Peace-building through health: challenges and opportunities
for an American NGO working with Israelis and Palestinians
Medicine, Conflict and Survival Vol. 28, No. 2, April–June 2012, 147–153.
Current events around the world make peace-building more challenging than it has ever been. Yet many health professionals continue to engage in activities that bridge their Hippocratic Oath with community/country-wide and even regional activities that attempt to resolve conﬂicts. This commentary will summarize the eﬀorts and highlight the challenges of one organization, Healing Across the Divides, in its eﬀorts to improve the health of marginalized populations and sow seeds of peace in an intractable peace-building challenge, the Israeli–Palestinian conﬂict.
While developed only in the past 25 years, the idea of ‘Peace through Health’ has achieved signiﬁcant importance, most evident with the award of the Nobel Peace Prize to International Physicians for the Prevention of Nuclear War in 1985 (Nobelprize.org). Despite these achievements, I would like to state at the outset that I do not believe in the phrase ‘Peace through Health’ as ﬁrst articulated by the health professionals working at the World Health Organization in the early 1990s. However, I completely agree with the concept that health professionals working in their professional capacity can contribute to peace-building through health. Peace through health (or any other area) is a political process and requires the intervention of individuals/groups that have political standing (‘multi-track diplomacy’, as it is called in the jargon of peace-building). In contrast, peace-building through health consists of creating ‘an environment that increases people’s investment in peace and can reduce, if not relieve, tensions that contribute to conﬂict’ (Rubenstein 2010).
Healing Across the Divides is an organization that is committed to peace-building through health. Its mission is health improvement of women and individuals with common chronic diseases such as diabetes via community-based interventions. Funding for Healing Across the Divides comes from both American private donors and foundations; there is no government funding. Peace-building through health is an expectation and a mission objective, but considering the ongoing challenges in the Israeli–Palestinian conﬂict, it is our position that peace-building through health should not be the overarching focus; it is a hoped for by-product. If we make peace-building through health our overarching focus we will be just another organization that has entered into the Israeli–Palestinian conﬂict, many of which have spent not insigniﬁcant sums of money with minimal impact on the lives of any Israelis and Palestinians. Instead, Healing Across the Divides aims to, at a minimum, improve the health status of Israeli and Palestinian marginalized individuals. We have other objectives, too, in the area of peace-building through health, some of which we have achieved and which will be detailed in this paper.
Below, I outline the context in which Healing Across the Divides is working, in terms of how the agendas of donor agencies play into the conﬂict. I then brieﬂy describe some of the peace-building through health tools that are relevant to our work, and say more about how Healing Across the Divides seeks to work.
Donors in health care delivery in Israel and the Palestinian Authority
Since the founding of Israel, American individuals and foundations have also provided billions of dollars in infrastructure funds for the Israeli government and to the Israeli people. On the Palestinian side, there is modest charitable American aid provided under provision 501 c3, providing support to the Palestine Authority. There are also a signiﬁcant number of wealthy Palestinians living in the Gulf States, Europe, and the United States who contribute to Palestinian organizations. The US-based Ford Foundation, which did support civil society initiatives in the West Bank and Gaza, was criticized for supporting what some considered to be terrorist activities, and
Although there are a huge number of other foundations and NGOs active in Israel, the West Bank and Gaza, governments have more leverage (political power) and also more means in comparison to private donors. Hence they can dilute out the eﬀorts of alternative (non-governmental) eﬀorts. This dilution increases the challenges for NGOs to have a measurable impact on either peace-building through health or the health of the population, but it does not make it impossible. It is in this environment that Healing Across the Divides seeks to work.
The tools of peace-building through health
Among these ‘peace-building through health’ tools, Healing Across the Divides, in particular, has advocated strengthening of communities. The objective behind the strengthening of communities/community-based organizations is not just to achieve health improvement for individuals, but to accomplish this within a community-based framework. It is disparities between communities that lead to disparity in health among individuals. At the same time, an important aim of our grant mechanisms is to strengthen leadership of these organizations. Healing Across the Divides believes that strengthening of communities via health can encourage already disposed leaders of these communities to collaborate with each other across divides. We hope that this type of collaboration across the divides will impact national leaders who are leaders in an ongoing conﬂict. We have seen this happen across religious and political divides, such as between Israeli Arab and Jewish community-based groups that we have funded and are now collaborating to press the Israeli government on health care inequalities.
Communication of knowledge is another important ‘peace-building through health’ tool. Healing Across the Divides places signiﬁcant value on training individuals and local organizations in research and evaluation techniques, which are critical to the success of any community-based health intervention.
Personalizing the enemy is another ‘peace-building through health’ tool that attempts to put a human face on suﬀering that occurs on both sides of the conﬂict. Healing Across the Divides, Physicians for Human Rights – Israel, and other organizations, have tried to do this. Healing Across the Divides has sponsored speaking tours in the United States of directors of projects aiming to improve diabetes care among Palestinians living in the West Bank, early detection of breast cancer among orthodox Jewish women in Jerusalem, and health improvement among Arab or Palestinian women living in extremely impoverished conditions in the northern part of Israel.
