Ancient ideas of land and faith must underpin a new Middle East peace initiative

Having reported on the conflict for years, James Rodgers explains why energy and ambition alone will not be enough to secure peace.

It was a day of extreme heat, and extreme emotion. The prisoners were due to be released at Tarqumia, a checkpoint between Israel and the West Bank.

It was August. The Middle Eastern summer was at its hottest. There was no shade. Waiting families did not seem to mind. Perhaps they had been strengthened by learning to endure absence and separation. Perhaps hope and expectation alone sustained them that afternoon. Their excitement seemed to increase the air temperature even further.

The newly-freed prisoners were Palestinians who had been held in Israeli jails, mostly for carrying out, or planning, attacks on Israeli targets. A similar release is planned now, as part of moves by the US Secretary of State, John Kerry, to restart the peace process between Israel and the Palestinians. It was just such a restart, in this case prompted by the launch of the "Roadmap" for Middle East peace, which had led to the prisoner release I witnessed then, in 2003.

Such new beginnings seem often to be prompted by the ambition of politicians or diplomats. In this case, Kerry, new in his post, is taking on one of the toughest diplomatic challenges of the age. In his announcement last week, he talked of £a significant and welcome step forward", which would see delegations coming to "Washington to begin initial talks within the next week or so" – in other words, very soon now.

Without the dedication and energy which Kerry has shown, this stage might not even have been reached. It is his enthusiasm which is the catalyst. The need to end the conflict is nothing new. There seems to be a growing opinion that it may soon be impossible to create a Palestinian state on the West Bank. The European Union’s view, published last December, is typical. Foreign Ministers decided then that continued settlement expansion, "would seriously undermine the prospects of a negotiated resolution of the conflict by jeopardis­ing the possibility of a contiguous and viable Palestinian state and of Jerusa­lem as the future capital of two states."

If attempts to take on the challenge are not prompted by ministerial ambition, they are often prompted by more than circumstances inside Israel and the Palestinian territories. The Roadmap of 2003 came in the aftermath of the invasion of Iraq; the Madrid talks of 1991 followed the collapse of the Soviet Union.

The disputes remain the same: borders; refugees (those who fled the 1948 war, which brought Israel into being, and their descendants); the status of Jerusalem. Any solution to these fundamental issues will require compromise, or acceptance of loss or injustice. So far, this has proved impossible.

As the BBC’s correspondent in Gaza from 2002-2004, I was the only international journalist then based in the territory. I watched the conflict unfold from a rare viewpoint. Reporting the news gave me an understanding of daily reality, and the longer I did it, the more I sought to understand the deeper, enduring, causes of enmity between Israeli and Palestinian.

Taking a week or so away from news reporting, I made a radio documentary about the conflict and ideas of home.

It seemed that the more you went beyond the questions designed to get a soundbite for that day’s bulletins, the more ideas of historical destiny, reinforced by religious faith, came to the surface.

I was reminded of this recently when watching a BBC Television documentary, Israel: Facing the Future.

"Both sides claim to have rights on this land, and they claim that they are the only ones who have the rights on this land, and no side can in any way forego its rights on every inch of territory because it’s holy land," Ephraim Halevy, a former Director of Mossad, told the reporter, John Ware.

This is the extremely inconvenient truth which conventional diplomacy, and the journalism which reports it, too often underplays. Taking it into account is no guarantee of a successful peace process. Ignoring it seems to guarantee failure. Energy and ambition alone are not sufficient. This new diplomatic initiative will need to understand ancient ideas of land and faith if it is to succeed.

James Rodgers is the author of the newly-published No Road Home: Fighting for Land and Faith in Gaza (Abramis) and of Reporting Conflict (Palgrave MacMillan, 2012). From 2002-2004, he was the BBC’s correspondent in Gaza. He lectures in Journalism at City University London. 

US Secretary of State John Kerry earlier this year. Photograph: Getty Images
Photo: Getty
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Last year, keeping me alive cost $141,257. But Republicans want to stop paying

Medicaid is the only thing standing between millions of Americans and death, but it doesn't have to be this way. 

My prescription for rifaxamin, an antibiotic, costs Medicaid $4,315 per month in the United States. Medicaid – arguably the closest thing the US has to the NHS – is keeping millions alive, including me. Without this staggeringly expensive drug to help control the symptoms associated with my Inflammatory Bowel Disease (IBD), I would be left with constant, crippling, and incredibly painful diarrhoea. Malnutrition and dehydration would force my doctors to surgically implant a port in my chest and put me on a nightly intravenous infusion of saline and nutrients. I’d spend eight hours hooked up to a whirring infusion pump. For five hungry months in 2015, instead of eating food IV nutrition was pumped into me every night – the profoundly unpleasant experience was also ridiculously expensive, costing up to $64,000 a month.

