Public Health and Palestine w/ Danya Qato
Death Panel podcast host Beatrice Adler-Bolton speaks with Danya Qato about the political economy of health in Palestine, and how to understand the intersection of the pandemic and colonial occupation. This episode was originally released for Death Panel patrons on August 22nd 2022, and was re-released alongside this transcript on October 11th 2023. This transcript has been lightly edited for clarity, in collaboration with Danya.
Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)
Danya Qato 00:00
That there was this continued lionization of the Israeli public health approach to vaccines. So, as a Palestinian, the whole conversation around COVID-19 access began to circulate. Lo and behold, sort of the model nation was an ethnostate that was predicated on the erasure of my people.
[ Intro music ]
Beatrice Adler-Bolton 00:49
Welcome to the Death Panel. Patrons, thank you so much for supporting the show. We could not do any of this without you. To support the show, become a patron at patreon.com/deathpanelpod, to get access to our second weekly bonus episode, and entire back catalogue of bonus episodes. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore or request it at your local library, and follow us @deathpanel_. Today I am joined by our guests Dr. Danya Qato, who is a pharmacist, epidemiologist and health services researcher. Dr. Qato is an associate professor of epidemiology and health services research based in Baltimore, and also curated the summer 2020 issue of the Journal of Palestine Studies on the pandemic and Palestine and wrote the introduction called “Public Health and the Promise of Palestine.” And she is here today to discuss and revisit that essay with me. Danya, welcome to the Death Panel. It's so great to have you here.
Danya Qato 01:36
Thank you so much for having me. I'm so honored to be on your podcast.
Beatrice Adler-Bolton 01:39
Thank you so much for being here. As I told you when we were planning this, I've really appreciated this essay that you wrote for a long time. And this episode is an opportunity for a very long overdue conversation about what happens when a pandemic intersects with and overlaps with structures of colonial occupation. Before we get into your essay called Public Health and the Promise of Palestine from 2020, can you tell listeners briefly about your background and research interests and sort of what brought you to writing this essay?
Danya Qato 02:12
Sure. I was born in Palestine and grew up in Chicago in a primarily Palestinian community. And in 1987, my family moved back to Palestine in an effort to sort of lay our roots down. And later that year, in 1987, the First Intifada began or the first uprising against the Israeli occupation. And our – my siblings and I – education was disrupted, our classes were canceled, school was cancelled. The Israeli army was throwing tear gas bombs into schools. And there were curfews on a daily, weekly basis, sometimes monthly basis [lasting a month]. And so my parents made the very difficult decision to go back to the US. Fast forward a few decades later and I started my pharmacy degree, completed training in clinical pharmacy and got my PharmD from the University of Illinois, and then did my Master's of Public Health in humanitarian aid and international development and international health, and spent many years working as a pharmacist before I went on to get my PhD in epidemiology and health services research. And all throughout this way, I started to think about these broader public health questions, but didn't quite have the tools to think about them in a systematic way, and then began to engage with the literature. After my PhD in 2015, I was based at Birzeit University as a Fulbright Scholar, Birzeit University in the West Bank, at the Institute for Community and Public Health. And while I was there, I worked with the Palestinian National Institute of Public Health, and the World Health Organization on a few consulting projects. And that experience and the experience of engaging with other NGO workers in the West Bank and in Palestine, more broadly, really pushed me to think even more critically about how we talk about structures and their impact on health. And that experience was really invaluable both for me connecting personally, with my homeland, and my children connecting with their homeland, but also in thinking about these broader structures in a really granular way.
Beatrice Adler-Bolton 04:40
Before we talk about the core argument in your piece from 2020, I think it would be good to pause for a moment on settler colonialism. This can sometimes be a kind of contested topic and since we're going to talk about the pandemic and Palestine as a kind of object lesson on the ways that settler colonialism manifests in the arena of both health and public health, it would be great to just sort of have you speak on when you use that term in your work, what do you mean and sort of how do you conceptualize settler colonialism?
Danya Qato 05:11
Yeah, it's really important to start with that to sort of set the groundwork for the conversation. I borrow my definition from this piece that came out about 10 years ago, in Settler Colonial Studies. The piece is entitled “Past is Present: Settler Colonialism and Palestine”, by Omar Jabary Salamanca, Mezna Qato, Kareem Rabie, and Sobhi Samour. It was a special issue of Settler Colonial Studies that emerged out of a conference that was held in London. And this piece really signaled a shift in the conversation around framing the situation in Palestine. And I'm going to read what they describe as settler colonialism and also just say a few words about why I think it's important to make some of these distinctions clear, so they write, "from the earliest Palestinian accounts to the vast majority of contemporary research, the crimes committed against Palestinian society by the Zionist movement, and the state it builds have been well recorded. Zionism is an ideology and a political movement that subjects Palestine and Palestinians, to structural and violent forms of dispossession, land appropriation and erasure in the pursuit of a new Jewish state and society. As for other settler colonial movements, for Zionism, the control of land is a zero-sum contest fought against the indigenous population, the drive to control the maximum amount of land is at its center. The continued existence of Palestinians, therefore, poses severe problems for the completion of the Zionist project, and consequently informs Israeli state policies against Palestinians inside Israel, and the occupied territories, and in exile". I borrow this definition of settler colonialism, which is essentially: land expropriation, theft, and appropriation in service of an ethnostate predicated on the erasure of the native indigenous people. And in this case, those people are the Palestinians. The shift that I'm talking about is this increased recognition that it wasn't just apartheid that's the problem. If we're using this root cause analysis, it's not just apartheid, apartheid signifies separation of communities, segregation of communities. And that certainly is one of the tools of the Israeli occupation and really is one of the centerpieces of the architecture of the occupation is apartheid vis-à-vis checkpoints, vis-à-vis illegal colonies within the West Bank that fragment and distance Palestinians from one another, and makes mobility and ambulation within the West Bank and within other parts of Palestine, uncertain, uneasy, unsafe, often violent. These are all tools that are used in service of a larger political project. And that project is the project of settler colonialism. And this is why you see this kind of duh moment when Amnesty International and Human Rights Watch came out with their reports around identifying Israel as an apartheid state. And Palestinians were like, thank you, welcome, thank you for acknowledging the reality that we've long known. But it's more than just an apartheid state. Again, apartheid is a tool that is organized vis-à-vis these different tools and state military processes. But these are tools that are used in service of this larger settler colonial goal of land appropriation, land theft, land expansion, and ultimately, the elimination of the native. And this is a very rich conversation that's happening in Settler Colonial Studies. And it's an important conversation. The reality on the ground points to this being the project. Even early Zionist writers and thinkers were very clear that the Zionist project was a project of colonialism, and a project of colonization that had as its patrons, the US and Britain and so this is a matter of historical record, but that we're now naming it as a framework and trying to frame it as and center it in this conversation in public health as a fundamental cause of health in Palestine. That's a shift that's been made in I would say the past 10, 15 years. And that's not to say the conversations were not happening before. But these conversations are more public, and are being had in academic, activist, and other circles in a more rigorous way.
