First of two parts

On a recent November morning, in between his administrative hospital rounds and amid various workers’ strikes, continuing political uncertainty and growing worry that the Israeli-Palestinian conflict was on the verge of yet another cycle of spiraling violence, Dr. Tawfiq Nasser pulled out his wallet and showed a visitor his identification cards.

“In this country, we have a habit of collecting cards,” the Palestinian doctor said dryly.

He held up three cards in quick succession: a magnetic security card to expedite his way through Israeli checkpoints; an identification card issued by the Palestinian Authority; and a third card certifying that he works for a nongovernmental organization: in this case, for the Lutheran World Federation, for which he serves as head of the Augusta Victoria Hospital in Jerusalem and also oversees the hospital’s program of village health clinics in various parts of the West Bank.

Nasser’s main focus, and worry, however, was about a permit due to expire the next day that allowed him to enter Israeli territory and return to his office in Jerusalem. A strike by Israeli bureaucrats was suddenly complicating his life -- without a new permit, he and his staff would be stranded.

The sudden concern about the permit overtook Nasser’s rapid-fire explanation about the fragmented health care system in the Palestinian territories. He argued that as long as an occupation exists, with its attendant checkpoints, delays and transportation snafus, villagers closer to one city to will be forced to go to another for their basic health care. And as a result, their health will suffer.

With a sudden, unexpected snafu about permits added to the mix, Nasser began to lose patience, becoming increasingly impassioned and angry as he spoke to a visitor. “All of our lives are run by bureaucrats in a settlement. You tell me this is no occupation, that it this is just security,” he said.

“Tomorrow, I don’t know if I can go to work,” he said, his voice rising. “And who is punished? The patients. Hamas, they’re not punished. It’s my patients.”

Declarations of impatience, frustration and outright anger are becoming increasingly common among Palestinians these days -- particularly those whose faces and voices are too rarely seen or heard in depictions of Palestinian reality in the West.

The “moderate” sector of teachers, academics, students, government officials and doctors -- the vanguard of Palestinian “civil society” who are not questioning the permanence of the state of Israel, even though they are clearly fed up with the politics of the Israeli occupation -- have, by dint of professional training and patience, kept day-to-day Palestinian society running. They have done so amid an ongoing political stalemate between rival political factions, militants and the Israeli government, and a humanitarian situation that has been worsening by the week.

Weary of politics but keenly aware that just about everything in their contested land is highly political, they are increasingly pessimistic about any resolution to their plight.

Something of their situation was summed up recently by Latin Patriarch Michel Sabbah of Jerusalem, a longtime champion of Palestinian rights, when he met earlier this month with a group of American journalists who write for Catholic publications.

Speaking of the situation in the Gaza Strip but also about the fate of Palestinians generally, Sabbah said: “They are not terrorists; they are people who are living under oppression and who are reacting. And not all of them are reacting. There are Palestinians who don’t react at all, who go on living their lives in despair and humiliation and poverty. They go on living under occupation without any reaction.”

Others feel similarly -- with a pronounced touch of pessimism. “We’re going nowhere,” Rafik Husseini, the chief of staff to President Mahmoud Abbas, said during an interview at the Palestinian Authority’s headquarters in Ramallah.

Sulieman Harb Shalaldeh, the mayor of the municipality of Sier, near the city of Hebron, expressed the hope that he could soon govern normally.

“Let us keep the politics outside so that our people can continue their lives,” Shalaldeh said recently to the group of journalists. Shalaldeh has to deal with competing political claims, day-to-day-tensions, and now strikes by frustrated Palestinian workers who have not been paid since U.S.-led international sanctions and cuts to the Palestinian Authority by the Israeli government were imposed in March. The cuts by the Israelis alone have resulted in a monthly loss of $50 million in customs receipts.

The mayor’s comments were echoed by a teacher who greeted her American guests with fresh fruit, cakes and tea. “The majority of Palestinians, 90 percent, have no relationship with politics,” she said. “But politics are reflected severely in their daily life.”

So is history. To an outsider what is perhaps most striking in Palestinian refugee settlements and other public spaces are murals depicting uprooted villages lost for 50 years or more, with some still clinging to keys and land titles of areas now occupied by Israeli homes, public spaces and even shopping malls.

Given the overwhelming sense of history and grievance that prevails here, the teacher’s name is all the more revealing. The woman speaking was named Palestine Hussein.

Facts on the ground

The phrase “facts on the ground” is often used to describe the reality of what Palestinians see as the things that make a viable Palestinian state and society difficult if not outright impossible: Israeli settlements, outposts, settler roads, checkpoints, the routing of a 420-mile separation barrier. But it just as easily could describe the deleterious humanitarian situation in the Palestinian territories themselves.

The territories’ gross domestic product stands at $1,183 per capita, according to the World Health Organization. Unemployment rates overall stand at 25.3 percent, while rates of poverty overall are 56 percent. The poverty rate in the impoverished Gaza Strip stands at an astonishing 80 percent.

“The population’s socioeconomic conditions and access to health care are severely affected by lack of contiguity between the West Bank and Gaza and restrictions on movements,” the World Health Organization said in a recent summary.

