| Federico
Allodi, MD
International conference, Siege and Mental Health: Walls vs. Bridges. view or download Powerpoint presentation
Outline
of the paper:
Quotations on history The purpose of history is to explain the changes which have taken place in a society (Eric Hobsbawm, 1997). This in turn, we hope, will teach us about our current problems and how to cope with them. Though Herodotus said that history is a teacher, much have also been said to the contrary, that is, that history does not repeat itself or that history moves in cycles or in a spiral form, which means that it does repeat itself but in different contexts. Some skeptics of human nature believe that man never learns from the past, and even more negatively some notables, like Henry Ford, thought that "history is bunk". Whatever we may or may not learn from history I am partial to the saying of Mark Twain, "History does not repeat itself, but it does rhyme".
Some definitions and model of analysis. It is appropriate on the occasion of this conference sponsored by the World Health Organization to use its definition of health as a state of harmony between the biological, psychological and social components of man. Since many of the determinants of health are of a social and environmental nature it is only logical that the promotion of health or the fight against illness will involve the ideas and actions pertinent to the life in the city (polis, in Greek), that is, the organized society or government. Rudolf Virchow, a 19 century German pathologist, pioneer of social medicine, equated medicine to politics, and public health as politics to the nth power. Thus, it is a necessity that in speaking of the mental health of the population of Gaza under siege we involve ourselves in the political processes which determine their states of illness and health. Gaza is under siege, a radical social and political situation which begun in its most acute form in June 2007 as a reaction of the Israeli government to the political events in the occupied Palestinian territories. By definition, in a siege armed forces surround, cut supplies or communication and attack a besieged group, armed or not, resisting the attack. There are different types of sieges:
The motives for sieges are:
For the purpose of this study on sieges the sources of information and data available will be ranked by their reliability. From a historical point of view at the bottom of this gradient we will place religious or mythical documents or sources (such as The Bible), followed by epic literature and poetry, (such as The Iliad), legends and oral traditions, historical writings, chronicles and archeological artifacts, and modern history with scientific measurements and methods of analysis. The value of a document may have doubtful historical value, but it does not deny its moral, philosophical or aesthetic value. For instance, The Bible contains deep moral truths and the historical context may be accurate in many instances, but it is not a historical book. With all respect to the readers of the Holy Book I will cite Northrop Frye, possible the greatest Canadian scholar on the Bible, who said, "Any relation between The Bible and history is mere coincidence". More detailed scholarly studies have shown that the greatest biblical characters have no proven historical existence. (Thomas L. Thompson, The Bible in History. How Writers Create a Past, 1999). In our review of sieges we will look for the following parameters of analysis:
Naturally, in our analysis the emphasis will fall upon the behavioural and psychological aspects as health determinants on the sample of sieges presented.
SIEGES IN
ANTIQUITY Siege of Megiddo, 15th century BC This the oldest siege in history. The city of Megiddo, located in a rich valley, was on a trade route from the Mediterranean coast to Egypt and Mesopotamia. The Canaanites and their allies rebelled against Egyptian rule. The forces of Pharaoh Thumotse III with 10-20,000 soldiers, after a siege of seven months, ended victorious. The outcome resulted in 38 killed, 340 prisoners and a great deal of booty, namely 2041 mares, six stallions, 924 chariots, 200 suits of armour, cattle and 20,500 sheep. The city and the citizens were spared. The unrest against the Egyptians continued for years and so did the Egyptian campaigns. This is recorded in the temple of Karnack of ancient Egypt.
Siege of Jerusalem by Sennacherib, Assyrian king, 701 BC The city of Jerusalem has had the most sieges in history, 24 in total. Sennacherib did not sack the city. The siege is reported by Herodotus. The Bible says that an angel protected the city and the siege was abandoned.