Beatrice Adler-Bolton 10:29
One of the things that we wanted to talk about was, and this is something you touch on in your essay, which is sort of the pandemic overall in Palestine, and how yes, colonial occupation has shaped it, but that the pandemic isn't this kind of, you know, necessarily neat system of layering, right, where, as you talk about colonial occupation is sort of framed as this quote, ultimate, comorbid condition. And this is a kind of framework that you reject. And I wondered if we could start from the beginning and sort of talk about what were the first few months of the pandemic like in Palestine since your piece is from summer 2020? And though this essay was written early on in the pandemic and published in 2020, it's still so relevant in part because it's a very sharp contextualization of just the general landscape of public health and Palestine. So can you talk about how this essay sort of maps that early pandemic response onto existing political economic dynamics and sort of walk us through the basic argument that you make in the piece?
Danya Qato 11:30
Sure. So I think it's really interesting to point out that what brought me to writing this piece and guest editing the summer edition of the Pandemic and Palestine (for the Journal of Palestine Studies) precedes the pandemic. I presented at the Brown University New Directions in Palestine Studies conference on this issue of displacement and health in Palestine. I was reflecting and ruminating on my experience working on a project for the Palestinian National Institute of Public Health, where we were trying to figure out what factors at the individual, family and community level appeared to put residents of the Jordan Valley (which is an area that is primarily and predominantly under Israeli control in the West Bank) population at risk for adverse health outcomes related to malnutrition, and we used a series of metrics such as anemia, obesity, stunting (all can be problematized in their own different ways). The data was collected before I signed on to support the project. In terms of the analysis, it got to the point where we were running the multivariable regression model. And surprisingly, there were no factors associated, not even contextual community level factors that were associated with the adverse health outcomes. This was surprising because one would think that exposure to forced eviction would impact your health, one would think that destruction of your home or exposure to a home demolition would impact your health. But here we had a regression model that was telling us that it was not a statistically significant relationship. And I had to really reckon with that from both the methodological standpoint and the ethical standpoint, what would it mean to say that exposure to communal violence does not impact health outcomes? And that was really the spark, that study and thinking about how to sort of wrap it up very neatly for these international funders. I made a point in the discussion section to say, and this was after much discussion and thought that, the exposure to latent daily everyday violence means that the overall condition of Palestinians living in the West Bank, and in this particular case in the Jordan Valley, a population that is perpetually at risk of being displaced, that it's so overriding that it's impossible to differentiate statistically the experiences of those who, in particular, are exposed to home demolitions and those who are not because there's a superseding, overriding structure and that structure is settler colonialism. I think that that context is helpful because the energy of this piece and the energy of the special edition more broadly precedes the pandemic and the pandemic just brought to light what aspects of our health care system were troubled, that we already knew about, Palestinians already were talking about and had already identified as roadblocks to realizing our health. And this was the opportunity to really talk about them in a more systematic way.
Beatrice Adler-Bolton 15:18
Right, absolutely. And I think one of the things that really sort of stuck out to me the first time I read this piece, which would have been I guess, late summer 2020, was that this point that you talked about in terms of like what the data says, right? We kind of privilege these modes of analysis, right, which we say are supposed to tell us the truth about a situation. And this idea of this sort of regression analysis to "prove the impacts" of eviction or "prove the impacts" of settler colonialism on health in a way that like would be satisfactory, right, to these levels of data that we require at an international level, that are tied up more into the sort of funding apparatuses and NGOs and charity industrial complex in the way that we pay for research, as you mentioned, but that this is a privileged analysis, and that it often contradicts, I think, embodied experience, and what people who actually live through these experiences feel about their own lives. And I think one of the things too that's really important about your piece is that you talk about how, in a sense, this is a means of constructing a framework for Palestinian health that's always doomed. Would you mind talking about that a little bit?
Danya Qato 16:34
Sure. And just to make a clarification, when we talk about eviction here, we're actually talking about forced displacement. There's no legal apparatus that's underlying these evictions. I want to make that clear. We're talking about forced displacement, home demolitions, and other forms of violence that are part and parcel of the architecture of Israeli settler colonialism and occupation. So, you know, that bit, the idea of perpetual despair and slow death and “necropolitics”. You know, I'm not a social scientist, I am a public health researcher, practitioner, and health provider. And I read that work in two ways. One is, there is a reality of deteriorating health conditions among the Palestinian people, there is a reality of the decimation of the health care system in Palestine. There is also a reality of Palestinians living and insisting on living. And my problem with ways of speaking about Palestine and ways of speaking about the Palestinians, and in particular this happens when we talk about Palestinians living in Gaza, we have this sort of self-fulfilling prophecy problem. The UN report said by 2020 Gaza will be unlivable, and we're in 2022. What does that mean to tell people who are living and surviving under a draconian economic blockade of nearly 15 years that's closed them off from access to the remainder of humanity? What does it mean to tell them that we anticipate that by 2020, the land you ambulate on is going to be unlivable, but that you're actually living there and you're trying to make sense of life under these conditions of great violence. And a lot of that gap in understanding is filled by what I call in the piece, Resilience, Inc. The idea that Palestinians are so resilient that Palestinians are able to overcome, you know, this draconian economic blockade that stipulates what can and cannot enter Gaza, that has prevented the development of the healthcare system, that has in fact decimated the healthcare system system time and time again, including targeting hospitals, ambulances, targeting health care workers. And the issue with that is that it prevents the possibility of actively engaging to prevent that inevitability. And I reject a language that makes inevitable violence against my people. And I reject language that allows people to absolve themselves of responsibility in that trajectory towards destruction. And I think it's really instructive here to talk about the Scientific American scandal. And I'm not sure you're aware of it. But a year ago, around June 2nd, 2021, Scientific American published an opinion piece [link to an archived version of the piece, since retracted] that was written by health care providers in the US across a spectrum of disciplines, a few of whom were Palestinian. And the piece was published while Israel was raining death on the Palestinian people in Gaza. And the piece was called, “As Health Care Workers, We Stand in Solidarity with Palestine”, and in this piece, and it's still available on the web archive, they asked health care workers, health practitioners, to demand their health care institutions uncouple themselves from the Israeli apartheid settler colonial project. And they make very clear demands of both health care workers and health care institutions in the US. Now this is on June 2. A few days later, another piece came out, A New Mental Health Crisis is Raging in Gaza. This is an article by Yasser Abu Jamei, who's a physician practicing in Gaza, and essentially, it's talking about the mental health situation in Gaza, which is as you can imagine, quite profound.
Beatrice Adler-Bolton 21:32
Yeah.
