CAN the ceasefire endure for any significant length of time? This would go some way to ameliorating the incredible suffering in the region, but does it all hinge on one man, more than the future of the region has ever depended in its entire history?
Ceasefires can’t hold if no progress is made in addressing the underlying issues that led to the conflict in the first place.
This, very unfortunately, appears to be the case in this Middle East conflict.
Given the hugely positive response from the world to the ceasefire, what could possibly go wrong?
Surely, everyone wants it to work?
But what actually led to the cessation of hostilities in the first place?
Logically, it follows, something must have changed, given how long the atrocities had been going on for? If that something was not something in the public domain, it was something behind the scenes, perhaps even a secret that the actors involved don’t want ever emerging.
One key thing that definitely changed was the recent election of Donald Trump as US president, and the ending of the presidency of Joe Biden. Biden had also put an atbest fragile appearance of being even-handed and pressing for peace. This was despite the United States continuing to supply the weapons that were being used by the Israeli Defence Force, to kill so many largely defenceless and innocent men, women and children.
For many watching the horror played out daily on our TV screens, it was frankly bizarre to see Biden repeatedly complain that too many civilians were being killed, yet to do little to nothing to stop supplying the very weapons that were inflicting the carnage.
Palestinians transport belongings in Gaza’s Rafah last Wednesday (22), following a ceasefire between Israel and Hamas
Indeed, one of the reasons the Democrats may have lost the election was the desertion of the vote sympathetic to the Palestinian plight. Opinion polls across the world show support for the Palestinians by the ‘man on the street’, while ruling classes, in contrast, seem to support Israel.
The role of the United States is crucial to understanding this Middle East conflict. It is not clear whether the average North American voter really cares that much about an issue so removed geographically from their shores. Yet, the perception around the rest of the world is that the Israeli/Jewish lobby appears to have hijacked the US economy to serve a small state thousands of miles away.
But, given the decisive role of US supplied military and financial assistance to Israel, then the American president has always had the power to bring Israel to the negotiating table and introduce a ceasefire. The fact they have not used that power, is because, it would appear to the rest of the world, that they have tacitly supported the expressed aim of Israel to kill a lot of Palestinians. This goal is a step along the way to prevent a two-state solution and indeed to drive the Palestinians from their ancestral land.
Given Israeli leader Benjamin Netanyahu’s explicit opposition to a two-state solution and his view of the whole area as part of Israel, it follows there must be a policy of ethnic cleansing.
A ceasefire clearly doesn’t serve that purpose. Also, it doesn’t make logical sense to agree to a ceasefire if you believe you can win and are indeed winning the war. This is what the Israelis believe.
So, if a ceasefire makes no sense from their perspective, why did they agree to it?
The answer surely has something to do with the one thing that has changed, and that is Trump’s election to the Oval Office.
Given the new US president is no friend of the Palestinians, they why did he apply pressure behind the scenes to produce a ceasefire?
The answer has to be that covertly he has, in exchange for a ceasefire, which made him look statesman like at his inauguration, and much more effective than his adversary, who he has nothing but disdain for, Biden, therefore, he must have made sweeping and unprecedented promises to the Israelis. In exchange for these, they agreed to go through the theatre of a temporary ceasefire.
We are seeing some of those promises. He has agreed to restart the supply to Israel of weapons which even Biden blocked, because they were too powerful. He has ended sanctions against settlers on the West Bank who had exercised lethal force against Palestinians.
All of these, from a Palestinian perspective, were ominous developments from the get-go.
Now Trump has made off-the-cuff remarks about expelling all of the Palestinians from Gaza and relocating them in Jordan or Egypt. Both countries have rejected this bizarre proposal.
Donald Trump
Basically, given Trump has been such a significant and powerful influence, he was able to produce a ceasefire agreement in just weeks, which eluded the capability of Biden for a year, this means the future of the ceasefire and the region, depends on whatever is motivating Trump. He has clearly promised the Israelis massive support for their apparently ruthless anti-Palestinian policy in the future in exchange for temporary respite that made Trump look good and that also got hostages back.
No ceasefire can endure when the underlying issues remain unresolved. Also, it cannot pertain as long as the Israelis remain convinced that they have a chance of ultimate victory. To believe that, they have to also be convinced in the unwavering support from the US, no matter what atrocity they commit. It would appear that behind-the-scenes Trump has given them those assurances.
Any president in their final term of office begins to become obsessed with their legacy. Trump would like to be seen to be the world leader who finally resolved several planetary problems. He has a messianic view of himself as chosen by god to perform miracles. He is primarily selfserving and also suffers from a prickly sensitivity to the idea of not being popular.
He is also capricious, so the Israelis may be cautious about taking his support for granted.
Trump also exhibits the psychology of the bully. He will take Greenland and the Panama Canal, because these are small countries who have little chance of standing up the might of the US.
Trump may indeed take the same view of Israel, which is in reality, a similarly small country. Biden put up with being bullied by Netanyahu, but will Trump?