Current conditions -- exacerbated by an unsettled political situation -- are believed to have worsened humanitarian problems: Chronic malnutrition has long been a problem in the territories and has been particularly acute in Gaza, where a 2003 study by CARE International indicated that 13.3 percent of small children in Gaza suffered from chronic malnutrition -- 11 percent higher than a “normally nourished” population would suffer.

What precipitated the current crisis was the January victory of the political faction Hamas in Palestinian Legislative Council elections. Hamas’ victory in turn led to international sanctions that have cut assistance to the Palestinian Authority -- a move that Palestinians have decried as unfair and unjust.

“You wanted democracy and now when you see the fruit of our democracy you say, ‘No, we will boycott you.’ ” Sabbah said about the popular reaction to the move: “This is wrong, unfair and unjust for the Palestinian people.”

The Israeli and U.S. governments said sanctions are justified because Hamas is a terrorist organization. Palestinians -- and this includes those aligned with the rival political faction Fatah -- acknowledge and even embrace Hamas’ militancy. But they have also stressed what they say is Hamas’ political and humanitarian roots and argue that Hamas is no al-Qaeda. In fact, they contend, beginning in the 1970s, Israel itself helped foster the creation of Hamas as an Islamic alternative to the secular Palestine Liberation Organization.

The Israeli and U.S. governments have interpreted the Hamas victory as a worrisome sign of growing Palestinian and Islamic militancy, while Palestinians have tended to view the Hamas victory as a protest vote and a referendum on what they say was a corrupt and out-of-touch Fatah elite that had, the sentiment went, cravenly compromised with Israel during the 1990s. (While Hamas controls the Palestinian legislature, President Mahmoud Abbas is aligned with Fatah.)

Over dinner at a Ramallah restaurant, Nader Said, a development studies specialist who teaches at Birzeit University, said public sentiment went something like this: “Let’s try Hamas; we know Hamas won’t work, but let’s stick to our identity.” He said that Hamas had hit a deep public nerve.

However one defines Hamas and interprets the elections, the results proved a smashing blow in at least one respect: Western sanctions remain in place against the Palestinian government, with assistance being cut off until Hamas recognizes Israel’s right to exist and renounces violence against Israel.

These demands form the core of contention between various the Palestinian factions and were cause for continued dispute recently between Hamas and Fatah over a new compromise prime minister. The current prime minister, Ismail Haniyeh of Hamas, has said he would resign if it would help restore international assistance to the Palestinian government.

The practical result of all of this is that salaries for some 140,000 government workers are not being paid -- prompting a joke by Husseini, the presidential chief of staff. He said recently on a Sunday evening that he was beginning his second work shift, at no pay. “I knew this would be a 75 percent reduction of pay,” he said. “I didn’t expect it would be 100 percent.”

Jokes aside, the sanctions have not only caused obvious hardships but also prompted a 70-day teachers’ strike, as well as walkouts by other public employees. Worsening day-to-day public services have become the norm.

“The boycott has had a devastating and cumulative effect,” said Tom Garofalo, the Jerusalem-based country representative for Catholic Relief Services. “Things are declining geometrically.”

Maybe not indefinitely, however: The end of the teachers’ strike Nov. 11 proved a major relief, and Arab nations that had joined the boycott have announced they will drop it, in part because of anger over a recent Israeli military attack in Gaza.

Nonetheless, reminders of what has been a stark, confusing and dispiriting time are everywhere: A school built with assistance from Catholic Relief Services in the village of Sier recently stood empty. A group of school administrators and parents huddled around a small administrative office and said both they and students have felt stranded and isolated by the strike and the international boycott, which they said have worsened the day-to-day hardships imposed by the occupation.

“What can we do?” said headmaster Ahed Mohid Jebreen who, like the parents, spoke about their coping mechanisms in an economy that has stalled -- be it borrowing from shop owners (and piling up debts), or selling family jewelry to pay bills.

“All the world is punishing us for our democracy, and that is not fair,” Jebreen said. Such punishment, he and the others stressed, is not punishing Hamas, but punishing the struggling Palestinian middle class and poor people.

A recent survey spearheaded by Said’s Development Studies Program confirmed those anecdotal observations: Of 1,200 persons surveyed in September, nearly three-quarters said their daily lives and living conditions had become worst since the January elections.

The survey also revealed that while Hamas’ popularity has declined precipitously -- from 50 percent in April to a mere 31 percent five months later -- a majority of those polled still thought Hamas should form a coalition government. And a majority, 62.3 percent, also said Hamas should not be expected to recognize Israel immediately. The poll also found that distrust of the United States was as widespread and deep as could possibly be: a full 94.4 percent said the United States had not played a constructive role in resolving the Israeli-Palestinian standoff.

This tense environment has also affected the response of American humanitarian agencies, such as Catholic Relief Services, that receive U.S. government funding for projects in the Palestinian territories. Catholic Relief Services has to abide by a no-contact rule with all Hamas officials, though it can still keep contact with such national bodies as the Palestinian president’s office.

