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CHRISTIANE AMANPOUR, INTERNATIONAL HOST: Hello, everyone, and welcome to “Amanpour and Company.” Here’s What’s Coming Up.
Israel expands its ground operation to all over Gaza as the U.S. makes public appeals to protect civilian lives. I asked former State Department
official Josh Paul why he resigned over this war.
Then, an Israeli and a Palestinian peacemaker looked beyond this war to a final peace.
Plus, why are so many people dying in Puerto Rico? “Washington Post” reporter Arelis Hernandez tells Hari Sreenivasan.
And finally, “All the Light We Cannot See.” I speak with newcomer Aria Mia Loberti about taking Netflix by storm.
Welcome to the program, everyone. I’m Christiane Amanpour in London. Israel is expanding its ground operation to all over Gaza, warning civilians to
move and evacuate yet again.
After three days of intense fighting and airstrikes, the U.S. is stepping up its public warnings, as the death toll has risen to over 15,000,
according to the Hamas authorities in Gaza.
U.S. Defense Secretary Lloyd Austin stressed Israel’s “moral responsibility” to protect civilians. He also said it can affect the
battlefield.
(BEGIN VIDEO CLIP)
LLOYD AUSTIN, U.S. DEFENSE SECRETARY: You see, in this kind of a fight, the center of gravity is the civilian population. And if you drive them into
the arms of the enemy, you replace a tactical victory with a strategic defeat.
(END VIDEO CLIP)
AMANPOUR: Vice President Kamala Harris weighed in from the COP28 climate summit in Dubai.
(BEGIN VIDEO CLIP)
KAMALA HARRIS, U.S. VICE PRESIDENT: Too many innocent Palestinians have been killed. Frankly, the scale of civilian suffering and the images and
videos coming from Gaza are devastating.
(END VIDEO CLIP)
AMANPOUR: CNN is also saddened to report that at least nine members of our own colleague, Ibrahim Dahman’s family, have been killed in Gaza. That
happened yesterday.
So, what influence does the United States have as Israel seeks to avenge the slaughter of 1,200 people on October 7th, and to remove Hamas from
power in Gaza? Our first guest tonight, Josh Paul, resigned from the State Department soon after October 7th in protest of what he said were
unscrutinized U.S. arms transfers to Israel.
In his resignation letter, he said the Israeli response and American support “will only lead to more and deeper suffering for both the Israeli
and Palestinian people and is not in the long-term American interest.”
And Josh Paul is joining me now. Welcome to the program.
JOSH PAUL, RESIGNED U.S. DEPARTMENT OVER ARMS TRANSFERS TO ISRAEL: Thank you very much indeed for having me.
AMANPOUR: So, I was struck by what the U.S. defense secretary said. I mean, this is a very bold military assessment that this amount of civilian
killing is going to lead not only to this tragedy that the world is witnessing, but a strategic, he used the word, defeat.
PAUL: Yes.
AMANPOUR: And, so tell me, how do you assess what he said?
PAUL: I think he’s right. And I think what you see is a tension between those of us who have worked in political and military fields on the ground
in the Middle East and in the defense establishment in the uniformed services who understand that this is not going to work.
This is not going to lead to the result that Israel wants. It is just going to prolong the suffering of both the Israeli and the Palestinian people for
another generation as opposed to, I think, a very political, ideological perspective that is coming from the political level in the U.S. and in
Israel and in the U.K. that thinks that there is a way to make this work. There is not.
And the suffering we are seeing on the ground really reflects that. I can’t recall a time, in my experience, where I’ve seen such a disconnect between
our values and our actions or between the perspectives of our political leadership and the realities on the ground.
AMANPOUR: Can I ask you where and how you draw that line and make that difference? This is not the first time Israel has gone to war against Hamas
in Gaza, and it’s not the first time there has been backlash around the world. What makes you say that this is so different to have caused you to
have resigned?
PAUL: So, a number of factors. The first of which is just the scope and the scale. You know, here we are two months into this conflict, and we have
seen three times more children die, 6,000 in Gaza, than in two years of Russia’s war against Ukraine.
We have seen over 50 journalists killed, over 100 U.N. aid workers, over 200 medical professionals. You know, do you know what it takes to be a
doctor in Gaza?
So, the scale —
AMANPOUR: We’ve interviewed a lot of them and it’s a terrible situation for them.
PAUL: The scale of the loss has been astounding. And, of course, my role in the State Department It involves approving many of these major arms
transfers that are going to Israel right now that are enabling this killing.
AMANPOUR: But this is American policy. It’s not like these are rogue transfers. This is American policy, bipartisan, decades long. Israel is
America’s strongest ally in the Middle East, and America provides the most aid in the world to Israel and obviously to Egypt as well, but in general
to Israel.
Again, what is so unscrutinized about this? What was so different that made you resign publicly?
PAUL: Well, in all the arms transfers I’ve been a part of discussing before, including to Israel, there has always been space for discussion and
debate. You can raise concerns about how are these arms going to be used. Do we have confidence that laws of war, laws of proportionality are going
to be respected? Do we have concerns about some of the units that these arms might be going to and their track records?
What was different here was that there was no discussion. There was no space for that discussion. There was simply an approach of essentially the
barn doors are open and that remains the case.
You know, “The Wall Street Journal” reported just in the last couple of days that America has transferred over 4,000 dumb bombs to Israel, several
thousand guidance kits, and 45,000 artillery shells. So, the barn doors remain open. And while I’m certainly encouraged to hear what Vice President
Harris said, what Secretary Austin has said, for as long as those barn doors remain open, I don’t know why Israel would take those warnings
seriously.
PAUL: Can I just read the State Department response to your resignation, basically saying that it expects and appreciates employees have different
beliefs. And of course, one thing that is actually kind of interesting for all of us is to know that there is a dissent, there’s an official dissent
channel in the State Department that allows people to air their concerns. And that is, you know, history from the Vietnam War.
