August 31, 2010, 12:59 pm
Source: Donald L. Mellman, MD, MPH, MBA
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Dr. Don Mellman

With apologies to Mark Twain (Innocents Abroad) and Martin Indyk (Innocent Abroad)


Donald L. Mellman, MD, MPH, MBA


I first want to thank Gerri Haynes, whom many of you may know, for the opportunity to twice visit -- first in October 2009 and again in May of this year -- Gaza and Jerusalem with her group from PSR-state of Washington. Gerri was to speak here today, but was unable to attend, and she asked that I stand in for her. David Hall, a psychiatrist and former president of PSR, also whom many of you know, was on the trips as well.


While in Gaza, I consulted on patients in the neurosurgery clinic and the wards and assisted in surgery. I also did leadership coaching and management consulting for leaders of various NGOs. I had not been to the Middle East before.


I am a non-practicing Jew who is against organized religion. The Mellman family of Columbus, Ohio is a strong supporter of Israel and of the powerful lobby, the American Israel Public Affairs Committee, known better by its acronym, AIPAC. I, personally, do not support AIPAC. In my childhood, I gave nickels and dimes each Sunday at temple to plant trees in “the land with no people for the people with no land.” I now know that statement was only half true. My pro-Israel stance and belief in its right to exist as anation state have been strengthened by my visits, discussions and study. However, I am not “Israel, right or wrong.” I am, at my core, a strong believer in the Universal Declaration of Human Rights.


The conclusions of this talk are that there are no clean hands in the Gaza-Israel relationship and Israel’s attempt to isolate Gaza and inflict a collective punishment has failed. Israel has destroyed the relatively effective economy of Gaza and created an inefficient and perversely effective tunnel economy. The question, of course, is: what should be done now? I will suggest an answer.


Gaza (The Gaza Strip) is ~7 x 20 miles or 140 square miles (~40 x 9 kilometers or 360 square kilometers) at the northwest corner of Israel and borders the Mediterranean and Egypt. It has ~1.5 M people and is the most densely populated region of the world. Sixty-five percent of its citizens are refugees. Essentially all are Muslims. For mathematical ease, I estimate the haves:have-nots to be 1:14; i.e. 100.000:1,400,000. This is important because there are photographs circulated on the Internet that only show the haves and purport things to be wonderful in Gaza. There is near-hunger in every home of the 1.4 million. The water for all is non-potable. I will discuss later in more detail the ~18 million gallons (~72 M litres) of raw sewage that is dumped into the Mediterranean daily.


The history of Gaza goes back thousands of years, beyond even the pharaohs. There are artifacts in the museum in Gaza City dating back thousands of years BCE. Any trade or war with Egypt from what is now Europe and Asia had to go through Gaza.


Zionists began moving into Gaza in the late 1800s. The UN creation of the state of Israel in 1948 decreased Gaza’s land area by about 1/3 from that created by the British mandate in 1917.


The Arabs know the Arab-Israeli War of 1948 as The Nakbah – the Catastrophe. The Catastrophe, of course, refers to the loss of the war and to the estimated 725,000 Palestinians who lost their homes. They lost their homes primarily because they were told at the beginning of the 1948 war by the surrounding Arab states to leave their homes. This was under the assumption they would return in a few weeks to those homes after the Jews were defeated. Another important reason that they left is because, indeed, there was a war and they were, appropriately, afraid of the Israelis.

Many of those Palestinians, in 1948, escaped to Gaza. The population of Gaza then went from approximately 80,000 to greater than 200,000. After that 1948 war, Gaza was considered a Palestinian region controlled by Egypt. However, Egypt had little concern with the economic condition of Gaza and did little, if anything, to improve it.


Israel, in the six-day war of 1967, took back Gaza from Egypt and the West Bank from Jordan. Israel also captured the Golan Heights from Syria. These occupations, it should be noted, are problematic and debated by many who believe the laws of war state, to the effect, that a winning nation should not occupy a nation that it defeated.


Starting in 1967, Israel put settlements into Gaza. However, in 2005, it chose to leave and pulled its settlers out, some forcibly. It is important to note that while there were no more Israelis in Gaza, Israel maintained rights of registration into and out of Gaza and maintained control of Gaza’s borders, including the Mediterranean and even the airspace over Gaza. Egypt was allowed to keep control of its border with Gaza.


Almost immediately after Israel pulled out from Gaza, Hamas militants began shelling the state of Israel - over 6,000 Qassam rockets since 2005. There were deaths and injuries as well as economic damage from those rockets. And the psychological effects were severe. Post Traumatic Stress Disorder is estimated to be over 95% in Israeli children living in the areas of attacks. These attacks as well as suicide bombers and the kidnapping of Galid Shallit, an Israeli Defense Force soldier in 2007, have led to Israel’s

collective punishment of Gaza characterized by the wall surrounding Gaza on its three sides, the Mediterranean blockade, the refusal to allow Gazans to work in Israel, and the severe restriction of “dual use” imports into Gaza.