As a practical result, that means the Catholic agency “has had to roll with some big changes,” Garofalo said. It has also made it occasionally difficult for local staff who, like any “on-the-ground” humanitarian workers, must deal with local authorities and governments no matter what their political affiliation. “We can function, but it has been difficult for our staff who work in Hebron, Bethlehem and Gaza,” Garofalo said.

These and other difficulties have changed a society that despite its many challenges was, in Said’s words, vibrant and hopeful. Now, day-to-day life seems more fragmentary and pinched, with horizons eclipsing. “The whole dream of a Palestinian state is in danger,” he said.

“We’ll do the small things we do each day,” he said. “But the big picture is desperate.”

He paused for a moment. “We’re asked, “Why do you have fundamentalists?” he said. His response: “It’s because you are closing all of the windows of fresh air.”

That is perhaps nowhere more evident than in Gaza, a place other Palestinians call everything from a prison to a mental asylum.

Potential powder keg

It doesn’t take long to learn that Gaza can break your heart.

A sunny Mediterranean outpost that contains some of the most crowded and densely populated urban areas on the planet, Gaza is an impoverished and dispiriting place until you listen to college-age students and young people speak passionately about furthering their skills in computer sciences and English -- although they do so amid the more-than-occasional and not terribly distant cracks of gunfire rounds.

Kidnappings are common here -- though it is said that they often stem more from boredom than from any political or even monetary motivation -- and have added to the sense of a powder keg in the making.

Now in the hands of the Palestinian Authority after a series of well-publicized withdrawals by Israel, Gaza is distinctly different from the West Bank, where Israeli and Palestinian communities collide and jut into each other. In Gaza, a sense of isolation and even imprisonment has taken root, resulting in ennui at best, contempt and extremism at worst.

“Throw whatever you want at us” is how presidential chief of staff Husseini describes popular sentiment in Gaza. “They are desperate. They have no hope. And they have nothing to lose but their chains.”

It is from Gaza that small, homemade rockets are often fired into Israel, prompting what Palestinians have called Israeli overreaction, but what Israel has declared as justified security measures of self-defense.

“I know the Gaza people are suffering,” said Bahij Mansour, a one-time member of the Israeli diplomatic corps who now heads Israel’s department of religious affairs and who spoke on Israeli policies recently to a group of Americans. But he said that Israel feels justified in protecting its borders along the Gaza Strip.

It is Gaza, in the town of Beit Hanoun, that drew worldwide focus recently when Israeli artillery killed 18 Palestinians -- including 13 members of a single family -- in a military operation that was criticized internationally and resulted in a United Nations Security Council resolution of condemnation that was vetoed by the United States. Israel, apparently embarrassed by an incident that killed primarily women and children, called the shelling “a mistake.” The move prompted new threats of suicide bombings, as well as fury throughout the Arab-speaking world and even talk of a third intifada within the occupied territories.

If the long-term ramifications of the Israeli action and the Palestinian response remain to be seen, it is not hard to imagine that the voices of Palestinian moderates in Gaza may become harder to hear.

Mohammed Ismail, 22, is one such voice. Active in a Gaza youth leadership program, Ismail is a one-time English student, an avid reader of Ernest Hemingway, and has hopes of studying English at the graduate level. He acknowledged that Gaza residents have reached a level of anger where they are “not afraid of losing everything.”

At the same time, though, he knows there are liberals in Israel who do not support their government’s policies toward the Palestinians and wishes there was a way for them to make common cause with Palestinians like himself.

One reason he believes that should remain a priority is because of a simple truism, recognized by many but maybe by not all on both the Palestinian and Israeli divide.

“We are here, they are there. We’re not leaving, and they’re not leaving.”

Chris Herlinger, a New York freelance journalist, recently traveled to Israel and the Palestinian territories as part of a prize for Catholic Relief Services’ Eileen Egan Award for Journalistic Excellence, which he won for reporting on Darfur for NCR in 2005. Photographer Paul Jeffrey, also an Egan Award winner, assisted with the reporting for this article.

We are either living in a reverie or in denial. When someone you know gets injured in this conflict, you expect to have feelings of outrage, deep sadness, or at least the manifestation of these feelings should be the normal outpourings of grief, sorrow and concern. And yet, news of casualties of a latest Israeli atrocity or an inter-factional battle does not faze people as it once did.

I want to be in hysterics. I know it is not something ordinary to say, but the truth is, this conflict has made people accept as normal, things that elsewhere would elicit deep reactions of wailing, or at least tears, or the momentary satisfaction of venting anger by breaking dishes across a room. Are the restrained reactions that many Palestinians have are merely a self-defense mechanism? Or are we really in denial about what is going on in down town Ramallah or on the beaches of the Gaza Strip? Has the daily dose of grim stories become such an ordinary thing in our life that we wake up each morning, wanting, needing a fix of the usual blood-drenched front page that we pour over while doing something as normal as having our morning coffee and scrambled eggs?

