Tending the Seam: Psychiatrist Dr. Samah Jabr Holds Together Hope

Palestinian Jerusalemite psychiatrist Samah Jabr lives and works on a seam in Palestinian life that is invisible to most: the thin boundary that exists between the crushing day-to-day realities of military occupation, and the human capacity to endure them.

As the chair of the Palestinian Authority (PA)’s Mental Health Unit in the Palestinian Ministry of Health she traverses East Jerusalem, the rest of the West Bank, and the Gaza Strip, coaching, advising, and managing the very small cohort—there are only 34 trained psychiatrists—responsible for the well-being of 5.35 million Palestinians.

Some situations she describes are unimaginable. A woman has numerous symptoms of trauma. She was fleeing in a vehicle with her family in the middle of Israeli bombardment—an apocalyptic hellscape where every intersection was cut off by falling missiles—when her child fell from the vehicle. The family was unable to turn around to get her child, and the mother, years later, cannot forgive herself.

In another instance, Dr. Jabr was training a team of medical professionals how to recognize suicidal thoughts and feelings in their patients when one of the doctors confessed that he himself could not stop thinking about ending his own life. He is unable to escape the memories of triaging patients struck by Israeli shelling, he says, haunted by the decisions he made as to who would get immediate attention in his resource-poor hospital, essentially sentencing the patients to live or die.

Some situations she describes are unimaginable. A woman has numerous symptoms of trauma. She was fleeing in a vehicle with her family in the middle of Israeli bombardment—an apocalyptic hellscape where every intersection was cut off by falling missiles—when her child fell from the vehicle. The family was unable to turn around to get her child, and the mother, years later, cannot forgive herself.

In another instance, Dr. Jabr was training a team of medical professionals how to recognize suicidal thoughts and feelings in their patients when one of the doctors confessed that he himself could not stop thinking about ending his own life. He is unable to escape the memories of triaging patients struck by Israeli shelling, he says, haunted by the decisions he made as to who would get immediate attention in his resource-poor hospital, essentially sentencing the patients to live or die.

“What could I provide for him?” she ruminates. “I listened to him, and referred him to colleagues. Many of us providing support are traumatized.”1

But other situations are more mundane, and cut against what are presumed to be best practices in mental health provision:

• How to treat with consistency the patient who fears that anything written down will be used by Israeli security services against them, either as blackmail for cooperation or as evidence that they do not live in Jerusalem, which can put their Israeli permanent-resident ID at risk?
• How to diagnose actual paranoia in a client who insists that all phones and computers be removed from the room because they worry about digital monitoring by Israeli forces—a real and documented threat?2 
• How to convince someone with suicidal ideation to disclose it, risking not only social stigma (many Palestinians view suicide as a religious transgression), but also tracking by Israel’s intelligence services? The Israel Security Agency does not differentiate between Palestinian acts of political violence and that moment when the mind breaks, crossing into new realms because it cannot withstand the pressure of this one.

Dr. Jabr has written throughout her career. In the early 2000s, she was prolific, publishing articles like “Language: A Tool of Oppression and Liberation,” and “Israel’s Refusenik Pilots: Heroes of a Different Kind” for the Washington Report on Middle East Affairs and other Western publications. Later, after studying in France, she began to write in French and was featured in a French documentary, Beyond the Frontlines: Tales of Resistance and Resilience in Palestine (Alexandra Dois, 2017). Her storytelling often had a message for American and European readers, describing Palestinian life but also exhorting her readers to act for change.

It is no surprise, then, that as a mental health professional, she has developed a cutting critique of the manner in which Western medicine seeks to provide healing in the Palestinian situation.

“All the Western interventions in trauma depend on first establishing a safe place—something that we can rarely do in Palestine,” she says. “A safe place, relaxation, and narrating or retelling the story. This is an individual intervention and [whatever the type of therapy], we need to reprocess the traumatic events.”

This situation rarely exists in Palestine. “When we receive an individual in therapy, the experience is usually collective, sometimes the experience is also individual, and there is no single trauma—usually it is repetitive. Sometimes they come to see us during the traumatic situation and they are usually threatened—threatened with their home being demolished or going back to prison and being tortured, for example—so it is difficult to establish the safe place.”

This is essentially a different take on a familiar commentary: that the West has spent hundreds of millions funding Palestinian agencies, restoring infrastructure and homes after Israeli incursions, and delivering psychosocial programs to improve Palestinian well-being, but is unwilling to spend the kind of political capital that would truly make Palestinians safe.

