize, secretly hoping the new space does the same to it.

But for a second, the therapies backfire. The sunshine when I come up for air from my swim reminds me of a Mediterranean beach, and the scent of my lotion suffocates me as I breathe in Haifa. For a second, I lean my head on the window of the bus or play an old game on my phone on the train and I remember passing time at the border at Jericho, a servees ride to Nablus, or an uncomfortable transition from Akka to Yaffa on the train, my parents looking for seats next to Arabic sounds, trying to be lost in the view and not the soldier across the aisle.

And I told a friend once, I tried to explain how terrifying it is to leave Palestine. I tried to tell her that we always know it could be the final departure. That we in the shatat know risk in different ways. And she smiled and hugged me and told me “see you after graduation.”

And I did, I saw her again. After graduation. After writing about all of it, and studying hard, I defied the fear of the final departure. I had five more months on my clock. Five. It took that long for me to unlearn, to forget 25 years of what we knew. I wanted to unlearn and believe, imagine new possibilities and erase terrifying knowledge.

But you can’t unlearn what will reteach itself to you through truth. The truth is, when they put me back on the bus across the border, my heart was humming “Walkin in Memphis.” And when I called you in Ramallah, in tears gasping for air my lungs begging like after a long underwater swim, I couldn’t hear Zareef il-Tool.

I heard Delilah’s voice coming through the desert air in the cab-ride back to Amman, asking me if I really felt the way I felt. “Shock, really?” I could hear her ask me with sass.

And at the detention center months later, there she was again with her soulful musings — “You should have known better.”

But when I landed back in America, Delilah was still back in Palestine and Jafra was what was buzzing in my ears.

The mijwiz full blast.“O dakhlek ya habeeb il-roh, la tohjor ya asmar” drowned out the customs officer’s “Welcome home.”

There it is. Of course. Home. The narrative seems old. Tired.

Months later, during a day-to-day therapy ride down the coast, I say to a friend in exasperated tone, “I miss home.” And a glance from her asks me without words, “which one?” And so I respond “all of them.”

And in the moment I want to write off the borders and nations and settled senses of familiarity of any place, I remember how distasteful I find the privileged who can do so with such ease. With their theory and liberal, above-it-all indignance, with their ignorance of the violence of insecurity of home.

And so I respond “all of them.”

End transcript.

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David replied on

Technically, the doctor is not correct when he says snipers use smaller calibre bullets. They use larger caliber rounds (7.62mm is the most common for snipers, 5.56mm is NATO standard for normal rifles) because larger bullets are more stable and less easily blow off course by the wind, plus they do more damage with a single round. That high a percentage of head injuries does suggest they were targeted with aimed fire, but not from with a specialized sniper rifle which in any case would be unnessesary for ranges of under 500m or so, which presumably this was.

A rather limited and technical quip with a otherwise good interview by the doctor but I thought I'd throw it out there.

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Tarek Loubani replied on

Hi David,

Thank you for this. A couple of points if I may also be pedantic. The Egyptian Army uses an AK-47 clone (the Misr)[1]. It fires the same shot as the AK47 - 7.62 x 39mm. I have seen M16s before, but rarely. The referenced page says only a few units have them. The three sniper rifles in use by the army use 7.62 x 54mm (Dragunov) and 7.62 x 51mm (PSG1 and M40A3). I believe the Dragunov was the main rifle used from the video I've seen, but I actually have no real idea.

To be clear, on that day I did not myself recover any bullets, nor could I personally tell the difference between a 39mm and a 51mm (or even 54mm) length in a fragmented or compressed bullet even if I did recover any. Without the bullet, the entry wounds are the only marker (exit wounds generally look blown out), and naturally there would be no difference between an AK47 and any of the sniper rifles in use by the Egyptians (all 7.62mm). Even if it were a 5.56mm vs. 7.62mm, there's really no practical way of telling on the field from the entry wound without some fine calipers and a lot of confidence.

So, what the heck am I talking about with 'small caliber'? Starting about halfway into the massacre, patients started coming in with entry wounds that were wider than the width of my finger, generally in the chest (instead of head and neck) and multiple entries (between 3 and 5 for most patients). I concluded that these were the result of large caliber guns. Looking post-facto, it seems this is one of the large caliber guns with 12.7mm rounds.

The caveat is that I have no formal weapons training, and have never handled a gun. My knowledge comes by talking to pathologists and fellow doctors, as well as my own experience in the field. I think my conclusions are correct based on the injury patterns I saw and the video I watched after my release, but I'm always happy to refine my understanding.

tarek : )

References:
1. https://en.wikipedia.org/wiki/...

Nora Barrows-Friedman

Nora Barrows-Friedman's picture

Nora Barrows-Friedman is a staff writer and associate editor at The Electronic Intifada, and is the author of In Our Power: US Students Organize for Justice in Palestine (Just World Books, 2014).