Danya Qato 21:33
So this was June 4. On about June 10th or 11th, the original piece, the text, the entirety of the text was disappeared off the Scientific American website. And a disclaimer was included. And in that disclaimer, essentially, the editors say, this article has been removed because it fell outside the scope of Scientific American. Not only that, and this is where I think it's super instructive, the title was completely changed. So remember the original title, As Health Care Workers, We Stand in Solidarity with Palestine. The new title was, Health Care Workers Call for Support of Palestinians. So, you know, anyone --
Beatrice Adler-Bolton 22:22
Wow. I mean, just flip the passive switch up to 2000 why don't you.
Danya Qato 22:28
There you go. And just click that button on Word.
Beatrice Adler-Bolton 22:33
Clippy's like, are you trying to minimize something? Let me help you.
Danya Qato 22:37
[laughter] Are you trying to erase settler colonialism? The thing that is instructive here is the erasure of the word Palestine.
Beatrice Adler-Bolton 22:47
Yeah.
Danya Qato 22:48
But also, so importantly, removing the word solidarity. And what I think is so fascinating about this case study is that the mental health piece in Gaza remained, right, none of text was removed. So long as you're tabulating, calculating, cataloging the crimes that are committed against the Palestinian people, and the health effects of these crimes like deteriorating mental health, deteriorating physical health, as long as you're doing that, they're good. But once you get near making demands, once you get near this question of solidarity, then you're erased. And this happened in real time in front of people's eyes, they saw this erasure happening. And it's not lost on anyone, that there's a deliberate reason why that solidarity was removed. And I think that's partly what this individuated health model, these health metrics, have sort of lent themselves to, this idea of cataloging which is important, as a matter of record to catalog, it is important as a matter of history to catalog. But it doesn't come with some active engagement. It doesn't come with demands, it doesn't come with a political praxis. Once you inject political praxis into the matter, then it becomes dangerous. And this was I think, the conversation you all had with Abby Cartus, when you were talking about the social determinants of health, as long as you sever that particular social determinant of health, for example, housing, from the broader political determinants that decide who gets housing and who doesn't, then the NIH will fund you, right? They'll fund you, they'll throw millions of dollars at you? And they'll throw millions of dollars at Palestinian NGOs that do this work? But once you make a political demand, or once you situate that social determinant within that broader fundamental cause as it were, then that type of public health engagement, that type of public health framework is rejected. And in fact, as I mentioned, in the Scientific American case, it's erased. And what was quite sad about the Scientific American scenario is that this piece really circulated pretty widely. And as a Palestinian, it was really -- it was really nice to see colleagues share this article to talk about Palestine, and to actually start thinking about, what does it mean for us as citizens of the imperial core, as health care providers that work and benefit from the imperial core, what does that mean to us that Palestinians are being wholesale killed, and that type of conversation has been very rare in public health and medical circles generally, and to have seen it for that very brief moment in time. And then the outrage at it being erased. That was really -- it was nice, for lack of a better word. It was really nice to see that.
Beatrice Adler-Bolton 26:23
Well, I mean, I think you're pointing out a very important -- I mean, there's a reason why this piece was attacked, right, I think the declaration of saying, you know, we're health professionals and we're in solidarity with Palestine, versus this kind of corrective framework that they applied to try and make it seem passive and make it seem instead of a real -- when you declare yourself in solidarity, that is the true call to action for others to do the same, not to call for solidarity, right? I think when we see this sort of language of, oh, we want -- we're just trying to make sure that the headline's not so offensive, so we've toned it down, right, to make sure that it's more acceptable, quote, unquote, but what's actually done in that moment is a really important process of translation where you take something very active, where you position the state of Palestine as being a state too, into a framework where you've removed the right of statehood from the headline itself. And that's really powerful. And I think it's so -- you know, it can be so frustrating to see people play that off like it's a really simple or innocent or innocuous rhetorical shift towards sort of the greater civility of us all or some bullshit like, whatever the reason and I think what, as you point out, these are such important moments, because it's not just a simple rhetorical move. This is literally a really important moment where eugenic lies and fake science that ascribes destiny to people based on sort of where they're born and who they are. This is really what holds it up and reproduces it. These kinds of things that we pretend are innocuous have tremendous power.
Danya Qato 28:15
They absolutely do. And, you know, there's a bit in that Scientific American piece, I wanted to read it, because what it does, it says something very basic, but that is often ignored in these conversations about Palestine. And I'm quoting here, "in light of the illegal, immoral and targeted attacks on healthcare workers and healthcare infrastructure, we call upon us healthcare systems and academic institutions, as well as our colleagues in health care, to unequivocally condemn Israel's long standing oppression of the Palestinian people, and the ongoing decimation of their health care system. This violence does not end with a ceasefire, so long as the devastating economic blockade of Gaza continues. We affirm that health is a universal human right, including for the Palestinian people, and that the time for silence has long passed. Silence from this point forward is complicity". What I really think is important here is this conversation that you sort of gesture to around this biological determinism related to Palestinians in particular, that Palestinians are just destined, and they're perpetually on this journey towards dying, and death. And I think I've really thought a lot about this exceptionalization of Palestine. And two things to caveat. One is pointing out specificities of the situation in Palestine and of the Palestinian people. That does not mean that we are making an exception of Palestine, right?
Beatrice Adler-Bolton 30:03
Mhm. So important.
Danya Qato 30:07
Right. There are unique political conditions by which Palestinians live. And I hope we can get to it a bit in our discussion. The primary one, I think, is the fragmentation and deterritorialization of the Palestinian people that unless you are there, and you really understand, it's hard to even believe that it's real, the fragmentation. So that's one thing, and the other is this exceptionalization that forecloses possibilities of solidarity, right? That if you think that this particular condition of the Palestinian people or in Palestine, is so insolvable, right, that it has no relationship to what's happening to us here, it has no relationship to broader imperial, colonial, racial capitalist goals, then you start seeing that the solutions are not connected. And it makes it harder and harder to build solidarities. When you understand, for example, that Israel per capita is the largest arms exporter in the world, and that it markets itself as having battle tested technologies, battle tested against the Palestinian people, and the surveillance technologies that are advanced in Israel, and then exported to the rest of the world, the containment strategies, the population containment strategies that are tested, and actualized on Palestinian people. These are all technologies that, whether we're experiencing them now, we may experience them in the future. And if you don't care about the Palestinian people, because you know, they're an other, or they are otherized to the extent that you can't begin to see yourself having solidarity with them, than at least you can make these connections to your own lived experiences and the potential of these experiences to happen in the near future to you, but that they're now happening to the Palestinians. And I think Jasbir Puar says this thing about, you know, Palestine is not exceptional, but it's exemplary. It's exemplary of some of the ways in which society writ large is moving towards mechanisms of containment, population control, surveillance and hyper surveillance, and obviously, state violence. So those are to me the two important points to make about this question of exceptionalism. And what I like here is saying something so basic, so basic: That health care is a human right for all people, and that people contains the Palestinian people, that we're contained in that conversation about health and human rights. And it's so critical to make those connections. It's so critical to make those connections to de-exceptionalize Palestine, not ignore its specificities, but to build those internationalist solidarities.
