How maternity care deserts are leading to a spike in infant syphilis and mortality rates.
For two weeks in a row, the Centers for Disease Control and Prevention (CDC) has released data with a clear and dismal message: It’s getting increasingly dangerous to be a newborn in the United States.
First, last week, the agency published statistics showing that in 2022, the death rate for American infants increased for the first time in 20 years. Then, on Tuesday, the agency released a report showing rates of congenital syphilis — that is, syphilis infections acquired in the womb — have risen tenfold over the past decade.
Although a lot of different risk factors drive each of these trends, there’s an important one they have in common: bad — and worsening — health care access for mothers and babies.
In the US, the obstacles mothers face in accessing health care are too often insurmountable — and as this latest data shows, the consequences to American children are dire. Things might only get worse, some experts fear, as financial, political, and social pressures drive providers further from many of the places where they’re needed most.
“We only are hearing about more [obstetricians] leaving and more maternity wards closing,” said Tracey Wilkinson, a pediatrician who specializes in reproductive health issues at Indiana University’s medical school. “I am terrified about what the data is going to look like next year.”
Congenital syphilis and infant mortality are on the rise
Both the syphilis data and the infant mortality data represent stunning setbacks after years of progress.
Syphilis is a sexually transmitted infection caused by a spiral-shaped bacterium that leads to skin rashes in its early stages and, in its later stages, complications ranging from neurologic problems to cardiovascular disease. It can be lethal if untreated, but in its early stages, syphilis has been curable with penicillin since the 1940s.
Babies can catch syphilis from their parents while in the womb, and the infection has high rates of complication: In different studies, anywhere from 7 to 31 percent of babies with congenital infection die as a result, and another third develop health problems that can include liver disease and bone and neurologic abnormalities.
For decades, congenital syphilis was a rarity in the US. An intensive syphilis eradication campaign in the late 1990s and high rates of condom use due to concerns about HIV transmission led to a syphilis low at the turn of the millennium. Over the next decade, the CDC identified 300 to 400 cases of congenital infection every year.
As HIV treatment became more widely available and condom use dropped over that period, syphilis transmission increased, with the highest rates of transmission among gay men and people in their sexual networks. But around 2014, syphilis cases began rising in women, too, and as they did, rates of syphilis infections in babies also began to rise.
Yesterday, scientists in the CDC’s STD (sexually transmitted disease) branch reported that in 2022, more than 3,700 cases of congenital syphilis were reported across the US — a 1,000 percent increase from 2012.
As with syphilis, the story on infant mortality in the US had been largely a positive one, with rates decreasing steadily for at least 30 years. But in 2022, there were 600 more infant deaths than in 2021 — a 3 percent increase in the age group’s death rate.
A range of factors can contribute to infant mortality, such as congenital abnormalities and sudden infant death syndrome, or SIDS. But in last week’s report, CDC authors singled out bacterial bloodstream infections and maternal complications of pregnancy as particularly notable rising threats.
Neither congenital syphilis nor infant mortality is evenly distributed across the US. In 2021, babies born to Black, Hispanic, or American Indian/Alaska Native mothers were up to 8 times more likely to have congenital syphilis (the same analysis has not yet been performed on the 2022 numbers).
And when it comes to infant mortality, Black newborns had the highest death rate, with nearly 11 deaths per 1,000 live births — about twice the average rate. American Indian babies had the most dramatic rise in deaths — a 20 percent increase, from 7.5 to 9 deaths per 1,000 births. And the uptick in deaths was particularly pronounced in four states: Georgia, Iowa, Texas, and Missouri.
How pregnancy care deserts amplify threats to babies
The risks for both infant mortality and syphilis are directly related to what happens during pregnancy.
Because the stakes are so high for maternal syphilis infection, all but eight states require syphilis testing during pregnancy. That means prenatal care is a key opportunity for preventing congenital syphilis for babies born in the US.
But that system only works if people are reliably getting prenatal care and if everyone who tests positive during pregnancy gets treated. According to the newborn health nonprofit organization March of Dimes, about 15 percent of American women get inadequate care during pregnancy.