This is what the State Department says about you. With respect to this specific criticism that’s been aired, we have made very clear that we
strongly support Israel’s right to defend itself. We’re going to continue providing the security assistance that they need to defend themselves. But
the president and the secretary of state has spoken to this very clearly, that we expect Israel to abide by all international law as they defend
themselves. Israel says it’s doing that to the best of its ability.
PAUL: So, I think we have a responsibility as the larger, more powerful partner in this relationship, to give advice, to give guidance, to step in
when things are not going right.
And when we say that we have a responsibility to — or a commitment to defend Israel and to support Israel’s security, I have — I think we have
to look at the situation on the ground and say, is that what is actually happening? Is Israel more secure as a result of our assistance or has our
military assistance enabled Israel to move ahead with the expansion of settlements in the West Bank to continue the siege of Gaza and to take
steps that ultimately undermine its own security rather than leading to a comprehensive peace?
AMANPOUR: As you know, the U.S. administration believes and, you know, whether it says it publicly or behind closed doors, that the only way to
get — for instance, there — it’s not a secret that there’s no love lost between President Biden and Prime Minister Netanyahu before this —
PAUL: Correct.
AMANPOUR: — over the attempted essential, these are my words, overthrow of a democratic system in their so-called judicial reform. I mean, President
Biden didn’t even invite him to the White House. It’s a total rarity.
However, they believe that in order to affect Israeli policy, the likes of which you’re talking now to affect the policy and make it more towards the
peace process, they have to embrace Israel, defend Israel, support Israel in order to get the trust of the Israeli people so that they can then speak
— you know, speak clearly to the Israeli government.
And you saw what happened under the Obama administration. The people of Israel didn’t support the Obama administration. They thought Obama didn’t
support them.
PAUL: So, first of all, I would ask where that embrace gets the United States. If you look at what is unfolding now, it is not only a disaster in
Gaza, but it is a foreign policy disaster for the United States, across the Arab world, and frankly, across the Global South.
We seem like hypocrites when we criticize Israel where — rather when we criticize Russia for human rights abuses, but fail to do so with Israel.
And so, I think that our embrace, we have to be careful with that embrace, because it is — it draws us in as well.
Secondly, of course, the answer is we do have leverage that we can use within that embrace. I’m not suggesting that America should not remain
close with Israel. I’m suggesting simply that as we are the provider of arms, as we are the provider of billions of dollars in taxpayer funded
assistance every year, to what is actually a wealthy country, we do have a fair amount of leverage.
And of course, we provide Israel with security and diplomatic backup across the region that has enabled its integration. We have a lot of leverage here
to set Israel on a better path and to end the senseless killing in Gaza. We are not using it.
AMANPOUR: How does — what happened on October 7th in Israel was barbaric, it was savage.
PAUL: Yes.
AMANPOUR: We’ve heard the stories of rape and gang rape, of children being shot to death in front of their parents, we know what’s happened with more
than 250 people who’ve been taken hostage, including babies. How does a nation get — I don’t even know what the right word is — beyond it? I
don’t know what the right word is. How does it get to feel that it’s being supported and that it then doesn’t, you know, have to do what’s going on in
Gaza right now?
The elders, which is a group of former presidents, prime ministers, and U.N. officials, have also questioned now, they’ve just put out a statement
questioning arms transfers, and talking about the inhumanity that’s happening in Gaza that’s rising to an intolerable level.
PAUL: I think what happened on October 7th was an absolute atrocity, was a thousand atrocities. I think at the same time we condemn those atrocities,
we have to condemn the atrocities that happen every day to Palestinians in the West Bank.
You mentioned sexual violence. I was part of the human rights vetting process for arms going to Israel. And a charity called Defensive Children
International Palestine drew our attention at the State Department to the sexual assault, actually the rape of a 13-year-old boy that occurred in an
Israeli prison in Moskobiya (ph) in Jerusalem.
We examined these allegations. We believe they were credible. We put them through Israel to the government of Israel. And you know what happened the
next day? The IDF went into the DCIP offices and removed all their computers and declared them a terrorist entity.
I think it is vital that atrocities not happen to anyone, not sexual atrocities, not sexual violations, not any kind of gross violation of human
rights. We are looking at a situation where there is so much dehumanification where people are not seen for the value that they have.
And I think that’s true whether you’re talking about those who are attacked on their kibbutz or those who are attacked in their homes in Gaza or in the
West Bank.
What we really need is to center the human beings who are at the core and who are suffering so much in this conflict.
AMANPOUR: Do you believe that in order to have some kind of peaceful resolution, so this never happens again, that Hamas has to be removed from
power?
PAUL: How do you neutralize Hamas? The answer is through a lasting political settlement that provides a Palestinian State, not a process that
promises one, holds out the promise and never gets to it.
You neutralize Hamas by showing the Palestinian people that if they want to succeed, the route is there for them to do so through a political process
rather than through violent resistance. Until we have that political process in place, you cannot defeat the Palestinian resistance.
AMANPOUR: The Palestinian Authority on the West Bank is a different entity to Gaza, which rules — sorry, to Hamas, which rules Gaza. You have worked
with the Palestinian Authority specifically on security.
PAUL: Yes.
AMANPOUR: Can you tell me how that went? Because the Israeli government for many, many years, particularly Netanyahu governments over the last many,
many years, say that they have no partner for peace. They’ve even threatened — and I don’t know whether they’ve carried this out — not to
keep paying the Palestinian security officials in the West Bank since October 7th.
PAUL: Yes. I was part of the U.S. Security Coordinator, which is the team responsible for training and building the capacity of Palestinian security
forces in the West Bank. The reason it never worked was because we were always doing it on behalf of the government of Israel. The goal was always
to show to Israel that the Palestinian security forces could be trusted with Israeli security rather than with Palestinian security.