Like most people, I don’t have thousands of dollars to spend on medication. Instead, I rely on Medicaid, which is a government-funded social health insurance program for low-income Americans. I qualify for Medicaid because I’m disabled and my government disability benefit – the entire amount I’m expected to survive on – is only $750 a month, well under the Medicaid eligibility cutoff. Meanwhile, the US government considers anyone living on less than $1,011 a month to be living in poverty. Against the crushing backdrop of that inhumane, sub-poverty disability allowance, without Medicaid I’d have no hope of affording the medicines that keep me from an agonisingly painful and entirely preventable death.  

And in the land of serious chronic illness, rarely do patients escape with just one prescription. Every 28 days I inject Cimzia, a biologic medicine, into my thigh at a cost of $3,888 per dose. That yearly tab of $50,544 exceeds the median personal income in the US by almost twenty thousand dollars.

And it isn’t that I’m some sort of black swan outlier. A newly published study in the Journal of the American Medical Association (JAMA) concludes that the US spends “approximately twice as much as other high-income countries on medical care”. These peer-reviewed findings in an influential journal confirm that my experience is all too common and are useful in advancing the cost of care discussion, but not as immediately useful to me as Cimzia.

Cimzia helps control my IBD by slowing the rate at which my immune system shreds my small intestine. Without effective treatment, my small intestine becomes inflamed and ulcerated, leading to the formation of inflexible scar tissue. Over time, the bowel progressively narrows until food can no longer pass through. The resulting intestinal obstruction is a potentially life-threatening emergency for which I’ve been hospitalised six or seven times over the course of my life. Eventually, the only option is to surgically cut out the diseased portion of intestine. Hopefully, Cimzia calms the inflammation effectively enough that we don’t have to cut any more of my small bowel out of me. If Cimzia does fail, Medicaid will cover the surgery. But only if Medicaid still exists.

The Republican party has set about dismantling Medicaid, which has provided health care for some of America’s most vulnerable populations since 1965. Trump’s proposed budgets would make disastrous cuts to the health care program. And, with the encouragement and cooperation of the Trump administration, at least 10 GOP-governed states are moving to impose punishing and unprecedented requirements on the people it covers.

Lose your job? These states will exclude you from their Medicaid programme. Too poor to pay your newly increased health insurance premium? Same. Too sick to turn in your eligibility assessment paperwork on time? You’ll be punished with loss of coverage for six months. Their strategy is to create a bureaucracy so confusing, demanding, and hostile that hundreds of thousands of people have no hope of complying with its requirements. I trained as a health care lawyer, yet even I wouldn’t be able to keep Medicaid coverage if I lived in a state with these rules. During an IBD flare, no matter how motivated I am, or how much legal experience I have, I’m simply much too ill to navigate complicated eligibility assessment paperwork.

As a disabled, chronically-ill patient struggling to survive on $9,000 a year, without Medicaid I wouldn’t be able to access the medications that keep me alive, to say nothing of the brilliant clinicians who prescribe them. I simply could not afford both private health insurance and food. And the $141,257 Medicaid paid for my medications in 2017 would be utterly beyond my reach.

Ultimately, no matter who pays the bill, my health care costs too much. Republicans argue the answer is to cover fewer people. But the JAMA study tells a different story: it's not too many people, it's uncontrolled prices. The authors report US per capita health care spending was $9,403 in 2016, while in the UK it was $3,377. Medication bills on their own add up. US per capita spending on prescription medications was $1,443 in 2015 versus $779 in the UK. And yet, even after nearly a decade of Tory austerity that threatens its future, the NHS outperforms the US health care system in JAMA's analysis.

The researchers also show the folly of keeping that American system lurching along: they found the US spends significantly more on “governance and administration, which includes activities relating to planning, regulating, and managing health systems and services” than the UK. Sadly, this is hardly a surprise to anyone who has tried to pick an American health insurance plan, fought gigantic corporate middlemen to get a prescription paid for, or had the misfortune of dealing with debt collectors from a US hospital. Unless those who wish to privatise the NHS succeed, it’s unlikely the UK will overtake the US in the league tables of percentage of doctors who say they spend “a lot of time on paperwork or disputes related to medical bills” – that’s 16 per cent of US doctors compared to 0 per cent of their UK colleagues.

Instead of asking tough questions about why Big Pharma is allowed to charge Medicaid more than $8,000 a month for just two of my medications, Republicans are designing a labyrinth of deliberately complicated forms, taking coverage away from the unemployed, and demanding premium payments for Medicaid from some of the very poorest Americans. They don’t seem to mind that those new layers of bureaucracy will drive up the program’s historically low administrative costs. After all, they’ll succeed in lowering the number of people covered by Medicaid. But at what price? Taking health care away from patients with serious chronic illnesses will kill some of the sickest and most vulnerable.

The solution to high health care costs cannot be to kill the most vulnerable people in America, people like me, by depriving us of the health care that keeps us alive.

Matthew Cortland is an attorney and campaigner for disability and patient rights.