Lesley Dawson recalls the struggle to motivate her Palestinian students as they lived with occupation and war.

Recent news items from Israel and Palestine and emails from friends in Bethlehem and Gaza that describe the present conflict as the "second intifada" brought back memories of teaching physiotherapy students at Bethlehem University between 1988 and 1999.

The pressures on Palestinians of living under occupation for three decades, the rising population density and the erosion of extended family structures formed the background to my time there.

I often felt guilty about my relative freedom of movement compared with colleagues and students. I could visit areas, now part of Israel, where the families of my students and colleagues had once lived. I could leave Bethlehem if the situation got too bad and go home to a peaceful, democratic country. I was not trapped in a small area and unable to move freely.

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There were times when I felt angry about the occupation, when I felt unwilling to visit Israeli friends because I could not begin to describe events that I had witnessed. There were other times when I needed to get away from the claustrophobic conditions in Bethlehem. Many times I was angry at the Palestinian leadership's lack of control and the anarchic behaviour of various political factions. When students were unable to get to class or to clinical placements because of roadblocks or curfews, I felt that circumstances were completely beyond one's control. I had to learn what issues were worth getting angry about and what was not worth expending energy on.

Many of my students were from refugee camps or remote villages. Their reasons for training as physiotherapists were many. Some genuinely wanted to help those who had been injured during the intifada; others viewed it as a way to a better standard of living and perhaps a new life abroad. One of our difficulties was to inspire them to high standards of care without causing them to despair about being unable to achieve such standards within the existing health infrastructures.

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The general undercurrent of discontent pervaded every activity and affected students' ability to concentrate and focus on their work. For me, it was easy to forget what I intended to teach with the sound of gunfire and the smell of teargas coming through the window. In such circumstances, it was difficult to persuade students that they had a responsibility to be present in class and remain focused on the needs of their patients, as opposed to their own and their family's needs and problems.

Family and clan links were very strong despite the weakening effect of the intifada, and it was not always easy to make students understand that all patients (not just clan members) had the right to good treatment. Patients would use connections to jump the queue. It is important that you know key people in the community because this allows you to go straight to the top with a request, or to rely on the sponsorship of community leaders to lobby to get what you want. The years of occupation had given rise to the feeling that external circumstances controlled people's lives and therefore that no individual could be held accountable for his or her actions.

Many of the young men resisted being corrected by an older foreign woman. Young people played an important part in resistance to the Israeli occupation because they were disillusioned by the inactivity of their elders and frustrated at their lack of freedom. Having been in positions of informal leadership in this way eroded the respect that had traditionally been accorded to teachers. These shabab were also tired of being told what to do by westerners who did not understand Palestinian culture.

The 1991 Gulf war brought additional problems such as students being confined to their homes and widespread fears of being gassed or deported to Jordan. It was difficult to motivate students to think about anything long term. During the war, society was so demoralised that students and staff felt they would never be able to return to Bethlehem to complete their studies and work as physiotherapists. When classes began again, it was an uphill battle to convince them of the value of continuing their studies.

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I did have and still do have good relations with some of the Israeli physiotherapy educators in Tel Aviv and Beersheva. We were able to visit them, but they did not feel able to visit us. The physiotherapy adviser at Israel's ministry of health helped us to get our BSc physiotherapy qualification from Bethlehem University accepted by the Israeli government so Arab Jerusalemites could work in Israel.

Some of our students worked with Israeli students and staff during clinical attachments at Hadassah Hospital and Alyn Children's Hospital in West Jerusalem. They encountered language problems and suspicions that they were terrorists.

Although my links with Israelis meant our students and teachers had more contact than most at Bethlehem University, in our daily life of classes and clinical attachments in the occupied territories, we did not come across any Israeli healthcare staff or students. There were individual teachers who had links with peace activists in Israel and a few students who had attended peace camps with Israeli students. But even before the recent worsening of tensions, for the vast majority, there was a tremendous ignorance and fear of the other side.

Lesley Dawson is a senior lecturer in the School of Health Professions at the University of Brighton. She will give a talk on her experiences at a one-day workshop on medicine in times of war, organised by the University of Brighton's Philosophy Society on March 16.

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