And that’s contributing to the syphilis trend. According to the CDC’s latest data, nine out of every 10 congenital syphilis cases in 2022 were born to women who didn’t get adequate syphilis care during pregnancy. Four out of 10 were born to women who didn’t get prenatal care at all, and an additional five out of 10 were born to women tested while pregnant but not treated. (Confirming a current syphilis infection usually requires two tests done several days apart. It’s possible some of these women who initiated testing never followed up.)
Lapses in maternal care are likely contributing to the infant mortality trends, too. Although the CDC’s report on infant mortality did not explore how maternal care access is related to risk, other research suggests they are closely linked.
Many of the leading causes of infant death are related to premature birth, i.e. birth before 36 weeks of gestation, which is more likely to happen when a pregnant person doesn’t get adequate prenatal care.
And pregnant people are increasingly finding themselves facing barriers to adequate prenatal care: Nearly 11 percent of American women of childbearing age live in counties with inadequate maternity care — meaning they lack the obstetric providers and labor wards necessary to meet people’s needs.
So, just as maternal care deserts are on the rise, so are premature births and the risks associated with them.
To make things worse, at the same time people’s access to premature birth prevention care is falling, many of the social and health risk factors for prematurity are rising, like obesity and lack of health insurance.
The big picture: Better access to maternal care could reduce premature birth rates and, potentially, infant mortality. But so long as prenatal care remains scarce for many Americans, they’ll be more likely to have their baby early, without the advantage of managing any risk factors they have that might affect their baby’s health.
Notably, congenital syphilis transmission is probably itself contributing to rising infant mortality rates. In 2022, there were 610 more total infant deaths and 62 more syphilis-related infant deaths than in 2021.
Although these numbers come from different sources, this suggests that congenital syphilis, and the prenatal care failures that are fueling its rise, may have accounted for about 10 percent of the increase in infant deaths.
A broken insurance system, abortion restrictions, and punitive policies on pregnancy are driving a wedge between maternal care providers and the patients who need them
Why are so many American women not getting the maternal care they need?
A big part of the problem is related to the hollowing out of rural health care. As rural fertility declines and rural areas lose maternity wards and hospitals — largely because of the high cost of maternity care, the difficulty of recruiting and retaining staff, and several states’ refusal to expand Medicaid — pregnant people in rural areas are finding it increasingly hard to find care. According to the March of Dimes 2022 report, two-thirds of maternity care deserts are rural.
But urban hospitals with labor and delivery wards are also shutting down or cutting services, especially safety-net hospitals that care for cities’ most vulnerable populations. These closures, which are also generally blamed on financial reasons, mean parents in urban areas also have less access and lower-quality pregnancy care than they once did.
There’s another important reason some states may soon see their maternal care capacity further hollowed out. In the wake of the Supreme Court decision eliminating the constitutional right to abortion, maternal care providers are leaving red states that have chosen to tighten abortion restrictions due to concern they won’t safely be able to provide the full spectrum of maternity care. Additionally, medical trainees are avoiding these states because they know that in a state that does not permit abortion, they won’t get training in a key part of pregnancy care.
“Maternity care deserts are widening,” said Wilkinson, the Indiana pediatric reproductive health specialist. “We are seeing the experts in maternity care, such as OB-GYN and maternal-fetal medicine doctors, leave — they’re just leaving states. And we’re seeing hospitals close because of the costs of that. It’s almost like a double hit.”
“We knew there was a train crash coming, and Dobbs actually just took the train off the rails completely,” she said.
Even when they can access prenatal care, women who live on the margins of society — in particular, women who use drugs — may avoid contact with health care providers out of concern that punitive policies around drug use in pregnancy could lead to bad consequences for themselves or their kids. Unfortunately, these women are among those whose babies are at highest risk for congenital syphilis infection and other conditions that could lead to death in infancy.
Authors of the infant mortality report did not suggest solutions in their publication. But on syphilis, CDC representatives articulated a strategy centered on broadening testing to more people and places and treating people who test positive during their first office visit.
Problems with multiple causes require multiple solutions, said Laura Bachmann, the chief medical officer of the CDC’s Division of STD Prevention, in an interview. “There’s a lot of work to be done,” she said.
Companies are opting for shorter weeks. But without worker power, they’re just another employer perk.