The most recent collective punishment was Israel’s “Operation Cast Lead,” the air and land attacks of December 2008 into January of 2009. In this action over 1300 adult Gazans were killed, mostly civilians. Over 300 children also died. Additionally, Israel used white phosphorous, usually used as a fogging agent, as a direct weapon on the population. Collective punishment violates the Fourth Geneva Convention.


In 2006, democratic elections were held in Gaza. Hamas wrested power from Fatah in that election. It is important to note that on the ballot the name “Hamas” was not next to any candidate. The only two parties on the ballot were Fatah and Change. The Change Party happened to be a conglomerate of numerous parties, of which Hamas was the major member. The reason the Change Party won the election is the Gazan citizens wanted change from the corrupt and ineffective government of Fatah. With that election, Hamas won control of Parliament and named Ismael Haniyeh as its prime minister.


In 2007, the Palestinian Authority, of which Fatah and Hamas are the two major political parties, removed Prime Minister Haniyeh from power and put in its own person, Salam Fayyad. Shortly thereafter, Hamas, through a bloody coup, removed that prime minister from power and reinstated Mr. Haniyeh, who remains as prime minister today. Our group has met with Prime Minister Haniyeh on each of the two visits. Although some members of our group disagree, I believe those were primarily photo opportunities for

Prime Minister Haniyeh and for our group. I think the words of David Hall our spokesperson, and those of Prime Minister Haniyeh were simply platitudes. Additionally, I am always concerned we were just serving as “useful idiots,” that term given by Lenin and Stalin to those of the west who would sympathize blindly with Communism.


The blockade has forced creation of a tunnel economy that can pay teenagers as much as $200,000/week. Goods go from Egypt to Gaza; food to automobiles to weapons traverse the tunnels. Also, militants go into Egypt for training and return via the tunnels. Hamas has set up a taxing district for these tunnels.


The quartet (The United States, Russia, The United Nations, and the European Union)has insisted on three concessions by Hamas before it will recognize Hamas’ legitimacy: (1) recognition of the State of Israel, (2) cessation of violence, and (3) recognition of previous agreements between the Palestinian Authority and Israel. Hamas, formally, has done none of these. However, Hamas’ rhetoric does not always match its actions. I will

allude to this later.


Some issues arise from my discussions with physicians and civil society

leaders of Gaza:


1. The blockade causes physicians to be unable to take their board exams or obtain outside continuing medical education. This is because Israel, for reasons unknown to the physicians, refuse to allow them passage.


2. The blockade keeps patients from getting needed care from regional hospitals. Some patients die while awaiting transfer. When Israel was in Gaza, such patients received immediate transfer. Also, the blockade restricts needed medicines and supplies.  Electricity, controlled by Israel, often goes out during surgery.


3. The conflict and despair has distorted the values of children such that they wish to be suicide bombers. Many under the age of twenty have never been outside of Gaza and thus cannot relate to the humanity of most Israelis – they have a collective hatred of all Jews.


4.  Hamas cronyism adversely affects patient care.


5. The Fatah-Hamas conflict causes much stress among NGO leaders who are relatively apolitical and care primarily for their own NGO agenda.


  1. Hamas does have a conundrum: Trying to simultaneously satisfy its religious right and govern its religiously diverse (in terms of devotion to strict religious law) population.


7. An NGO leader told me of his teenaged son inadvertently injured when a Israeli drone killed a terrorist. Israel had recorded the event, found the boy who was in Al Shifa hospital and transferred him to an Israeli ICU. The father met an orthodox rabbi whose son was in the same unit. After a few days, the two men became friends and decided that there was nothing that could not be negotiated and fixed between Gaza and Israel. That is, despite their ethnic differences, they shared the same set of values, hopes, and fears.


8.  A vignette in which Israel’s actions came back to bite it: Over 18 million gallons of raw sewage goes from Gaza into the Mediterranean every day. Thus, there is significant pollution ofthis portion of the Mediterranean. Israel has stopped allowing“dual use” items into Gaza – items, such as drainage pipes, that can also be used to fire missiles into Israel. However, there is a natural flow -- in this case, literally and figuratively -- to this issue. The natural flow in this particular case is north from Gaza to the Israeli city of Ashqelon. Ashqelon has a desalination plant, which requires extreme measures to protect the waters going into that desalination plant. Additionally, the beaches of Ashqelon, for which it is noted, have become polluted. Therefore, suddenly,Israel has a dog in this fight. There are now four projects, each with Israel as a participant, such that in two years this raw sewage drainage problem will be resolved.