So, what they end up doing, for example, is when there is a protest against the Israeli Defense Forces, it is the Palestinian police who line up in
between. And what that does is it undermines the legitimacy, as it would of any country, when you see your security forces not protecting you, but
protecting someone else.
So, if we’re going to make this work again, we need a process that really starts with statehood rather than laying out a convoluted path to get
there.
AMANPOUR: So, how does that happen? Because obviously there are many people, including our next guest, an Israeli and a Palestinian, will talk
about their shared vision for the day after, so to speak.
Do you really think there’s that opportunity? Won’t it take an intense international commitment, energy, and not only that, Arab leaders to step
up?
PAUL: Yes.
AMANPOUR: I mean, where have they been on the Palestinian issue? Where have they been?
PAUL: I think there are a couple of Arab leaders who have stood up on the Palestinian issue. King Abdullah comes to mind. But I think you’re
absolutely right. To get to statehood, to resolve this conflict, is not going to be something that can be left to the parties to resolve as we see,
and nor is it something where we can simply keep providing arms, keep providing, you know, funding and trust that they will sort it out. That’s
not going to work.
This does require a significant international effort. The U.S. certainly has a role in that as Israel’s closest ally, but so does the E.U., so does
the Arab world. And I think we all need to come together to address this, or we’re just going to be doing it again in five years’ time, I fear.
AMANPOUR: And there — it looks like — I mean, certainly from, from listening to IDF statements, to the Prime Minister Netanyahu’s statements,
and others, it looks like they’re in this for a long haul. I had the former prime minister, Ehud Barak, on my program a few weeks ago, and just sort
of, it slipped out. He kind of said, yes, I mean, this may go on for another year.
PAUL: Well, I mean, of course, Prime Minister Netanyahu is in it for the long haul, because the longer this lasts the more he can postpone any sort
of trial, given the corruption indictments he’s facing. So, I think we have to be very careful to separate out what is in the political interests of
Prime Minister Netanyahu, of his right-wing coalition, and what is in the actual interest and the security interest of the people of Israel.
AMANPOUR: The people of Israel are behind this war. They want it. They cannot live with that kind of threat anymore and they want it neutralized,
but they’re not necessarily behind their government. And even some of his very extreme coalition partners, Ben-Gvir and the others, have threatened
to pull out their support. I don’t know whether it will happen —
PAUL: Yes.
AMANPOUR: — but this is going on right now. From what you know of the political situation there, where do you think this is headed? I think it’s
a very difficult question. I think, you know, we’ve seen as well, and I think been really touched by the protests led by the families of the
Israeli hostages outside Prime Minister Netanyahu’s house that have been very moving in their calls, and many of those family members have spoken up
and said, you know, that don’t Palestinian mothers cry as well, was one of the statements by a father of a girl who was taken hostage.
I think that’s where the future lies. The future lies in the good hearts of the people in Jerusalem, in Gaza, in Ramallah, in Jenin who will find a way
to work together. But to do that we need to insert ourselves. We need to make sure that there is an international backing for a solution that does
not, again, dangle out the hope of statehood, but gets there quickly and then moves forward together.
AMANPOUR: And, Josh Paul, you resigned. Are you an outlier? Have you heard from colleagues? Do they support what you did?
PAUL: I have heard from actually so many hundreds of colleagues at this point, who support what I did, who are fighting the fighters, as it were,
within the bureaucracy, trying to make a difference within their capacities, within the State Department, within the Defense Department,
within the White House, on the congressional staff, members of Congress as well.
I have been actually really encouraged by the number of people who have reached out to say that they are finding what is happening both a moral
disaster and a policy disaster for the United States, and really want to see if they can change and set the ship on a better course.
AMANPOUR: Such a vitally important part of the world as well. Josh Paul, thank you so much indeed.
PAUL: Thank you very much indeed for having me.
AMANPOUR: And, in your words, those with good hearts all over the Middle East are the subject of our next guest. Israelis and Palestinians and
leaders around the world are thinking about one key question, what happens when the war ends?
Well, two young women on opposite sides of the occupation are leading the search for a way out. May Pundak, an Israeli human rights lawyer, runs the
organization A Land for All. Her father took part in the Oslo Peace Accord negotiations, and she now has a dream for what she calls two-state solution
2.0. Rana Salman, a Palestinian human rights activist, is co-director of Combatants for Peace.
Now, Rana and May live on different sides of the wall that divides Israel and the occupied West Bank. They’ve never met, but when we spoke recently,
they demonstrated a shared vision of their shared future.
(BEGIN VIDEO CLIP)
AMANPOUR: May Pundak, Rana Salman, welcome to the program. So, Rana, your organization is called Combatants for Peace, and you’re working, I think,
with people who actually were actual combatants and who now want to do things in a different way.
RANA SALMAN, CO-FOUNDER, COMBATANTS FOR PEACE: Yes. So, I work with the Combatants for Peace, which has actually started in 2006 from ex
combatants. So, Israelis who served in the Israeli army and Palestinian fighters who spent time in Israeli jails for many years. And they both
recognized that there is no military solution for the conflict. They both decided to lay down their weapons and join their forces to fight against
the occupation and the oppression and all of this oppressive system.
And our fighters, they already have experienced violence and the conflict for many years. So, they know that this is — there is no solution out of
it. And because of this experience, we also have been embodying the nonviolence principle as our main DNA of the organization and teaching this
as our methods for resisting the occupation for many years.
AMANPOUR: And, May, your father, as we said, was one of the negotiators in the Oslo Peace Accords. What did you learn from him about occupation, i.e.,
Palestinian rights and what would make Israel safe and secure as well?
