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.

Gaza, drawings by Gazan children, Photograph: Mohammed Baroud, Screen Photograph: Yoram Kuperminz

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?

Gaza, Photograph: Khalil Hamra, Screen Photograph: Yoram Kuperminz

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.

Gaza murals, Photograph: Mustafa Hassona, Screen Photograph: Yoram Kuperminz

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.