Gaza is a public health nightmare, which is defined by an incident reported in The London Times. Early in the morning of March 27, 2007, while most of the village of Umm al-Nasr, in Northern Gaza, were asleep, a sewage treatment facility just above the village collapsed. It had been slowly and steadily leaking human waste for some time. The foul-smelling effluent caused the drowning deaths of five persons: two women in their 70s, a teenaged girl, and two boys, aged 1 and 2. Fifteen people were injured and scores more were missing. For months previously, the villagers had pleaded with Israeli authorities to allow the importation of the pumps, pipes, and filters necessary to stem the flow, but Israel, rattled by a ceaseless barrage of crudely constructed rockets, launched daily from Gaza, some of which were constructed from old sewage pipes, refused. The villagers built an earthen embankment around what was fast becoming a giant lake of human waste. But the embankment would not hold. The village was inundated. According to the London Times, as far back as January 2004, UN aid agencies in the Gaza Strip had warned that the sewage treatment facility was operating far beyond its capacity and posed a grave danger to nearby residents. Designed to serve just 50,000 people, the plant was then handling waste from 190,000 Gaza residents.


Israel’s attempt to isolate Gaza has failed. While there is always a trade off between security and human rights, the situation in Gaza has always been unsustainable – it is perhaps coming to a head.


In 1948, U.S. President Harry Truman wrote to Eleanor Roosevelt, immediately prior to being the first international leader to accept Israel as an independent nation-state, “I fear very much that the Jews are like all underdogs. When they get on top, they are just as intolerant and cruel as the people were to them when they were underneath.”


David Ben-Gurion said, “The Land of Israel is in this part of the world, surrounded by Arabs. And we will have to, to the extent it is up to us, find a way to (coexist with) the Arabs - (find) a way to an agreement, to a compromise…we are now full of bitterness toward the Arab world, but they are here and will remain here and we must look to the future.”


It is important at this point to mention religious extremism, practiced by a relatively few Jews, Muslims, and Christians, which is a deterrent to peace in the region. Their leaders appear willing to end the world if it will achieve their goals of utter destruction of those considered non-believers; a doomsday scenario. The Jewish and Christian extremists want the Muslims to leave Israel, the West Bank and Gaza. Similarly, the Muslim extremists wish the Jews to completely leave the region. Both say, “Go back to where

you came from!” Exactly where that might be is never defined. 


But neither the Jews nor the Muslims are going away. 


The majority of people in the region, Jews and Muslims, want to get along in a peaceful coexistence. They just wish to be left alone, raise their family, have good relationships with those around them, earn a decent living, and have meaning in their life.


The creation of a milieu for such a relationship is the job of the leaders supported by us, members of civil society. Within each population, there are always people who will reconcile to change and those who are irreconcilable; usually an organized minority. To effect change, leaders must work with the reconcilable portion of the population.


Similar to the relatively rare religious extremists are the great number of persons who refuse to disaggregate groups. If Muslim, they look at all Jews as being of one mindset. If Jewish or Christian, they look at all Muslims as being of one mindset. They refuse to disaggregate the group into conservative, moderate and liberal. They each say, “Kill them all, and let God sort it out!”


The one with less to lose is always in control of a conflict. Israel, because of empathy for its cause – a people that have been forcibly evicted from nations for centuries and suffered the holocaust in WW II - until recently has had nothing to lose by its actions and behaviors. But this is changing. In 2006, Israel lost its pre-emptive war with Lebanon during which it inflicted many civilian deaths. Operation Cast Lead and the resultant Goldstone Report and the most recent flotilla incident have been difficult public relations situations for Israel – it is losing support at many levels.


Nietzsche said, “Anything that doesn’t kill me makes me stronger.” This is why Israel’s control over Gaza is failing – because the Gazan people and Hamas are becoming stronger; they are becoming more united against Israel.


My suggestion for a next step is an incremental one. It applies only to the movement of goods and supplies in and out of Gaza. Completely open such movement to all materials that are not obviously of military use. Allow the reconstruction of Gaza’s infrastructure and economy. Let Gaza trade on the regional and global economies. This makes economic sense and respects human rights. This puts Hamas in a “be careful what you wish for” position. The oversight of the materials coming into Gaza would be by the EU or the UN. Israel would have their own people at each site of embarkation of these

materials for overall control. Then, only illegal items and items of war will enter via the tunnels, and policing of the tunnels will be straightforward.


Should shelling resume, Israel must not create a collective punishment, but rather work with Hamas to capture those who are creating such action.


Unintended consequences of lifting the blockade, such as seen in the UN’s Oil for Food Program in Iraq under Saddam Hussein, where there was much corruption, can occur. But if this is done transparently and for the whole country and monitored, any such corruption could be caught early on.


Simultaneous with the lifting of the blockade, the NGOs of Israel, and indeed the world, must create closer ties with those of Gaza. Even more so, physicians of Israel and the world must work to improve the care of patients of Gaza.


The dynamics of all will change for the better once there is a relatively effective and efficient economy in Gaza. 



Mellman, D. (2010). AN INNOCENT IN GAZA. Retrieved from


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