Beatrice Adler-Bolton 33:17
I wonder if we could return to what you mentioned about the fragmentation and the sort of decentralization of the provisioning of health services and health resources and pharmaceuticals and health care and the physical locales of care within this specific context. Can we talk about as I said, in the beginning, you know, one of the arguments that you make is that a lot of what the idea of the intersection of the pandemic and Palestine is is really an understanding of what the health system is like that pre-exists it and what the political economic factors are that really sort of drives specific social determinants. And one of those is, you know, this primarily sort of economic mode of strict deprivation of health resources to people living within Palestine. Can you talk a little bit for people who have not been there, who do not know what healthcare is like in Palestine?
Danya Qato 34:18
Sure. I think to answer that question, it is really important to have kind of geographic orientation. So, you know, when I talk about Palestine, there's a geographic demarcation there. I want to say that first and foremost. When I talk about the Palestinians, I'm talking about the Palestinians that live inside the West Bank, that live inside Gaza, that live inside '48 Palestine, or what is known as Israel, and Palestinian refugees and Palestinian diaspora communities, many of whom are unable to return to their homeland if -- even if only to visit, so that's one point. When I'm talking about Palestine, I'm talking here about what is happening inside Israel, what is happening in the West Bank and what is happening in Gaza. And a lot of our metrics for Palestine and Palestinian health are coming through the West Bank and Gaza. And these are two essentially geographically disconnected areas of land that are governed somewhat separately, one by a Ministry of Health in the West Bank and one by the Ministry of Health in Gaza. And before we even got there, there was this accelerating program, especially after the Second Intifada, the Al-Aqsa Intifada, around 2000, of accelerating development of illegal colonies or settlements inside the West Bank, transplanting and transferring Jewish people into those colonies on expropriated and stolen Palestinian land. And there's about 700,000 plus settlers now living in the West Bank, and they're living on settlements that are only accessible to them. And so you can imagine that there are these 200 plus settlements that are connected through settler only, Jewish only roads that are inaccessible to the Palestinians within the West Bank. So this is a fragmentation, one fragmentation layer. And then you add on to that another layer, and that's the checkpoints, there could be 600, sometimes 700, checkpoints scattered throughout the West Bank. And these are checkpoints that are essentially barriers that are manned, or womaned, by IDF soldiers. And they could have a number of tactics, right? “I need to see everyone's Palestinian ID card, I need to see, you know, the driver's registration” all that stuff. One of their other mandates is to waste our time, to waste people's time at checkpoints.
Beatrice Adler-Bolton 36:59
If you thought American administrative burdens were bad.
Danya Qato 37:02
Oh my goodness. I have to -- as I mentioned earlier, I brought my documents because people don't believe it until they see it like, really like you have to -- aren't you a US citizen, Danya? And I'm like, yeah. I show up at the border, they'll throw that citizenship in my face, they'll throw that passport in my face. I'm a Palestinian ID card holder. And that's what dictates the circuits and places that I can ambulate in within the West Bank. I can't go to Jerusalem without a permit. I can't go to Israel without a permit. I can't go to Gaza period without some kind of support from an NGO. And so if you think about, the elaborate permit system, the elaborate and multi layered ID card system, it's working at multiple scales, this fragmentation and deterritorialization of the Palestinian people. And so that, as you can imagine, you know, anyone that studies health, even if you had the best health care system, right, if people can't access it, people can't access the hospital, if people can't access the help of the clinic, or the pharmacy, or if people can't -- their companion can't come from out of town and accompany them on the hospital visit. And this happens a lot in Gaza, where people in Gaza who need advanced, for example, oncologic care, are denied permits to leave Gaza. And even when their medical permits are approved to leave Gaza to seek care, for example, in Jordan or the West Bank, their companions aren't approved to leave with them. And so they're traveling as a person who's suffering from a chronic condition that needs care. They're traveling alone. This is real. And you know, a couple of weeks ago, when Israel was raining death on Gaza again, a girl was hit. Her name was Layan al-Shaer, and she was hit in Gaza and they had to bring her to a hospital in East Jerusalem. And this child, this 10 year old, she died alone, of course, you know, our people were there for her. But her parents couldn't be there for her in East Jerusalem, because of this permit system. And so it just -- I think you really cannot overstate, how normalized it's become, right, even in conversations among Palestinians, it's been completely normalized? But just because it's been normalized, that doesn't mean it's okay or permissible or defensible in any way, shape or form. And this hyperfragmentation affects access to health care resources, first and foremost. So if you can't access care, however stellar that care is, you can't access it and your health outcomes decline as a result. The other is the deliberate decimation of the health care system and I mean physical, structural attacks on the healthcare system. There were stories that came out during COVID, of Israel destroying testing sites, testing sites in the West Bank, especially in the Jordan Valley area, and the inability of people to access care, vis-à-vis testing. And I think the other bit is the complete control Israel has over the Palestinian economy. And that trickles down on the capacity and ability of the Palestinian Ministry of Health to be able to provide care for the population. And so if you're stealing, right, 300 plus million dollars a year from the Palestinian people, and the World Bank likes to use this really horrific euphemism, they use the term "fiscal leakage".
Beatrice Adler-Bolton 40:50
Like it's a little simple mistake, just a little leakage off the top.
Danya Qato 40:54
Right, exactly. Somebody left the faucet on too long. No, this is a deliberate theft of Palestinian taxes that is owed to the Palestinians, that is stolen from them from the settler colonial state, and it's often stolen, not always, but it's often stolen as sort of punitive political pressure tactic. And so if the Ministry of Health or the Palestinian authorities are not able to fund the provision of care, then we see declining salaries for health care providers, that health care providers go on strike, they're not receiving their salaries. We see extreme shortages in essential medicines, upwards of like 30%, 40%, 50% shortages, in essential medicines. And in Gaza, these are very pronounced because of the economic blockade, and the inability of medical products to come into Gaza freely and to come out of Gaza freely. And so you have all of these inputs that are coming in, that are informing the health of people. And these inputs are being informed by what I call in the article this fundamental cause, which is settler colonialism. And I didn't invent this term, fundamental cause. This idea of fundamental causes has been around for a couple of decades. And it's often been used to describe racism, for example, as a fundamental cause of poor health outcomes in the US. And in some circles, capitalism and racial capitalism as a fundamental cause, meaning that it impacts every risk factor, and that it's almost static over time, how it impacts these risk factors, regardless of whether or not the conditions on the ground are improving. So regardless of whether or not we improve health services delivery, or we improve the capacity of healthcare centers, and hospitals to provide care, as long as the central determinants and as long as this fundamental cause remains unaddressed, then we continue to see poor health outcomes among Palestinians. And you see this across every health metric. I don't want to go through the list of the health metrics. But you know, the predominant one that's often offered is life expectancy, there's minimally, a 10-year life expectancy difference between Palestinians and Jewish Israelis. And of course, this is also just an average, there's a spectrum here. And it's obviously informed by class and geography, and other sort of determinants.
