Amid the Killing, E.R. is an Oasis

By Matt Rees/Jerusalem Jamil Hamad/Bethlehem

The 18-year-old girl screamed in agony as the E.R. technician carried her out of the ambulance. Her arms and legs were fractured, her spleen and lungs damaged. Rawand Ratrout, a Palestinian anesthesiologist, inserted intravenous drips into the girl's smoke-blackened arm. She ordered a nurse to inject the patient with a muscle relaxant while the technician, Mohammed Assaly, checked the girl's ventilator, careful not to touch her face, which was burned raw and bloody. "I always imagine what would happen if I were this victim," says Ratrout. In this case, that required more imagination than usual. The young patient was not a Palestinian

compatriot but rather an Israeli, Ludmilla Lekior, a victim of the Hamas suicide bomber who killed 17 in a bus attack in central Jerusalem last week. Lekior, who immigrated to Israel from Ukraine nine months ago and was studying Hebrew, was among the 60 wounded in the attack who were brought to Jerusalem's Hadassah Hospital.

At Hadassah, Jews save Arabs and Arabs save Jews. Though the hospital treats and employs mostly Jewish Israelis, Ratrout is one of 10 Palestinian doctors who work at Hadassah's two facilities, one in the Ein Kerem neighborhood (Ratrout's branch) and the other on Mount Scopus. What's more, about 10% of the staff are Arab residents of Israel, and Arab patients and their visitors can be seen in the halls. Though Hadassah Ein Kerem has handled more victims of terrorist attacks than any other Israeli hospital, it stands as a model of integration in the conflict between Israelis and Palestinians. As politicians continually fail to find compromises for peace that will stick, Hadassah's mixed staff--operating under terrible pressure--manages to make coexistence work. "I've seen our Palestinian victims, and I've seen Israelis after suicide bombs," Ratrout says. "I don't differentiate between them. Each time, I think, How can this happen?"

She put this question to Assaly as they worked side by side piecing victims back together last week. Assaly, who has tended patients in the aftermath of more than 20 major terrorist attacks, knew that Ratrout was thinking about President Bush's recent push to revive the peace process, an effort that gave some small degree of hope to Israelis and Palestinians. "It's a catastrophe," Assaly told her, referring to the bombing. "It's supposed to be a time of peace, but all the violence is coming around again."

Palestinian doctors who work at Hadassah face an agonizing choice. Ratrout, who was raised in Nablus, the big Palestinian town in the northern West Bank, first came to the hospital in the 1990s after attending medical school at Baghdad University. Following the onset of Palestinian self-rule, Palestinian health-ministry officials pressured her into working in the West Bank, where there is an acute shortage of trained staff. During the height of fighting a year ago in the West Bank, Ratrout worked for weeks around the clock in a government hospital in Ramallah. But she eventually decided to return to Hadassah, hoping to improve her lifesaving skills by working with the best surgeons in the region. "I had to do this to make something of my career," Ratrout says. "I worked hard for my people, and now I need to do something for myself."

Ratrout's parents nonetheless criticized her for abandoning needy Palestinians to treat Israelis and kept the news of her return to Hadassah from disapproving neighbors in Nablus. Ratrout, who lives in a one-room apartment near the hospital, goes home to see her family only every two weeks, since it takes at least a day to get through the Israeli checkpoints to Nablus, which should be less than an hour's drive from Hadassah. Though Israel promised to ease West Bank roadblocks after President Bush's recent meeting in Jordan with Israeli Prime Minister Ariel Sharon, it took Ratrout two days to get to Nablus last week.

In the bed next to Lekior's in intensive care, Steve Averbach, a victim of an earlier bus bombing, on May 18, watches Seinfeld on a portable television through eyes barely open. Seven people died in that blast, which left Averbach with a spinal-cord injury and lung damage. One of the nurses who cared for him was Naela Haeik, who was born in an Arab village in Israel's Galilee region. She recalls that after surgeons operated on Averbach's spine, she spent four hours settling him into his bed. She hooked the 37-year-old father of four onto a cardiac monitor, a mechanical ventilator and an intravenous drip. It was hard, physical work for her and another nurse, lifting the helpless body of the tall, muscular Averbach, who works as a private weapons instructor. Then she introduced herself. With a name that any Israeli would recognize as Arab, Haeik says this is the moment when 1 in 10 of her Jewish patients recoils from her. "Hello, I am Naela," she said softly. Averbach didn't react, and Haeik simply checked his monitor.