Siege of Jerusalem by the Babylonians, 597 BC King Nebuchadnezzar II the Great of Babylonia invaded Judea several times. The city suffered at least three sieges but it was only destroyed in 587 BC. In the siege of 597 BC he conquered it and took with him to Babylon the Jewish king Joachim, his family and officials, 1000 craftsmen, and a total of 4,600 people. He left in Jerusalem a puppet king. However, because there were further rebellions, he finally destroyed the city. In the Bible the destruction is fully described with the embellishments expected in a religious book. The prophets Ezekiel and Daniel were taken along to exile. Daniel became adviser to King Nebuchadnezzar. The king, because of his own sin of pride (hubris in Hebrew and narcissism in modern psychiatric nosology) was punished by God, and, thus engaged in the most bizarre behaviour, letting his hair grow and eating grass on all fours like an animal. This has been interpreted in modern psychiatry as the sign of a disorder called lycanthropy (lykos, wolf, and anthopos man, in Greek) which in the Middle Ages would have been known as the belief in werewolves, that is, humans becoming wolves. To cure his malady Daniel interpreted the king's dreams and the king recovered, and so Daniel became the first psychoanalyst recorded in the literature (Never underestimate the potential contribution of exiles to the host country). In exile the Jews lived in a multicultural society and learned the proto Arabic alphabet of 26 letters, adopting it as their own square alphabet which replaced their ancient script of Sumerian origin with 600 signs. This calamity of the exile has been critical in cementing the Jewish identity to this day.
Siege of Jerusalem by the Romans, 70 AD (April 4-September 8) The Roman consul Pompeius had subdued Judea in 65 BC after which it became a Roman client kingdom. The siege is fully described by Titus Flavius Josephus (37-100 AD), a Jewish historian and a most interesting character. The Romans under Emperor Vespasian (AD 9-79) dominated the province of Samaria with the capital in Caesarea Augusta. With 60,000 legionnaires he settled the Jewish rebellion in Galilee. Jerusalem's Jewish population was increased to one million by the refugees from the adjoining regions. The siege lasted five months. Eleazar Ben Yair, leader of the zealots organized the defense. The Romans, with their customary skill and parsimony, built massive ramparts, siege towers, mangonels and catapults. Supplies and communications were effectively cut off and hunger became the most powerful Roman ally. The Jewish deaths totaled 115,800. When the city fell the Romans took 90,000 prisoners, the youngest and the handsomest of which were taken to Rome to parade in the Emperor Vespasian's triumphal entry. The victory was immortalized with bas-reliefs in monuments erected to him. During the siege the behaviour of the Jewish population under prolonged massive starvation was described by Josephus: "Throughout the city people were dying of hunger in large numbers - and enduring unspeakable suffering." He continues to say that in every house mothers robbed food from their children, husbands from their wives, neighbours attacked neighbours and gangs of thugs would roam the streets and go from house to house battering people so that they would reveal where they had hidden their food. Josephus adds "The moral degradation that this siege inflicted on the besieged lasted a full generation." Josephus's impartiality has been subject of controversy. He went to Rome where he wrote in Greek his History of the Jewish Wars. This book was kept for centuries by the Christian church. He provides excuses for the destruction of Jerusalem by Titus, blaming the soldiers, when in fact the Romans' ultimate plan was to deal with the rebellion once and for all, and destroy the city. We could say that as a war correspondent he was embedded, that is, truth was his casualty and he became part and active instrument of imperial Roman propaganda.
Siege of Ma'arrat al-Numan by the Crusaders, 1098 AD From the time of the destruction of Jerusalem by the Romans till the arrival of the Caliph Omar in the 630s Palestine remained in Christian hands under the emperors of the Eastern Roman Empire in Byzantium. From there on it remained under Muslim control till the arrival of the Crusaders from Europe in the 11th century. From December 11th to the 5th of January, 1098, the fortress of Ma'arrat al-Numan, North of Aleppo, was besieged by Raymond IV Count of Toulouse (also known as Raymond St. Gilles) and Behemond de Tarente. After a three-week siege, he took the city and killed 20,000 inhabitants. A remarkable event took place at the siege which became known throughout Christianity. Acts of cannibalism were perpetrated by the Crusaders. A Christian chronicler writes, "Ours boiled pagans in the pots and fixed the children on picks to devour them roasted." The excuse was that "it was in winter and there were hardly any supplies." It is true that on their way through the arid lands of what is today southern Turkey, north of Ma'arrat, the Crusaders ate their horses, and with the practice of scorched earth of the Muslims no animals or fruits were left to eat, and the wells had been poisoned. Nevertheless, after the city had been taken and food supplies were not scarce the Crusaders continued roasting Muslim children. This scandal reached the pope in Rome who spoke sternly against the practice. In acquiring a taste for roasted child in their menu the crusaders displayed the callousness of antisocial personalities among the aggressors so frequent still in modern armies.