So, shouldn’t I be in hysterics? When I heard that a photojournalist that I know, Osama Silwadi, had been shot while doing something quite unexciting as to look out his office window during a procession on Ramallah’s main street, I cannot describe the feelings that went through my head. Funny, but I thought emotions are not supposed to be cerebral, and yet, I block feelings, like so many Palestinians (and even some foreigners living among us) have become used to doing, in order not to allow myself the luxury of sinking into a depression every time I hear a story of a child killed or a family annihilated, because there are far too many to count. Many of us have learned over the years that if you allow yourself the slightest chance to let the situation overcome you, you are done for and you will be unable to function.

Osama used to be a photojournalist for AFP and Reuters before he decided to become a freelancer and create a Palestinian image bank (www.apollo.ps). He is a father of three children, who now lies in a coma in a hospital bed in Tel Aviv, so far away from his family and friends in Ramallah that no one can visit him or offer his wife the support she needs at this time.

As Osama watched the procession below on Ramallah’s main street from his office window this past Sunday, boys were shooting into the air to commemorate a fallen comrade. I say boys because my (female) mind cannot accept the fact that mature men would be so irresponsible as to shoot in the air in a densely populated area, where the chance of a stray bullet hitting someone is not a remote possibility, but a certainty. And so, the bullet traveled from the barrel of one of those boys’ guns into Osama’s now non-existent spleen, up near his heart to lodge finally in his spinal cord.

The prognosis is not good and we all hope and pray for his recovery, knowing that when he finally wakes up from his coma, he will find that his reality has changed so dramatically around him and he will have to grapple with whether or not he will be able to resume his life as he had once lived it. All those times in the field when he knew that he was a taking chance on life by snapping shots of stone-throwing youths confronting soldiers, or non-violent protestors against the Wall, did he never stop to think that life is so fragile in any case that even a simple walk under rickety scaffolding or taking the wrong turn in a road can result in a fatal accident?

Not to sound like a cliché, but such is life, whether you have lived in a conflict zone all your life or not, you cannot cower in your house forever in the off-chance that you might be struck by lightening. Perhaps, however, people who have gone through trauma feel invincible and the sense of danger is blunted and lightly brushed aside, and so it could quite have possibly been those thoughts that went through Osama’s mind seconds before the impact of the bullet ripped through his body.

It is odd how yesterday morning, when I heard the news, all I could think about is how ordinary this news sounded, despite the fact that Osama had been on my mind quite often these past few days, because I was looking at some recent photos I had taken with his voice about light, lines and frame running through my head. I realized with some unease that I lost the ability to be shocked, indeed a friend told me once that he also lost the ability to be astonished by such things as the first flowering of spring or the birth of a child and that is how I feel sometimes, like I am a car in neutral mode most of the time. And while I am deeply saddened by what has happened to Osama, I am unable to reach down into that deep place where I will allow myself to feel more than the very superficial of feelings and I know that tears will not come.

It completely worries me, this sense that we are becoming a nation of zombies, who have turned off the tap of basic human responses to bad and good news alike that something like the recent inter-factional fighting is not so shocking or unexpected. Once you stop being shocked, then you stop being afraid, and once you stop being afraid, you can do anything out of the bounds of acceptable human behavior. The signs of intimidating armed men running unrestrained among the population should be dealt with immediately and decisively.

More importantly, the indications that we are heading toward a civil war that so many are trying to suppress and deny, will become a full-blown reality if this is allowed to continue and then there will be no turning back to a time when Palestinians put the national interests before the factional, if ever there were such a time. If that should happen, there will be more innocent bystanders like Osama, who will pay the heavy price of the craziness that we have sunken to in recent months, and ultimately Palestine will hemorrhage outwards and be drained of its wealth of people, who today still have the ability to save it from becoming yet another tragic tale for the history books.

Authors in the Frontline

On his first visit to the Gaza Strip, Daniel Day-Lewis meets the Palestinian families living in the heart of the danger zone — and the psychologists who are counselling them

Mossa'ab, the interpreter, leads the way, carrying a white Médecins Sans Frontiéres (MSF) flag. Its psychology team, myself and the photographer Tom Craig are in full view of an Israeli command post occupying the top floors of a large mill. It is draped in camouflage netting, as is the house close by. It is to this house that we are heading, across 200 yards of no man's land; the last house left standing in an area once teeming with life.

Civilians have been the main victims of the violence inflicted by both sides in the Middle East conflict. In the Gaza Strip the Israeli army reacts to stone-throwing with bullets. It responds to the suicide bombs and attacks of Palestinian militants by bulldozing houses and olive groves in the search for the perpetrators, to punish their families, and to set up buffer zones to protect Israeli settlements. It bars access to villages, and multiplies checkpoints, cutting Gaza's population off from the outside world. MSF's psychologists are trying to help Palestinian families cope with the stress of living within these confines; visiting them, treating severe trauma and listening to their stories. Their visits are the only sign sometimes that they have not been abandoned.

Israel's tanks and armour-plated bulldozers can come with no warning, often at night. The noise alone, to a people who have been forced to suffer these violations year after year, is enough to freeze the soul. Israeli snipers position themselves on rooftops. Householders are ordered to leave; they haven't even the time to collect pots and pans, papers and clothes before the bulldozers crush the unprotected buildings like dinosaurs trampling on eggs — sometimes first mashing one into another, then covering the remains with a scoop of earth. Those caught in the incursion zone will be fired on. Even those cowering inside their houses may be shot at or shelled through walls, windows and roofs. The white flag carried by humanitarian workers gives little protection; we'll have warning shots fired at us twice before the week is out.

