A neuroscience initiative in Palestinian West Bank

by Salman Hameed

There is an excellent news feature in last week's Science about a Mohammad Herzallah, who founded the Palestinian Neuroscience Initiative (PNI) back in 2009, when he was only 24 and still a medical student. Now he wants to expand the facility. This is a fascinating story:

On a sunny winter afternoon, Mohammad Herzallah is driving his father's Hyundai north on highway 60 to see his family near the town of Jenin. The road weaves through rugged terrain and olive groves in the heart of the West Bank, passing the occasional Palestinian village. Some hilltops are crowned with the modern contours of Israeli settlements, a major obstacle in the quest for peace. “They're called facts on the ground. … It's an interesting term,” Herzallah says, coolly. 

The Israeli military checkpoints dotting the area can paralyze traffic at a moment's notice, but today they aren't causing delays. Herzallah, a Palestinian neuroscientist now at Rutgers University, Newark, in New Jersey, recalls how hard the roadblocks made life early in his career, when he crisscrossed the West Bank visiting Parkinson's patients. “I learned to live with the checkpoints,” Herzallah says. He passes them very slowly. “You don't want to get shot at,” he says. 

But Herzallah isn't interested in discussing the Israeli occupation. His prime concern is the Palestinian Neuroscience Initiative (PNI), which he founded in 2009 as a medical student at the tender age of 24. What he has built is remarkable, colleagues say: a research and training program in the impoverished, conflict-riven West Bank, where neuroscience, until recently, was nonexistent. Based at Al-Quds University in Abu Dis, on Jerusalem's outskirts, PNI has already trained dozens of students, bagged a $300,000 grant with Rutgers from the U.S. National Institutes of Health (NIH), and started publishing papers. A key focus is clinical depression, which is rampant in the Palestinian territories. 

Even without the tools found in neuroscience labs elsewhere—brain imaging equipment, animal facilities, or DNA sequencers—Herzallah has accomplished a lot, says neuroscientist Edvard Moser of the Norwegian University of Science and Technology in Trondheim, who visited PNI in January 2014, 8 months before he and his wife May-Britt Moser won a Nobel Prize in Physiology or Medicine. “He is very determined, balanced, thoughtful, and pragmatic,” Moser says. “I admire him.”

The project grew out of a collaboration between al-Quds University and Rutgers - and on research on untreated severe depression:

The main campus of Al-Quds University abuts the eastern side of the 8-meter-high concrete barrier separating Israel and the West Bank. From some vantage points, you can see Jerusalem, including the glimmering golden dome of Al-Aqsa mosque, which adorns the university's logo. A few Al-Quds departments and training hospitals are in East Jerusalem, on the other side of the wall, greatly complicating life for faculty and some of the 12,500 students. When Herzallah arrived here as a medical student in 2003, the wall was lower; you could jump it and walk to the old city in less than half an hour, he says. Now, the trip takes twice as long by public transport, via a checkpoint to the north. (West Bank Palestinians are not allowed to drive to Jerusalem.) 

The neuroscience program here grew out of a long-time friendship between Mark Gluck, who leads a group at Rutgers focused on memory and learning, and Adel Misk, a neurology professor at Al-Quds. In 2008, Misk and Gluck set out to recruit and train three Palestinian medical students for a study on cognitive function in Parkinson's patients. One, Gluck says, was “a superstar” who overcame all manner of hurdles and collected most of the data. That was Herzallah. 

In 2009, Herzallah spent 6 weeks at Gluck's lab, where he finished a paper on the Parkinson's study. (Its main finding: anticholinergic drugs for treating Parkinson's impair generalization, the application of previously learned rules to a new situation.) Together, Gluck and Herzallah raised money from private donors in the United States for what was initially called the Rutgers/Al-Quds Brain Exchange Program. Herzallah later founded PNI at Al-Quds; he moved permanently to Rutgers in 2010 to begin his Ph.D. with Gluck. 

As an initial project, the duo applied for NIH funding to expand the Parkinson's work, but their proposal was rejected because there was nothing special about Parkinson's in the West Bank, Gluck says. The project “didn't cater to a specific need in the area.”
Clinical depression fits that bill much better. Studies have found that about a quarter of West Bank Palestinians suffer from major depression disorder, a severe, disabling condition. That's about three times the percentage in the United States. (Based on his own unpublished work, Herzallah says the West Bank rate may be as high as 36%.) Many blame the Israeli occupation, economic stagnation, and a general sense of hopelessness that pervades the West Bank. Herzallah says he's not sure of the causes: “We're brain scientists, not epidemiologists,” he says. 

Few patients here seek treatment because there's a strong stigma attached to mental illness. “It's related to the Arab mindset,” says PNI's Hamza Mousa, a collaborator on the depression project. “Being depressed is seen as shameful and weak. People will think you are crazy. Your daughters may be unlikely to get married.” Even those who want treatment are hard-pressed to get it: Herzallah says there are fewer than 25 psychiatrists in the West Bank, which is home to some 2.8 million Palestinians. 

That makes it possible to do studies that would be difficult in the United States, where untreated severe depression is hard to find. “Anybody who has a hint of depression is put on medication,” Gluck says. “If you want to study cognition in clinical depression, you never know if you're looking at the underlying depression or the side effects of the drugs.” Gluck and Herzallah convinced NIH that studying depression in the West Bank had local as well as global significance, and they set up several studies that required little more than laptop-based tests.

And of course, it is tricky to decide on whether to collaborate with Israeli neuroscientists or not - and I think it is a good thing that he - and his collaborators - are keeping politics out of this:

Few are willing to discuss any political dimension to their support. “I'll be blunt and say that I'm not going to talk about politics and religion,” Gluck says. “I'm not going to analyze the Middle East conflict in Science magazine,” Moser says. 

PNI has no links with Israel and its vibrant neuroscience scene. Few Palestinian scientists do. After the Oslo Accords in the 1990s, when a peaceful solution seemed in sight, ties between Israeli and Palestinian academics flourished. But as violence on both sides flared, virtually all partnerships disintegrated. Al-Quds's policy since 2009 has been to not collaborate with Israel, says the university's president, Imad Abu-Kishk. Any collaboration could lead to political problems—or worse, others say. “You would immediately be labeled a traitor,” Treves says. “Your life would be in danger.” 

The cold shoulder frustrates scientists like Yonatan Loewenstein at Hebrew University in Jerusalem, who co-organizes meetings that bring together Israeli and Arab scientists (see sidebar) and is eager to work with Palestinian counterparts. “It doesn't make any sense that I work with researchers in the U.S. and Europe, but I can't meet colleagues who are less than 10 miles away,” Loewenstein says. 

Herzallah has avoided any collaboration with Israel out of what he calls “a mix of pragmatism and principle.” He prefers to stay focused on building up his creation. As the sun sets and he looks out from the roof of his parents' home in Ya'bad over a West Bank valley dotted with scrubby vegetation, Herzallah is clear about his ambitions. “A full-blown institute here in Palestine, where I can pursue my scientific interests. … That's what I want. I want to show that in spite of all of the suffering and the obstacles, we can move forward.”

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