Siege of Jerusalem by the First Crusaders, 1099 AD (June 7-July 15) The Crusaders besieged and stormed the city and captured it from the Fatimid Egyptians. The Crusaders probably suffered as much as the citizens of Jerusalem because of the lack of food and water in the lands around Jerusalem. The struggle was tough and when the city was taken 50-90,000 people were slaughtered. It is reported that the city was awash with corpses and that the Crusaders waded in knee-high blood. This probably was a poetic exaggeration. The defenders were led by Iftikhar al Dawla, who resisted to the last moment in the tower of David. All those in the redoubt of Al Aqsa, mostly refugees, were slaughtered. To this day they are remembered as the martyrs of Al-Qud al-sharif. The Jews, who were among the most vigorous defenders, were locked in a synagogue and set on fire. Godfrey of Bouillon, after a struggle against a rival party that wanted to establish a theocratic state under the Pope, conquered the city and became the secular ruler of Jerusalem. This victory established the Christian Kingdom of Jerusalem which lasted just under 200 years, with the fall of Acre to the Mamelukes in (1291).
The siege and conquest of Jerusalem by Saladin, 1187 After the battle of Hattin near Lake Tiberias with the massive defeat of the Crusaders forces the fall of Jerusalem was predictable. From the time of their arrival the Crusaders had fought among themselves while Saladin had spent considerable time in uniting the various Arab factions and cities. After a fierce battle and a siege of thirty two days the city surrendered under generous terms for which Saladin has been criticized. The Crusaders with their families and property were allowed to retire to Acre along with the soldiery and the common folks after payment of a ransom. The motives for the battle could not have been more symbolic. In the movie, the Kingdom of God, the Crusader Sir Balian of Ibelin asks Saladin "What is Jerusalem worth to you?" He answers, "Nothing -- and everything." The fall of Jerusalem shocked Christendom and the Third Crusade was launched. Perhaps Saladin was right. There was no point in eliminating the Christian forces and people of Jerusalem. He knew there were many more in Europe to replace them. Perhaps it was a model of successful negotiations.
Siege of Acre July 1189-July 1190 The city was taken by the king of England, Richard the Lionhearted, who provided effective leadership to the Crusader camp. The city surrendered and prisoners were exchanged but Richard became unhappy with the exchange and he slaughtered the Saracens prisoners. In turn, Saladin slaughtered the Crusader prisoners. Acre became the capital of the Crusaders' kingdom, which lasted altogether almost 200 years when it fell to the Muslins.
Siege of Byzantium by the Crusaders, 1205 In the Fourth Crusade a mixed force of French, German, English, Venetian and papal forces on their way to Jerusalem were cajoled by the Venetians to lay siege to Byzantium, a Christian city and the last capital of the Eastern Roman Empire. The Venetians had for some time wanted to eliminate the trade competition from Byzantium. A 90-year-old blind man, the Doge of Venice, Enrico Dandolo, led the siege and attack. The booty was enormous, rich in treasures and precious relics to be found later in Venice and the rest of the capitals of Christianity in Europe. It is the best example of a siege for commercial purposes. The Venetians, a trading people, were inspired by their motto: Prima Veneziano, poi Christian, that is, "First Venetian, then Christian".
Siege of Aleppo by the Mongols, 1259 Hulagu Khan, the Mongol leader, with a large army cornered a much smaller force in the fortress of Aleppo. He invented germ warfare. He catapulted corpses infected with plague to the city, causing infections and epidemics, thus weakening the strength of the defenders. It worked although he didn't know the mechanism for the transmission of plague infection.
