Esam Daod: Making migrants whole

THE STATISTICS are appalling. According to the United Nations refugee agency, there are 66 million displaced persons in the world – asylum seekers and refugees (25 million) or internally displaced (41 million) within their own countries. And every year that number grows. Some 5.5 million people have fled Syria while 6.3 million fled their homes but remained within Syria. Over half of Syria's population has been displaced. More than 2.5 million refugees hail from Afghanistan and 1.4 million from South Sudan. Why so many refugees? The United Nations High Commissioner for Refugees, Filippo Grandi, explained, “Old conflicts linger, new conflicts erupt, forced displacement is a symbol for wars that never end.” He noted that the vast majority of migrants, 84 percent live in poor and middle-income countries. Reading Grandi's words, I recalled what Nadeem Aslam, a British Pakistani novelist, once wrote, “The opposite of war is not peace but civilization.” And in Israel and other wealthy countries, treatment of migrants is not civilized. Israel wanted to dump asylum seekers (illegal infiltrators, the government calls them) on Uganda. Uganda already has a million refugees, mainly from South Sudan, and has one of the world's largest camps, Bidi Bidi, home to a quarter of a million refugees. Uganda gives refugees the right to work and to travel – which Israel denies them – despite being desperately poor, with per capita GDP of only $700, just 2 percent that of Israel. Would you, dear reader, as a migrant, agree to leave a wealthy country for an abysmally poor one, of your own free will? On April 24 the government told the Supreme Court it would no longer try to expel migrants to Africa, and as a result reopened migrant detention centers. According to Israel's Interior Ministry and the Population and Immigration Authority, there are currently 37,288 African migrants, not including children born to migrants here. The actual numbers may be at least half again larger. The Supreme Court is currently blocking the Netanyahu government's efforts to expel the migrants to Rwanda and Uganda. The global migrant crisis was predictable. As globalization and flows of goods and money made some nations wealthy and democratic, it left others poor and despotic – and led to civil wars and massive migration of those seeking better lives. People from “have-not” countries risked their lives to make it to “have” countries. Most of Israel's African migrants came by land, through Egypt and Sinai, before December 2013, when the fence along Israel's border with Egypt was completed. The fence closed the migrants' last land route escape. They then were forced to undertake dangerous, deadly trips across the Mediterranean to Europe in flimsy boats. Many perished. We will never know how many. The cold statistics do not tell the real story. In our warm comfortable homes it is easy to wring our hands, cluck our tongues and carry on, doing nothing, ignoring the epic tidal wave of humanity risking life and limb for a slim chance to survive. But a few have taken action. One who has is Dr. Essam Daod, an Israeli Arab child psychiatrist who works for the Clalit HMO in Haifa. In October 2015, Dr. Daod took part in a medical aid delegation to Greece. He was supposed to provide psychosocial support to Syrian refugees. However a few hours after he landed, he was already knee deep in water, unsuccessfully trying to revive a drowned woman. Three months later, in his small flat in Haifa, he and his wife Maria Jammal launched a humanitarian aid organization Humanity Crew [www.humanitycrew.com] to provide mental health and psychosocial support to refugees and displaced populations in their own language. Humanity Crew is a nonprofit organization, which provides mental health support to refugees at every stage of their journeys. So far, the group's therapists and trained volunteers have provided more than 26,000 hours of counseling to over 10,000 displaced people. Lately Dr. Daod returned from rescuing migrants off the coast of Libya. He featured in two remarkable interviews with Ayelet Shani, a contributor to the daily Haaretz, in 2016 and again recently in 2018. He told Shani, “When you see so much suffering and relate to it, you come to realize that borders are just a political game. If you are a human being, then you ought to behave like one. The refugees opened my eyes. They gave me the opportunity to regain my humanity.” Dr. Daod grew up in Kafr Yasif, an Arab town in northern Israel, population about 10,000. Kafr Yasif is largely Christian with a significant Muslim minority and a small Druze community. In his latest interview with Shani, he was asked why he went on the dangerous mission to help the boat people desperately trying to reach Italy from Libya. “How do people feel whom we rescued after 15 hours on the sea, on a crowded boat, with people who urinated into bottles and made in their pants, all of them suffering appalling skin diseases from the camps [they were imprisoned in] and with women who were raped in Libya and are undergoing terrible trauma, simply trembling with fear? “AND THIS boat is drifting and drifting and they don't even know where to. It wouldn't be accurate to say they're trying to cross, because that's impossible. Not one boat has actually managed to make it from Libya to Italy. It's as if we were now to take off from Haifa Port here in a rubber dinghy and head for Cyprus. When these people board these boats, they know they're going to die. That's what