Another peace-building through health tool is ‘construction of goals in common’. It attempts to thread a needle between opposing sides on initiatives where there might be agreement. Bridges, a publication of the World Health Organization, which has both Israeli and Palestinian health professionals on its editorial board, has tried to do this with modest success (Bridges Magazine nd). Unfortunately, the articles themselves are somewhat generic and there appear to be few concrete joint projects that have emerged from this publication. But the publication is an example of construction of goals in common. While Healing Across the Divides does not demand that
Beyond the work of Healing Across the Divides, other activities relevant to peace-building through health are being practiced by medical and health personnel. Health professionals in the Israel–Palestinian conﬂict have always given of themselves for the treatment of individuals suﬀering on the other side of the conﬂict on an altruistic basis. Israeli health professionals – both Jewish and non-Jewish – practice this on a daily basis, particularly in Israeli hospitals. Physicians for Human Rights – Israel, in particular, has engaged in this important ‘peace-building through health’ tool and has directly contributed to saving the lives of thousands of Palestinians.
Medical professionals can also extend solidarity merely by their presence and use of their clinical skills; that is, by risking their own lives to treat people in war zones. Physicians for Human Rights – Israel has done this extensively and was extremely supportive of Palestinians in Gaza and the West Bank during the most diﬃcult and personally endangering times of the ﬁrst years of the second Intifada which began in 2000 (Physicians for Human Rights – Israel 2003).
‘Non-co-operation and dissent’ describes the refusal of medical personnel to participate in what are considered unjust war campaigns of their governments. In my view, this has happened only minimally on the part of Israelis or Palestinian health professionals in the Israeli–Palestinian conﬂict.
Healing Across the Divides
Healing Across the Divides is speciﬁcally focused on initiatives to improve women’s health and common chronic illness. We only support community-based organizations. We do not insist that the groups that we fund within Israel or the West Bank (we hope to be operating in Gaza by the end of 2011) work together. While they meet each other on a regular basis especially those within Israel (there are still signiﬁcant physical/time/check point barriers for groups that we fund in Bethlehem and Ramallah in the West Bank to meet) they almost never work together. We have fostered communication between Palestinian groups living in Israel and their
Under the guidance of a Board of Directors and Board of Scientiﬁc Advisors, Healing Across the Divides pursues initiatives that have resulted in documented improved health status of the population served in the areas of women’s health and/or common chronic illnesses such as obesity, diabetes: today’s epidemics. We also aim to increase awareness, on the part of policy-makers and other interested parties, of the obstacles to improvement in the health of both populations.
Healing Across the Divides has provided extensive training to community-based groups on both sides of the Green Line on evaluation of health care interventions; quality improvement techniques and organizational capacity building. In peer reviewed publications, community-based organizations partially funded by Healing Across the Divides have documented health disparities and programmatic impact on health of Palestinian diabetics, Orthodox Jewish women, and Palestinian women in
Given the fact that foundations have had a signiﬁcant role on both sides of the Israeli–Palestinian conﬂict, we’ve tried to encourage policy engage-
In what ways if any can we say that health programmes – especially health programmes based on quality improvement – contribute to long-term political stability or peace? In this commentary I’ve tried to argue that interventions that focus on community-based improvement from the bottom up can interact with other programmatic interventions occurring ‘across the divides’. We believe that communities engaging in these interventions can eventually ‘meet’ in a mutually reinforcing manner and even promote national political changes coming from the top down.
At the same time, would it be intellectually more honest to say that the current political stalemate is overwhelming any political impact of health improvement via community-based interventions? Was there a time when peace-building through health initiatives had more promise, or is now a time when these eﬀorts are even more important? Even though I personally believe that we have come to the end of a negotiated two-state solution, I would try to convince readers that now is the most important time. This is especially true in light of the signiﬁcant political movement of attitudes and actions in both the Arab world and Israel. We must seize the moment to see if there are any mutually reinforcing community-based health improvements that can occur alongside political changes happening at a national level, distant as they may seem.
Bridges Magazine, nd. About us. Available from: http://www.bridgesmagazine.org/Index.php?page¼contents.about [Accessed 20 January 2012].
Challand, B., 2009. Palestinian civil society: foreign donors and the power to promote and exclude. London: Routledge.
Ghosh, H.A., et al., 2007. Diabetes control in three villages in Palestine: a community-based quality improvement intervention. Journal of Ambulatory Care Management,
Khatib, M., Efrat, S., and Deeb, D., 2007. Knowledge, beliefs, and economic barriers to healthcare: a survey of diabetic patients in an Arab-Israeli town. Journal of
Nobelprize.org, nd. The Nobel Peace Prize 1985: International Physicians for the Prevention of Nuclear War. Available from:
Physicians for Human Rights – Israel, 2003. Health in the Occupied Palestinian Territories. Memorandum submitted to UK Parliament Select Committee on International
Rodriguez-Garcia, R., Schlesser, M., and Bernstein, R., 2001. How can health serve as a bridge for peace?. CERTI Crisis and Transition Tool Kit Policy Brief. Available
Rubenstein, L., 2010. Peace building through health among Israelis and Palestinians. United States Institute for Peace: Peacebrief 7, January 28. Available from:
World Health Organization, 1995. Health in social development. WHO Position Paper, prepared for the World Summit for Social Development, Copenhagen, March, p. 19.
To cite this article: Norbert Goldfield (2012): Peace-building through health: challenges and opportunities for an American NGO working with Israelis and Palestinians, Medicine, Conflict and Survival, 28:2, 147-153.
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