MODERN SIEGES. Surrender of Granada, 1492 The Catholic Kings, Ferdinand and Isabella, besieged the palace and fortress of Alhambra and conquered the city of Granada from King Boabdil, the last Moorish monarch in Spain. By this time the Islamic rulers of Spain had spend centuries warring with each other, split into dozen of small kingdoms (Taifas) and their cultural splendor had been much reduced. The terms of surrender (Capitulaciones) were honourable and generous, and the Pope agreed to them. However, the Pope and the king were too far from Granada to be able to enforce them. The local governments added new taxations to the Muslims who also resisted acculturation. The populace resented their non-Christian habits and practices. The Moorish rebelled in 1525 and were finally expelled in 1609. The loss of 344 000 Muslims, most of them skilled farmers, caused immense damage to the Spanish agriculture. No wonder that the nobility, for which they were most valuable tenants, fought so hard to have them peacefully reconciled. Recent research has shown that they were in correspondence with the Ottoman Empire in Turkey and the rulers of North Africa in preparation for a new invasion in support of the Moorish rebellion.
The great siege of Gibraltar, July 1779-February 1783 During the American War of Independence 100,000 Spanish and French troops with 48 ships added the last siege to the long history of sieges of Gibraltar. The defenders of the garrison, 7000 at the most, survived the assault. The Treaty of Utrecht, 1783, settled the peace between France and England and annexed Gibraltar to Great Britain as a colony. When the citizens of the Rock were given the opportunity to swear allegiance to the king of England all of them, except a handful of priests and other unmarried folk, decided to leave the Rock. The rest settled in the parish of San Roque close to Algeciras. A town was born and to this day its inhabitants consider themselves as the legitimate Gibraltarians. Here we have a forced Diaspora and the everlasting issue of national identity.
El Alamo siege, Texas 1836 From the 23rd February to 6 March, 1836, 2,000 Mexican soldiers under General Santa Ana (El Generalito) surrounded 189 Texans and U.S. settlers, including the adventurer Davey Crockett. There was no surrender and the Alamo was taken by the Mexicans. The Mexicans lost 1,600 troops and the Texans all the 189. There were neither negotiations nor bridge in El Alamo. The motive for the dispute was land appropriation in the face of ongoing U.S. expansionism towards the West. In 1841 Texas became independent from Mexico and joined the United States. In 1847, through the Treaty of Guadalupe Hidalgo, Mexico lost 50% of its national territory, i.e. Texas, California, New Mexico and parts of Arizona, Nevada, Utah, Colorado and Wyoming. The negotiations and the signature of the treaty took place with the U.S. marines occupying on and off Mexico City.
Siege of Madrid by General Franco's rebel army, 1938-1939 On the 18 July 1936 Generalisimo Francisco Franco staged a military coup d'etat against the democratically elected republican government of Spain. Four of his divisions surrounded the city of Madrid, defended by a civilian militia, the Civil Guards and other armed bodies. Beside the Spanish army, Franco had the support in Spain of 70,000 Italians sent by Mussolini and an air force squadron (Condor Legion) sent by Adolf Hitler. This air force bombed Guernica, the ancestral capital of the Basque country, an event immortalized by the painting of Pablo Picasso. The Non-intervention Committee organized by England and France was a shameful charade: it blocked all aid from the Allied Powers to the Republican Government and turned a blind eye to the massive support of Franco's forces by the fascist regimes. There are three emblematic sayings and images left by this war which to this day form part of our vocabulary: 1) "Fifth Column" was the term used by Franco to refer to the rebel forces inside Madrid that collaborated with him and aided his four columns or divisions attacking Madrid. These were Franco's "collaborators". 2) "No pasaran" (They shall not pass) was the battle cry of the Republican defenders in Madrid against the besieging forces. They conquered the city but not the spirit of the defenders. Franco has become a hiatus in Spanish history without much significance and no influence after his death in 1975 and the return of Spanish democracy. 3) The continuous rebuilding of the top storey of the Telefoica building in Madrid, then the tallest building in Spain. The top floor was bombed and demolished regularly and quickly rebuilt by the defenders. It ended the war intact as a symbol of the resistance of Madrid.
Siege of Leningrad, 1942 From 8 December 1941 to 27 January 1943, 872 days, the German Fourth Army attacked and besieged the city of Leningrad with 2 1/2 million people. One million Russians died, making probably, in human terms, the most costly siege in history. Bombardment by artillery and starvation reduced the besieged to one loaf of bread of 125 grams daily at the lowest levels of the siege.