I didn't understand at first – how much they want to die.” Dr. Daod was on the rescue boat of the Spanish organization Proactiva Open Arms. Often the only slim chance refugees have of surviving depends on their being found by a rescue boat. He told Shani: “When they see us, the rescuers, they go into a mad panic. Right away they start shouting and crying for us to leave them alone, they want to stay on the boat, they don't want to go back to Libya. There are boats that aren't even found, that are simply lost. The people on them don't even enter the statistics of the missing and the dead, because there's no record of them. Ghost boats. No one even knows what happened to them.” A recent CNN documentary revealed that there were weekly slave auctions in Libya, in which migrants were sold as slaves. Shani asked Dr. Daod, why is a psychiatrist needed in a maritime rescue operation? Dr. Daod answered, “It's simple. It's impossible to rescue the body without rescuing the psyche. The rescue itself is traumatic and it comes on top of a large number of previous traumas. These people sit there in the boat, they don't know what's happening with them, they gape. Someone has to be there, to calm things down, explain to them where they are, what's going to happen next.” I queried him further about his work with the migrants. The Jerusalem Report: As a child psychiatrist, do you believe migrant children will suffer permanent trauma? Or will they bounce back? Post-traumatic stress disorder has a way of hiding for years − as we saw with American veterans or some Israeli soldiers after the Yom Kippur War. Dr. Daod: “With regard to African migrants in Israel, we do know, from research and from my personal knowledge and involvement with the Gesher Clinic for Mental Therapy for asylum seekers in Jaffa that the percentage of those with mental illness is higher and more serious [than average]. But the fact that you may believe, like many others, that the asylum seekers are more resilient does not surprise me. The media and press and mainly the politicians give us the feeling that the moment we describe them as heroes or, the opposite, as evil persons, they give this description great power. There is a lack of research and a lack of direct support for them, for their mental well-being − the problem is known but not dealt with. “For the second part of your question, the case of the American soldiers is not different or atypical. This is in my opinion a typical presentation of post traumatic stress disorder. The late appearance of PTSD doesn't mean anything, the opposite – this is typical in many cases, the trauma is there always, in all of us. There is no one alive who has not experienced trauma. The question is how was it experienced and how did we store the memory of it −and most importantly, what causes us to recall and relive it?” “Regarding the children of the asylum seekers, they are without doubt the most vulnerable, first, because they are children, and second, because their parents are also vulnerable, which makes it difficult for them to develop, in the future, in a healthy atmosphere. This is obvious for all trauma, and is neither new nor surprising. But with the current crisis of the migrants in Greece, there is something novel about it that we did not encounter in the past, which influences the mental disturbances among children and adults alike – and that is the cultural change and the great distance from home, the emotional home of course. Throughout history, this is the first migrant crisis in which such numbers, over 1.5 million, in a short time of only three years, move from one continent to another, with an enormous change in culture, mentality, language …which makes it even more difficult for the integration process and worsens their mental and emotional conditions.” “Of course, during WWII the [migrant] numbers were even larger. But the refugees mostly remained in their own familiar territory, culturally and emotionally, of course dealing with other terrible things, but the migrants were not a central problem that countries had to deal with. In the past, there were a number of migrations that were planned, by choice or by other factors, for work, without any background of trauma or war, e.g., the Turks who migrated to Germany.” The Report: “My own father migrated from Bessarabia, now Moldova, when he was 16, with his 12-year-old sister. They were stuck for a whole frigid winter in Antwerp and had to struggle to make a living and stay alive. He went on to Canada, brought his family over, and later built affordable houses for low-to-middle income working people. He was resilient, yet was marked forever by the poverty and life-threatening danger he had faced. Does this describe migrant children too? Are the Europeans badly mishandling the way they integrate the migrants, or fail to – especially the kids?” Dr. Daod: “The Jewish people went through the Holocaust and unbelievably cruel murders! As a mental health care worker, I don't know how the Jews survived it! I know the history, and value it, but I am astonished, and appreciate even more the mental resilience that is not taken for granted, nor even natural! And unlike other crises of the past or present, and even future, I think that this resilience came from the power of narrative. For thousands of years it was passed from generation to generation, the strong belief and great confidence, and lack of doubt, which made it possible for some of the Jews to survive during the Holocaust and to succeed to deal with