MAY PUNDAK, ISRAELI EXECUTIVE DIRECTOR, A LAND FOR ALL: Yes. Well, you know, we see now that there really is no military solution to this
conflict. I mean, there is no military solution that will ensure not Israeli security and definitely not Palestinian security. And so, I think
that that’s one of the realizations that I hope that everyone understands.
Since October 7th, there will not be a military solution. And also, after investing, you know, billion of dollars of a huge wall and putting all the
IDF technology and this still hasn’t gained security for Israel. So, I think that we learn a few things from that, A, we won’t have security and
safety or any viable future if we don’t choose right now a political solution, and that the Netanyahu government has invested in Hamas, seeing
it as an asset instead of investing in peace and negotiation. I hope that that’s number one that we learn.
And the other one is that, you know, even if we separate and build a huge wall between Israel and Palestine, if Palestinians don’t have security and
safety and their interests met, of course, side by side by Israelis having their safety and security needs, interests met, we won’t have security for
anyone. We are tied together in this homeland, which is one. We are two people, but this land is very, very, very small and interconnected and
interdependent, and that’s what we need to understand and realize.
And thinking about my father, what I’ve learned is that, you know, I treasure my values. I treasure my Jewish tradition and history, but with
the values of equality and justice, with commit — being committed to my people and my own liberation, I know that that is dependent on my partner’s
liberation and peace and security.
I know that those two have to go together, and if we disintegrate those two, we are — you know, if we punch a hole in this boat, we will all sink
together.
AMANPOUR: It’s incredible to hear you as a Jewish Israeli talking about your own liberation and how dependent that is on your neighbors.
PUNDAK: I think that — first of all, I hope that one other thing that we’ve learned on October 7th is that there’s no shrinking this conflict,
there’s no managing this conflict, you can’t normalize this conflict.
And the only maybe silver lining is that conflicts can and should be solved. And I think the International Community has also been a part of not
solving this conflict, not understanding that it has to come to an end. Putting Palestinians behind a big wall and not taking into consideration
their interests, as well, of course, as Israeli Jewish interests, that just won’t cut it.
We have to think together. We have to co-create and come together to build the sustainable, viable future that we all deserve.
AMANPOUR: So, Rana, from your perspective, Palestinian perspective, what is your vision for how you can implement what you’re both talking about?
SALMAN: I think it’s commonly known now, basically, that a two-state solution might be physically impossible to implement. Because of how long
the occupation has been going through and the facts on the ground that has been created, especially about — when we talk about the illegal
settlements within the West Bank, there are over 500,000 Israeli settlers in the West Bank.
So, basically, now I think we need to talk beyond the two-state solution and discuss new strategies and come up with maybe an alternative, an
alternative solution that will guarantee that all people will live in peace, security, dignity and stability. And then end actually of the
conflict and the occupation.
AMANPOUR: So, I know that May has talked about a kind of a confederation. What does a confederation mean?
PUNDAK: So, I think maybe the best — if we try to imagine the impossible, which I know is really difficult to imagine right now, but I think it’s
really important to imagine a different future, I would go to the European Union. I mean, would you ever imagine France and Germany being, you know,
with an open border? I don’t think anyone 80 years ago would be able to imagine that.
What we start by saying, you know, there are two people, but we all have a very, very strong commitment and sentiments to this homeland, that’s the
beginning. So, what we’re talking about is what we call two-states, one homeland. So, yes, two independent sovereign states, but mutual recognition
and a mutual infrastructure in a way similar to the E.U. with — sorry, they’re heavy bombs happening. So, I’m a little distracted by the bombing.
AMANPOUR: Are you all right? Are you OK?
PUNDAK: But what — really. Yes, yes. I mean, we’re, we’re safe and OK. It’s just, you know, intense days and we’re so lucky to be here and safe
right now as opposed to other people.
So, we’re talking about a shared infrastructure. So, mechanisms, for taking care of things that we have to share, like human rights, like resources,
like Jerusalem, like in a way, even security. If you think about security, which does not exist for Palestinians, but for Israelis for the past 30
years, there has been a sense of security, that has been, in many ways, thanks to very tight collaboration between Israelis and Palestinians, not
only due to the separation barriers.
And so, I think that we need to start learning, if we learn about the world, again, the E.U., but even Northern Ireland, moving from intense
violence not so long ago to power sharing. We are trying to learn from the lessons, both in Israel, Palestine, both from the negotiation deadlocks,
through the paradigm of sharing and through our idea of two-states, one homeland of a more confederal model. We actually have very creative
solutions. Two deadlocks that have prevented us from moving forward into peace.
So, it’s very important for us to convey this message now. The day after is now.
AMANPOUR: So, Rana, finally to you. You know, I’m talking to two young women who’ve really thought about this intently. Who believe that even now,
at the height of this war, it’s time to talk about the future. What is the constituency for peace? What is the sort of generational divide amongst
Palestinians in terms of even having hope that there could be some kind of reasonable peace solution?
SALMAN: Yes. I think right now, it’s very difficult to talk among Palestinians about the solution or like to see the future because the war
is still ongoing and people are still grieving and in pain. So, it’s very difficult to talk or have a vision for the future.
It’s an ongoing Nakba for now, 75 years on. So, until we solve the roots of the conflict, then this will keep happening every few years. So, that’s why
we need to find a solution right now. Otherwise, we will still experience the same events over and over again, because violence just begets violence
and revenge begets revenge. So, it needs to end now.
AMANPOUR: Do you also — do the people who you talk to, the Palestinians in your circle, understand that Israel also needs its security and that it
does feel like it’s under threat? Do you want — do you all have to understand the story of the other in order to make this happen for the
future, Rana.
SALMAN: Yes, definitely. Like, I work at Combatants for Peace and we’re a joint community. We’re an alternative community. We’re a group of
Palestinian and Israeli activists working together and co-resisting together. Because what May talked about is also our collective liberation.