Siege of La Moneda, Santiago de Chile, 1973 On 11 September, 1973, General Gustavo Pinochet staged a coup d'e'eat against the democratically elected president Salvador Allende. The army surrounded and assaulted the presidential palace in Santiago, La Moneda. In the assault many of the defenders, mostly staff and palace guards were killed. Among the handful of survivors was Dr. Jos'eQuiroga. It had been rumoured that the president was not killed by the attackers but that he committed suicide. Many years later, in an Amnesty International meeting, Dr. Quiroga was asked what was the truth. He declined to answer. Still a few years later, in 2003, at a meeting in Uppsala, Sweden, Dr. Quiroga, Dr. Allende's colleague, physician and personal friend, could not say whether the president had killed himself or not. It was too painful for him to say. It was well known that President Allende had been badly wounded in the fight and that he was found dead in the presidential office sitting in an armchair with a rifle in his hands. He knew that the plan of General Pinochet was to capture him alive, humiliate and torture him, force him to sign a legal document giving full presidential authority to General Pinochet, and then be killed and "disappeared". He refused, and he took his life rather than risking surrendering the country to a dictator. In the history of President Allende one can see the parallel case of President Arafat. Both were besieged, they did not collaborate and both died. General Augusto Pinochet of Chile explained that he would model his own coup against the elected government on General Franco's coup, and, as recently as 2003 on the eve of the USA and its allies' war on Iraq, posters with the image of Guernica were carried at pro peace demonstration in many cities of the Western World This episode of Allende's suicide could be the basis for a discussion of what is egoistic and altruistic suicide. The first is motivated by a primary wish to die or be killed, of a pathological or existential nature; the latter can be motivated by self immolation as a ritual of protest, like Buddhist monks did in Vietnam and Thailand, the Japanese kamikaze pilots in the Second World War, heroes in warfare who attack knowing their minimal probabilities of survival, or the sahid or Palestinian resistance martyr. The different terminology applied to this phenomenon reveals its controversy. It is called Palestinian kamikaze in the European press and suicide bomber in most of the Anglo-speaking world.
Siege of Sarajevo, 1992-1995 In March 1992 Bosnia declared its independence from the Yugoslavian federal socialist state. The Serbs in Bosnia became a minority and under Bosnian Serbian leader Radovan Karadzic, they attacked and surrounded the city of Sarajevo. For 3 1/2 years the city was bombed and subject to massive starvation. The huge bread lines continued until food was airlifted in June 1992. Ten thousand people had been killed. As an aftermath there was massive corruption and profiteering from the UN aid handed to the Serbian Bosnian forces for the relief of the Sarajevo population. Dr. Karadzic was captured in September 2008 and appeared in front of the International Court of Justice in The Hague. The siege of Sarajevo cost casualties that have been very well reported (see slide). Out of 65-80,000 children 40 percent had been shot at by a sniper, 51% saw someone killed, 39% saw a family member killed, 48% saw their house occupied by someone else, 33% had their house attacked or shelled by soldiers. In 1987 a patient of mine, a Muslim from Bosnia and a refugee in Canada, spoke about the siege of Sarajevo. He was taken prisoner by the Serbian forces and sent to a POW camp. He had been referred to me by the probation officer after he was charged with wife assault. The patient said that he was arguing with his wife loudly in a very small apartment. The neighbours heard the shouting but did not understand it because it was in Serbo-Croatian and the wife spoke no English at all. The neighbours called police who came and arrested him. There was no interpreter. He was kept overnight and the next day appeared in front of the judge. He learned that he had been charged with wife assault and forbidden to visit his wife and baby child or to talk to them. He said "I cannot bear being alone without them." I asked him, "What is worse? To see your fellow prisoners being shot by the Serbian soldiers in front of you as punishment, or being apart from your family in Toronto?" Without hesitation he replied, "This is much worse." "Why?" I asked. He said, "There I had my friends, here I have no one." Altogether Sarajevo shows the importance of good documentation on the process of ethnic cleansing, the mental health consequences of sieges and blockades, the value of the network of personal and social support, and the bringing to justice those criminally responsible.
