North Africa, West Asia

‘Pessoptimism’ and the politics of Palestinian health

The development of culture-specific research measures takes time, but adding the dimension of human insecurity and distress to quality of life measures is a vital step.

Aimee Shalan
21 October 2013

“Science is political. I want to use science as a political instrument to promote social justice.” These were the words of Dr Richard Horton, editor of the Lancet, at the opening session of this year’s Lancet Palestinian Health Alliance (LPHA) conference. His keynote speech hinged on the notion of accountability, which has become something of a watchword in global health. We have a historic opportunity, he suggested, to use this growing interest in accountability and “to put science in the service of social justice and self-determination.”

Held in Cairo from 18-19 March, and organised by the Institute of Community and Public Health (ICPH) at Birzeit University and the American University of Beirut, the conference focused on the ‘Health of Palestinians inside and outside the Occupied Palestinian Territory’. As an external observer, it was of particular interest to see how the discipline of science might be used to inform political argument in a Palestinian context. 

Established in 2009, the LPHA is a network of Palestinian and international researchers committed to using the highest scientific standards to describe, analyse and evaluate the health and healthcare of Palestinians. Led by Dr Horton and a group of around 20 academics, the alliance provides the challenge, the opportunity and necessary support to produce research that is subject to high level peer review. A selection of the abstracts presented in Cairo will be published by the Lancet  in November. Many LPHA research findings deserve to be more widely known in order to make an impact.

This year’s presentations included the medical consequences of Israel's offensive on Gaza in November 2012; the psychosocial health of Palestinian children in the aftermath of the attack; the risks of chronic exposure to demeaning political violence; and sniper femoral syndrome as an example of psychological warfare against civilians. More unspoken issues affecting Palestinian health, such as economic decline and environmental degradation were also explored, while papers on perceptions of drug abuse and sexual behaviour among adolescents in the West Bank; the impact of infertility on women in occupied Palestine; and a story of discrimination surrounding Palestinian breast cancer patients in Israel brought to light some fascinating new research.

Given events in the region, holding a conference in Cairo with a special focus on Palestinian health could be regarded as shoring up exceptionalism – at a time when the security situation in the Sinai is adding yet another layer to Egypt’s political turmoil; when, after two years of bloodshed in Syria, more than one million people have sought shelter in neighbouring Arab countries; and when political instability in Lebanon is being exacerbated by the spill-over of violence in Syria and the influx of hundreds of thousands of refugees.

Palestinians and Palestinian healthcare face a unique situation owing to prolonged occupation, the impact of internal divisions and the difficulty of establishing a sustainable health system. Yet, as Dr Ala Alwan, the WHO’s Regional Director for the Eastern Mediterranean, observed in his opening remarks, many of the difficulties Palestinians face are common to the region, including the rising burden of non-communicable diseases; the problem of equitable access; the importance of being able to respond to crises and the need to strengthen information systems and evidence-based research for decision-making.

The development of culture-specific research measures takes time, but adding the dimension of human insecurity and distress to quality of life measures is a vital step. As Professor Graham Watt, a trustee of Medical Aid for Palestinians, pointed out during the conference, “measuring health, without a political element, misses the point.”

Indeed, the political element is hard to ignore. As the proceedings began, participants discovered that two people from Gaza and three people from the West Bank had been denied permission to travel. In response to the news, Professor Rita Giacaman of the ICPH, Birzeit University, declared that this year the conference would draw on Pierre Bourdieu’s notion of ‘habitus’, which in the Palestinian context is about accepting and resisting the Palestinian predicament – summed up by the Palestinian novelist Emile Habiby’s notion of ‘pessoptimism’. “We felt pessimistic and then sad when we realised that we don’t have five people with us,” observed Professor Giacaman, “but in optimism we are hoping that everyone will be able to make it next year.”

Emailing from Queen Mary University of London, Dr Ali M Ghanem, the supervisor of one of the researchers from Gaza who had been prevented from attending the conference, wrote:

“It is with a great sadness that the ordeal and medieval blockade of the Gaza Strip continues, mostly affecting the vulnerable such as students, the sick and the poor, as politicians and decision makers are spared and enjoy freedom of movement. All the stronger argument for this collective effort to transform the socioeconomic political and humanitarian oppression of the Palestinian people through science and medicine.”

Until now, perhaps the greatest impact of the alliance has been its very existence, as a highly productive partnership between Palestinian and international researchers. The conference was told of how hundreds of angry emails were received by the Lancet after one of its LPHA publications. When they were reviewed, however, it became apparent that few of the complaints concerned the detail of any of the research abstracts. It was their very appearance, the idea of alternative versions of the truth of what is happening being published in a credible medical journal that caused alarm.

The norms of the debate about Palestine, which the LPHA is a part of, are changing. As Professor Paola Manduca of the University of Genoa put it, "Truth, as we can seek by science, has its revolutionary potential in the history of humankind." In this respect, the LPHA's focus on Palestinian health should not be seen as shoring up exceptionalism. Rather, it can be viewed as a critical response to the current political environment that is both helping to ensure the Palestinian experience is not forgotten and making a scientific contribution to the potential for change, which unflagging 'pessoptimists' are still hoping to bring to fruition throughout the region.    

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