Averbach, who emigrated from the U.S. at 18, has recovered enough to be able to speak to his family, though he hasn't moved his limbs. His mother Maida, who along with her husband flew in from West Long Branch, N.J., was visibly moved to see Arab nurses like Haeik working so closely with Jewish medical staff members on their son. "Why can't it be like this on the outside too?" she asks.

Hospital employees are not immune to the violence. Ghalab Tawil, 42, a Palestinian from Shuafat, took a job as a janitor at Hadassah so he could be closer to his daughter Iman, 13, during leukemia treatment at the hospital. He died in the explosion that wounded Averbach. Passions ran high after one of Hadassah's doctors, Shmuel Gillis, was shot dead in the West Bank by Palestinians in February 2001. To avoid clashes with victims' families, an Arab social worker usually stationed in the E.R. no longer works there immediately after terrorist attacks. E.R. technician Assaly is also wary of victims' relatives, who often lash out at him on the wards. As he develops Lekior's chest X ray, Assaly, who learned Hebrew from a suicide-bomb victim he treated, recalls stopping at the site of a terrorist attack last year and administering first aid. An Israeli identified him as an Arab and tried to drag him away, he says. Assaly's mother, who was with him then, tells him to keep a low profile around the hospital after a terrorist attack. "When people behave like that because I am an Arab, it makes me mad," he says. "But I don't think about the nationality of the patient."

Whatever their politics, those who work at the hospital have generally risen above the conflict. Until he took a leave of absence to serve in the Israeli Knesset as a representative of a party that advocates the "voluntary transfer" of Palestinians from the West Bank, Arieh Eldad, head of plastic surgery, who used to operate with a loaded pistol in the back pocket of his green scrubs, worked closely with Khaled Abu Ajamia, a Palestinian physician who lives in Hebron. "Outside they are big enemies, but in here they are forced to touch," says hospital director Shlomo Mor-Yosef. Hadassah was founded by the eponymous U.S. Jewish women's organization with the hope that it would be a place where Jews and Arabs worked together--a broad current in early Zionism that eventually was overridden by the more separatist ideas of rival Zionist leaders. Now 20,000 people pass through the hospital daily.

In the child oncology department, toddlers who would never meet outside the hospital play together. This is a city where people, for fear of either attack or arrest, immediately take note of the ethnicity of those around them by examining hair color, hairstyle or skin tone. That makes this department a confusing place. It's impossible at first to distinguish a Jewish child from an Arab one, because the children playing on toy trucks and fitting jigsaw pieces together have lost their hair through chemotherapy. Parents sit on plastic chairs, ultra-Orthodox Jews in black suits and Homburg hats next to Palestinian women in traditional embroidered robes, watching the kids play. Chief nurse Fatma Hussein believes it's not just the outward signs of suffering on the children that increase tolerance among people who would be suspicious of one another beyond the hospital confines. "In this community of the sick, everyone understands what pain is," she says. "Nobody has patience for anybody who would inflict pain on others."

The hospital also has to tend combatants at times. Samer Qawasbeh was one of 40 Palestinian gunmen who took refuge from invading Israeli troops in Bethlehem's Church of the Nativity in May last year. During the Israelis' 14-day siege of the church, Qawasbeh was shot in the stomach. By the time he reached Hadassah, his abdomen and bowel were gangrenous and filled with maggots. "He was pretty much dead," says E.R. chief Avi Rivkind, who treated him. After a series of operations that left him with only 12 inches of small intestine, Qawasbeh went home a month ago to his family in Bethlehem. "Thanks to God, Master of the Universe, he came home safe--and thanks to the Israeli doctors who didn't treat him any differently from an Israeli," says his mother Hilweh.

Qawasbeh, 27, came back to the vicious realities from which he was sheltered at Hadassah. He returned to his parents' house and a room next to his sister Suheir and her two children. She had gone back from her home near the village of al-Khader, west of Bethlehem, to live with her parents after Israeli troops shot her husband. He had been caught in the street when gunfire erupted and was felled by a shot to the chest. Qawasbeh needs to visit another hospital in Jerusalem for further treatment every two weeks. The last time he tried to cross Checkpoint 300 between Bethlehem and Jerusalem, Israeli soldiers turned him back.

Rivkind, a tall, exuberant man with curly gray hair, thinks back on Qawasbeh's stay at Hadassah as he moves through the crowded E.R. wearing bloody scrubs a few hours after last week's bombing. "The guy's a terrorist, one hundred percent, but I don't care," he says. Hadassah, Rivkind pledges, will help the Palestinian get a permit to cross the checkpoint. --With reporting by Jamil Hamad/Bethlehem