POLICE SIEGES Stockholm bank robbery and hostage crisis, 1973 In 1973 young Erik Olsson, a convicted felon, held up a bank in central Stockholm. He took four hostages and made demands. In the process of negotiation with the police one hostage, Kristin Enmak, said she felt safe with Olsson, though he had threatened to kill the hostages if his demands were not met. When Prime Minister Olaf Palme phoned, Kristin picked up the telephone and said she was very displeased with his attitude (the Prime Minister's) and asked him to lift the siege and let Olsson and the hostages go. Police used tear gas and Olsson and his pal (Clark Oloffson), who came in the middle of the negotiations, surrendered. No one was killed after six days of confinement. The hostages said during the five-day siege that they felt more threatened by the police than by their captors whom they considered their friends. Olsson was sentenced to ten years in prison. Kristin continued to see Oloffson and a group of women admirers, one of which married Jan Erik Olsson. This incident originated the Stockholm syndrome, defined as a reaction of sympathy and admiration of a victim towards the captors. It has been interpreted as a psychopathological reaction of identification with the aggressor, meaning that the fear, anxiety and anger of the victim are transformed into submission and friendliness to secure survival. In the case of Patty Hearst of 1974 this young woman, heiress of a U.S. fortune, was kept captive for two months by the Simbionese Liberation Movement, for days at a time shut in the dark of a small cubicle. She was made love to by the leader, Cinque, and went over with the group into a number of bank robberies. She went to jail and eventually was pardoned by President Carter. Afterwards she wrote her memoirs and spoke of going into "a mission" (meaning a bank robbery), fell in love with her bodyguard and married him. In the same way she was thought of having suffered the Stockholm syndrome as a survival strategy which may have saved her life.
London Spaghetti House siege and hostage crisis, 1975 From September 28 to 30 October, 1975, three men held hostages, nine staff, all Italians, in this Knightsbridge Italian restaurant. They were after the weekly take of GBP13,000. The attackers took the hostages to a basement room but one staff escaped and alerted the police who cordoned the area. Two hostages were released because of illness. There was plenty of food that the hostages and staff shared. The Italian consul and the police negotiated, and the gunmen gave up with no concessions; no one was hurt. The story ran that after the siege the staff, gunmen and police sat together to eat a good dish of spaghetti.
THE SIEGE OF GAZA BY THE ISRAELI ARMY, 2007- The siege began in June 2007 after the people of the Palestinian territories democratically elected the party of Hamas, the President, belonging to the rival Al Fatah party, dismissed the Prime Minister and, thus, the government was split. A struggle between the two factions took place with the victory of Hamas, who took over the government in Gaza. Israel, already exercising a tight control on all Gaza entry points, tightened its grip. Supplies, travel, communications were reduced to a minimum to levels insufficient to maintain life, health and social security. The situation was denounced internationally and by U.N. agencies as a "humanitarian disaster, a form of genocide and a great crime against humanity." (BBC News Monitoring program, 21 January 2008). The powerful Israeli army and air force has pounded regularly with missiles, shelling and sonic booms the residential areas in a part of the world where the density is probably the greatest in the world at over 3,000 persons/square kilometer. Hospitals, residences, public markets, police headquarters and industrial sites are next to each other and it is not possible to attack any target without risking seriously to hit another next to it, intended or not. The results have been the destruction of the basic material infrastructure and the severe obstruction of the flow of supplies essential to maintain life, health, and the institutions of social support and control. Consequently, a threat to health and the health care determinants of catastrophic proportions. Let us look at the available statistics: 1) slides of health determinants 2) mortality and morbidity 3) children's physical health and mental health The overcrowding, high rates of unemployment and malnutrition, lack of access to clean water, poor waste disposal and destruction of housing have left the population of Gaza (half of it 17 year old younger) extremely vulnerable to ill health including mental health. Infectious gastroenteritis and diarrhoeas have reached levels comparable to undeveloped countries in Africa. Symptoms of psychological morbidity related to the stress of war environment (anxiety, fears, bed wetting, clinging and regressive behaviours, and a more specifically PTSD) have reached rates affecting 68-90 % of the population. These reactions of general populations under similar conditions of stress have been reported all over the world whenever data has been available. It is to the credit of the Gaza mental health professional, in particular the GCMHP, and to the various organs of the UN and other NGOs that so much good data has been