Beatrice Adler-Bolton 43:38
Right. And actually, maybe I'll just reread the quote that I actually read from your essay in the episode we did about social determinants of health with Abby Cartus that you referenced, for people to just sort of have that there for context. So you wrote, "as an interdisciplinary field of inquiry, public health, unlike clinical medicine, is interested in the prevention of disease and the promotion of health in populations rather than in the treatment of disease in individuals. If we accept here the definition of health articulated by the World Health Organization as, 'state of complete mental, physical and social well being and not merely the absence of disease,' we understand that both individual and public health are determined predominantly by the structural and political contexts within which medical care is received. Defined in epidemiology as determinants, these include the environmental, economic, and social contexts within which people work, play, eat, struggle and live. In other words, public health is political inasmuch as our social and economic context are political, health then for Palestinians is inextricable from the ongoing Israeli settler colonial project of dispossession and erasure from the capitalist policies and practices that undergird the project in Palestine, in refugee camps and in diaspora communities. This is not to say that settler colonialism is a social or political determinant of health. Rather, it is to say that settler colonialism precedes and is fundamental to all other determinants of health, be they clinical, economic, social, or political". And I just wanted to read that because I think that point is so important to sort of not collapse this as just another social determinant of health that should be sort of seen as on equal footing. This is a structural component that I don't think that we actually have the rhetorical armature to address within the current ways that we study health disparities, globally. I think we like to think of things as being very easily quantifiable and countable. But I think even in the way that we count these health disparities, we're sort of counting to make the idea of settler colonialism go away, right? We're trying to create these kinds of frameworks for almost other justifications and explanations for why for example, you know, there is sort of worse life expectancy or why, for example, so many people are disabled in Palestine or so many people are not able to get the permits to access the care that they need. You know, do you mind sort of just elaborating on like, why it's very important to think of this not collapsed, but expansively.
Danya Qato 46:24
Sure. I mean, I think, first and foremost, and we sort of talked about this earlier, but I think because it makes clear that there's a political project that's at stake, right, it makes clear that there are nodes by which we must act to improve health outcomes in this population. So it's moving from the passive to that active solidarity. And in my case, as a Palestinian thinking about nodes of action that are required to, again, improve health outcomes. So that's one aspect of it that's critical because it allows for that possibility of making change. I think the other part of it that's important to consider is, you know, as an epidemiologist, I often start my intro to epidemiology course talking about the counterfactual. When you want to establish the causal relationship between an exposure and an outcome, you want to, you know, have this kind of thought experiment where you imagine an alternate universe or you imagine going back in a time machine, and having that person or having that population experience, the same experiences, but now without that exposure. And so you craft your epi studies with that in mind. That you try to find a population that can be compared to your population of interests, that they're a population that's similar in every other way, except that they don't have that exposure. And I think about that, in this context, how do we do we imagine a counterfactual for the Palestinian people? How do we imagine a world where the Palestinian people didn't wake up on May 15, 1948 and Palestine was erased off the map? And what would that trajectory have been, without this settler colonial project of erasure? And that's where I think, for me, I want to think more deeply about that question. And I want to think about what it would mean, to live in a world as a Palestinian, whether it's in the diaspora, or living in Palestine, without the specter of settler colonialism informing the every day, informing when and how I can get to work, informing whether or not I even have work, informing whether or not I can go visit my family who's sick in a hospital somewhere, informing whether or not I can even go to Jerusalem, or go to Haifa, or go to my mom's town in ‘48, Taybeh, a town I've never been to, that I need a permit to go to. I think, to me, it's like, it's more than a thought experiment, right, to think of the counterfactual. It's the political project. And it permeates every aspect of Palestinian life, that it truly becomes indiscernible from housing, it becomes indiscernible from land, and it becomes indiscernible from the everyday and Palestinians inside and outside experience this in different ways. And one thing that I've been very vocal about is rejecting the fragmentation of the discourse around Palestinians, that it's only the Palestinians that live in the West Bank and Gaza that have a right to have a voice. There are millions of Palestinian refugees that have been denied their right to return to their homeland, that have lived through three generations in refugee camps in Jordan, Lebanon and Syria, and to ignore them in this conversation is so egregious, and I think has been a sort of consequence of this hyperindividuation of the question of health in Palestine, that we start picking and choosing which Palestinians matter and which Palestinians don't.
Beatrice Adler-Bolton 50:54
No, I'm sitting with that last thought, you know, the idea of who's the worthy, who's coming from the worthy standpoint versus who's not?
Danya Qato 51:05
Well, I was just gonna say that, I think, a Palestinian, who rejects the narrative of inevitable death, a Palestinian who rejects the narrative of the inevitability of dispossession and erasure -- that's the most dangerous Palestinian. And those are often the Palestinians that are not centered in even our human rights discourse. Even in our humanitarian discourse. The Palestinian stories that are centered, are the stories that center the despair and the disability. And it's, you know, that conversation that was happening with the Great March of Return, in which Palestinians in Gaza bravely walked close to the border, in the hundreds and the thousands. And we're being shot at with the point to disable, the point to debilitate. The sort of narratives that came out of that, the narrative of the Palestinian who is the victim, and the Palestinian who is disabled, and focusing not on the fact that these brave Palestinians were coming to the border to assert their right to return to their homes. The vast majority of Palestinians in Gaza are not originally from Gaza, they're refugees from inside '48. And it's almost like the only good Palestinian is the Palestinian that is a consumer and the Palestinian that can be consumed. And you know, my friend "S", we were talking about it the other day, we were talking specifically about the discourse and narratives around the Great March of Return and that Palestinian resistance and Palestinian acts of refusal are often decentered in this conversation. And I see that as part of the dehumanization of Palestinians as a people that are not afforded that right to resist their erasure. And it's part of the discourse of selecting who is the good Palestinian, right. The good Palestinian, who again, is consumed and is consumable -- is a consumer and is consuming. And the bad Palestinian, which is the Palestinian that is rejecting the status quo actively, in the everyday, vocally, through little acts of resistance that happen that are unrecorded, and they're intentionally unrecorded by Palestinians. And I think the other bit of it is this idea of quantification, for a population that is hyper- surveilled is also an ethical question, right? We talked about in data sciences, who -- what do you know, and what do you not know? And I'm always thinking about Palestinians and other populations, for example, undocumented immigrants in the US who don't want to be known, who don't want to be counted, and don't see being counted as part of their project. And that's also one of the dangers of the hyper-quantification is that it assigns a lot of weight to the data that's known and refuses to acknowledge the data that is willingly undisclosed.