Sometimes a family will not leave an area that is being cleared, believing if they do leave they will lose everything. It is a huge risk to remain. Sometimes a house is left standing, singled out for occupation by Israeli troops. The family is forced to remain as protection for the soldiers. Last year an average of 120 houses were demolished each month, leaving 1,207 homeless every month. In the past four years 28,483 Gazans have been forcibly evicted; over half of Gaza's usable land, mainly comprising citrus-fruit orchards, olive groves and strawberry beds, has been destroyed. Last year, 658 Palestinians were killed in the violence in Gaza, and dozens of Israelis. This ploughing under, house by house, orchard by orchard, reduces community to wasteland, strewn and embedded with a stunted crop of broken glass and nails, books, abandoned possessions. As we weave our way towards the home of Abu Saguer and his family — one of several families we will visit today — we are treading on shattered histories and aspirations.

Abu Saguer's own house is still standing, but its top floor and roof are occupied by Israeli soldiers. His granddaughter Mervat is with us, a sweet, shy seven-year-old with red metal-rimmed glasses, her hair in two neat braids held by flowery bands. She wears bright-red trousers and a denim jacket. Last April her mother heard an Israeli Jeep pull up briefly at the military-access road in front of their house. Some projectile was fired and when Mervat reappeared — she had been playing outside — she was crying and her face was covered in blood. They washed her. Her right eye was crushed. A month later in Gaza an artificial eye was fitted. It was very uncomfortable, so a special recommendation was needed from the Palestinian Ministry of Health to finance a trip to Egypt for one that fitted properly. Mervat needs this eye changed every six months, so the ministry must negotiate with Israel each time for permission to cross the border. Fifty cars are permitted to cross each day; each must carry seven people.

Abu Saguer has five sons and four daughters — "You'll go broke with more than that," he says. He lives near the big checkpoint of Abu Houli in southern Gaza. He wants the photographer, Tom Craig, to take his picture and put it on every wall in England, Germany and Russia. He is 59. At 12 he went out to work, and at 16 he began to build the house he had dreamt of, "slowly, slowly" as a home and as a gathering place for his extended family. He had grown up in a house made of mud in Khan Yunis, which let the water in whenever it rained, and all his pride, hope and generosity of spirit had invested itself in this ambition. He had worked in Israel, like so many here, before the borders were closed to all men aged between 16 and 35.

For over 20 years, Abu Saguer had his own business, selling and transporting bamboo furniture. During the second Gulf war all his merchandise was stolen. After that he relied on his truck for income. He had cultivated 300 square metres of olive trees, pomegranates, palms, guavas and lemons in the fields around his home. After the start of the second intifada (Palestinian uprising) his crops were destroyed by the Israeli army — for "security". A road that services the Israeli settlements of Gush Katif had been built, and during our visit the traffic passes freely backwards and forwards, along the edge of the barren land where his orchards once flourished.

On October 15, 2000, Abu was at home with his wife when Israeli settlers emerged on a shooting spree. He and his family fled to Khan Yunis. After four days he returned. He was hungry. There was no bread, no flour. He killed four pigeons and prepared a fire on which to grill them. The soldiers arrived suddenly, about 20 of them, and entered the house. He followed them upstairs. "Where are you going?" he asked. One smashed his head into a door, breaking his nose. They kicked him down the stairs and out of his house. They kicked half his teeth out and left him with permanent damage to his spine. "If you open your mouth we'll shoot you," they said. They left, returning in a bigger group an hour later, to occupy the top of his house, sealing the stairway with a metal door and razor wire. The family has lived in constant fear ever since. The soldiers urinated and defecated into empty Coke bottles and sandbags, hurling them into his courtyard. They menaced his children with their weapons. After two years of this an officer asked: "Why are you still here?" "It's my house," he replied.

For four years, Abu Saguer has been afraid to go out, afraid to leave his wife and children alone. He is a prisoner in his own home, just as the Palestinians are prisoners within their own borders. The facade of self-government is an absurdity. The Strip, with its 1.48m Palestinians, is a vast internment camp, the borders of which shrink as more and more demolition takes place, and within which the population rises faster than anywhere else in the world. Meanwhile, about 7,000 Israeli settlers live in oases of privileged segregation. This is a state of apartheid. It's taken me less than a week to lose impartiality. In doing so, I may as well be throwing stones at tanks. For as MSF's president, Jean-Hervé Bradol, has said, "The invitation to join one side or the other is accompanied by an obligation to collude with criminal forms of violence."

The late Lieutenant-General Rafael Eitan, the former chief of staff of the Israel Defense Forces (IDF), once likened the Palestinian people to "drugged cockroaches scurrying in a bottle". In 1980 he told his officers: "We have to do everything to make them so miserable they will leave." He opposed all attempts to afford them autonomy in the occupied territories. Twenty- five years on, it seems to me that his attitude and policy have been applied with great gusto. Every movement here in any of the so-called sensitive areas, which account for a large, ever-increasing proportion of the Strip (borders, settlements, checkpoints), is surveyed and reacted to by a system of watchtowers.

