This blog is the second of the health in urban development blog series. View also:
Health in secondary urban centres: Insights from Karonga, Malawi

If you are interested in DPU’s new MSc in Health in Urban Development, more information can be found on our website.

“I’m like a bird in a cage”, told Shaheen in an interview to Al Jazeera as she lay in bed at Al-Rantisi hospital. “Outside of my cage I can see water and food, but I can’t reach it. This is my condition right now.” Shaheen suffers from breast cancer, her condition has been deteriorating ever since she was denied exit from Gaza for treatment. The Gaza Strip does not have adequate resources to provide her with appropriate treatment, yet she cannot leave, as Israeli authorities rejected her permit three times in a row without explanation. But this is not an anecdote – current data indicates that 54 Palestinians, including 46 cancer patients, died in 2017 after their requests for permits were delayed or refused.

The case of Shaheen illustrates the ways in which health, death, life and space are entangled. It is not just about the crossing of the border between the Gaza strip and Israel, but also about being in a “cage”, an urban territory where electricity, clean water, sewage system and adequate housing which are basic conditions for ensuring a health – are absent. As already noted,  in 2017 more than 96 percent of groundwater is unfit for human consumption, and the forecast is that the damage would become irreversible by 2020; Due to chronic shortage in electricity operating pumps, there is a constant threat of raw sewage flooding residential areas. The beach areas of Gaza strip are polluted by more than a hundred million litres of raw sewage flowing into the sea every day. This matter was recently defined by Zeid Ra’ad al-Hussein, the UN’s High Commissioner for Human Rights as a “TOXIC SLUM”, claiming that Gazans “…are… caged in a toxic slum from birth to death”, a ghetto of 1.9 million residents (50% under the age of 18) living in one of the most densely-populated places on earth.

The spatio-politics of health, death and life goes beyond the notion of necropolitics; it is not just about the use of social and political power to dictate how some people may live and how some must die as Achile Mbembe suggests; rather it is also about the spatial dimension of “cage politics”. Within this context I argue that spatial organisation determines the right to kill as defined by Foucault; blocking Gaza, isolating its habitants, controlling the goods that can enter the strip (such as food, construction materials etc). Yet the question is not whether the organisation of space and health are linked, but why is space organised, controlled and destructed in certain cases so as to protect the right to health; What are the ideological forces and the political processes that promote or hinder the organisation of space?

The conditions in Gaza are not the result of any natural disaster, neither the outcome of the last few months events along the border. Rather, I would suggest to see it within the context of settler colonial political history, which prioritises territorial and demographic control over basic rights. As already noted the establishment of settler colonialism is based on “the will of erasure”, or at least the “systematic containment” of the original inhabitants. First of all, the refugees: close to 70% of the Palestinians living in the Gaza Strip are refugees. Most of them ran away, or were expelled from villages, towns and cities that are part of the State of Israel today.

Since then, Israeli political discourse focuses on the idea that this problem would disappear by itself. Yet, as the last few months demonstrate this is not the case: Young Palestinians who are demonstrating at the border are the third and fourth generations of the original refugees, and they are willing to die for the right to return, reminding us that 1948 is still with us, waiting for a political (rather than military) answer. Indeed, links between health, death, life and cage politics should be understood within a wider context, where freedom of movement, access to public services and infrastructure, as well as freedom from pollution and environmental hazards, are obvious rights linked to space.

Indeed, the case of Gaza illustrates the ways in which people who have been displaced experience “root shock” – the traumatic stress reaction to the loss of some or all of one’s emotional ecosystem. As the case of Gaza demonstrates, the very historical foundations of the root shock are the expelled of Palestinians after the 1948 war from Israel, the creation of the “refugees crisis” and the ongoing violence in the last few decades. Root shock is both personal and collective: on the individual level emotional trauma affect a person experiences when his or her environment is destroyed. It causes the risk for stress-related diseases like depression and diminishes social, emotional, and financial resources. Here, several reports point on the growing number of mental illness in Gaza, including a growing number of suicides.

