9. At the Al-Saraya Centre. Self-harm versus resistance.

9).  Occupied East Jerusalem:  the Al Saraya Centre.  Collective resistance to domination as a preventative treatment for the self-damaging behaviour of the oppressed.

On the next day we visited the Old City in East Jerusalem, and this involved first alighting from the minibus by a section of the Apartheid Wall, to go through a checkpoint which was for pedestrians to enter Jerusalem, after having their IDs checked.  This took us about half an hour, and the experience was in essence like going through any other border control, with the x-ray machine for your bags, someone to look at your passport and so on.  The difference was in the horrible revolving metal gates which opened at irregular intervals when a light would suddenly change to green, of which one had to go through three, the generally dismal and prison-like interior, and the insolent and hostile attitude of the two young women behind the I.D inspecting glass partition, one of whom was holding a large automatic weapon.

We went into the Old City, which is surrounded by 17th century Ottoman walls, through the Damascus Gate.  We went through streets lined with market stalls to the Al Saraya Centre.  This was founded as a non-profit organisation in 1991, close to the Al Aqsa Mosque, in an area of the underprivileged and disadvantaged that is constantly under attack by Jewish settlers. it was founded to try to strengthen the Arab presence there and improve their cultural,  social, educational and economic conditions.  It is an attempt to minimise the effects of all the systematic Israeli policies aimed at increasing the Jewish proportion of the population of the city, by developing the life skills of its targeted groups - children, women and youth - so that they can be as resilient and dignified as possible in the face of the threats to make their lives there unliveable.  One goal is to empower children at the personal, social and academic levels to deal with challenges in their lives, through direct work with children but also through supporting school teachers and counsellors in providing a stimulating learning environment and through supporting parents and imparting positive parenting skills.  Another goal is to empower young entrepreneurs who are capable of bringing about social change in the community, with special attention to marginalised women’s potential, promoting volunteerism to create catalysts for change, and community initiatives of mutual support amongst young people.  A third goal is to develop its own institutional capacities and resilience, financial and organisational stability, develop a media strategy and enlarge its network - this was why they were so accommodating and helpful to us as CADFA visitors, with a reception that included a welcome late breakfast.

 As part of the response to what they see as the ongoing collapse in the structure and cohesion of Palestinian society in the face of the occupation, in the face of systematic de-development and destruction, Al Saraya sets itself against the successive political and social forces that controlled the educational system and thus reinforced indoctrination to control people, and rather seeks to promote individual intellectual freedom and emotional well-being.  This liberal and feminist approach seemed to be about helping women to develop their potential and to find out what they wanted to do with their lives and develop the appropriate skills - sometimes this involves helping them develop work such as hairdressing which they can do inside the home.  It involves help ing women in making the right decisions when it comes to addressing the very difficult situations they face, such as how to keep Jerusalem residency, by avoiding being absent from the city for more than two years, which can be very difficult if you are married to a man from the West Bank, who will not be given a permit to come to Jerusalem if they are under 35 years old.  Children of such a relationship will lack a birth certificate, and the struggle to get one may take from 2-7 years and cost an enormous amount in legal fees.  If the authorities visit the house at any time and find the woman absent, then the process of seeking an ID for her children has to start again.  About 10,000 children have residency difficulties.   Residency rights are required to access health insurance and education.  Women from the West Bank who marry a Jerusalemite can be given permission to visit, but not to stay - they may apply to do so but this takes a long time;  they may get stuck here without any rights,  and if they are caught together the man will be fined, or if it happens again, sent to prison.   Yet there are some women who have lived in East Jerusalem for 15 years without permission.  It is easy for people to get very depressed in this situation of powerlessness and precarity. 

