Historically, miasma theory was used to explain diseases that were the result of ābad airā. Although miasma theory has since been made obsolete by the development of germ theory in the late nineteenth century and other advances in public health, today the concept represents a constellation of unhealthy physical living conditions. In this chapter, miasma theory is applied to the context of Palestine where the geographical effects of occupation on children and familiesā wellbeing has been under-examined. Interviews with 18 Palestinian families (n = 149) revealed four factors contributing to the miasma of occupation in their neighbourhood communities: (1) increasing settler violence, (2) a childhood culture of conflict, (3) distrust between Palestinian neighbours and (4) the politicisation of neighbourhood communities. This chapter argues that these elements constitute the miasma of occupation, illustrating the damaging effects of structural inequalities on Palestinian children and families.
Contextualising Palestine
For the past century, the conflict between Israel and Palestine has continued to wreak havoc on the Palestinian and Israeli people and their land. Israel has occupied the Palestinian West Bank and Gaza Strip since 1967, marking the longest military occupation in modern history (Hajjar, 2005). Since then, violence has ebbed and flowed with tens of thousands ā Israelis and Palestinians ā injured or dead. Since the start of the first Palestinian intifada (uprising, in Arabic) in 1987, recurring hostilities between Palestinians and Israelis have left thousands of civilians dead and injured. These statistics have increased since 2008, which marked the start of three large rounds of hostilities focused in the Gaza Strip. Between January 2012 and December 2016, UNOCHA (2016) reported 2904 Palestinian deaths (70 per cent civilians) within the Gaza Strip, West Bank and Israel compared to 136 Israeli deaths (40 per cent civilians) within the same five-year time period.
Although the Israeli government maintains a public position of negotiating peace with Palestinians, it has also enacted an incremental process of Israeli territorialisation while simultaneously engaging in Palestinian deterritorialisation (Yiftachel, 2006; Weizman, 2007). As a result, Palestinian geographical space has been shrinking under the weight of Israeli-driven policies, such as the control of the Palestinian movements, the continuing development of Israeli settlements in Palestinian land and violence that is a symptom of the occupation. These elements are described next.
Over the last decade, in the name of Israeli national security and supported by the international āwar on terrorā, Israel established a network of restrictions in Palestine, dividing Israelis and Palestinians and controlling Palestinian movement. These policies contribute to what Halper (2000) has identified as Israelās āmatrix of controlā. The matrix of control includes elements such as the separation wall enclosing the West Bank, checkpoints that control Palestinian movement within the West Bank, the development of Israeli settlements on Palestinian land and complex policies of identification cards and travel permits (Weizman, 2007; Jones, 2012). The matrix of control cultivates artificial borders, deprives Palestinians of their freedom of movement and effectively suppresses the progress of human development within Palestine. Israel has faced broad international condemnation for these policies that carve off large segments of the West Bank, divide families and communities and separate Palestinians from their land. These policies also disrupt labour flows and basic commerce, eroding the productive capacity of the Palestinian economy.
For the most part, settlements are the main reason for the development of the devastating route of the separation wall and the ubiquitous checkpoints that make up the matrix of control. Settlements are organised residential, industrial and farming communities of Israeli civilians established on Palestinian land with the āapproval and direct or indirect support of the Israeli governmentā (UNOCHA, 2007: 13). However, settlement construction is considered to be a violation of international law (Defence for Children International (DCI), 2010). Since the beginning of the occupation in 1967, Israel has established some 200 settlements in the West Bank. Currently, over 350,000 Jewish settlers live in the area between the separation wall and the Green Line. An additional 300,000 settlers live in parts of East Jerusalem that Israel captured from Jordan in 1967 and later annexed in a move also considered illegal under international law (Sherwood, 2012; Rudoren and Ashkenas, 2015). Settlements have a profound effect on Palestinian life. Apart from the loss of Palestinian land taken for settlements, the seizure and/or destruction of property is an everyday occurrence in the lives of Palestinians, further contributing to the impoverishment of families and, as this chapter argues, the miasma of occupation.
As a place affected by political violence, Palestine is a landscape deeply inscribed with physical, emotional, cultural and political scars. To echo Tyner, violence in Palestine is both everywhere and nowhere: āā¦ violence can be so pervasive, so prevalent, that we donāt always āseeā violenceā (2012: viiiāix). Fifty percent of children in Palestine are regularly exposed to various forms of violence in their homes, at school, on the streets or traveling between these places (DCI, 2008). Furthermore, DCI (2014) reports that each year approximately 500ā700 Palestinian children, some as young as 12 years old, are detained, arrested and prosecuted by the Israeli military. Palestinian childhood is also characterised by violent experiences such as night raids, arrests of family members, home demolitions, construction of the wall around or through their communities, and personal assaults and injuries (Qouta et al., 1995; Arafat and Boothby, 2003). Intra-Palestinian violence is also a threat to the wellbeing of Palestinian children. Hatred between Palestinian political groups, such as Fatah and Hamas, have resulted in hundreds of Palestinians being injured or killed (OāCallaghan et al., 2009; BāTselem, 2011a). Palestinian civilians have also been specifically targeted by Palestinian entities such as the Palestinian Authority, Fatah or Hamas on suspicion of collaboration with Israel. Collaboration has been broadly defined to include directly assisting Israel, agreeing with Israelās political positions, selling oneās land to Israeli authorities, failing to participate in strikes, and marketing banned Israeli merchandise (BāTselem, 2011b). Families of accused collaborators face extreme stigma and discrimination within their communities.
