Two Palestinian students stood at the Surda checkpoint, a dry stretch of road just outside Ramallah. The Israeli Defense Forces were not letting any Palestinian vehicles through – not even ambulances – so hundreds of Palestinians walked the mile stretch on their way to school, shop or perhaps to visit a friend. Under a hot, Levant sun, it is not an easy walk for many, especially the elderly, disabled or sick. That was where Ziad Darwish and Mustafa Sabri came in. They rushed back and forth, pushing the infirm in wheelchairs. The students wore yellow vests, which are instantly recognizable by anyone who has spent time in the Occupied Territories. The vests are the signature of the Union of Palestinian Medical Relief Committees (UPMRC), a nongovernmental organization that plays a vital role in providing health care to Palestinians.

Providing health care in the territories has always been difficult, not just during periods of hostilities like today. First, there is a simple lack of funds. In 1993, the last year before responsibility for health care was handed over to the Palestinian Authority, Israel spent about $67 million on health care in the West Bank and Gaza. During the same period, Israel spent about $6.25 billion – almost 100 times more – on health care for its own citizens. (During this period, however, the Palestinians also received many millions of dollars for health care from other countries, international aid groups and other donors.) Today, Israel annually spends about $1,000 on health care for each citizen. Only $80 is spent annually on each Palestinian, with funding coming from the Palestinian Ministry of Health, international organizations and an assortment of NGO’s.

Much of the health care work falls to the Union of Palestinian Medical Relief Committees, which today serves more than 400 communities in the West Bank and Gaza. The union has provided health care to more than one million people, nearly one-third of the Palestinian population, said its president and co-founder, Dr. Mustafa Barghouti. “It’s the most important NGO in all of Palestine.” The union operates with a $5 million annual budget, securing funding from local and international donors, including Arab states, NGO’s and private citizens (CNEWA was among the first to support UPMRC). It also works closely with other NGO’s, including Israeli Physicians for Human Rights.

Since the outbreak of the second intifada in September 2000, the task of providing health care in the territories has grown more difficult and more costly. Groups like the union are more vital than ever.

Dr. Barghouti, 50, is used to working long hours, but recently his schedule has grown more hectic than ever. In addition to running the union, he is the director of the Health, Development and Policy Institute, a Ramallah think tank. He is also running for president to succeed the late Yasser Arafat. (This article went to press before the 9 January election; Dr. Barghouti was not the favorite.)

Born in Jerusalem, Dr. Barghouti grew up in Ramallah. He knew he wanted to become a doctor since he was 12 years old. “I was a boy scout when the 1967 war broke out, and we were all taught first-aid care,” he said. “So, even at that early age, I was treating wounded Palestinians. It left a strong impression on me. I knew from that time on I wanted to be a doctor.”

After finishing medical school in the Soviet Union, Dr. Barghouti, a cardiologist, and several other doctors established the Union of Palestinian Medical Relief Committees in 1979. Their goal was to build a community of doctors, nurses and pharmacists willing to volunteer their time and services on a regular basis, train Palestinians to serve as health aids and raise funds for medical equipment.

From its inception, the union has faced serious operational challenges. A paucity of doctors meant that physicians had to travel great distances between patients. Volunteers must also learn to dodge bullets. “I was shot during a conflict with the Israelis in 1996, when I was trying to treat a wounded man,” said Dr. Barghouti. “I was in my white medical coat inside a building in Ramallah, trying to stop this person’s bleeding. And an Israeli sniper shot me. It wasn’t a mistake. I was treating someone, and that’s why he shot me. And that’s why I have 36 pieces of shrapnel inside me.” Medical personnel continue to be among the casualties of the intifada.

Over time, the union built up its force of volunteer nurses and doctors. (Today, there are about 1,500.) But by the mid-1990’s, it recognized a need for additional first-aid workers. During the first intifada (1987-1993) there were countless cases of the wounded being further injured as they were taken to hospitals by well-meaning but untrained civilians. “We realized that we were never going to have a sufficient number of doctors or nurses to cover the entire country,” said Dr. Barghouti.

“The only way to respond was by encouraging communities to get involved, get trained and volunteer to help.”

Palestinians answered the call. Today, the union counts on about 30,000 volunteers. “In some cases, they’ve saved lives, because they were the only ones who could get to the injured and treat them.”

As it has grown, the union has also expanded into other areas. It has been a ceaseless advocate for the disabled, working to integrate them fully into Palestinian life. Before, in schools and other institutions, they had been isolated. The union successfully lobbied for legislation that would require Palestinian employees to hire the disabled.

The union has also redefined health care for women in the territories. Previously, women could expect little more than prenatal care. Today, postnatal and routine gynecological treatment is much more common.

Perhaps the best testament to the work of the union over the past 25 years is that today, in many respects, a trip to the doctor’s office is no different in the West Bank or Gaza than it is in, say, Toronto or Cleveland.

Not long ago, inside a stark white room in the West Bank village of Qibya, 10-year-old Muhammad Abdel-Rhim sat on a plastic chair, face to face with one of the few Jewish Israelis the boy had ever met. Muhammad’s mother spoke with the man in Arabic.

“He’s snoring and his speech isn’t clear,” she said.

It was Dr. Aaron Karni’s first volunteer visit to the West Bank. A physician from Jerusalem, Dr. Karni, through Israeli Physicians for Human Rights, has volunteered with UPMRC.

The examination room was crowded. Two other doctors were also treating patients, whose families stood nearby. Outside the room, another 300 patients waited. It was quite a turnout for Qibya, a village of 5,000.

“This one will be hard for me to test, since my Arabic is not so good,” said Dr. Karni, in English, to his Palestinian colleague Dr. Khalid Abu Taha, a union volunteer.

Muhammad’s tonsils were removed more than a year ago, and his family believed the operation may have affected his speech.

“I’m not sure if I can tell if he has a lisp or a more serious problem,” Dr. Karni said.

Dr. Abu Taha asked Muhammad to count to 10 in Arabic.

“He sounds good,” said Dr. Abu Taha.

Dr. Karni prescribed a nasal spray and told the family that if it has not helped in two weeks, he will send Muhammad to a specialist.

It is a routine doctor’s visit, but in the war-torn territories achieving the routine is a major accomplishment.

“I always knew, for myself, medicine was the right thing to do both professionally and politically, in terms of helping Palestine,” said Dr. Barghouti.

“As a doctor, you are helping thousands of patients and, in many instances, saving lives. Through medicine, we can get cooperation among all the parties, which is often difficult to do. And not just among Palestinians but with Israelis too. Being doctors, there is something that binds us together. And that’s something we can build on.”

Ben Cramer is a New York-based journalist and radio producer.