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An Israeli nurse prepares Abdullah Siam for surgery to repair a congenital heart defect at the Wolfson Medical Center January 29, 2009 in Tel Aviv. The 6-year-old Palestinian boy's relative, Hamas Interior Minister Said Siam, was assassinated by Israel during an offensive in the Gaza Strip.(David Silverman/Getty Images)

In an old stone house on Nevi’im street in Jerusalem on a recent afternoon, young Kurdish and Syrian girls played with wooden toy sets on the floor while their mothers, clad in colorful head scarves and black clothing, chatted on their phones in Arabic and Kurdish with relatives back home. The children were awaiting heart surgery at Israeli hospitals and the parents were nervous, both for their children and because being in Israel at all is a risky proposition for someone from Syria, Iraq, or Jordan. They were brought to Jerusalem as part of a unique relationship between the Israeli NGO Save A Child’s Heart and the Christian group Shevet Achim. The former provides free surgical care for children with life-threatening heart conditions from around the region (and the world). The latter locates children in need of such care and is able to bring them across tense Middle Eastern borders to Israel for treatment.

Medical diplomacy—humanitarian work that can also serve as grassroots statecraft—has gotten a quiet boost in Israel in recent years. Though it remains haphazard and the various groups involved are largely uncoordinated, collectively their efforts have been growing. In the past year, Israeli physicians have treated the daughter of Hamas leader Ismail Haniyeh, the President of Zambia Michael Sata, Syrian rebel fighters and civilians, and Kurdish and Jordanian children. Every Tuesday children from Gaza and the West Bank arrive in vans to Wolfson Medical Center in Holon for surgery and check-ups.

The most dramatic example of medical diplomacy is happening on the northern border—taking in wounded from the Syrian Civil War (Syria being a country Israel remains technically at war with) to Israeli hospitals for urgent care. Col. Dr. Tarif Bader, the deputy surgeon general of the IDF and former head of Northern Medical Command (which oversees the Syrian mission), said that since they began admitting Syrians on Feb. 16, 2013, more than 1,500 Syrians have received medical care in Israel. “For the first time we built [a field hospital] inside Israel for giving treatment to enemies across the border,” Bader said. The majority of the patients have come with conflict injuries—fractures, head trauma, shrapnel wounds—but a minority were simply sick, had been injured in a traffic accident, or were going into labor and had nowhere else to go.

The portable field hospital the IDF set up for Syrian casualties is usually reserved for foreign disaster zones. Bader was part of the delegation sent to Haiti five years ago that included roughly 250 Israeli medical workers and soldiers. He said the Israelis were the first to get a hospital up and running in Haiti, just 89 hours after the earthquake. According to Bader, Israel has also sent disaster relief teams to Turkey, Japan, and the Philippines. Israel was recently recognized by the United Nations for its work helping to contain Ebola in western Africa.

But the Syrian effort is unique. Or at least it was until this past summer’s war with Gaza when Israeli authorities tried to do something similar. They set up a field hospital on the Gaza border, at the Erez Crossing, and, in the midst of an ongoing battle, invited injured Palestinian civilians to seek treatment there at the Israeli government’s expense.

Unlike the Syrian effort however, calls to come to the Erez Crossing Hospital did not lead to a flood of patients and increased coordination with onetime adversaries. On the day the IDF brought foreign journalists to see the hospital, it stood empty. Though they did manage to treat some injured patients, doctors there blamed threats from Hamas for scaring Palestinians away. Journalists derided it as a PR stunt.

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The partnership between Save a Child’s Heart (SACH) and Shevet Achim is among Israel’s most successful nongovernmental medical diplomacy arrangements. SACH performs surgery on more than 250 children a year, half of them coming from the Palestinian Territories, Jordan, Iraq, and Morocco—many of them ferried over by Shevet. “As a non-Jew, that’s a unique role that we can fill,” Jonathan Miles, the founder of Shevet Achim said. “That bridge between many doctors of good will in Israel and their neighbors they can’t reach on their own. You have to go to refugee camps, Gaza, Iraq, find these kids, and carry them out to Israel.”

Shevet manages to bring between 30 and 40 Iraqi children and a growing number of Syrian refugees every year, as well as Palestinians from Gaza each week. But there have been setbacks. “In the beginning we had a lot of Arab Iraqis coming out,” Miles said. “But at one point six or seven years ago, the Muslim Scholars Association heard about it, caused a fuss, went to the parliament in Iraq and said this has to stop. Our kids can’t go to the Jews for medical care. But,” he added, “the Kurds kept coming and the odd Arab Iraqi here and there still come. And the Yazidis come and some of the Christian refugees from Mosul.”

A Cuban internal medicine specialist examines an elderly woman in the town of Mondesillo, 150 kilometers from Tegucigalpa, Hoduras, 1999. (Orlando Sierra/AFP Photo/Getty Images)

To understand the potential diplomatic effects of these arrangements, one might consider another small state that attempted something similar, implementing an extensive program of Medical outreach over the course of decades, including to hostile neighbors: Cuba. 1962 was a low point in Cuban foreign relations. In January of that year, the Organization of American States, of which Cuba was a founding member, voted to exclude the country from all proceedings and banned its representatives, largely at the request of American allies in the region. The Cuban Missile Crisis that October led the United States to expand their embargo to cover almost all products (whereas before food and medicine had been excluded), impose travel restrictions, and prohibit aid to any country that provided assistance to Cuba. Though it retained friends in the Soviet realm, Cuba was quickly becoming a pariah state.

