The phrase “it’s complicated” is used so frequently to describe relationships in the Middle East that it has almost become a punchline. In this issue of Congress Quarterly, physicians in northern Israel describe their experience in treating refugees injured in the Syrian civil war. This may be the first account of the experience written from the perspective of the caregivers — I searched all of the usual sources and could find no other account. In any case, as a matter of background, the Geneva Convention as well as United States Military Doctrine clearly state that medical decisions should be based on medical priority without regard for nationality in the care of civilians and combatants. The YouTube video of Stephen Tschiderer — a U.S. Army medic stationed in Baghdad, who survived being shot in the chest by a sniper and subsequently treated the would-be assassin for wounds incurred during the ensuing firefight — has been viewed by millions, and dramatically illustrates the principles outlined in the doctrine being operationalized with extraordinary compassion and professionalism.
The situation in Israel is more confusing from both a policy and a humanitarian standpoint. First of all, it is important to remember that Israel and Syria have been at war for decades, and that there are no diplomatic relationships between the countries. Secondly, Israel is not a combatant in the Syrian civil war. Thirdly, there are substantial potential repercussions for both Israeli and Syrian refugees as a result of any perceived “meddling” of Israel in Syria’s affairs. These repercussions, according to a New York Times article written by Isabel Kershner (January 29, 2014), include retaliatory killing of repatriated refugees as well as their extended families for perceived collusion with Israel. Israeli charity groups have been forced to hide their identities in order to deliver basic resources such as water, blankets, clothing and food, to Syrian refugees in Jordan — a country with diplomatic ties to Israel (Simone Wilson, December 11, 2013, Jewish Journal).
There is no way to conceal an Israeli hospital behind a false identity, and no way to hide the injuries suffered by civilians and combatants alike in the Syrian conflict. Those who seek care in Israel expose themselves to significant risk. Ironically, the risk is more related to their own government than their traditional enemies. Treatment of these refugees is also risky from Israel’s perspective: are they innocent civilians, or are they foreign insurgents? There are no reliable methods to accurately identify the history or intentions of an individual in need of medical attention. Furthermore, does providing such aid exacerbate the danger faced by friends and family on the other side of the border who may or may not have assisted in the transport of the injured? To quote Mencken, “For every complex problem, there is a solution that is simple, neat, and wrong.” To ignore human suffering is wrong. To risk exacerbation of the suffering is wrong. The enemy of my enemy may be my friend. Achieving a balance that allows for the provision of humanitarian aid without unnecessarily provoking reprisal and without supporting destabilization of the region is a feat which requires tremendous courage, tact and perspective. It’s complicated.