“Our suffering is collective and there is a need to provide a collective intervention. International organizations overemphasize neutrality,” says Dr. Jabr. “I view oppression and military violence as a major cause of pathology. If every health professional has the obligation to inform about gender-based violence when we confront that in our work, how can we be silent about military violence in our work?”

These days Dr. Jabr is much busier and writes less frequently, although more often in Arabic. Her time is consumed with her professional engagements as supervisor at George Washington University in Washington, DC, and fellow at the Centre for Science and Policy at the University of Cambridge. She is often traveling to conferences, and volunteers for the Public Committee Against Torture in Israel, collecting testimonies from Palestinians against their perpetrators.

But this is time spent conducting her work. It is the minutes that are stolen from her every day as the travels back and forth from her home in East Jerusalem’s Beit Hanina to the PA medical clinics in Ramallah and elsewhere in the West Bank aggravate her.

“I spend long hours, especially at Qalandiya [checkpoint on the way to Ramallah] or sometimes at Huwara [in Nablus] or Sarra [another checkpoint in northern East Jerusalem] or at Erez [checkpoint controlling the crossing into Gaza]. I spend a long time just crossing, my time being wasted. Sometimes it is risky. I got my car damaged twice—once I was hit by a rubber bullet and in another case I was hit by a stone where my front glass was damaged. It is a frightening experience. It is not only a depletion of time but of our energy. By the time that we arrive at work, a lot of our patience is gone, is wasted at the checkpoint. This is an indirect way of attacking the health system in Palestine.”

Many doctors with Israeli permanent-resident ID cards work in the Israeli medical system where pay is higher and there is no need to cross such flashpoints. But Dr. Jabr decided a long time ago that her role was a different one.

“I think that my work is very important for Palestinians. We are very few. My work is both clinical and administrative. I develop strategies for mental health in Palestine. The need is huge.”

Some statistics state that over 40 percent of Palestinians suffer from clinical depression, the highest rate in the world.3 (Dr. Jabr is highly critical of these studies, saying that they pathologize the Palestinian experience instead of focusing on the existence of ongoing violence.)

“Mental health provision is liberating for the individual. I enjoy my work because it is important for the individuals who seek help, but it is also important for the community. There is a contribution to the overarching project of liberation, which is the aspiration of every Palestinian.”

In her beloved Jerusalem, however, Dr. Jabr sees deep changes in the social fabric. “The space is shrinking in a way that it damages relationships. People kill each other for a parking lot. Palestinians kill each other because there is a dispute about land,” she says, reflecting on how the extreme overcrowding of Palestinian spaces due to the expansion of Israeli settlement affects the community. “Marginalization and difficult life conditions have a heavy weight on their relationships. When we cannot oppose the Israeli oppression, we express it against each other, and that is very visible in Jerusalem. The community is tired.”

Dr. Jabr talks about the high rates of poverty in the city, and a school dropout rate—mainly among males—at 13 percent.

And she observes changes in Palestinians’ relationship to the al-Aqsa Mosque, which has always been a vital social and religious center for Muslims in the city. “Israelis are becoming more brazen and aggressive in their appropriation of what is perceived by Palestinians as theirs. To connect to the place means that you take a big risk. People who go frequently to al-Aqsa, who pray there, who spend their Ramadan near Bab al-Amud and want to make a statement that, ‘We belong to this place; this place is ours’ can be beaten, arrested, deported.”

Also, because she spends so much time in the West Bank, she hears often of her friends’ yearning to come to Jerusalem, even though it is so difficult and risky for many of them.

Among her favorite places in the city are the Mount of Olives, where she did her practical medical training in the city’s two main Palestinian hospitals, Makassed Hospital and Augusta Victoria Hospital, and the small kitchen garden that she tends in her back yard.

“I’m a spiritual person. I try to make meaning of my experience. I maintain a positive imagination in hard times. I imagine a better future. Also, the way that I understand trauma is that the experience makes you helpless. I don’t become helpless; I always feel that I have agency to do something about this situation. And I have learned to take care of myself—writing is one tool and now I have a garden.”

Tending her onions and carrots, beets and beans, strawberries and blackberries, Dr. Jabr also tends to her sense of hope. “It taught me patience and mindfulness. It is very meaningful.”