But the Castros felt they were the vanguard of a global revolution. They were stubborn and ambitious. To combat the diplomatic backlash that had followed their coup in 1959 and reached its zenith in 1962, the brothers began sending doctors and medical personnel abroad to foreign disaster zones and countries in need at rates far out of proportion to their size. According to Robert Huish, a Canadian Global Health professor who has written extensively on the Cuban initiative, in the decades to follow, the program would expand dramatically. They built medical schools and began inviting foreign doctors to study medicine in Cuba for free, graduating thousands of doctors a year and sending them back to their home countries. They took in 18,000 Chernobyl survivors and treated them. They offered free cataract surgery and eye care to people around the Caribbean. And anytime there was a disaster anywhere in the world, Cuba sent its doctors. Sometimes, if the need was great enough, those doctors stayed abroad for years or even decades.

Sometimes they traded medical workers, for oil for instance in the case of Venezuela or for literal peanuts in the case of Ghana. Sometimes the countries were able to pay in full for their services. But mostly the missions were strictly humanitarian. As of 2008, more than 30,000 Cuban medical professionals were working in 70 countries around the world.

The unique thing about the Cuban effort is not only the number of health professionals they send, but also where they are sent. According to Huish, Cuba has dispatched doctors to its political enemies just as often as its friends, especially in Latin America, and has achieved real diplomatic results by doing so. “There was a massive earthquake in Nicaragua in the ’70s,” Huish said. “Cuba was one of the first countries to show up, and that was a dictatorship that actively supported the overthrow of the Cuban government. Uruguay opposed them in the ’90s but Cuba sent medicine. Same thing with Mexico and Honduras. Through these medical exchanges, now there are very warm relations.”

Huish, who had a chance to take a look at the Israeli health system when Ben Gurion University invited him to speak to their Global Health students in 2011, said that he was impressed by the egalitarian treatment received by Bedouins, Jewish-Israelis, and Arab-Israelis alike and said he saw similarities between Israel and Cuba in this respect. “The sort of outreach that Israel has done in the past, and is very good at, could be very important for diplomacy. It’s a brilliant example of soft power,” he said. “If Israel can get boots on the ground by providing healthcare and offering education, that can be a really big benefit.”

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In many cases, the medical contacts that we hear about are only half the story. While the opening of the northern border to injured Syrians and the Gazan border to injured Palestinians marks a public shift in the way Israeli doctors interact with their Middle Eastern neighbors, privately connections like these have existed for decades. An excellent example of this under-the-table brand of medical outreach is Dr. Joseph Schenker, a fertility doctor and a professor of Obstetrics and Gynecology at Hadassah Medical Center, who also serves as president of the International Academy of Human Reproduction. His work with couples from the Arab and Muslim world has been extensive. “I have patients from Egypt, Lebanon—all these countries,” he said. Schenker said that his international work has allowed him to meet Arab doctors at conferences abroad, and those doctors sometimes recommend their patients to him. He has also visited universities in the Arab world, and he gave a talk at a university in Cairo just seven months after the peace agreement between Israel and Egypt was signed in 1979.

Over the course of his long career, Schenker has treated some surprising patients. He said he helped the niece of Ayatollah Khomeini with reproductive issues, and she and her husband even traveled secretly to Israel for the procedure. He has also dealt with the wife of a Muslim president who had trouble conceiving. “The wife was here and we went abroad to some neutral country in Europe to bring the sperm,” he explained, as the Muslim leader was unable to come to Israel himself.

Once, the daughter-in-law of the infamous Palestinian terrorist George Habash, who masterminded the hijacking of several Western airliners in the 1970s and founded the Popular Front for the Liberation of Palestine, came to see him. “His daughter-in-law comes to me and sits in my office and asks if I will treat her,” Schenker said. “I said, ‘Why wouldn’t I?’ She said look at my name—Habash, he was a very famous terrorist. So I told her, ‘OK, it’s not a problem. You come in as a patient and I will treat you, try to help the next generation.’ ”

Schenker said that sometimes others have questioned whether he should do so much for the families of terrorists or patients from enemy states but he has no qualms with his work. “They did not come to me to make politics,” he said. “They came to me as a patient.”

While it is hard to answer whether work like this has a diplomatic effect on the region, Schenker said he thinks it does. “I think the patient who comes and sees our attitude—how they are treated, not only medically, but how we deal with them as persons,” he told me. “They change their view about this country.”

To illustrate his point, Schenker told a story about his father, who was a well-known surgeon in Israel: “In ’48 we had many problems, we were not so strong as today.” His father was chief surgeon and commander of the army hospital in Safed during the war. At the time, Schenker continued, “the Druze were against us. They fought against the Jews and one of the Druze leaders was wounded and drove to the hospital in Safed. He was afraid that the Jews would kill him. But my father operated on him and he survived. That leader got better and he changed the Druze [under his command] from supporting the Arabs to supporting the Jews.”

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