I asked specifically about drug and other self-intoxication problems in their client groups.  I learned that In Jerusalem some Arab youth are offered supplies of heroin, supplied from Israel, in order to compromise and blackmail the family, and to create informers.  Otherwise there is not much of a problem with drugs of abuse amongst the youth in Palestine, despite the daily oppression that they have experienced.  Domestic violence, however, is an issue which seems to be related to the stresses of the occupation and the disempowerment of men that is vented on the women in their families, and which has increased in the Old City with the intensification of practices of domination associated with the occupation.

 In my work as a general practitioner in London,  in an area marred by chronic poverty and lack of employment, I found that a large proportion of my work involved addressing people damaging their own health, either by taking substances that were clearly harmful, such as alcohol in excessive quantities, or cigarettes, heroin, cocaine or other psychoactive substances, or alternatively by not taking properly medications prescribed to treat their long-term conditions, such as diabetes, thyroid diseases, or asthma.  The surgery was encouraged, indeed paid case by case, to provide ‘health promotion’, that was supposed to tell smokers or heavy drinkers that they were harming their health, as if they did not already know it, and as if that knowledge was not indeed an unconscious or rather unadmitted part of their reason for continuing - if the system allowed people to own or control nothing, at least it had to acknowledge that they owned their own bodies, the very basis of the supposed right to sell your labour on the market as if it was a commodity.  Indeed by wielding thus the patronising negative power of doctors as instruments of the State and distributors of ‘knowledge’, we were most likely making worse the feeling of damaged autonomy that made people want to assert their right to their bodies and their ultimate control over it in a destructive way.  

Whilst some of the worst cases were clearly related to personal histories of abuse during childhood and adolescence, leading later to self-damaging through cutting the skin, or smoking,  or drug addiction, much of the problem seemed to relate to the more insidious disempowerment and domination involved in poverty, unemployment or under-employment, racial discrimination, and abuse and disadvantage related to gender or sexuality or to chronic health problems.  These experiences of bullying, humiliation, and discrimination that people had experienced seemed to tend to reduce their capacity to avoid activities that endangered their own health, and I believe that this is an important contributory mechanism to the association - in developed economies - of relative poverty with poorer health outcomes - in other words to the fact that inequality of income in any economically developed society leads to poorer health outcomes, as well as to more people in prison, more social mistrust, more teenage pregnancies, more domestic violence, more crime and so on. ( ref Wilkinson and Pickett, 2010, ‘The Spirit Level’. )

 This superficial inquiry suggests that the much more overtly political and overtly racist domination practiced by the Israeli state on the Palestinians of the West Bank and Jerusalem does not seem to have quite the same set of ill-effects on health-related behaviours, though male cigarette-smoking might be an exception to this, and it is possible that gender-related violence and domination stoked by religious fundamentalism is also a mimetic outcome of the racist militarised system of oppression here.   If it is true that the impulse to self-harm is less salient, it may be because of social solidarity in a war situation, so that failure and defeat are less stigmatised at the individual level.  Indeed it was quite easy to believe that every setback in individual Palestinian lives could quite easily justifiably be attributed to the Israeli oppression, such was the force of their domination evident in more or less every aspect of daily life.  Where in inner-city London anger born of racial discrimination, class discrimination, or the abuse of those with learning difficulties or other chronic health problems struggles to find, and in the current political situation often tends to fail to find an object, and can easily be turned against the self or against vulnerable others, in occupied Palestine it seems possible that the object of anger and stigmatisation, the oppressive Other, is much more easily identified, which then would have massive public health implications.

This encourages me.  When the mass of the oppressed overcome their inertia and divisions and finally begin to act together to take control of their own future, that is, to demand to take back control of what is now privately-owned  land and wealth, when they identify the system of domination, they may, except for the most severely damaged, be able to overcome the self-damaging practices of their lives as wage-slaves or unemployed wage-slaves and will be able to make better health-related behaviour choices as a more equal society emerges.  Self-damaging on this analysis is thus a response to abuse that follows a state of powerlessness and defeat only when the perpetrators are mis-recognised, and as it were still respected as fathers rather than seen as collectively-identified enemies.