Importantly this has also an effect on the community level; root shock is expressed by the loss of interpersonal ties that is vested in the collective connections and affect negatively a community resilience. A telling example is the aspect of the high rates of sexual assaults in Gaza resulted of the common addiction to Tramadol which is available in Gaza, and popularly traded as an illegal street-drug. According to Mansour, the Tramadol side-effects have an immense impact on the frequency of sexual assaults and other un-healthy sexual behaviours. In general, Mansour describes Gaza as a society in “a tremendous and accelerated disintegration” in which “people are losing their humanity”. Another aspect is gender-based violence. In 2016, more than 148,000 women were subjected to psychological and physical abuse. Studies show a link between violence against women and the worsening of living conditions. According to the UNFPA, ‘The structural, cyclical and hierarchal nature of violence… means women often become “shock-absorbers” of the crisis’ in Gaza.

To sum up, cage politics violence has two dimensions that affect health conditions in Gaza. Active violence stemming from direct military actions and explicit policy. This affects water supply, electricity, nutrition. It also causes a severe shortage of equipment, medicines (including antibiotics and morphium), and medical expertise. This, for example, means injured people with gunshot wounds to the legs are not always treated quickly, leading to amputation. But cage politics is also discursive, symbolic and implicit; this is expressed in the very de-humansing and demonising public discourse in Israel, that in turn justifies active state violence. A current example is the building of an underwater sea barrier that according to the Israelis aims to prevent Palestinian infiltrators from entering Israel by sea. The barrier will consist of three layers. The first will be below the water; the second will be made of stone; the third will be made of barbed wire. An additional fence will surround the sea fence. The effect of this project on Gaza is clear: fishing, mobility, health and economy is one side of it, but this also takes us back to the very argument presented today: cage politics of health, life and death are highly political and that access to water, electricity and services, or proximity to environmental hazards, are not neutral facts but rather the results of policy and violence.

 

Haim Yacobi is a Prof of Development Planning and the Programme Leader of the Health in Urban Development MSc Programme at the DPU. In his current research he focuses on the ways in which ideology, planning and health are entangled in conflict zones.

The contemporary urbanisation of Amazonas is a geopolitical creation, and a recent phenomenon. For long time native communities have been living in sparse, often isolated, settlements. Adapting to the mutable conditions of the river, they created a system based on mobility, economic diversification and ‘multi-sited territorial appropriation’ (Peluso and Alexiadis, 2016). Such use and production of space was and still is disarticulated from any single master principle of spatial organization and from usual dichotomies such as rural/urban and public/private. Starting from the 1960s, extractive activities favoured rural-urban migration. Cities such Iquitos, Tarapoto and Puerto Maldonado in Peru, Leticia in Colombia, Belem and Manaus in Brazil grew immensely in few decades. Rural population moved to the cities, settling along the river, often retaining the traditional spatial organisation. Their survival is now threatened by climate change and flooding risk, coupled with recession and growing unemployment following the recent decline of oil extraction. Exploitation of resources prevented the growth of productive activities offering now little alternative sources of income to the urban population.

 

It is in this complex context that the research project Ciudades Auto-Sostenibles Amazónicas (CASA), led by Pablo Vega-Centeno at Pontificia Universidad Católica del Perú (PUCP), and coordinated by the BUDD alumna Belén Desmaison (PUCP), with the involvement of DPU’s Camillo Boano and Giovanna Astolfo, is developing a participatory process with local communities, local authorities and the national government to co-produce sustainable spatialities and promote alternative livelihoods systems in the Amazonas, starting from local technologies and knowledges. The project aims to create evidence-based methodology for a more participatory implementation process of preventive relocations. The project looks at the city of Iquitos, in the Peruvian Amazon, where a massive relocation process of around 16,000 people living in the flood-prone low-district of Belén is undergoing amid great difficulties and resistance. The government-led relocation has been implemented following a DRM policy released in 2011 and as part of the national programme “Programa Nuestras Ciudades”; despite many positive pioneering aspects, the decision-making process was centralised and the project poorly articulated, failing to capture the socio-spatial complexity of the context. Particularly, the relocation threatens the traditional spatial organisation of Amazon’s communities, negatively impacting the livelihoods system.

 

 

Approximately 200 families have been relocated to date. However, the decision whether to move or not is creating tensions and conflicts amongst the remaining groups, as highlighted in earlier research conducted by the Facultad Latinoamericana de Ciencias Sociales (FLACSO) as part of the research “Reducing Relocation Risk in Urban Areas” led by Cassidy Johnson at DPU.  If, on one side, relocation can improve health condition and security, on the other side it might result in greater impoverishment consequent to the loss of jobs and traditional ways of living. Currently, most of the population is against relocation. Lack of trust in the process, and the polarisation of political parties are poisoning the debate (Chavez, 2016). Understandably enough, relocation is, above all, a matter of the narrative that is created around it.