We also want the Israelis to be free from the fear and to have their sense of security. But as long as this keeps happening, no Palestinian or Israeli
will have this sense of security at all.
And definitely, we feel the pain of the other. We see the other and we work together. Our lives are intertwined. So, definitely like the people are —
know each other, like thousands of Palestinians actually work inside Israel, but since the war, they have been deprived like to continue their
work.
So, there is already like some mixed cities within Israel. So, people already have been living together in a way, but the problem is with the
system itself, the oppressive system and the discrimination that is happening between Palestinians and Israelis.
AMANPOUR: It’s really amazing to hear from you both. It really is incredible to hear your optimism and your realism. Rana Salman and May
Pundak, thank you both for being with us.
(END VIDEO CLIP)
AMANPOUR: Our recent conversation with two women searching for a solution.
And now, to a growing problem in America’s backyard. Puerto Rico is in the midst of a health care crisis after a series of natural disasters hit its
rapidly aging population.
“The Washington Post” Arelis Hernandez writes, more people are dying in Puerto Rico as its health care system crumbles. And she’s telling Hari
Sreenivasan how what’s happening there could be a signal of what’s to come in the U.S.
(BEGIN VIDEO CLIP)
HARI SREENIVASAN, INTERNATIONAL CORRESPONDENT: Christiane, thanks. Arelis Hernandez, thanks so much for joining us.
You and a group of folks at The Washington Post” looked at the rate of death in Puerto Rico over the last year. What did you find?
ARELIS HERNANDEZ, NATIONAL REPORTER, THE WASHINGTON POST: Well, we found that there was an excess in mortality, not dissimilar to what we saw after
Hurricane Maria in 2017. But in this case, there wasn’t a hurricane to explain what was going on.
We figured that about 3,300 people more than is expected based on average rates, annual rates died in 2022, part of it was COVID, but there were a
lot — it went beyond that. There were a lot of other reasons for why people were dying on the island.
SREENIVASAN: Let’s start to unpack a little bit of that. 3,300 people is a lot above the kind of average that you would expect. Was it any specific
group of people that were impacted more, the young or the old or the male or the female?
HERNANDEZ: Yes. Puerto Rico actually has been aging quite rapidly in recent years, and that’s aging by compression as social scientists will tell you,
meaning that there’s been an out migration of young working age people from the island.
And so, what you have is a population that’s significantly older that is more prone to chronic illness and who have, in some cases, a lot more
difficulty reaching the health care resources that might help them to manage those diseases.
SREENIVASAN: OK. So, does that explain it all? I mean, if the young people leave, the old people are left behind, they can’t get to the ambulances or
the hospitals fast enough? Is — what else is happening?
HERNANDEZ: No, no. The chronic illness, these are largely preventable diseases. These are things that point to an overall collapse or collapsing
within the healthcare system and unable to deliver care to patients in a way that is adequate that helps them manage their chronic illnesses.
I mean, we look at the over 65 population, but we’re also talking about folks who are 50 and older as well that are having a lot of difficulty. The
other reason that this is happening in Puerto Rico is that you have many, many, many doctors that are fleeing Puerto Rico, going to the mainland,
United States, in search of other opportunities.
SREENIVASAN: Why are healthcare professionals leaving Puerto Rico?
HERNANDEZ: They can’t afford to stay. The schema for insurance and the reimbursements that they get from government healthcare, whether it La
Reforma in — on the island or Medicare or Medicaid, just simply doesn’t pay the bills for doctors.
And they’re also overworked. There are few numbers of specialists that are there to treat a thousands of people, and they’re unable to keep up with —
and there are some doctors who told me during the series of reporting that, you know, it just didn’t feel — it got them depressed to know that there
were thousands of people that they couldn’t reach who needed them and they were unable to deliver the quality care because they’re having to roll
through large numbers of people. It’s just not a situation that’s sustainable for medical doctors.
SREENIVASAN: So, you’re talking about these big shifts here. If you lose the younger population and you start to lose doctors, what’s left? I mean,
describe the kind of health care infrastructure. You have these sad sorts of stories. Tell me about some of the people that you spoke to and how
they’re emblematic of the problem.
HERNANDEZ: Absolutely. I mean, what you have left is a considerably young and old population, both of whom are severely vulnerable to some of the
issues that Puerto Rico faces with climate change, for example. You have a traumatized population. For example, Wilfredo Ramos (ph) who I met in
Utuado, which is a central mountain town, pretty remote. This is a guy who had a stroke. And no one found him.
He lived alone in this remote home in the mountains, not super far from his family, but far enough where no one found him for three or four days. And
he was bleeding out of his head for a while.
I went to visit him with a — what they call a health promoter, it’s someone in the community who goes from house to house trying to find out
what the particular health needs are. And this is an individual who hadn’t had his prescriptions renewed, who was struggling with anxiety and
depression and sleeplessness. This is the state of so many of the people that I met in Puerto Rico, this last trip.
SREENIVASAN: And then, you also talk about just, you know, calling 911 isn’t really a surefire way to get care.
HERNANDEZ: No. The main character in our story is a woman and her family who also live in a fairly remote area of Puerto Rico. The topography is
challenging. Let’s state that outright. Puerto Rico is not easy. But when you call 911, you expect a certain level of service.
And in this case, the ambulance that was dispatched, a private ambulance, did not get there in time. They got lost. Asked for directions, but
couldn’t reach Margarita (ph), who herself was suffering from breathing. She was struggling to breathe and having all kinds of issues, and she
passed away in front of her family.
SREENIVASAN: So, what is the health department or the health system in Puerto Rico trying to do to deal with some of these challenges?