A widely shared definition of “freedom” is tough to agree upon, but until the 1930s, a broad group of Americans, from poets and architects to business owners and conservative politicians, shared a vision that capitalism would deliver on the hazy idea in a very concrete way: more and more leisure time for all.
In their view, economic progress would carve a path from the grueling factories of the Industrial Revolution to a not-so-distant future largely free from work. As the British economist John Maynard Keynes put it in 1930, “for the first time since his creation man will be faced with his real, his permanent problem — how to use his freedom from pressing economic cares, how to occupy the leisure which science and compound interest will have won for him.”
For many decades, things seemed to be on track. New technologies helped drive up productivity, while the labor movement helped steer that growth to shift the balance of life for ordinary citizens from employment to leisure. Americans began shifting from agriculture to manufacturing jobs, where the average working week dropped from over 70 hours in 1830 to roughly 40 hours in 1930. In 1933, a bill passed the Senate — with initial support from then-President Franklin Roosevelt — that would have created a 30-hour workweek. But following significant industry opposition, Roosevelt shifted toward focusing on 40-hour workweeks for all rather than shortening them. The aim of progress followed the same shift — away from gathering more leisure time and toward securing full-time employment.
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Our World in Data
Now, the lingering disruptions of the pandemic and rapid progress in AI and automation are helping to revive the dream that economic progress could lead to more leisure time. Nowhere is that clearer than in the rising interest in four-day workweeks. Results from international trials of the idea across wealthy countries are beginning to roll in. The word is good — employees are happier, and employers seem to exhibit the same amount of productivity they do with five-day weeks.
Four-day weeks would make for an excellent perk wherever they fit — like free lunches at the office, but way better. I hope they spread. That said, convincing some companies to offer four-day weeks falls well short of designing an economy that translates economic growth into the option of more leisure time for all. Leisure isn’t just an extra vacation day here or there. As the German philosopher Josef Pieper wrote, it’s the basis of culture, a “condition of the soul,” a way of living where people aren’t forced to sacrifice most of their waking lives for a paycheck.
The deeper issue is that convincing companies to adopt four-day weeks does little to change the balance of power between workers and employers. Left unchanged, the negotiation over how many hours should constitute “full-time” would continue being held in the boardroom, where workers and their interests are largely without representation, and given today’s hampered labor movement, without much influence. That would significantly reduce the scope of our potential leisure time by leaving employers — rather than workers or an empowered labor movement — in virtually sole control of deciding when economic growth translates to more time off.
In the glory days of the American labor movement, when unions were strong and wages rose alongside productivity, “organized workers could cash that out as more free time,” said Aaron Benanav, a professor of sociology at Syracuse University and author of Automation and the Future of Work.
“But for decades, workers haven’t even been getting that choice because, for the most part, productivity growth has ended up as higher profits and more inequality,” he said. “It takes a political movement to cash that out in terms of a reduced workweek.”
A renewed politics of leisure time should return that choice to workers by focusing on the old program of raising labor’s bargaining power. Familiar ideas like unions and sectoral bargaining are good starting places. But beyond institutions that give workers an organized voice, other avenues that provide unconditional resources to all citizens — like guaranteed income, baby bonds, or universal health care — can also help give workers more of a say in what they do with their time by making their basic needs less dependent on having a paycheck.
Without these pieces, the working week, and through it, the shape of most Americans’ lives, will continue being set by the clock of business. But the old ideal of leisure, what the poet Walt Whitman called both “higher progress” and “the task of America,” held that human potential goes far beyond the scope of what’s good for business. “The world of work,” Pieper cautioned, “threatens to become our only world … grasping ever more completely the whole of human existence.” Leisure expands the world beyond work, adding a richness and depth that exceeds the logic of business.
Alone, four-day weeks will probably not bring on a leisurely transformation of the soul toward Whitman’s vistas of higher progress. But combined with empowered workers who wield more of a say in the shape of their lives, we could recover the sense that economic progress expands the horizons of human life, even if that means leaving economic logic behind.
Four-day workweek experiments bring good news
Societies can approach a four-day workweek from two directions: above or below. From above, the government could lower the overtime-pay threshold of weekly hours — the limit at which employees are contracted to work without additional pay — from 40 to 32. The threat of extra pay creates enough incentive for most employers to set what counts as “full-time” at the overtime threshold. This is how the Fair Labor Standards Act, signed into law in 1938, codified the 40-hour workweek in 1940.