Beatrice Adler-Bolton 54:54
Well, and the other thing that I keep thinking about while you're talking is also the framework of resilience, right, and how it's very selectively applied. And for example, in a lot of public health literature or sort of international NGO language, you'll see references to political resistance pathologized as [so-called] "risky behavior" or that the political resistance itself is framed as having detrimental health consequences because of, for example, like Israel's policy of shooting to maim and disabling people who are engaging in protests. And that's kind of treated as if that maiming is both like deserved and naturalized and part of it, but it also rejects the idea that political resistance is incredibly important and therapeutic to people who are oppressed, who are living under surveillance, who are occupied, who are counted in this invasive way that rejects their humanity, but prefigures their deaths in the same moment. And I think it's really important also to just think about how the political agency of Palestinians is also kind of stripped away, almost as if this is a kind of bad health choice, like drinking soda or some bullshit, you know, the kind of personal responsibility framework of like, oh, well, you know, if you really wanted good health outcomes, and you lived in Palestine, the thing to do would be not to protest, right? And to avoid that kind of debility, which is like inherent to the political act. And these kinds of frameworks not only justify and perpetuate these things as okay, but they also explain away to the outside world, like a kind of dynamic that is so far from the truth, and that frames political resistance as not liberatory, but as itself dangerous.
Danya Qato 56:56
Absolutely. And, you know, the thing is, this is a very nuanced conversation among Palestinians too, what does it mean to resist? What does it look like to have a strategy for resistance or a strategy for liberation? And we have, before us, one of the very real consequences of fragmentation, which is the inability for there to be social cohesion, and to be social -- for there to be social mobilization. You cannot go to Gaza as a Palestinian if you don't live there and you don't have an ID card where your residence is Gaza. What does that mean for the ability of Palestinians inside the West Bank, inside '48, inside Gaza, to have conversations, to strategize collectively, and to think about a collective project of national liberation. And I'm not thinking about, you know, the political parties here. I'm thinking just at the population level, that this is one of the very real consequences of the fragmentation is the inability for there to be social cohesion and political mobilizing between localities and between geographies, but also within geographies within the West Bank, because of the difficulties of traveling across checkpoints, in between checkpoints, and between settlements, illegal settlements that pocket the West Bank. And so there definitely is, I think, an overriding energy that pathologizes Palestinian resistance. And this is also part and parcel of the larger conversation on the war on terror. And you know, we're not going to get to it, and it's certainly not my area of expertise, but the conversations around Palestine are also laden with this anti Muslim animus -- forget the fact that there are a sizable portion of the Palestinian population is also Christian, but forget that for a minute. The anti Muslim-ness, the anti Palestinian racism that animates a lot of these spaces, including public health and health and human rights spaces is so palpable, and to your point, yes, Palestinian resistance is pathologized. That if only they just stayed at home, they wouldn't have been victims of this assault by one of the most powerful armies in the world against a stateless people. And this is -- this kind of discourse has certainly become normalized, to see Palestinians in that light.
Beatrice Adler-Bolton 59:33
Right. So if we've talked about, you know, during the normal state of affairs within the health care system within Palestine, a lot of that is mediated through actually being able to get out of these spaces that are heavily gate kept by Israel into the Israeli health system or into health facilities outside of Israel, Jordan, for example, like you were mentioning, and one of the things that was very common as you were saying before the pandemic was these kinds of restrictions on imports and exports of essential medicines. Basically not only is there kind of an attack on the physical health infrastructure within Palestine geographically, there are these other restrictions layered on top of it. And part of what always existed is the idea that while Palestine is in this kind of perpetual freefall of health disparities, that Israel has this very superior and sort of high tech, precise health care system, and I think this has been a sort of major PR moment, the pandemic has been a major PR moment for the State of Israel, in terms of how the data from its Pfizer vaccine trials was used globally to help enthusiastically support efforts to quickly roll back restrictions in pursuit of a vaccine only strategy. I mean, I think the role that Israel as this kind of global health leader has played in the pandemic has really become exaggerated outside of proportion. And I'd love if we could take a second to sort of talk about both the reputation of Israel as an international health technology and security power, but also, you know, how this regime of care and how control of pharmaceuticals in particular is really key to their colonial occupation?
Danya Qato 1:01:21
Yeah, tell me about it, right?
Beatrice Adler-Bolton 1:01:23
[laughter]
Danya Qato 1:01:24
So, you know, when Eric Topol was cheerleading --
Beatrice Adler-Bolton 1:01:29
[sighs]
Danya Qato 1:01:30
The vaccination efforts and celebrating the vaccination efforts and fixating on the speed of the vaccination efforts, and it was so widely taken up. And the pandemic was really -- especially the early part, was really one of those moments where you sort of had to take a breather every once in a while, because again, it was predicated on the complete erasure and abandonment of the Palestinian people. And a lot of the initial sort of advocacy discourse was Israel is an occupier and according to the Fourth Geneva Conventions, they're required to provide vaccines to the population they occupy. And that population is the Palestinians. And I always had a problem with that framing as being the primary demand is that Israel vaccinates the Palestinian people, when that demand was not coupled by the demand to end the settler colonial project. We aren't charity cases, we aren't begging to get our vaccine, you prevented us from getting our vaccine, you deliberately -- not only did you not provide, if we are to follow the Fourth Geneva Convention stipulation, not only did you not provide vaccines, you got in the way of us transporting vaccines into Palestine. And it was mind-boggling, Beatrice, mind-boggling to see otherwise thoughtful, engaged public health researchers and practitioners completely ignore that aspect of the story. And I do believe the arrangement was with Pfizer, the early rollout of the vaccine in Israel was under an agreement that they would also share data. And so there was also the ethical issue of data sharing without consent. And I don't know the parameters of the agreement. But there was also this ethical issue around data sharing that folks didn't really talk about and focus on. I remember, in particular, and a lot of Palestinians remember this, the Israeli health minister, he was asked in early 2021, about the mandate for Israel to provide vaccines for Palestinians. And he said something that circulated quite widely among the Palestinians and in the diaspora, and he said, if Israel is responsible for vaccinating Palestinians, then the Palestinian health minister should take care of the dolphins in the Mediterranean. So. And you know, I'm thinking, I'm an animal rights person, okay well, I care about the dolphins in the Mediterranean. I didn't know there were dolphins in the Mediterranean. But it was so sickening to see the Palestinians become an afterthought in this international discourse that valorized and lauded Israel, even -- even as it was attacking Gaza, even as it continued its targeted killings of Palestinian resistance fighters in the West Bank and Gaza, even as it was engaging as an occupying power and continued engaging as an illegal occupier in the West Bank and Gaza. That there was this continued lionization of the Israeli public health approach to vaccines. So I think the latest numbers by the end of 2021, for example, nearly 70% -- now it's much higher, it's around 80 or so percent of the Israeli population had two shots, were fully vaccinated. And then nearly half of the population has had its third shot. And less than half of Palestinians by the end of 2021 had even their first shot. And so it is acknowledging the conditions of the settler colonial project and its architecture, including apartheid, that results in this inequity. But it's also that they were deliberately denying Palestinians access to the vaccine. That's really important to mention here. And I think, you know, when you think about the broader role of the Israeli pharmaceutical industry, Teva, the largest generics manufacturer in the world is based in Israel, and Teva, among other manufacturers in Israel is a great beneficiary of the occupation. It's a great beneficiary of the economic blockade on Gaza, it's been able to take advantage and exploit the captive economy. The human rights organization, Who Profits?, has a really great report. It's a little dated now, it's about 10 years old, but it's called Captive Economy, and it's essentially on pharmaceuticals and the occupation. For anyone interested, I recommend reading that report. But Teva in particular, as the largest global generics manufacturer, has been able to capitalize on the captive economy of the Palestinian people. They can circumvent marketing rules, they don't have to have a label in Arabic, they don't have to go through additional registration, they can have, you know, cargo ships come in and out without any legal administrative barriers and taxes that are levied against Palestinian cargo ships. And this has made it so that the Palestinian economy is dependent on not only Israeli generics manufacturers, but also international manufacturers that can circumvent some of these rules that are imposed on the Palestinian native pharmaceutical industry, but also the inability of near markets. So Jordan has a very healthy generics industry. But the Israeli government has put stipulations on what types of pharmaceuticals can get into the West Bank and can get into Gaza and those stipulations privilege the Israeli pharmaceutical industry. And then after that privilege, the multinationals. And this is partly why there's been such a huge issue around drug shortages, because the Palestinian ministry is unable to afford these medications, because they're at a price point that's not suitable for the economic conditions of the Palestinian people.