Violence permeates the unhealthy social and physical environment in which Palestinians live. However, this violence is not always directly related to the occupation. There are violent aspects of Palestinian society such as child abuse, family violence and gender-based violence that may be further exacerbated by factors such as unemployment, poverty and religious ideology. However, the occupation has ultimately created an environment where violence is commonplace and impacts on childrenās physical, social and emotional wellbeing. Ultimately, few Palestinian children are spared the osmotic effects of violence in their society (Baker and Shalhoub-Kevorkian, 1999; Thabet et al., 2004; Shalhoub-Kevorkian, 2006).
Miasma theory
Prior to the development of germ theory in the late nineteenth century, diseases were thought to be the result of ābad airā. The theory of āmiasmaā, a kind of polluting vapour that emerged from the accumulation of waste, prevailed as the main reason for disease (Tsuang et al., 2011). At the end of the nineteenth century there was a dramatic change in understanding the cause of disease, shifting from miasma theory to infectious disease transmission (Tsuang et al., 2011). At the same time, there was a shift in understanding that disease transmission was also related to social factors (Tsuang et al., 2011). From this understanding, an approach conceptualised as the social determinants of health, which emphasises the broad social factors causing disease, replaced the previous focus on microorganisms (Tesh, 1995). Although miasma theory has been made obsolete by advances in public health, this chapter suggests that the concept of miasma can be revisioned under a social determinants of health framework by describing the unhealthy physical living conditions experienced by war-affected populations.
This chapterās understanding of miasma is related to the social determinants of health. Scholars have examined local patterns of distress and also the long-term health impact and psychosocial consequences of various forms of political violence (Pedersen, 2002), as well as the relationship between health inequalities and place (Bernard et al., 2007). Summerfield (1998) notes that the effects of war cannot be separated from other factors such as structural poverty and injustice, and that these may āundermine the social fabric no less effectively than the wars there have doneā (Summerfield, 2000: 418). Social, political and economic injustice all contribute to a context of suffering, distress and disease (Pedersen, 2002). In other words, when trying to explain disease, distress, trauma and suffering in relation to violence, the issue of social inequality cannot be ignored as a critically important social determinant of health (Pedersen and Kienzler, 2014).
As an example of the relationship between modern interpretations of miasma theory and the social determinants of health, Epstein (2003) coined the term āghetto miasmaā to describe disadvantaged neighbourhood communities with high morbidity and mortality rates in New York City.1 People in these neighbourhood communities experienced stress from simply walking outside their homes:
Poor parents, terrified that their kids will be killed on the street, tend to keep them inside, with the windows shut and the TV on, where they are constantly exposed to contaminants in indoor air, which some researchers believe can be as damaging as industrial pollution. ā¦ Mothers trying to protect their kids from crime may not realize they are putting their future health at risk.
(Epstein, 2003: 6)
For the families in Epsteinās report, the negative neighbourhood community created feelings of oppression and depression, especially because they felt as if they could not do anything to change their situation. Furthermore, the constant strain of oppression affected their sense of self-worth and dignity. With this thesis, Epstein suggested that constant stress and material deprivation are inseparable parts of the contemporary miasma of poverty and thereby important social determinants of health (Wilkins and Marmot, 2003). By concentrating the poor, any mysterious and poorly understood factor that makes people sick becomes clustered in these neighbourhood communities. Even though Epstein is describing spaces within New York City, her article provides strong parallels to neighbourhood communities in Palestine.
There is a large body of research that examines the effects of occupation on Palestinian children, and yet the impact of unhealthy living environments in Palestine has been under-researched. Even though community conditions are caused, to some extent, by violence, the priority has always been the effects of violence. However, studies of the poor and their living conditions indicate that there is a strong correlation between quality of neighbourhood community and wellbeing for families and children. Elements of neighbourhood communities that have been investigated in regards to childrenās development include residential instability, housing quality, noise, crowding, toxic exposure, quality of municipal services, recreational opportunities and the quality of educational and health facilities (Kopko, n.d.). Studies in the US show that people who live in disadvantaged neighbourhoods are more likely to have poor physical health than people who live in middle-class neighbourhoods, even when controlling for poverty (Diez-Roux, 2001; Cohen, Farley and Mason, 2003; Cohen, Mason, et al., 2003). Furthermore, studies have found an association between chaotic environments and levels of psychological distress in children (Kopko, n.d.).
Methodology
This chapter represents part of a larger qualitative research project exploring the concept and meaning of place for children and families living in Palestine. In 2010, pilot interviews were conducted with Palestinian children, families and organisations.2 Research continued in 2012, with the inclusion of families from various administrative regions of the occupied West Bank and annexed East Jerusalem, making a total of 18 participating families (149 individual participants). A minimum of three family members (parent; older child aged 9ā18; and younger child aged 8 and under) were invited to ...
