Reframing Public Health in Wartime: From the Biomedical Model to the “Wounds Inside”

Abstract

This article traces the research trajectory of the Institute of Community and Public Health (ICPH) at Birzeit University, whose work focuses on life and health outcomes for Palestinians living in chronic warlike conditions under Israeli settler-colonial rule. Over decades of field-based work, ICPH researchers came to the realization that medicalized responses to trauma contributed to concealing the social and political meaning that Palestinians attribute to their collective experience. By adopting an approach that linked the biological/ biomedical sphere to the political sphere through the concept of suffering, and exposing the sociopolitical conditions of life and the collective trauma-inducing nature of Israeli military occupation and repression, ICPH's research has allowed for the simultaneous personalization of war and politicization of health. In addition to discussing some of the health problems identified by ongoing investigations, the article also touches on the ways in which institution building and research production are linked to the capacity of Palestinians to endure and resist violation in their struggle for justice.THE MISSION of the Institute of Community and Public Health (ICPH) at Birzeit University (BZU) is primarily defined by the extraordinary conditions of the West Bank, including East Jerusalem, and the Gaza Strip as territories under protracted Israeli military occupation, now spanning half a century. The institute's work aims to contribute to the protection and improvement of the health of Palestinians: by conducting research, producing knowledge, and generating the evidence required to develop independent and informed health policies, plans, and programs; through teaching; and by strengthening the capacity of public health professionals. Given its public health focus, the institute's primary objective is to test existing health measures or develop new ones, and to produce numerical evidence linking health to the broader context in which people live.ICPH's approach has been interdisciplinary almost from the beginning, with public health defined as a field of inquiry drawing on relevant conceptualizations from the medical sciences, the social sciences, and related disciplines that are subjected to empirical scrutiny. This interdisciplinary approach comes from firsthand experience with life under military occupation and colonization, and is inspired by the work of Rudolf Virchow, the nineteenth-century father of social medicine who coined the aphorism: "Medicine is a social science, and politics is nothing else but medicine on a

The psychoanalytic encounter with settler colonialism in Palestine/Israel

“…Beginning work in the late 1980s, Giacaman found that traditional approaches to researching public health were unsuited to identifying the needs of the residents of the occupied Palestinian territories. Giacaman and her team adapted or replaced abstract and dehumanizing Western approaches, moving from reliance on “the biomedical model” of health to an attention to “the ‘wounds inside’” (Giacaman, 2018a). In a fascinating overview of the work of the ICPH, she highlights the growth in confidence in asserting an independent approach that begins with the knowledge of those at the margin itself:

For example, international researchers were asking, How can we get these violent Palestinian youth off the streets?, a framing that assumed Palestinian youth were violent by definition.

…”

“…Framing the question differently made it possible to expose the violations that Palestinian young people were experiencing, and the effects of those violations on their behavior, health, and well‐being, as well as their hopes for change and justice. (Giacaman, 2018a)“In the Palestinian context,” she continues, “where we had long been silenced and our narrative was disqualified (a practice that continues to prevail), knowledge production became part of the resistance to our settler‐colonial predicament… Our quest thus became one to reframe and measure the effects of political violence on the living beyond apparent physical health, uncovering the wounds inside, the invisible traumas of war that, cumulatively and over the life course, can lead to visible and diagnosable disease” (Giacaman, 2018a). Here we can see immediately the interface not only with mental health, but with psychoanalytic concerns with the large group impacts of traumatic social events.…”

“…Framing the question differently made it possible to expose the violations that Palestinian young people were experiencing, and the effects of those violations on their behavior, health, and well‐being, as well as their hopes for change and justice. (Giacaman, 2018a)…”

“The utmost strength I can bear”: Strategies and psychological costs of mothering within political violence

“…The ongoing political violence in the Palestinian context must be understood through a larger settler-colonial framework, characterized by Israel imposing systems of dispossession and control (Salamanca, 2012). This is done by the spatial constraint of Palestinian people and places via land takeovers, home invasions, and a series of Israelionly roads and checkpoints that take up upwards of 40% of Palestinian land in the West Bank (Hammami, 2015; United Nations Office for the Coordination of Humanitarian Affairs [UN-OCHA], 2007;Weizman, 2007); arbitrary and politically motivated arrests, detainments, and imprisonment (Giacaman & Johnson, 2013;McNeely et al, 2015); ongoing economic, educational, and social de-development (Barber et al, 2014;Roy, 2016); and humiliation and control (Giacaman, 2018;Sousa, Kemp, & El-Zuhairi, 2019).…”

Religiosity as a Cultural Resource for Arab-Palestinian Women’s Coping with Cancer

“…Trust in religion as a resort and a coping strategy can also be explained by the difficulties experienced by patients in accessing cancer care in the OPT. Treatments available are limited (in particular there are restrictions on radiation therapy due to security reasons; treatment plans can be delayed due to lack of medications); moreover, patients face many challenges in accessing the health system due to the military occupation and the restrictions to mobility (Giacaman, 2018;Hammoudeh et al, 2017).…”