These sinister structures cast the shadows of malign authority across the land. On our third day, as we stood at the tattered edge of the refugee camp at Rafah, the forbidding borderland between Gaza and Egypt, bullets bit into the sand a yard and a half from where we stood. It was in this place — was it from the same watchtower? — that Iman el-Hams, a defenceless 13-year-old schoolgirl, had been shot just weeks before. She ran and tried to hide from the pitiless death that came for her. I felt her presence; the sky vibrating with the shallow, fluttering breath of her final terror.

I read this transcript before I left home; the cold facts ran through me like a virus. It is a radio communications exchange by the Israel Defense Forces, Gaza, October 2004. Four days later, crossing into Gaza, I'm still shivering: what the hell is this place we're going to?

Soldier on guard: "We have identified someone on two legs [code for human] 100 metres from the outpost.

Soldier in lookout: "A girl about 10." (By now, soldiers in the outpost are shooting at the girl.)

Soldier in lookout: "She is behind the trench, half a metre away, scared to death. The hits were right next to her, a centimetre away."

Captain R's signalman: "We shot at her, yes, she is apparently hit."

Captain R: "Roger, affirmative. She has just fallen. I and a few other soldiers are moving forward to confirm the kill."

Soldier at lookout: "Hold her down, hold her down. There's no need to kill her."

Captain R (later): "...We carried out the shooting and killed her... I confirmed the kill... [later]... Commanding officer here, anyone moving in the area, even a three-year-old kid, should be killed, over."

A military inquiry decided that the captain had "not acted unethically". He still faces criminal charges. Two soldiers who swore they saw him deliberately shoot her in the head, empty his gun's entire magazine into her inert body, now say they couldn't see if he deliberately aimed or not; another is sticking to his damning testimony.

Every weighty bag of flour for Abu Saguer's household must be broken up and lugged across the 200 yards of wasteland. Everything must be carried. We are smoking apple-flavoured shisha in the courtyard after a lunch his wife made of bread, tomatoes, olive oil, olives and yoghurt, all from the small plot left to him. "Take some puffs so you can write," he says. He speaks with great urgency and my pen lags behind. On November 7, during Ramadan's month of fasting, a three-tiered perimeter of razor wire was laid, encircling his house. This forced him and his family to use the military access road, walking his children past tanks to get to school. It's a much longer and more dangerous route. After a week of this he was shot at from the watchtower. Abu Saguer gathered his wife and children, then they sat down in the road. All afternoon they sat.

"I didn't care if they crushed us there and then. I wanted a resolution," he said. Jeeps passed, nothing happened. After dusk they went in to break their fast. The next day a senior officer approached them in the road.

"What's the problem? Are you on strike? What is it, are you upset?"

"Yes."

"A lot?"

"A lot, a lot, a lot."

"Are you upset with us?"

"I'm upset with the whole lot of you."

"Why?"

"You're forcing my wife and children to walk in front of tanks and bulldozers — I want a donkey and cart."

"Big donkey or small donkey?"

"Big, to pull a cart."

"Impossible." (Abu Saguer, his eyes twinkling, smoke streaming from his nose and mouth, says: "If they'd said yes, I'd have bought a very big donkey to bite his nose, and donkeys that bite are very inexpensive.")

"Give me a gate, then."

"We don't have gates."

"I'll make one."

He makes a gate from two pieces of wood and a wire grill. They ask him to buy a padlock. He buys one. A soldier supervises as he cuts through the bottom tiers of razor wire (they won't allow the top one to be cut) and he installs his little gate. "If the gate is left open and anything happens, we will shoot you."

Sue Mitchell, the MSF psychologist, asks: "What's it like for you to tell this story?"

"I release what I have in my chest," he says. "I can't sleep. I woke this night at 1am. I thought it was sunrise. I woke the kids and told them to go to school. I look around and see that my life has been ruined. I'm like a dry branch in the desert."

Psychologists have been visiting the family since shortly after the occupation of their house began. Each time, they have to apply for access to Israeli authorities; it's usually granted three times out of four. Sue, a 41-year-old Australian, has a wonderfully gentle presence. She quietly steers her patients to and fro between the pain of their memories and a recognition and acknowledgment of their dignity, courage, generosity and good humour in the face of this desperation. She encourages them to voice their fears, tell their stories and, particularly with the children, act out their experiences.

Abu Saguer is a man of great affability. Because of his resilience, his wit, his tenderness with the children, it's easy to think of his survival in heroic terms, but often he has periods of deep depression, disorientation and forgetfulness. "I'm not scared any more, I can't explain it, I just don't care. There's one God, I'll die only one time."

The soldiers have decamped for the moment, but the family is never sure when they will come back. Part of their home has been lost to them. We walk through those rooms that the troops occupy. The curtains chosen with care by Abu Saguer's wife long ago billow inwards, in unsettling contrast to the camouflage netting in front of the window. His gate is visible from here. I imagine him approaching across the broken ground, struggling with a bag of flour, stooping to unlock and open that little gate.

