Turmus'ayya, West Bank -- Going to the hospital for the first time is difficult enough without worrying about a strike.
But the relatives of Yousef Abed Elatif Sedqee had to factor that in when they recently took the 7-year-old from the West Bank village of Megaer to the nearby clinic run by Augusta Victoria Hospital in the village of Turmus'ayya.
Young Yousef had hurt his hand in an accident -- requiring clinic personnel to remove a nail from one of his fingers. Normally such minor surgery would have been treated at a Ramallah hospital the family normally visits.
But Yousef's uncle, Ahmed Azem Naessan, said that hospital was affected by the strike of public hospital employees angry about not getting paid -- the result of international sanctions imposed on the Palestinian Authority since early 2006 for the Hamas party's victory in Palestinian legislative elections.
Luckily the option to go to Turmus'ayya proved a good one -- it is closer to Megaer, and the clinic staff proved attentive as the crying Yousef valiantly endured the agony of local anesthesia, surgery and stitches.
But the mental calculus of which hospital to use can get more complicated, with others living in the West Bank having to take into account the issues of checkpoints, travel time and permits needed to go to restricted areas.
Stories of pregnancies ending in death for either newborn or mother due to time at Israeli-West Bank border checkpoints are often shared among Palestinians. So, too, are the frequent, if matter-of-fact, recollections of travel restrictions that can cause a 45-minute trip to morph into a 17-hour journey.
'Everybody wants to be out of this game, this game of politics,' said Ahmad Abu Al Halaweh, manager of Augusta Victoria Hospital's diabetes center.
Al Halaweh said this at the end of a difficult year 'on the ground' in the Palestinian territories. A report released by UNICEF in mid-December said that with 'a massive swell in unemployment, and two-thirds of the population already living below the poverty threshold, humanitarian conditions have been pushed to the brink of collapse. The very fabric of Palestinian society is under extreme duress.'
Augusta Victoria -- a Lutheran World Federation (LWF) institution that has long received assistance by Church World Service and other members of the Action by Churches (ACT) International network -- is doing its best to help ease this frayed situation. The hospital runs four village clinics in the West Bank. Aside from the clinic in Turmus'ayya, another is in the nearby West Bank village of Shuqba, about an hour's drive from Turmus'ayya. The clinic serves about 5,000 persons a year.
Shuqba is small hamlet where, in early November, the olive picking season on the area's hillside terraces was in full swing. A drive there is instructive, partly because a visitor can get a good view of the controversial separation barrier that the Israeli government has constructed for what it says are justified security (and temporary) measures, given the threat that Israeli officials say is real. Hamas has not renounced violence against Israel, they point out, and increasing factionalism between Hamas and its political opponent, the more established political party, Fatah, has been brewing in recent months.
The view from inside the barrier's boundaries is markedly different, where Palestinians don't see the barrier as temporary but as one more impediment to the creation of a legitimate state. They assert that Palestinian land near the barrier continues to be confiscated by Israeli settlers and that there are Palestinians living on the other side of the barrier who no longer have access to their homes or to schools.
One of those who has watched this situation unfold is Dr. George Imseih, an Augusta Victoria pediatrician who works at the Shuqba clinic. He said emotional and psychological problems are becoming increasingly prevalent among the clinic's patients, given the area's high rates of unemployment and increasing militarization.
A particularly dire problem, he said, is the increase of family violence, which along with mental health problems, are not something that people in a culture marked by modesty and decorum speak of freely or openly.
Then there is the problem of medical access itself -- for many patients getting to Shuqba and the attendant difficulties of making their way through a dizzying maze of checkpoints are problems enough.
'We don't want to blame everything on the Israelis,' said Dr. Imseih, a soft-spoken, gentle man. 'But the Israeli occupation is having a major impact on the situation here.' He added: 'Building bridges would be better for Israeli's security than building walls.'
That is a theme that Dr. Tawfiq Nasser, Augusta Victoria Hospital's chief executive officer, took up with almost startling passion in an interview an hour later at the Turmus'ayya clinic, just down the hall from where young Yousef had his finger stitched up.
Nasser declared that the Israeli occupation and resulting political stalemate are creating a 'disastrous health situation' that has fragmented the Palestinian health care system, creating isolated 'cantons' in which the ability of first responders is hampered and makes it impossible to create a 'center of (medical) excellence' within the West Bank. In particular, he said, a system of checkpoints has seriously affected establishing an effective medical referral system that could, as one example, improve prenatal care.
'It's an unnatural way to run a health care system,' he said.
Frustrated that day by what he said were a series of bureaucratic snafus involving travel permits that would hinder his return to Jerusalem and harm his staff's ability to carry out their medical work, he asked, his voice rising : 'And who is punished? The patients. Hamas, they're not punished. It's my patients.'
Dr. Nasser was soon called away -- so it was up to Turmus'ayya's mayor, Mohammad Jamil Abu Said, 68, to finish the interview. Despite all the attendant frustrations his community has experienced, the mayor said the presence of the Augusta Victoria clinic -- a recent development, only in place since August -- was a needed balm. He said he admired the Augusta Victoria staff's commitment to provide health care amid so many problems.
The mayor then returned to an oft-heard theme that day. He said: 'We need a system of dignified health care.'
(Church World Service support for the work of Lutheran World Federation-Augusta Victoria Hospital is through CWS Emergency Appeal #6819, Palestinian Civilian Emergency Assistance. That support is not for the clinics mentioned above, but for other efforts to support the hospital's work. This includes providing, on a monthly basis, about 1,700 medical procedures for Palestinians, including dialysis, radiation, chemotherapy, endoscopy and head-neck treatments.)
Chris Herlinger, a communications officer for ACT member Church World Service and a New York-based freelance journalist, was recently in Gaza as a member of a delegation of journalists who won the 2006 Eileen Egan Award for Journalistic Excellence, a prize awarded by the humanitarian organization Catholic Relief Services, which is not affiliated with ACT or CWS.