Connected through a newly constructed road, Nuevo Belén is distant from the city of Iquitos, and from the Amazon River and its tributaries which are the main source of income. It is an artificial city that looks like a dorm, as few of the planned facilities have been built so far. Each family has been given a lot of around 120 sq.mt., out of which 40 are occupied by the house. The housing typology is far from reflecting the social organisation and the constructive tradition, let aside being suitable to the climate. Reason why most of the dwellers have already transformed the space. Shelters on stilts are popping up where the ‘gardens’ should be, while the concrete houses serve as shops. Productive spaces (‘huertas’) are mushrooming around the houses as a consequence of informal appropriation of land, although under temporary deals – as the land will be soon occupied by the second round of housing construction.

 

 

Starting from the ‘huertas’, the workshop that took place in July in Nuevo Belén focused on alternative design proposals for the creation of self-sufficient systems to ensure the economic sustainability of resettlement, and to create new livelihoods options. Proposals, developed by an interdisciplinary team of PUCP students and validated by the community, investigate what technologies and construction techniques are better adaptable to the context in social, spatial and climatic terms (particularly related to solar energy and rain collection).

 

 

Clearly, Amazonian cities posit great challenges, particularly to those communities affected by economic recession, settled on flood-prone areas and at risk of relocation. It is necessary to think a different urbanisation, flexible, adaptive and temporal, more similar to the tradition of disperse settlement of the native communities. Relocation should be conceptualised as an urbanism in flux characterised by interconnected mobilities and heterogeneity (Browder and Godfrey, 1997); and its open spaces should not be purely private nor merely public and should be understood as in-between spaces, reproduced through mobility that is constitutive of this urbanity in flux.

 

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DPU’s Camillo Boano and Giovanna Astolfo are involved in the research project Ciudades Auto-Sostenibles Amazónicas (CASA) that looks at the Amazonian city of Iquitos. The project is led by Pablo Vega-Centeno of the Centro de Investigación, Arquitectura y Ciudad (CIAC), Pontificia Universidad Católica del Perú (PUCP), and coordinated by Belén Desmaison (PUCP and DPU alumna). As part of the project, in July Giovanna Astolfo participated to the workshop ‘Taller Partecipativo’ in Nuevo Belen with CASA team and students from PUCP.

https://casapucp.com/

CASA is part of the CRC Initiative funded by CDKN, IRDC and FFLA. https://crclatam.net/

In July 2016, the 4^th Community Architects Network (CAN) Regional Workshop brought together community action practitioners from countries all over South East Asia. The first day was spent in Bangkok, Thailand, introducing the participants to the work done and challenges faced by CAN members in Thailand, China and India. The following five days were spent in groups – each focusing on a different sector of city development, for example the transport group, which I was part of – doing fieldwork alongside local communities in Chumsang City of Nakornsawan Province, Thailand.

 

Today is just about listening

 

“Today is just about listening,” we were told. That was how we started our fieldwork on the 16^th of July. Focusing our attention on understanding the local communities of Chumsang, listening to their ideas, concerns and how they wished their city to be in the future. This was a challenge, particularly as most of us had spent the first two days of the workshop meeting and exchanging with many different people from Sri Lanka, Nepal, India, China, Thailand, Indonesia, Philippines, Vietnam and Cambodia. So by the time we arrived in Chumsang, my mind was already full of questions and ideas. I was excited and a little rushed to quickly understand the context of Chumsang, considering we had very few days to do so and then to, somehow, ‘co-create’ something.

 

Co-Creation was the theme of the workshop. It was described in the introductory programme as the “co-creation and design between man and nature through a process of understanding and respect”. Understood in this way, co-creation was very representative of the dynamics and needs of Chumsang. Like other similarly sized cities in Thailand, Chumsang faces many concerns related to its natural resources and landscapes, the loss of its cultural traditions, the changing dynamics of migration in its young and old populations and as a result the increasing day to day challenges in making the city livable, sustainable and lively.

Following this theme, the workshop in general had a loose structure that allowed space for conversations to evolve, take different directions and reveal those elements that were not immediately obvious about the city and its people. At first this way of working felt uncertain, unfamiliar and risky but as we were immersed in to the fieldwork, the friendly people and the excitement of it all, it became easier to go with the flow and allow our ideas and projects to develop in a very organic way.