From below, individual companies can choose to offer shorter hours on their own. Before the 40-hour week was law, Henry Ford implemented one in his factories in the 1920s to prevent exhaustion among his assembly line workers and open up more time for consumption and travel, while still paying enough to help grow the middle class he needed to purchase his cars. It worked so well that it was eventually adopted across much of the economy, helping create the pressure that led to federal legislation.
It’s one thing to imagine shorter weeks working on an assembly line in 1920, where the work is so repetitive that it nearly automates itself by turning the humans carrying it out into robots. But today’s four-day experiments have seen success across a range of industries, from restaurants to healthcare to preschool education. Iceland experimented with four-day weeks across public sector jobs, including hospitals, preschools, and social service providers. Large companies like Microsoft and Unilever tried it at their Japan and New Zealand locations, respectively. And if companies can’t afford (or refuse) to pay the same amount for less work, Spain tried an approach where the government steps in to make up the difference in pay.
Across these experiments, the results tell a similar story: Paying people the same amount for less time leaves them feeling happier and healthier and often boosts business, too. “I used to be exhausted all the time,” Lise-Lotte Pettersson, an assistant nurse at a retirement home that dropped down to six-hour workdays for two years, told the Guardian. “But not now … I have much more energy for my work, and also for family life.”
One analysis made the case that reducing working hours could also help lower carbon emissions by cutting electricity use, commutes, and household consumption in the UK, a connection growing in popularity among advocates.
The world’s largest four-day experiment to date — a six-month trial with 61 participating companies and about 2,900 workers across the UK — wrapped up at the end of 2022 with another batch of extremely positive results. The average life satisfaction across all workers spiked from 6.69 to 7.56 on a scale from zero to 10. That’s nearly a 10 percent jump in overall life satisfaction, a pretty massive well-being gain. When asked about the amount of time they had to “do the things they like doing,” employee satisfaction went up over two points, or more than 20 percent.
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Companies did well, too. Resignations fell by 57 percent compared to the same period the year before. Employers rated the experiment an 8.3 out of 10. Months after the trial ended, 56 of 61 participating companies still had the four-day week in place, 18 of which had already made it a permanent change.
Even if the results from trials are positive on balance, there are already a few potential issues in view. First, especially if employers are dictating the terms, four-day weeks could simply come to mean cramming the same amount of work time into fewer calendar days, like working four 10-hour days. That might suit some people’s preferences. But for others, it’s a road to more burnout, not less.
To keep the idea of four-day weeks from pointing toward burnout, 4 Day Week Global, an organization behind many of the pilot experiments, advocates for the 100-80-100 model: 100 percent of the pay for 80 percent of the time, with 100 percent of the productivity.
But keeping productivity up despite less time creates a need to cut fluff out of the workday. That can mean unnecessary meetings. It can also mean those leisurely moments of communion with a colleague, spending an extra five minutes chatting while the tea steeps, or roaming the halls just to see what folks are up to. Some leisure at the workplace can be good, too.
More broadly, a review of the academic literature on four-day weeks found that while, yes, the balance of results looks good, negatives include an intensification of both employee surveillance and performance measures, while some employees’ positive reactions may fade over time. If shorter weeks drive employers to squeeze as much productivity as they can out of the remaining time their employees are on the clock, and technologies for employee surveillance continue their Orwellian development, more leisure time could paradoxically come at the cost of less freedom at work.
It’s incredibly convenient, then, that there’s a solution that could bring today’s four-day efforts back in line with the older, grander vision for a more emancipatory politics of leisure time, while also guarding against the downsides we’re seeing today: a focus on significantly raising workers’ bargaining power.
A politics of leisure time needs power, not perks
To design an economy that both sustains and spreads the option of more free time to all, we’ll need a political movement that gathers power. But for the moment, four-day weeks are more of a perk. The focus on pro-business merits like stable productivity levels and lower employee turnover makes the power dynamics clear: Even if workers want more leisure, unless their bosses sign off, they can’t have it.
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Bettmann
“That framing was really important for getting employers to sign on,” said Benanav. “My sense from talking to the researchers is that it was a very strategic way of presenting things to get the pilots off the ground.”