As we leave, Sue calls her base. Each visit must be registered with and approved by the District Civil Liaison (DCL). We hear that a doctor has been shot dead while treating a wounded boy at a crossroads in Rafah that we passed yesterday.

Entering Gaza for the first time at the Erez checkpoint, we saw some Israeli kids in army uniform — we'd seen them on the way from Jerusalem, hitchhiking or slouching at bus stops, dishevelled, their uniforms accessorised with shades and coloured scarves. Weapons were slung across their backs. They looked like they should have been on the way to school. One girl at Erez wearing eyeliner and lipstick, friendly with the implied complicity of "We're on the same side," said: "I'm laughing all the time — I'm crazy." Most of them appeared indifferent, almost unseeing. We walked through the concrete tunnel separating these two worlds. In the eyes of their bosses, we are a menace because we're witnesses. All humanitarian workers are witnesses. The UN has been on phase-four alert, the highest level before pulling out completely.

They're a little tired of being shot at. We travel south from Erez toward Beit Lahiya through the area "sterilised" during "Days of Penitence". That was Israel's 17-day military offensive in northern Gaza that started on September 29, after a rocket fired by the Islamic militant group Hamas killed two toddlers in the Israeli town of Sederot, a kilometre away on the other side of the border. These home-made rockets have a five-mile range, so Israel sent in 2,000 troops and 200 tanks and armoured bulldozers to set up a 61/2-mile buffer zone and "clear out" suspected militants. Days of Penitence killed 107 Palestinians (at least 20 of them children), left nearly 700 homeless, and caused over $3m in property damage.

Towards the end of it, even Israeli military commanders were urging Ariel Sharon to stop. He wouldn't listen. So there is not a building left standing that hasn't been acned by shells and bullets, many of them with gaping mouths ripped out by the tanks. A vast area has been depopulated and ground into the rubble-strewn desert we find wherever we go. A Bedouin encampment has settled, impossibly, on one of these wastelands. Half a dozen smug-faced camels and a white donkey stand behind the fence waiting for Christ knows what; the air is heavy with their scent. The families have constructed hovels of sheet plastic, branches and jagged pieces of rusting corrugated iron. They look like the last scavenging survivors of doomsday. As we head southwest towards Gaza City, the Mediterranean Sea appears like a mirage, shocking in its beauty: Gaza's western border.

We arrive at the MSF headquarters in Gaza City for the daily logistical meeting. Hiba, a French-Algerian about to complete her mission, has perhaps the most stressful job of all: to daily organise and monitor the movements of each of the six teams working here. She has to seek "co-ordinations", which, in the veiled dialect of occupation, means permission to enter and leave any sensitive area. This she achieves, if possible, through an Israeli DCL area commander in the department of co-ordination. We'd met one of them — just a kid like the others — at Erez. "Oh, Hiba, she takes it all too personally," he'd said. As if the whole thing were a game, with no hard feelings, between consenting adults. Even with this "co-ordination", an MSF team may arrive in the area only to be refused access by the local Israeli officer in charge (or, in some cases, to be shot at). No reason need be given. "Security," they're sometimes told.

Hiba is constantly assessing, reassessing, adapting. At any moment the heavily fortified Israeli checkpoint at Abu Houli, in the centre of the Strip, can be closed, effectively dividing Gaza into two parts. It may remain closed for four, six, 10 hours. It might be a security alert or an officer's whim. Yasser, Sue's Bedouin driver, once waited for three days to cross. We were held up there. A Palestinian officer, identifiable by the size of his belly, had overridden his leaner subordinates and waved us to the front of the queue. A babble of aggressive commands was disgorged from the IDF bunker through new burglar-proof loudspeakers. Recently a gang of young boys had made a human pyramid and stolen the originals. "Wah, wah, wah," the boxes yell at you from within their razor-wire cocoons.

Hiba rests only when the teams return safely to their bases in Gaza City, or in the south where another MSF apartment allows visits there to continue if the checkpoint is closed.

At the southern MSF base in Abassan I'm awoken on our third day at 4.30am by the call to prayer, then again at 7am by the surprising sound of children in a school playground. In any place, in any language, the sound is unmistakable. Gleeful and contentious. When you're in bed and you don't have to go to school yourself it's delicious. Are they taught here, among other things, that they have no future? The windows on this side of the apartment overlook a playground of pressed dirt with a black-and-white-striped goal of tubular metal at each end. The school, conspicuously unmarked by bullet or shellfire, is a long two-storey building, built in an L-shape along two sides of the pitch. It is painted cream and pistachio and resembles a motel in Arizona. (Later, in the refugee camp at Rafah, we'll drive past one riddled with bullet holes, and meet a grinning 10-year-old who proudly shows us the scars, front and back, where the bullet passed through his neck one day at school.)

After waking, I move to the back of the flat, to the kitchen. At the far side of a hand-tilled field warming itself in the early sunshine stand two pristine houses, white and cream, like miniature palaces. The field is hemmed at one end by a row of olive trees, and at the other by a large cactus.