Beatrice Adler-Bolton 1:04:05
[laughter] Ugh. Well, I think it's super important to consider the position that Israel set itself up for, which is that it's this total economic and political capture of all aspects of health, that then in the international arena, it has no responsibility for and it has no accountability for. And you talk about in your piece, why it's really important to challenge our understanding of these things of being natural or okay or justified or the way the world works and look at them for what they are, as the downstream result of essentially a regime of knowledge production that seeks to decouple material effects and political effects and seeks to de-emphasize the relationship that health has to the political and I think, you know, when you talk about the pharmaceutical situation, it makes me think of how so much in the US the conversation around drug affordability is always about, well, we just need more generics, we need more generics in the market. And there's never a discussion about price control or decommodifying patents or removing ownership of formulas or any of these sort of like broader structures that could -- or broader attacks to the structure of how these things are commodified. And then how that commodification is then used to dictate resource deprivation. And so I think just talking through the ways that the situation with drugs in Palestine is not a mere issue of oh, well, we just need to donate more drugs from the essential medicine list and everything will be fine. That's the kind of charity mindset that I think so many people approach health problems with, with like oh okay, here's this problem that's been quantified and calculated and we've got so-called proof of it, and now we're just gonna throw a product in that arena or throw something to try and mitigate that. But it never actually focuses on trying to look at, you know, what is constructing health totally. And we're focused on these very small outcome driven things that can be easily measured, but ultimately, these interventions, a lot of times seem to just reinforce existing structures of power or reify some of these dynamics that, as we're saying, is sort of justified as natural, but are absolutely the downstream result of discrete political decisions about empire and about domination.
Danya Qato 1:10:44
Bingo! [laughter] You know, we -- we, meaning I and many others who have a political practice that starts with the idea that health is not a commodity, we often say that public health and medical care in the US is sort of a whack-a-mole strategy. We're going to do this, we're going to do that, we're going to give people housing vouchers, we're going to give people, you know, six months of universal basic income, but God forbid we address the root causes, right? God forbid we address the root causes. God forbid we talk about the root causes, that's another issue is even talking and articulating the root causes as a sort of third rail in, for example, academia. But you talk a bit about this donating paradigm, this charity, medical industrial complex paradigm. And what's so important to talk about here, especially in this context, is that a lot of NGOs and a lot of international governments were actually donating to Gaza, actually donating essential supplies, essential medicines, and the problem is one, sometimes they wouldn't get in. But when they would get in, they would be almost near expiration date. And what is Gaza supposed to do with these expired tons of pharmaceutical products, its wastewater systems decimated, its sewage systems decimated, its access to ports non-existent. And so there's also a cost, right? The nothing is free, nothing's free. We're never getting anything for free. And this is, you know, in the medical care space, we talk about it in terms of antibiotics, for example: Oh, just give them an antibiotic. But there's a cost to that, we know that there's increased antibiotic resistance. And then future care may be foreclosed if a patient is no longer responding to a particular antibiotic, because it's been overused. And so it's almost like that same thinking here. Nothing is for free in this context, including pharmaceutical products, because there's a material cost to housing those pharmaceuticals and when they're arriving, and they're near expiration date, and they're not going to be used ultimately in the population, or they're inappropriate for the population, or inappropriate for the healthcare needs of the population, then they now have added to the burden of the Palestinian Ministry of Health. And so these are also dynamics that are happening behind the scenes when it comes to access to pharmaceuticals. And this is what I say is sort of like that whack-a-mole strategy that you're talking about. You know, just give them a voucher or give them a drug rebate coupon that we see in the US. But we don't talk about that bigger picture, which is that hypercommodification of health and of people being unable to access basic health services in not a one-off way, but in the continuous way that is critical for their wellbeing. And that's -- the same dynamic is happening in Palestine. And it's happening at different scales perhaps, and within different structures. But it's happening there. And the pharmaceutical industry has benefited, the other industries within Israel in particular, have benefited from this captive economy. I don't know if you had a chance to read Sobhi Samour's piece in that special edition, [Covid-19 and] the Necroeconomy of Palestinian Labor in Israel. And he writes in it, if I can --
Beatrice Adler-Bolton 1:14:45
Oh please, yes. Absolutely,
Danya Qato 1:14:45
He writes -- and Sobhi is a health economist based in Palestine. And he writes, I quote, "The specificity of Palestinian labor centers around it having to survive under two over-determining logics that often converge in practice, but do so conjecturally rather than structurally, the logic of settler colonial elimination and that of capital. That is to say, while Palestinian workers are exploited by settler colonial capital, this has historically not been Zionism's original or ideal arrangement. Rather, in its ideal scenario, there would be no Palestinian left to be exploited. After 1967, its policies of de-development resulted in hollowing out local productive capacity of the economy by preventing it from accessing and utilizing critical inputs needed to promote internal growth, thus rendering local job creation, structurally insufficient to meet demand of a growing population. Since the beginning of the century, it has bifurcated Palestinian labor by continuing to subject West Bank labor to conventional forms of colonial exploitation. Meanwhile, Palestinians in Gaza, once Israel's main reservoir for cheap labor have been rendered profitable, not through their labor force, but instead through it becoming a testing ground for Israel's high tech weapons and surveillance industry. While any analyses of the Palestinian labor question need to be attentive to its specificity, they need not foreclose situating it within a universal perspective, one that locates global forces operating in Palestine, and one that understands Palestine as an index of historical processes unfolding on a global scale, such as practices of surveillance and population control, counterinsurgency, and international aid." And what I think is so important about what Sobhi is saying here is this convergence of these hyperdetermining, overdetermining paradigms of capitalism and settler colonialism that kind of collide in the context of Palestine, and that have reverberations globally. And it is in the surveillance industry, it's in the captive economy. It's in the decimation of the Palestinian economy, affording Israel access to a cheaper labor force, Palestinians are forced to work in Israel, for lower wages, but also they're hyper-taxed and hyper-exploited. And I'm not speaking in hyperbole, if you want to hear it from the horse's mouth, you can read Haaretz and read about the taxes that are levied against Palestinian laborers that work inside Israel, and are forced to work inside Israel as a matter of survival. And so I think seeing those connections and unraveling those connections, both in Palestine, but internationally, are so critical for building a political project of solidarity that is premised on liberation, and premised on the idea that health, among other universal basic rights, is not a commodity, and we should not normalize health as a commodity.
