In sudden bursts of automatic weapons, Palestinian snipers fired on Israeli Defense Force (IDF) troops manning the checkpoint at the city's entrance. Israeli soldiers returned fire as more troops rushed in from all directions by jeep, truck, and armored personnel carrier. A team from MSF, which had been waiting for clearance at the checkpoint for 30 minutes, quickly turned back to the nearby village of Jalaman, storing 15 emergency health kits destined for Jenin in a clinic there. The MSF team planned to bring 15 emergency kits from Jerusalem to distribute throughout the district.

Each kit contains supplies - intravenous solutions, suturing equipment, and medications - that can help stabilize up to 10 wounded and 10 chronic patients until they are able to get to a hospital. But the violence in and around Jenin continues to thwart even the simplest of plans. "Even though our job is so easy and small," says Eukeni Soler, the Spanish head logistician for the MSF projects in the Palestinian territories, "we can't even reach that.

"Besides fraying the health infrastructure, the permanent stress of conflict and near-constant curfew in Jenin is taking a tremendous psychological toll on the city's 35,000 inhabitants.

The military occupation has brought almost universal unemployment, leaving the economy as ruined as the buildings reduced to rubble by Israeli assaults. "The whole population suffers," says Andre Sardo Infirmi, MSF's field coordinator in Jenin. "You can't do any other activity except for work and being inside. You can feel the stress." The previous night, Israeli tanks entered the city and shelled the refugee camp for hours.

By noon, the tanks retreated to their positions encircling the city, and strict curfew was imposed. Most shops remained shuttered in the city center with people confined to their homes. In April, entire blocks in the camp were reduced to rubble by an Israeli assault. Cars flattened by tanks line the streets, and many buildings in the city center bear scars from sporadic fighting since. "A lot of people are in a state of shock," said child psychologist Isabelle Gouret, who provides psychological support to 60 patients in Jenin. "People feel abandoned."

The strictly enforced curfew has meant she has worked 10 of the last 21 days. Earlier in the day, though, she did meet with one of her patients, a 27-year old mother of six whose husband was shot by IDF soldiers occupying their home. "She is alone, her family is from Tulkarm, she is crying all the time and her 6 children are trying to keep her alive," Gouret said.

Through weekly meeting she tries to help them cope with the senseless loss and the continuing pressure. She has worked with MSF in Rwanda, Bosnia, and Kosovo, and sees a disturbing lack of hope in most of her patients. "People here are tired." The medical infrastructure has also unraveled, with care to surrounding villages the most affected.

Palestinian medical personnel who live in Jenin are prevented by the IDF from traveling outside the city, cutting many people off from emergency and basic health care.

To help fill this gap, MSF has begun escorting Palestinian doctors and nurses to health posts in 11 surrounding villages like Beit Qad and Faqqu'a. "Without MSF, we wouldn't be able to get to work," said one doctor at a clinic in Jalama. Even with escort from an international aid organization like MSF, checkpoints often significantly delay or prevent the physicians from carrying out their daily rounds.

Ingrid Westerman, an MSF nurse from Chile who travels daily to the surrounding villages, remembers her first such checkpoint. A tank blocked the road. After ID checks, a soldier on top of the tank smiled at them, then tossed what looked like a grenade under the car. "After a few seconds, I saw a lot of smoke," she said. "I was still here. It was just a smoke bomb. After that, nothing really scares me."