A middle-aged man and woman in traditional clothes move the drills in unison. The distance between them maintained, gestures identical, they advance, bent at the waist, planting one tiny onion at a time plucked from a metal bowl. If an occupying force were ever in need of an image to advertise the benevolence of their authority, this would be it. I wonder what awaits them. I try but fail to imagine the roar of a diesel engine, the filth of its exhaust, as a bulldozer turns this idyll to dust.

Later, sipping cardamom-flavoured coffee, I look down on a fiercely contested football game. Half the kids have bare feet. There's a teacher on each side, in shirt and tie. One tries a volley which, to shrieks of delight, sails over the wall behind the goal. Two little boys watch, arms around each other. They turn and hug for a long time, then wander off still arm in arm. Sue Mitchell arrives. The co-ordination we needed has come through. After the warning shots fired at us from the watchtower at Tuffah yesterday, we'd thought maybe the Israelis would refuse it.

Yasmine is a grave, self-possessed 11-year-old. She emerged from her coma after a nine-hour operation to remove nails embedded in her skull and brain. An exploding pin mortar had been fired into her house. Her father was hit in the stomach and can no longer work. I've held this type of nail in my hand. They are black, about 1½ in long, sharpened at one end, the tiny metal fins at the other end presumably designed to make them spin and cause deeper penetration. We sifted through a pile of shrapnel at the hospital, all of it removed from victims. These jagged, twisted fragments, some the size of an iPod, were not intended to wound, but to eviscerate and dismember: to obliterate their victims. Yasmine lives a short drive away from Abu Saguer, in a ramshackle enclave with a courtyard shaded by fig trees. Across a sterilised zone lies her cousins' house, but it remains inaccessible (the cousins, including the most withdrawn child Sue Mitchell has ever met, are also her patients).

On the other side of a coil of razor wire, laid within feet of Yasmine's house, runs a sunken lane gouged out of the sand by tanks. When Sue first met her, Yasmine was terrorised, screaming and throwing up during the night. Such symptoms are common. In areas such as this, leaving your house day or night means risking death; staying there is no more secure. Nowhere is safe.

Under Sue's guidance, Yasmine and countless other cousins have prepared a show which, after many last-minute whispered reminders and much giggling, they perform for us. Yasmine is undoubtedly the force behind this. Her power of self-expression is immense. As she recounts the story of her wounding, her voice rides out of her in wave upon wave, full of pleading and admonition. Her crescent eyes burn within a tight mask of suffering; her hands reach out to us palms up, in supplication. At the end the tension in her fierce, lovely face resolves into the shy smile of a performer re-inhabiting her frailer self when the possession has lifted. Then there is a play, with sober, stylised choreography and a chorus of hand jives. A silent little girl whose expression is deadpan, unchanging, play-acts being shot by soldiers during a football game.

This four-year-old has witnessed much of the horror that has befallen the family. She lies obediently on the ground, splayed out and rigid. The mourners, curved in a semicircle around her, pretend to weep and wail, but they're all laughing behind their hands; we laugh too. Then they sing: "Children of the world, they laugh and smile, they go to sleep with music, they wake with music, we sleep with shooting and we wake with shooting. Despite them we will play, despite them we will play, despite them we will laugh, despite them we will sing songs of love."

Yasmine doesn't join the others as they cluster around us to say goodbye. Looking up, we see her leaning on the parapet of the roof, smiling down on us. Silent. Her dark face is golden in the rich, syrupy light of dusk.

Sue Mitchell is one of three psychologists here for MSF. Each will work with about 50 families during their six-month stay. The short-term therapy they offer is invaluable, but in some way it seems like a battlefield dressing with no possibility of evacuation for the injured. These stories are unexceptional. Every room in every humble, makeshift, bullet-ridden dwelling, in each of the labyrinthine streets of the camps, contains a story such as this — of loss and injury and terror. Of humiliation and despair. What separates those of Abu Saguer and Yasmine is that we carry their stories out with us. The others you'll never hear about.

HOW CHILDREN LEARN TO SURVIVE ON THE FRONT LINE

Violence and bloodshed are the backdrop to the lives of the children of Gaza. That they cling to hope and their dignity leaves psychologists such as Sue Mitchell deeply moved. With one group of young patients, she has produced a practical guide to help them and children in other war-torn areas. The children of the Abu Hassan family — 10 of them, aged from five to 13 — were caught in Israel's Days of Penitence offensive. "They'd been shot at, attacked, some of their houses had been demolished, they'd seen people blown up, and had been confined in the smallest room of their house for two weeks by Israeli soldiers," says Mitchell. Faces they drew in the sand showed inverted semicircle mouths and large tears.

"I was feeling my heart small and I was unable to talk. I thought I was going to die," said one. Mitchell was inspired by how they coped with the trauma, and wrote down what they told her. The result is a booklet in the children's own words, How to Manage the Effects of a Military Attack: Tips for Children. "Invent games that make you laugh and help you breathe," says one child. "Look at each other's faces. If you see someone is distressed, talk to them," says another. And there are dreams for the future: "Eat olives — the olive tree is the tree of peace."

"They're delighted by the book," says Mitchell, "but they also underplay their strengths. They say, 'We're not so special; all Palestinian kids know how to do this.'"