01 October 2010
Our teams tell us that for a year now the source of tension in Nablus (in the West Bank) has changed. Violence is now increasingly due to the forced cohabitation of Palestinian villages and their neighbouring Israeli settlements. Frédéric Ulmann was project coordinator. Here he comments on the three months he spend in Nablus, the way the situation has developed, and the needs to be met by MSF.
What is the current problem scenario in Nablus? Is it sufficient to justify the actions undertaken by MSF?
For around a year now the cause of violence in Nablus has been different. There are now fewer deaths and injuries caused by Israeli-Palestinian clashes, or more specifically clashes with the Israeli army (see box), while conflicts between Palestinians Israeli colonists are becoming increasingly common, and indeed increasingly violent.
There are around 160 settlements plus 90 more which are illegal (not recognised by the Israeli authorities) in the West Bank. In all, around 450,000 settlers are living among the 2.5 million Palestinians in the West Bank. Because Nablus contains several sites sacred to the Jewish religion, the entire district stands as a real colonisation issue.
Har Bracha (2,200 inhabitants today, compared with 150 in 1980) and Yitzhar (about 500 inhabitants) are the two major settlements in the region. They are located to the south of the city and surround the Palestinian villages in the zone, particularly Burin (2,200 inhabitants) and Iraq Burin (700 inhabitants). At the present moment, according to the Office for the Coordination of Humanitarian Affairs (OCHA), 75% of all incidents involving settlers and Palestinians in the West Bank take place in the governorate of Nablus: 1/3 in Har Bracha and 1/5 in Yitzhar.
When these incidents take place, the Israeli army sometimes arrests settlers, but this is rare. On most occasions it refuses to become involved. According to Yesh Din, the Israeli Human Rights organisations, 90% of the inquiries opened by the Israeli authorities in the wake of problems involving settlers, are closed without consequences.
What happens during these incident ?
A year ago, 47% of MSF actions took place in Nablus itself, or in the refugee camps. Nowadays, 47% of our actions take place in the villages in the district, where the settlements have been built.
The settlers launch attacks on the villages, particularly on isolated houses: they throw stones, Molotov cocktails, shots are fired, villages are threatened and the like. Fields are destroyed, burned, olive trees felled, water sources contaminated, while the settlers and Israeli soldiers are subjected to hails of stones and incendiaries, plus violent demonstrations which the army meets in strength, and these take place on a regular basis. Tension is at breaking point and the situation is speedily degenerating.
Who are our patients?
They are mainly farmers, workers, labourers, and the economically at-risk families. They have heard about MSF and the care we provide by word of mouth, in their families or their communities, while others are sent to us by other NGOs.
Most of them are women and children. In just over a year, the percentage of children treated by our psychologists has risen from 30 to 60%. The men are less willing to come to us. We are often able to approach them after we have begun to treat their families.
What are they suffering from?
The children suffer from post-traumatic stress disorder*, insomnia, failure at school and bedwetting, while depression, behaviour problems, flashbacks, emotional instability, family problems, etc., are common. 
The attacks launched by the settlers are intended to force the Palestinian families to leave, to abandon the zone. The aggression is constant and unpredictable. One of the families in our care has been attacked 95 times in eighteen months. Our patients live in a permanent state of anxiety.
What can MSF offer these families?
On the whole, the medical and social welfare systems work well in the West Bank. Psychiatrists and psychologists are practising in the city of Nablus itself, but MSF is the only medical service in the region to offer treatment - in the form of clinical psychotherapy - to the populations living in the rural zones and the victims of forced cohabitation with the settlements.
We also act very quickly: our psychologists go into action immediately the moment the patient is involved in a violent event and seeks help. Thanks to psychotherapy, we are able to treat their symptoms and provide them with "keys" which help them to get back to normal life and not to relapse if another incident occurs. Against this background of recurrent violence, this is also our value-added feature.
Our doctors take care of physical wounds and complete the psychological action by prescribing psychoactive drugs when the condition of the patient calls for them. Our social workers refer some at-risk families to other aid organisations: the Ministry of Health, UNRWA (the United Nations Relief and Works Agency for Palestinian refugees) etc.
We still find it hard to deal with some categories of patient, particularly the victims of intra-Palestinian conflict, who are highly stigmatised. We're trying to find ways to reach these individuals, but it will take time.
What are the prospects for MSF action in Nablus?
In just a few months time we are hoping to open a new strand of our programme in Qalqylia district, to the west of Nablus. An additional Palestinian psychologist is to be recruited. Our objective in this very landlocked, settlement-surrounded zone is to take care of the families exposed to violence, who are at risk, and have no access to psychological care.
MSF will continue to meet medical needs and handle unforeseen circumstances, always adapting its activities to suit the situation. Because the fact is, as far as I can see, the situation is not about to resolve itself. The settlements keep on growing and expanding, and the settlement problem in the West Bank, particularly East Jerusalem, is turning out to be a real source of local - and international - tension."
    * The psychological reaction following a situation in which the physical and/or psychological condition of the patient and / or their family and friends are threatened and / or actually injured.


MSF context and programme
Frédéric Ulmann: "The situation in the West Bank is fairly quiet. The Israeli army still makes arrests, mainly at night and in the refugee camps where tension hot-spots exist, but these are rare and carefully targeted. Even the number of incursions is noticeably down. All the main access routes to the big cities are still punctuated by checkpoints, but there are no more bombing raids in the cities, and the NGOs and the MSF teams move about relatively unhindered, although the same cannot be said for the large majority of the Palestinians.
In Nablus (population 200,000), the Palestinian Authority is managing the security situation and order is maintained. The Israeli army has abandoned the city centre and taken up positions at the city gates. The situation - life - is 'back to normal'. The shops are open and well-stocked, goods are moving freely. Even so, the unemployment rate is very high because, despite economic growth, full-employment is still a dream and few young Palestinian graduates are able to find a job." 

Since 2004 MSF has been running a psychological-medical-social programme in Nablus for the benefit of victims of psychological trauma associated with both domestic and external conflict. Our teams attempt to alleviate the psychological suffering of these patients (via short therapy programmes, 5 to 10 sessions, as needed). In a 6 month mission, a psychologist will treat around thirty patients and some 300 new psychological files are opened each year. In 2009, 301 patients were helped by psychotherapy and 2,100 consultations took place.