produced. The resilience of the native Palestinian population is explained in the same way as the resilience of the children of Ireland during the years of "the troubles" in the early 70s and the refugee children from Chile in Canada after the coup of 1973 (Allodi, 1989). The determining factors were, basically, a cohesive ideology with simple explanations to the children, parental and social support, and the response of professional institutions and of society as a whole. Before the siege protective factors were studied in Gaza by the GCMHP research group with compatible results. (Punamaki, et al) Violent behaviours towards members of their own group are commonly found in crisis situations in which food, space, and vital supplies are scarce. The population of Gaza as well as the West Bank has shown these patterns for some time, much more pronouncedly in Gaza since the siege. Physical and sexual violence towards women has increased about 400%. During the occupation there have been frequent individual reports of Palestinian policemen who have been tortured in Israeli jails using the same techniques against Palestinian prisoners. The explanation provided has been imitation or identification with the aggressor. Cases of collaboration and spying for the Israeli are common knowledge, though no methodical reports are available. As for the harm done to the aggressors in the occupation and this siege, that is the Israelis, there has been copious information reported both in the popular press and in scientific journals as to the type and rate of casualties. They would include deaths, injuries, psychological disorders, including PTSD, and divisions and factionalism in Israeli society including well known cases of war and occupation resisters and "refusenick" soldiers. There have been reports of individual cases of Israeli soldiers who, after committing abuses on Palestinian women, including assassination, repeated same abuses against their own women. Reports of cases of personality disorders, moral blunting and "degeneration", and rates of suicide and homicide in veterans and soldiers, which often are associated to war and armed conflicts, should be collected and examined.
ANALYSIS OF SIEGES AND CONCLUSIONS There will be no attempt in this paper to draw conclusions as to the mental health or social aspects consequent to the siege of Gaza. I should leave this to the professional and people of Gaza themselves. However, from the analysis of the above described sieges we can deduce the following general postulates: 1. Sieges occurred in cities which resisted conquest or surrender. 2. Hunger and starvation were routine siege strategies. It frequently led to social and political strain and disintegration. It splintered the communities and weakened their capacity for resistance. 3. Contrariwise, ideology and leadership enhanced unity and resistance. 4. The presence of a system of internal social and personal support is a most significant factor in alleviating harm and advancing the success of a resistance. 5. Both besieged and attackers suffered from privations and scarcity of supplies, food and water, and were subject to stress and trauma to a varying degree. 6. The rates of frequency and severity of the individual physical and mental health was directly proportional to: a. the severity and duration of the siege b. The integrity and quality of the internal system of personal and social support, both informal (family and friends) and social or institutional and professional. 7. External support is essential in the lifting of the siege, reducing its severity and completeness, supporting the resistance both materially and psychologically, and finally reducing trauma and its physical and mental health consequences, both acutely and long-term. 8. Ultimately, in the absence of an over-riding external power, the factors predicting a successful negotiation or reconciliation and the lifting of the siege remain elusive.
Permit me to say at least that in the case of Gaza the overwhelming superiority of the IDF, abetted by the unconditional material and diplomatic support of Western governments, has made resistance by the residents of Gaza symbolic rather than material. The Kazem do- it- yourself missiles sent over the border onto nearby Israeli towns, with all respect, have negligible tactical effect though they have claimed four or five lives over the years, which are regrettable and not acceptable. Other largely symbolic acts of resistance are the sporadic blowing up of the Rafah barrier with Egypt to allow people to go shopping for basic necessities and the system of the 350 tunnels dug under the same border to supply basic daily needs. Finally, most significant as an act of international solidarity, has been the running of the blockade by two small ships, the Liberty and the Hope, sailing from Cyprus to Gaza harbour in August and September of this year. They carried medical supplies, international activists and a message, a "moral message", of protest against the harm done and the continuous threat to the health and livelihood of the population in Gaza.
Many thanks <<>> "If vicious people are united and constitute a power, then honest folk must do the same." Leon Tolstoy (1829-1910). War and Peace.
Word count: 5594. References, upon request.
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