HERNANDEZ: Puerto Rico’s health care system is pretty complicated. It depends a lot on the federal government. And that’s where if you ask, you
know, state officials, people with the government, they’ll immediately sort of orient their answer to why these things are happening to, you know, the
colonial status of Puerto Rico. But we know that that’s only part of the story.
Some of it has to do with Medicaid reimbursements that are not equal to what doctors in the United States receive for the similar, if not the same
care. You have a situation where the government is right now not doing much to stand to the bleeding of young doctors, people who are studying in the
universities there in Puerto Rico, who are, you know, eager to work on the island and serve their people, but are unable to because they have student
loans and, you know, simply cannot make it happen.
Then you have the complicated sort of interchange of insurance companies in Puerto Rico and just very basically at a ground level. If you are someone
who’s looking for a specific specialist, a dermatologist, a rheumatologist and neurologist, you’re looking at, you know, anywhere from four to six
months to schedule an appointment with that individual. And if you have a condition that is exacerbated by, you know, the way, you’re in big trouble.
SREENIVASAN: So, you have spent years reporting from Puerto Rico. And I wonder how much of an impact was Hurricane Maria? I mean, to me, some of
this, certainly the out migration seems to have accelerated after Hurricane Maria.
HERNANDEZ: I think at the beginning, we sort of expected to some degree that the trauma and the aftershocks, if you will, of Hurricane Maria we’re
going to be severe. But it’s only now that I think we’re actually seeing sort of the manifestation of that trauma of the anxiety and the depression.
And remember, it wasn’t just Hurricane Maria. She was big hit for Puerto Rico, but you also had a series of earthquakes that happened. Hurricane
Fiona. You had the ouster of the governor in, I think, 2019, if I recall correctly, through protests.
So, it’s just been one thing after another. You have an exhausted population that has not rebounded as quickly as one might have hoped.
SREENIVASAN: So, is this kind of a longer tail of what happens when the demography shifts so much? I mean, would those 3,300 excess deaths not have
happened if, for example, 120,000 young people stayed in Puerto Rico instead of left?
HERNANDEZ: That’s possible. But I also think there’s deficiencies in mental health treatment. There are deficiencies in the system overall. Yes, it
would have helped if those folks had stayed. If you know, those elderly folks who consistently appear on the news of having died by themselves
inside their homes, if there were people there nearby to be, you know, watching or taking care of these folks, maybe that wouldn’t have happened.
But this a longer tail. And I think this is something that, as you know, as Americans on these residents on the mainland that we need to pay attention
to, because these are friends that are also appearing in other parts of the mainland U.S. with the sort of flight of doctors, decreasing number of
doctors, with the issues with insurance companies who make it difficult to access care in some cases.
So, in many cases, I think Puerto Rice is a canary in a coal mine, if you will, of what could happen when we’re not watching and we allow the
healthcare system to deteriorate in front of us.
SREENIVASAN: You’ve got so many different levels of deficiency, whether it’s human beings that are there to be doctors and nurses and fill the
infrastructure that way, or, you know, topography that you can’t easily change. I mean, what can you do?
HERNANDEZ: Well, I’m not a policymaker. So, I don’t pretend to have all the solutions by any means, but I do think there are certain, you know,
principles that are at play here. One, building incentives for people to stay.
If you’re studying at the University of Puerto Rico, you know, a premier institution for medical science, there should be perhaps incentives to keep
those folks on the island and to have them, you know, participate in the system for a certain amount of time, if they’re, you know, education is
subsidized.
Or maybe it’s changing the delivery system right now, because so many people live in, you know, their own communities, maybe the health care
system needs to go to them instead of expecting people to come to, you know, urban centers that are sometimes difficult for them, especially if
you’re elderly, to receive care.
There are a bunch of different things that we think. Mental health care, maybe the federal government needs to look a little bit more closely and
what — in what ways it can help support federally qualified health clinics that are in some of these communities to be able to reach those needs.
Overall, I do think that there is a lack of understanding, both at the state and federal level, of what individual communities actually need. And
that was clear from the very beginning that we don’t — they don’t know these communities. They don’t know where the needs are. And are able —
unable to deliver in that way.
SREENIVASAN: You said that there was, on average, one cardiologist for every 17,500 people, because there’s only some 95 cardiologists on the
island. Are these preventable deaths then if we basically had more cardiologists that could provide care?
HERNANDEZ: Well, again, I’m not a medical doctor, but I think some of the evidence that we’ve seen that points to that some of these absolutely could
have been prevented with more first preventative care. And secondly, consistent follow up care.
SREENIVASAN: You also spent some time in Aguas Buenas a small town in the kind of rural highlands and I wonder — or central highlands, and I wonder
they had a 50 percent increase in death compared to the years prior. So, is there something specific about this town, this location? Is it a rural
problem? What happened?
HERNANDEZ: It’s a rural problem. It’s a place that’s lost a lot of population. And so, who are left are retired and older individuals who are
living alone. It’s also a place with a really challenging sort of far flown barrios. The neighborhoods are at the tops of mountains that surround the
sort of — the valley where the pueblo, the central square is. They also lost about half of their doctors. So, primary care physicians that were in
town.
And while Aguas Buenas is not super far from San Juan or Bayamon, these urban centers in Puerto Rico, it’s far enough where folks who depended on
bus service, for example, that is no longer available can’t get to these places unless a family member takes them or they find a ride for some other
means. And in Puerto Rico, culturally, to burden someone else with, you know, giving this favor or giving you a ride is something that’s frowned
upon, particularly from an older generation.
SREENIVASAN: You also spent some time with these health brigades that were out there trying to get to these places. What was that like? Are they
frustrated with what they’re seeing?
HERNANDEZ: They’re absolutely frustrated and they’re heartbroken by some of the things that they see. There’s a lot of, again, pockets of communities
all across Puerto Rico. And when the health promoters, these brigades go into these communities, they find all kinds of problems. They’re having to,
in that moment, provide dental care, provide — you know, take their blood pressure.
