Abstract
This article explores the intersection between the professional politics of medicine and national politics during the second Palestinian uprising, which erupted in 2000. Through an analysis of stories about childbirth from actors in the birth process—obstetricians, midwives and birth mothers—it examines two overlapping movements that contributed to building the public health infrastructure, the movement of sumud or steadfastness (1967–87) and the popular health movement (1978–94), as well as their contemporary afterlife. Finally, it deals with relations between medicine and governance through an analysis of the interpenetration of medical and political authority. The birth stories bring to light two contrasting visions of a nation in the context of restrictions on mobility and a ground chopped up by checkpoints. The quasi-postcolonial condition of Palestine as popular construct, institutional protostate organism, and the lived experience of its experts and of its gendered subjects underlie the ethnographic accounts.
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Notes
Israel’s internationally recognized borders are those of June 4, 1967, preceding the occupation of Arab lands, including East Jerusalem, the West Bank and the Gaza Strip.
The intifada, or so-called revolution of the stones, broke out in Jabalia refugee camp, the largest one in Gaza, and quickly spread to the rest of the occupied territories. It was a mass movement that eschewed the resort to weapons. Within months, Israel and the international community had accepted that there would have to be changes made to the status of the Palestinians.
The “Oslo accords” were signed by Israel and the Palestine Liberation Organization (PLO) on September 13, 1993, on the White House lawn, and the autonomy regime they called for entered into force the following summer.
This uprising, the so-called al-Aqsa intifada, differed from the first one in the Palestinians’ willingness to resort to violence in their quest for national self-determination.
I conducted and taped 56 formal long interviews: with 20 birth mothers, 13 doctors/ public health officials, and 23 midwives/nurses/dayat. I also collected about 50 newspaper pieces about birth from two Palestinian daily newspapers, Al-Quds and Al-Ayyam. Most of the interviews were conducted in peoples’ homes and offices. In addition, as part of my participant observation work, I carried out research and interviews at the labor units of Al-Makassed Hospital in Jerusalem and the Red Crescent Hospital in Ramallah. I have used pseudonyms for all the doctors and midwives I interviewed for this piece.
The issue of the progressive closure imposed on the occupied territories, whose nature, intent and phases are sketched out above, has never been treated in a systematic fashion, although it is, yet today, arguably the most visible element of everyday life in Palestine.
Between 1967 and 1994, the Palestinian health system was under the control of Israel’s defense ministry, with the Officer for Health playing the role of minister. At public institutions, his prerogatives included the payment of salaries and the hiring and firing of Palestinian medical personnel, as well as the setting of health policies. The actual health providers were Palestinians.
The distinction between “static sumud” and “resistance sumud” (sumud muqawim) is found here and there in the literature (Farsoun and Landis 1990:28).
Women in Lebanon used the PLO’s sumud discourse to give political value to their daily activities of housework and child-rearing (Peteet 1991).
In the meantime, with the near-completion of the high wall around and within Jerusalem, the lines of communication have shifted once again, and it is very hard even for Palestinians from the immediate surroundings to get in, if they come from the “wrong” side of the separation wall.
The term “returnees” designates Palestinians from the diaspora, usually belonging to the PLO in exile, who came to the occupied territories with Yasser Arafat in 1994 or thereafter.
For another account of this event, see Barghouthi and Giacaman (1990).
For a discussion of Kanafani in the culture of Palestinian resistance, see Harlow (1996).
I conducted 23 formal interviews with midwives (qabilat), traditional birth attendants (dayat) and labor unit nurses (mumarridat).
Palestinians from Jerusalem have blue identification cards, like Israelis and Palestinians born within the pre-1967 borders of Israel. Palestinians from the occupied territories (excluding Jerusalem) hold orange or green IDs. The difference in the color of the Israeli ID cards is in itself a statement about which future nation Jerusalem (with, or for, the occupier, preferably without its blue ID-holding Palestinians) should belong to.
The borders of Israel prior to the occupation of 1967.
According to the Palestinian Association of Obstetricians/Gynecologists, less than 10 percent of obstetricians working in West Bank hospitals are females.
This story was repeated to me by a few midwives, including the head midwife at the hospital in question.
For a comparative description of policies and practices in Egypt, Palestine, Lebanon and Syria, see Choices and Challenges for Changing Childbirth Research Network (2005).
This doctor thought that in European and American hospitals, midwives did the nurses’ work and did not have much say in the assistance of childbirth.
One should note that other health professionals argue that coping mechanisms such as birth assistance by phone serve the closure policies by minimizing pressure to end them.
A home-grown, popular, elected West Bank leader sentenced to life imprisonment by Israel, head of the militant Tanzim within Fatah, which contested the bureaucratic and corrupt leadership as well as the occupation.
Leader of the Popular Front for the Liberation of Palestine (PFLP).
The first Palestinian woman suicide bomber.
A child killed by Israeli gunfire in his father’s arms at the beginning of the second intifada, on September 30, 2000.
It became clear as her story proceeded that the meanings of “natural childbirth” for her were different from the meanings attached to it in the West. Natural childbirth is not so much about giving birth without technologies and drugs as about locating the birth in women’s neighborhoods rather than in large, urban hospitals. Also, in the context of the Middle East, the term natural childbirth does not carry the same history of a feminist movement attached to it elsewhere.
For further discussion of the PA’s childbirth policy, see Giacaman et al. (2005).
Fatah is the hegemonic Palestinian nationalist party, headed by Yasser Arafat until his death in November 2005, and then by Mahmud Abbas (Abu Mazen), elected to succeed him as president of the PA.
The PFLP is a Marxist, pan-Arab party considered more intransigent than Fatah.
The Palestinian Communist Party (now renamed Palestinian People’s Party), unlike Fatah and the PFLP, had always favored a two-state solution for Palestine.
From inside the occupied territories, as opposed to the external leadership, which until the 1990s was headquartered in Amman, Beirut and, finally, Tunis.
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Acknowledgments
I thank the interviewees for taking the time to speak with me and making this work possible. I am grateful to Michael Fischer, Harriet Ritvo and Joseph Dumit for their ongoing advice and support. I am thankful to my former colleagues at MIT and Birzeit University and my present ones at the American University of Beirut for providing me with academic support. I am indebted to friends, colleagues and teachers for engaging with this work at different times during the process of researching and writing it: Diana Allan, Omar Al-Dewachi, Sosi Andesian, Deema Arafah, Farha Ghannam, Rita Giacaman, Byron Good, Evelynn Hammonds, Yamila Hussein, Erica James, Afamia Kaddour, Natasha Khalidi, Cynthia Mynnti, Esra Ozkan, Sarah Pinto, Anne Pollock, Aslihan Sanal, Hania Sholkami, Kaushik Sunder-Rajan, my sister-in-law and brother, Dahlia Gubara and Ali Wick, and my parents, Roger Heacock and Laura Wick, as well as the reviewers and editors of CMP. The research on which this article is based was partially funded by a grant from the MEAwards Program in Population and Social Sciences, the Population Council, and the WANA regional office in Cairo.
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Wick, L. Building the Infrastructure, Modeling the Nation: The Case of Birth in Palestine. Cult Med Psychiatry 32, 328–357 (2008). https://doi.org/10.1007/s11013-008-9098-y
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DOI: https://doi.org/10.1007/s11013-008-9098-y