 

Our behinds were burning but our faces were bright

 

As the transport and cycling group, we happily spent a lot of time on our bicycles, visiting the city and using any excuse to get on the saddle. By the end of the first day, it was harder to walk straight and our faces were quite pink from the sun, but it was through these rides around the city that we found inspiration to work. We even wrote a song!

Within the transport group, I felt very connected to my colleagues, not only by being part of CAN, which encouraged us to work together but also through our other interests, in my case cycling. In other cases, photography, culture, music, heritage and ecology brought people together to share ideas on making the city. These elements, represented through our different interests and hobbies, are also an important part of what makes cities vibrant and CAN Co-Create seemed to build on this synergy very well. It took a wholesome perspective toward community architecture and in this case, for the first time, at the scale of the city. I think this was one of its greatest strengths.

In this way, the opportunity that CAN workshops bring about by generating attention, bringing in professionals and practitioners from many contexts to work with local communities and catalyze change not only focused on one arm of city development but many. We established groups that addressed housing, mobility, politics, environment, culture, health and one that emphasized the connectivity and cohesion between these different elements at the level of the city. The workshop also became an opportunity for the mayor to come face to face with the energy of the city’s people, their desires and motivations and to engage in direct conversation with them about their different ideas for the future of Chumsang.

 

At the same time, this transversal approach also brought many communities to work together. We worked with two cycling groups, a group of elderly, the old market community, young school children, communities that were to be relocated and communities that had already been housed. Initially, it seemed that these different groups had their own motivations for participating in the workshop. However, at the end of each day, as we reviewed our progress and our findings, the work gradually demonstrated how intricately connected these different motivations and processes really were.

 

Although some groups progressed quicker than others during the five days of fieldwork, reviewing, changing and even starting over a couple of times; the level of involvement from community groups in the presentation of the outcomes, on the last day, was moving. It showed that these processes of participation intrigued people and invited them to feel part of something greater.

 

So although lengthy and sometimes frustrating, the time it took to build, validate and present ideas with communities, seemed to generate a collective sense of a ‘Community of Chumsang’. In a way, the notion of ‘co-creation’ really materialized through this challenging and timely process. Toward the end of the workshop, I increasingly noticed that people built on these connections and worked with them, moving around the room, between different groups, sharing information and presenting ideas in sync with each other.

Sharing is where everything starts

 

There were many things about the CAN workshop that motivated me but it is what happens after the workshops, which I find the most significant. How the transformative process that CAN workshops initiate, by bringing so many minds together in one place, can ripple out into a series of waves of transformation in other places; How those of us who attend the CAN workshop can carry our experiences and through them, diffuse the energy of CAN into existing and new networks. After the workshop I was left with this intrigue, excited to see what happens next.

 

The workshop produced Facebook groups [CAN Co-Create Chumsaeng City & Unsung Stories of Chumsaeng); brought cycling movements together to carry out a collective ride throughout the city with the support of the police; created brochures to promote tourism, made a song and proposed many other small achievable projects that the local communities could carry on after the workshop. I see these outcomes as small actions and tools that are practical and achievable in the short term but which have the potential to keep co-creation running by “people’s process”, as we like to say, in the long-run. If people follow up and use them.

 

A month later, I am visiting some of the CAN members in Vietnam. They have been great hosts, showing me around and teaching me about the beautiful city of Hanoi.

 

“Sharing is where everything starts” says Houng, one of my hosts and also a CAN member. Being back in conversations about community practices reminds me of my intrigue, what happens after the workshop? How does the transformative process of CAN Co-Create continue?

 

Still excited from the experience, I’ve noticed some signs that suggest the transformative process is still running. The actions that we took and the ‘web’ of tools that we began to create seem to have given the ‘network’ a potential to catalyze this process. Believing it all the more as I listen, discuss and exchange with people who, despite having returned to their busy lives, are still talking about visiting Chumsang again, strengthening the CAN network in Vietnam and even about extending the scope of the existing one.

 

 

[Video]

CAN Co-Create Workshop Teaser Video – Final Video will be published in October

 

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Luisa is an alumni of the MSc in Building and Urban Design in Development at the DPU. Currently she is working in Manila, Philippines as a beneficiary of the DPU/ACHR/CAN Young Professionals Programme.