Comment

Healing and peace making in the middle east: challenges for doctors

The efforts noted by Harvey Skinner and colleagues in today’s Lancet would not have been possible 10 years ago, and the subject was taboo 15 years ago. The launching of the peace process in the middle east in the early 1990s has allowed for cooperation in many areas.[1] The collaboration between Israeli and Arab doctors reported by Skinner is probably among the largest in health care.[2]Extending over many years and comprising many activities, the effort seems solid, having survived the collapse of the ill-conceived and ill-conducted political peace efforts. Obviously, all doctors should support initiatives that contribute to peace; how­ever, Skinner’s report raises several issues.

Skinner and colleagues tell us what is being done and how, but why is this collaboration important now? Most successful peace-through-health initiatives start after polit­ical resolution, although some, like this one and others,[3]begin during peace negotiations. In the current quagmire of continued escalation of conflict in Israel and Palestine, one cannot presume that cooperation makes sense. The ration­ale and value of cooperation need to be shown to the scep­tics, especially Arabs who will not consider cooperation until after the political conflict has been resolved, as docu­mented by both Arab and Israeli researchers.[1]Isolated by occupation and facing daily suffering, Palestinian doctors want solidarity, of which they receive little, rather than offers of cooperation, support for which is readily available from organisations and donors. Palestinian doctors think cooperating is like offering Israel the benefits of peaceful relations before Israel has given justice to the Palestinians. Arab doctors, including those from countries that have peace treaties with Israel, such as Egypt and Jordan, feel morally obligated to back this position. Many Israeli doctors support the rights of Palestinians and are ready to engage, but they face suspicion from Palestinians if they do not come under the umbrella of the solidarity movement and they receive straight-out rejection from most Arabs, doctors or not. In today’s context, would the cooperation efforts described by Skinner and colleagues add something new to break the impasse? We need to hear more views from colleagues, especially those in Israel and Palestine.

Can peace-through-health initiatives really afford to ignore politics? Skinner and colleagues seem to have answered yes, arguing that groups need to focus on cooper­ation itself rather than politics. Avoiding politics is a political position too. For Israeli doctors facing Palestinian scepticism, cooperation might reflect open-mindedness, but for Palestinian doctors facing public denunciation if they coop­erate, cooperation can be politically risky, even counter-pro-ductive. Legitimacy, an inadequately covered concept in the peace-through-health literature,[4] is essential if doctors want to take people with them on the road to peace. How would consideration of political realities reshape this and other peace-making efforts? Again, more views are needed.

Does the initiative reported by Skinner contribute to peace? Alex Vass challenged all peace-through-health initiatives to consider this important question.[5] Building trust among a limited number of collaborators across lines of conflict is important. But making peace is much more than individual relations. Cooperative efforts must show a broader impact, especially when the politics of cooperation are so daunting, as in this case. A focus on the individual, rather than the collective, might be inadequate, not only in terms of impact but also participation. Although a few people can certainly change the world, only a critical mass of committed doctors with a common agenda can stand a chance in the face of the political deterioration in the middle east. Unfortunately, this is too wishful today.

The views of the Canadian organisation assisting the cooperation are illustrative but all too prominent in Skinner and colleagues’ report. For example, the need for a third party as an “honest broker” is assumed but not well defended. There are grassroots cooperative efforts across the conflict line in Israel and Palestine that receive inade­quate world attention and support. These efforts are unique because they emphasise the political dimension. In the health arena, the most exemplary effort is Physicians for Human Rights-Israel.[6] discussion of the merits of the dif­ferent models of cooperation for peace-making in the middle east and elsewhere would be enriching.

My appetite for perspectives and experiences of collabora­tors from middle-eastern countries remains unsatisfied. A description of problems faced, solutions proposed, and lessons learned would be illuminating. I hope such a descrip­tion, and the aforementioned issues, will be the subject of future reflections by authors such as Skinner and colleagues.

Samer Jabbour

PO Box 9633, Aleppo, Syria sjabbour@post.harvard.edu

I declare that I have no conflict of interest.

[1] Scham P. Arab-Israeli research cooperation, 1995-1999: an analytical

study. Middle East Rev Int Affairs 2000; 4: 1-16.

[2] Barnea T, Abdeen Z, Gorber R, et al. Israeli-Palestinian cooperation in the

health field, 1994-1998. Jerusalem: JDC-Brookdale Institute, JDC-Israel

and Al Quds University, 2000.

[3] Payne D. Peace process leads to cooperation on health. BMJ 1999; 319:

870.

[4] Santa Barbara J, MacQueen G. Peace through health: key concepts.

Lancet 2004; 364: 384-86.

[5] Vass A. Peace through health. BMJ 2001; 323: 1020.

[6] Physicians for Human Rights. http://www.phr.org.il/phr (accessed Jan 24,

2005).

www.thelancet.com Published online January 25, 2005 http://image.thelancet.com/extras/04cmt309web.pdf

Published online January 25, 2005.http://image.thelancet.com/extras/04cmt309web.pdf

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