the mental implications of the Holocaust, in an astonishing and highly unusual manner! Of course the Holocaust had negative impact on mental health, and many people suffered post trauma from the Death Camp or Concentration Camp Syndrome (the reactions and behaviors of people who have survived massive and adverse events, such as the Holocaust). But, collectively, the Holocaust did not succeed in overcoming the Jewish soul or spirit, so the story of your father is indeed inspiring.” “To my sorrow, the current crisis is completely different! We are speaking about the total lack of a narrative, or more precisely the collapse and erasure of a historical narrative and culture and mentality, and transition to a foreign country − to a cold foreign land, not speaking the emotional and mental language, hostile to some degree, that does not make possible proper integration. “I want to sum up what is happening in Europe in one sentence: Working against the mentality not through the mentality − and this threatens the Eastern family unit, does not respect it, and causes crises of marriages, of parents and adolescence, and violence toward women. “I always say that terrorist organizations, for instance, do not enlist recruits but rather fill vacuums! And the lack of integration, the lack of mental health and adapting it to language and culture is a tremendous vacuum for terror, drugs, unemployment, violence and hatred that rush to fill it!” The Report: “You retell the migrants' stories to them from a new heroic perspective, and this seems to work. It seems to me that this is an exceptionally powerful, pragmatic psychotherapy. Do you use this in your regular Haifa practice as well? Can all of us, including non-migrants, make use of this powerful technique? I personally do this a lot – revisit traumatic events and retell the events to myself, with elements of forgiveness and grace.” Dr. Daod: “The first time I did this was in 2015. I was in the middle of my specialization in child adolescent psychiatry. The truth is, I did not know what a narrative was! I did not know what psychiatry is even! But I did it, because I felt that this was what was needed to be done. After many hours of work in the camps, and on the boats and on the beaches, you begin to understand what works and what doesn't. And, most importantly, you begin to understand that all that is written in the books does not really work! Especially books written in the past, by those from different cultures and with different backgrounds and different approaches to what is happening today and to what characterizes the current crisis. I don't use the recognized known method of narrative therapy, but I did use the narrative as a therapeutic tool, and what we do, we rebuild what exists, we reframe the trauma and establish a new narrative” Earlier, Dr. Daod explained to Shani: “I understood that the work I had done with children in Greece could also work with adults in Libya. I would say to the kids who came off the boats in Greece, “What heroes you are! What an achievement!” I'd retell the story as a heroic tale. So in Libya, too, I would say to them, “What courage, you did something that couldn't be done, our captain thought you were dead but you triumphed!” I discovered that after I told them this three, four, five times, their expressions changed. The story is told to them in a way that makes it possible for them to emerge from the position of the victim to a position of strength. With children it's easier of course. For them it really does completely erase the trauma, because they don't understand that's happening or why the adults are being cruel to one another. So you can give them another presentation completely. Like in [filmmaker Roberto] Benigni's movie “Life Is Beautiful,” in which a father convinces his small son that the concentration camp is a game.” Prime Minister Benjamin Netanyahu's abrupt U-turn, cancelling an agreement to give half of Israel's African migrants work and residency permits and half, voluntarily, a move to an African country, was just another page in an entire volume of ignominy. Israel's treatment of its migrants reveals deep hypocrisy, especially after celebrating the Jewish people's own migration out of slavery in Egypt to freedom, on Passover. Tell the story of the Exodus to your children, we are told. So we do. But what do we tell our children about our African migrants and how we treat them? When we read in the Bible, “Treat migrants like citizens, love them like yourselves,” do we squirm in our seats? It is painfully ironic that today, Dr. Essam Daod, an Israeli Arab doctor, is one who in his actions best represents true Jewish values. Dr. Daod regained his humanity. But are we losing ours? Postscript: On April 26, the daily Haaretz reported that Israel's only mental health clinic for refugees, the Gesher Clinic in Jaffa, will close in June, because it has run out of money. The clinic is funded by the Health Ministry, headed by Deputy Health Minister Yaakov Litzman, not a big fan of migrants. The writer is senior research fellow at the S. Neaman Institute, Technion and blogs at www.timnovate.wordpress.com

Esam Daod: Making migrants whole

Dr. Essam Daod, an Israeli Arab doctor, is one who in his actions best represents true Jewish values.

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Esam Daod: Making migrants whole

Dr. Essam Daod, an Israeli Arab doctor, is one who in his actions best represents true Jewish values.

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