Beatrice Adler-Bolton 1:14:47
Right. And I think one point that you make, and it's actually almost -- it's a question that you ask your reader in your essay is, you said, "what does it mean to invoke the right to health without accounting for conditions of sustained persistent, overwhelming and abiding terror and violence?" And I think that that's really the fundamental takeaway is we cannot -- we cannot continue to approach a public health lens and a lens of health, assuming that we can do it without tackling the political structures, like settler colonialism and like these extractive economic regimes of, you know, global scale, as we've been saying, There is no right to health for Palestine until Palestine has some kind of autonomy, like that's not possible, and we can't continue to try and study these small atomized pieces as if to tweak around the edges. The only way towards health as a human right is towards liberation.
Danya Qato 1:19:11
Yeah, and I think the response to that is often, you know, let's start small. [People will say] you know, I don't want to overwhelm people with the prospect of taking on settler colonialism. That's too vast of an undertaking. I don't want to overwhelm people, right, with the prospect or the thought of taking on racism, or taking on racial capitalism. And my response to that is I also don't want to lie to people. I don't want to engage in a project that elides and ignores and abandons people that are asking for freedom and asking for liberation. And especially in the context of health we think about people who become marginalized and become abandoned and disposable in the context, for example, of COVID-19 in the US, and you talk so much about this on your podcast, I'm going to start there, I'm going to start with those who will be most hurt by these policies that ignore truth of the matter. And it might be hard for some folks to swallow and that's fine, right. But we'll walk on this journey together to imagine a better world. I refuse to give in to this what is often called sort of the ‘pragmatic’ approach to healthcare activism. And that doesn't mean I believe that little changes are not important. I do believe little changes are important. But those little changes also have to be happening with the backdrop of the conversation very clear that what is fundamentally at stake is the survival of people. And what is fundamentally at stake for me, you know, as a Palestinian, and as a Palestinian public health researcher, but also just as a public health researcher and advocate, and as a pharmacist, as an epidemiologist, is to help make the world incrementally a better place for all people to live. And that tension is always there. And that's what's so important about solidarity, is you know, I experience gaslighting from sort of the disciplinary sense and the institution sense, seeing Palestinians completely ignored in this conversation. And if they're actually talked about they're demonized and dehumanized and othered. And then I also just experience it personally, as a Palestinian. As we talked about, when the whole conversation around COVID-19 access began to circulate, lo and behold, sort of the model nation was an ethnostate that was predicated on the erasure of my people. And what's so critical for me, is to have these conversations, like the one we're having today, the one that I have with my comrades, not all of whom are in public health, some are in other disciplines, some don't work in the public health space at all. But it's a political praxis. And we make mistakes along the way. But I think walking hand in hand with people makes the journey worthwhile.
Beatrice Adler-Bolton 1:22:50
Absolutely. And I have to say, I just really appreciate your work. It's personally been really important to me and inspiring in terms of guiding me to just remember what it is that I'm fighting for, at the end of the day, which is ultimately, not just that we deserve to survive, right, by the sort of bare minimum standards, but that, you know, health is not a commodity, health belongs to us and we have a right to assert it collectively. And the only way to do that is to, I think, realize that collectively, when we stand in solidarity, we have tremendous power over these individualized framings, which helped to, if anything, just reify these sort of existing extractive structures of power. And I think it's so important to just sort of take a moment and hold a mirror up and say, you know, when I'm counting, what am I saying? What does my counting mean? What does this sort of argument that I'm making mean once it hits the world? And how does it contribute to either building or dismantling these frameworks, which ultimately are -- you know, they may be helping us survive, as you're saying, incremental change is also important, but you know, not at the expense of preventing us from thriving.
Danya Qato 1:24:21
You said that so well.
Beatrice Adler-Bolton 1:24:25
I just really wanted to thank you for coming on today and sharing so much of your time and taking the time to talk to me. I mean, as I told you, I've been really excited to have this conversation for a long time. It's long overdue. Really appreciate it. Was there anything that we didn't get a chance to touch on that you wanted to talk about? Or are there any sort of final points or takeaways that you wanted to make?
Danya Qato 1:24:51
I think it would be nice to wrap up with this statement that I was so moved by, from the Palestine New Federation of Trade Unions which was issued May 1, 2020. And they talk about the COVID 19 pandemic and sort of the intersections of solidarities across the world and say, "we Palestinians express our solidarity with our sisters and brothers all over the globe, in fighting the pandemic, and the capitalist corporations which rake in profits on the backs of workers. Crises are moments of change. And today we reiterate our call for more collective action to intensify the movements that eventually will overthrow the racist, colonial, capitalist, patriarchal, and neoliberal world order that hinges on the exploitation and subjugation of workers. The COVID 19 pandemic has exposed that both the capitalist and colonialist enterprises speak the same language of discrimination, exploitation and racism by demarcating and differentiating, the 'lives that matter' from 'those that don't matter' more than ever before. Many governments in the so-called 'developed world' are now revealing the full scale of their contempt for internationalist values and principles of human rights as they respond to the pandemic, with hectic, protectionist and racist practices, leaving the rest of the world without support to mitigate the pandemic. Even towards their own citizens, Western governments adopted measures to contain and mitigate the pandemic, under the model of 'the survival of the fittest'. On the day of remembrance of those who wanted to force the capitalist enterprises to respect their humanity, through strikes and protests, we mourn all those colonized and the many old and disenfranchised people and workers who are among those not fit enough to survive and combat the pandemic".
Beatrice Adler-Bolton 1:26:51
Well, that is without a doubt the perfect place to leave it for today. Thank you so much again, Danya, for coming on. This has been absolutely an honor. You can follow Dr. Qato on Twitter @danyaqato. Patrons, thank you so much for supporting the show. We couldn't do any of this without you. To support the show, become a patron at patreon.com/deathpanelpod, to get access to our second weekly bonus episode, and entire back catalogue of bonus episodes. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore or request it at your local library and follow us @deathpanel_. As always, Medicare for All now, solidarity forever. Stay alive another week.
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Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)