In one of these situations, we were in Orocovis, Puerto Rico, also in the central mountains, where a woman, they took her blood pressure, the doctor
who was with us, and her blood pressure was enough to have put her in a coma and she had no idea. She was just so stressed. This also a place that
had been hit hard by Maria, didn’t have adequate access to water and where the electricity went out consistently.
SREENIVASAN: Given the status of where health care is in Puerto Rico today, are we likely to see an excess number of deaths again and again and again?
HERNANDEZ: It’s hard for me to predict this future, but the trends that we see and the data suggests that 2023 will also be a record year of deaths in
Puerto Rico. And it’s unclear to me demographically where that will take us in 2024 or 2025, but certainly, isn’t stopping now.
And you know, maybe the government authorities on the health officials are looking at COVID and trying to mitigate the destructive force that COVID
has been in Puerto Rico 2021 forward pretty much. So, maybe with COVID, we’ll see these numbers normalized. But keep in mind that before, you know,
hurricane Maria, these numbers were pretty much on par or lower than the United States.
SREENIVASAN: So, is there anything that’s working?
HERNANDEZ: There are some models that are in place that are specific to remote communities. There’s a group called Cosaw (ph), they’re a brigade,
again, of health promoters, mostly from the communities that they serve that have kept, you know, going censuses and they know where people live
and they’re able to bring that, but they depend on the, you know, generosity, nonprofits and other groups to be able to serve these
communities, and that isn’t exactly consistent.
There are models that are being tried. Federally, you know, qualified health clinics help with sort of bridging some of those gaps. But when it
comes to major health issues where you need hospitalization, that’s where the challenges, and you have hospitals that are running into bankruptcy and
all kinds of issues in Puerto Rico, closing and communities that desperately need them.
SREENIVASAN: So, how does all this factor into kind of the sovereignty versus statehood perpetual conversation that surrounds Puerto Rico?
HERNANDEZ: Well, it’s a difficult question. As I mentioned before, when you ask the state, when you ask Puerto Rico government officials, they’ll tell
you this all a problem that is coming from its political status. They blame it on the Jones Act, which is that, you know, this prohibition,
essentially, of ships with goods coming directly to Puerto Rico, they actually have to stop in Jacksonville, unload, put the merchandise on a
U.S. ship with the U.S. flag and then send it. And that drives up the cost of things like, you know, healthy food.
Puerto Rico imports a huge amount of its food, grocery food, including fruits and vegetables that are pretty expensive once they reach Puerto
Rico. So, they would tell you that. They would tell you that the Jones Act has everything to the Medicaid reimbursement, that inequality and
disparities that exists with the sort of the bulk sum that the federal government gives to Puerto Rico, essentially a doctor practicing in Puerto
Rico gets about half of the reimbursement, say, for reading an x-ray or, you know, whatever treatment, gets about half their reimbursement from
Medicaid and Medicare that a doctor in the Virgin Islands or the United States would. And that’s extremely frustrating to folks on the island.
So, there are aspects of this that are directly tied to political status, but it’s definitely not the whole story.
SREENIVASAN: What can we take from what’s happening in Puerto Rico and apply it to what could happen in the mainland?
HERNANDEZ: Puerto Rico once had a hospital and health care system that was the envy of the Caribbean. It was a public system. And in the 1990s, the
governor moved to privatize that system and sell off some of those assets in an attempt to sort of rein in some of the ballooning costs.
Instead of it being a cost saving measure, it turned into a huge issue and plummeted the government into debt, into the debt that they’re still trying
to get out from under in Puerto Rico.
I’ve seen reports out of California that sounds really similar to what’s happening in Puerto Rico, again, to the sort of decreasing numbers of
specialists and doctors who are available to provide appointments in a timely manner to be able to catch things before they become very serious
problems.
There are issues with private insurers that are, again, making it very difficult in the relationship between doctor and patient, they’re much more
severe in Puerto Rico than what I’ve seen in the United States. But also, just the model towards having people come to healthcare instead of
healthcare going to them, I think is something that is a major issue in Puerto Rico.
It might be unique to Puerto Rico, but I do think that there are parts of this country as well that are also challenging topographically or, you
know, where the population is, where we need to think about alternative models for how we deliver care.
SREENIVASAN: Arelis Hernandez, thanks so much for joining us.
HERNANDEZ: Thank you.
(END VIDEO CLIP)
AMANPOUR: And healthcare is such a topic all over the world. And finally, tonight, even in a time of war, a new miniseries from Netflix reminds us
that hope can be found in the darkness. “All the Light We Cannot See,” adapted from the Pulitzer Prize winning novel by Anthony Doerr, tells the
story of Marie-Laure, a blind teenager broadcasting uplifting and also strategically critical radio messages from the resistance in occupied
France during World War II.
Marie-Laure is played by actor Aria Mia Loberti, herself blind. Here’s a clip from the trailer.
(BEGIN VIDEO CLIP)
ARIA MIA LOBERTI, ACTRESS: Light lasts forever. Darkness lasts —
UNIDENTIFIED MALE: Darkness lasts not even for one second.
LOBERTI: — not even for one second.
When you turn on the light, I know that broadcasting can get me executed. But I will not be silenced. I hope you will tune in again tomorrow.
(END VIDEO CLIP)
AMANPOUR: It is gripping, and perhaps most remarkably, this her first acting role ever. Aria Mia Loberti joins me now from Los Angeles.
It is good to see you again. And I just want you to tell us how you went from never having been, you know, a professional actress, to, you know,
your first ever addition, getting you this part along with Mark Ruffalo, Hugh Laurie. How do you feel about it?
LOBERTI: Well, thank you so much for having me. It’s so good to see you again. Well, it’s been probably one of the greatest honors of my life to
get to do this. I never envisioned that I could be an actor. It was just a dream that I never thought I was allowed to pursue.