Trump falls out with everyone sooner or later, even apparently close friends. Given his complex psychology it is possible he may be the first US president to fall out publicly and fundamentally with Israel.
This may be the only hope for the Palestinian people.
Dr Raj Persaud is a consultant psychiatrist, broadcaster and author of books about psychiatry
‘Debate over assisted dying raises risks for medical staff’
AFTER five hours of debate over assisted dying, a historic private members’ bill passed its second reading in the House of Commons. This is a stunning change in the way we as a nation consider ending our lives.
We know from survey research that the religious tend to be against assisted dying. Given Asians in the UK tend to be more religious, comparatively, it is likely that Asians in general are less supportive of this new proposed legislation, compared to the general public.
One study found that assisted dying was considered by Muslims as a grave sin, indicative of turning away from god. Buddhists are inclined to oppose assisted dying, as they are against killing in any form. Hindus tend not to support a doctor’s decision to assist a patient’s request for euthanasia, because of the religious conviction that this produces an unnatural separation of the body and soul, resulting in damage to the “karma” of both the perpetrator (doctor) and the recipient (patient).
But Asians tend to have greater respect for doctors, and what concerns me as a clinician is that for all the hours and hours in the media and in parliament over the debate, this illuminated an entrenched tendency to just ignore medical professional’s opinions on health care. The public and the media seem to turn to anyone – an astrologer, a shaman, a receptionist, anyone – but an actual physician over any aspect of actual medicine.
Doctors confront at first hand unbearable suffering in their patients, so you might think that they would be strongly in favour of assisted dying.
However, I as a psychiatrist, remain concerned that many of those who want to shorten their lives may be doing so because they have become clinically depressed, maybe as a result of some terrible physical or even social predicament. Then, it is the depression that is driving them to choose an early and assisted death.
In other words, we need to be careful that assisted dying isn’t an assisted suicide, when the suicidal thinking could have been the result of a treatable mental illness.
We don’t know what the final legislation might yet look like, but if it includes an assessment is required by a psychiatrist, then would I be reassured?
What might happen – if this aspect is even entertained by legislators – is that they will use terms like ‘mental health professional’, which will make it look to the general public, like psychiatrists are involved, but in the end, the interventions will be done by much cheaper employees, who never darkened the door of a medical school.
We are seeing precisely this trend play out with the fight between doctors and the government over the introduction of ‘physician associates’ into the NHS.
So, in the end, any mental health assessment that is part of a new assisted dying policy will not be any real evaluation, and it will not actually be a genuine part of the contrasting landscape we find ourselves in.
After all, you try getting a mental health assessment at your local general practice for an ‘ordinary’ depression, and experience what a nerve-shredding nightmare that becomes. If NHS mental health care has in fact crumpled up and blown away, what chance is there that those applying for assisted dying are going to get any kind of decent mental health assessment, before being signed up for early dispatch by an already overstretched system?
But it’s not just the mental health of the patients who will come under this new proposed legislation that worries me; in fact, it is also the potential long-term impact on the different emotional demands created for doctors who will work in this alternative system.
I have been told that more medics come to consult with me over their mental health, than any other psychiatrist in the UK. They opt to see me privately in Harley Street in droves because they are nervous that any question over their mental health that enters their NHS medical records could trigger an unwelcome intrusive interest from the doctors’ regulator, the General Medical Council (GMC).
Physicians have an increasingly strained relationship with their regulator, which is widely seen as overly punitive, unfair, and has even been accused of racism.
Generally, doctors work under pressure, and already experience an elevated suicide rate, which varies from country to country, but can be up to two times the suicide rate of the general public.
Interestingly, veterinary surgeons have an even higher suicide rate than doctors, indeed some surveys suggest it is twice the rate of doctors. At first glance, this appears odd, as traditionally, it is even more difficult to get into veterinary college than medical school, so these are super bright, successful people doing a highstatus job, which is often very well remunerated. They would appear to have won the lottery of life.
After all, the hugely popular TV series, ‘All Creatures Great and Small’, was set in a veterinary surgeon practice in northern England, based on the best-selling books by James Herriot, and illustrated the enormous affection the public have for these professionals.
As the British prefer animals to people, so they hold the experts who treat their four-legged friends with much greater regard, compared to those who merely look after humans.
So, given all this love and adoration from the local community, why then do vets have such a high suicide rate?
One interesting speculation might be referred to as a ‘culture of death’ theory, which suggests that what the public don’t appreciate is that a huge amount of what vets do is, in fact, put animals down as a way of relieving suffering.
The theory argues that as a result of this, day in and day out, experience, vets come to see death as a liberation, and a solution to suffering. Perhaps this leads them to pull that trigger on themselves too early, when they encounter personal suffering. If this is the case, and if assisted dying is going to introduce a new kind of similarity to medical practice that vets already possibly endure, could it mean the suicide rate in doctors might also climb higher, strangely enough, because of this new assisted dying legislation?
Dr Raj Persaud FRCPsych is a consultant psychiatrist working in private practice in Harley Street London and is author of The Mental Vaccine for Covid-19 published by Amberley Press