So, I stifled it really deep down inside, because I think anyone from any marginalized identity sometimes can internalize when the world tells you
that you don’t matter. And as a young woman and as someone who is low vision, I definitely internalized that, and I never really pursued my
dream. I became an academic, and I did really enjoy that, but I didn’t know something felt wrong.
And someone sent me the audition, and I just did a tape in my bedroom in college, and it was not very good, probably. But then people saw it. And
now, it’s on the internet. And now, here I am. And I think what’s really profound about a part like this, working with people who are at the very
top of their field, like, like Mark, you mentioned and Hugh Laurie and our amazing director, Shawn Levy is, you know — I was learning my craft from
the ground up every single day, but they were there for me.
The challenge was not being someone in the industry who is low vision. Actually, that isn’t a challenge at all. And I don’t know why it’s
perceived that it might be. It certainly is though. But that’s OK. The real challenge was being a newcomer and learning how to craft this magnificent
story. And how to carry this piece that is so near and dear to so many readers’ hearts and now gets to live a life in a whole different medium.
It’s really special.
AMANPOUR: Yes. And we showed the clip and it’s obviously always gripping to see the resistance, to see heroes during World War II, you know, trying to
do their best to fight personal battles and also for, you know, the greater freedom.
But you mentioned Shawn, your director, and I do actually want to read from a little bit about what he said that he learned from you on the set. He
says, as I was helping her develop her acting technique, she was helping me understand what is the nature of a life without sight and how do I
represent that honestly? I need to think about my words, to be super specific in what I said and also conscious of how I said it.
Tell us a little bit about that process.
LOBERTI: I think for both of us, every single day we went in and we learned from each other, and that meant we had to be wildly candid with each other.
It was unlike anything I’ve ever had to do, it is very different from sitting in a library reading Ancient Greek, which is how I had spent most
of my adult life prior to this point.
But Shawn is very much an intellectual. So, we came at each other with this real common ground. And I told him, like, you’re not going to offend me if
you tell me that I’m doing something wrong, because I want to be great.
I think I found something that I loved. I think I found the thing I’m supposed to be doing. And I want to be great it, but even more so than, you
know, wanting to portray this character and the story well. I am a sort of representation that hasn’t happened before for people in my community. For
a hundred years of storytelling, we have been told that a blind person has a vacant expression, they don’t look at the person they’re talking to, they
shuffle their feet, they’re probably really vapid, and none of those things are true, even though they’ve been ingrained in our cultural identity.
So, when someone like me walks on set, and I don’t use a mobility aid, and I look you straight in the eye and my vision is variable, it’s not a
complete void of darkness, even if my characters — my character might not see anything, it’s a very interesting place to come from because media has
told us otherwise.
And, you know, I admire the work you do. And I admire the work of, you know, everyone who I got to listen to, like, coming on this program, like,
as I was sitting and waiting. And, you know, we’re not solving world hunger. We’re not tackling these issues, but I could bring a voice to
something and maybe it’ll make a difference. And —
AMANPOUR: Exactly. So, I’m smiling broadly because the last time we met was at University of Rhode Island. It’s your home state. You talked about being
an academic. You had your wonderful guide dog there with you.
LOBERTI: Yes.
AMANPOUR: And you credit the dog with really making you feel that you could tackle something like this and dare to —
LOBERTI: Yes.
AMANPOUR: — seek this kind of role.
LOBERTI: It’s incredible how — like, you know, other than my parents, I didn’t really have anybody sending me the messaging that I did matter. So,
it’s incredible that that responsibility then had to fall to an animal.
But her role was basically — I always hid my white cane. I learned how to use it, and it’s very difficult to learn that skill, but I never used it
because I was bullied so badly for it. And getting Ingrid, my guide dog, was this catalyst to not only being safe and independent and moving really
fast and freely through college at the time, but like displaying my culture to people and my identity. And it really is a culture.
And so, I would never have been able to put out this tape as much as I didn’t think anything was going to happen from it, I would have never been
able to even record the tape in the first place if I didn’t have the confidence in my own identity that she helped me instill in myself.
AMANPOUR: And now, you’re bringing the identity of an amazing resistance hero, you know, during the war in occupied San Malo.
LOBERTI: Yes. It’s really cool.
AMANPOUR: And you are reading from Jules Verne, and that we, at first, think it’s just because you’re reading to people who might be, you know,
awake on that frequency, but it turns out that these are coded messages.
LOBERTI: Yes.
AMANPOUR: So, what drew you to this story and what about it resonates with you?
LOBERTI: I think, you know, especially going into this as a non-actor, even though that is now my career, I think I approached it from the perspective
of the book, because that’s what I had. And I had connected to the book when my mom first read it in 2014. She actually got it — got the
recommendation from a doctor who told her that it might give her a lot of hope.
And I read it after her and I got maybe 75 percent of the way through. And I couldn’t get any further because my heart broke. And I think it’s so true
to life, right, that someone might not get a happy ending, that it might not work out OK.
And I wanted to end before it — jumped ahead to see their future. I wanted to end with the end of World War II. And I think what really speaks to this
character is she is, in every way, the opposite of the stereotypes we expect. But she persists and she fights, even though the Nazis are
persecuting people like her violently. It’s genocide too.
AMANPOUR: I mean, it is remarkable.
LOBERTI: And yet, she still stands up. Yes. She still stands up and transforms.
AMANPOUR: Everybody need to watch it.
LOBERTI: Yes. No, thank you.
AMANPOUR: We’ve unfortunately got to go, but that was wonderful. We could have talked for a lot longer. Aria Mia Loberti, thank you so much indeed.
LOBERTI: It’s so good to see you again.
AMANPOUR: And that is it. Thanks for watching. Goodbye from London.