When leisure time was understood as the measure of freedom through the early 20th century, it wasn’t primarily because more leisure time would be good for business. It was that human life could be about more than business. The struggle for subsistence, the “economic problem” as Keynes called it, is not the “permanent problem of the human race.” Selling the four-day week as a productivity boon belies the point: As it was historically understood by many, the point of raising productivity was to expand human leisure, not the other way around. Justifying leisure in terms of productivity is like justifying a vacation in terms of how much work you could get done once you’re back and well-rested.
But designing a world where economic logic doesn’t always have the final say over human life means workers need the power to make different choices or demand different structures of work, even — or especially — when businesses aren’t on board.
A politics of leisure led by boosting worker power is also far more flexible. Plenty of Americans really do love their jobs and would not want to work any less than they do. Particularly in the US, work can be an anchor of identity and a real source of meaning, community, and fulfillment. If Americans choose to work 40-hour weeks on the grounds of freedom rather than necessity — because they love the work and not because they can’t otherwise afford decent lives — then why not?
But plenty of Americans have no choice but to labor in full-time jobs that suffocate rather than nourish their identities. Here, access to more leisure can help people forge meaningful lives through activities outside the labor market.
“People talk about the decay of civil society,” said Michael Konczal, director of the Roosevelt Institute, a progressive think tank. “Control over time is such an essential part of whether or not you’re able to participate in your community. If you have very low control over your time, that really does cut against civil society.” Religious affiliation, for example, has been on the decline. Maybe more leisure time could afford people the space to build new institutions that help fill the gap and reclaim the prosocial effects that noneconomic activities can generate.
None of this works, though, if we stray from the 100-80-100 model and more leisure means less pay. That’s why a focus on worker power is so important — it can help spread the option of leisure to waged workers outside of the white-collar industries where employers might be willing to offer four-day weeks out of self-interest.
But the future of worker power in the US is deeply unclear. The last 50 or so years have seen one of the largest declines in worker power in American history. Wages stagnated while productivity and inequality rose. Union coverage declined to historic lows, where it remains today. The reclassification of some workers as independent contractors means a whole new group now misses out on traditional benefits like health care and sick days.
And yet, there are reasons for cautious optimism beginning to enter the frame. Wage growth is now outpacing inflation at the low end of the income distribution. The White House established a task force on worker power, signaling the much-needed return of federal support. Unemployment has remained remarkably low, leaving a tight labor market that can drive up wages. Workers have been flexing their muscles in a summer of strikes.
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David McNew
Like the four-day week, this is all good news. Also like the four-day week, it falls short of what may be required to put more worker control over their time on the bargaining table. To gain that sort of leverage, workers will likely need a lot more power, not just a tight labor market and slightly higher wages. So how do we get from here to there?
Bargaining for leisure
Empowering workers to bargain for more leisure means giving them enough leverage to make demands while conveying a real threat of walking away from the job if their demands aren’t met. Empty threats won’t change the economy, but credible ones could.
While it’s a long road to that kind of worker power, it’s pretty well mapped out. “The formula has more or less been there for a century,” said Konczal. First, make sure everyone in the economy has money to buy stuff. That drives up profits, leads to more hiring, lowers unemployment, and ultimately gives labor more leverage since employers are competing for fewer available workers. Second, let workers unionize and collectively bargain rather than firing them for it.
The road, though, doesn’t end there. “One thing you need,” said Benanav, “is something that was never really achieved in the US: actual sectoral bargaining. Not just collective bargaining at the firm level, but at the industry level.”
Sectoral bargaining means unions would negotiate standards that apply to all workers in an industry, not just those who work in unionized firms. To complement that greater representation, workers would also benefit from social programs like unconditional cash transfers, universal healthcare, or as the pandemic showed, stronger unemployment insurance. We already saw early tremors of the power such reforms can hold as part of the surprisingly generous US policy response to the Covid-19 pandemic, particularly the boosted unemployment insurance. “A lot of that was giving people resources to just make their own decisions,” said Konczal.
Having enough resources to make one’s own decisions is a key point. One particularly loopy assumption in economic theory is that workers are free to choose the precise balance between labor and leisure that reflects their preferences and values. In practice, most workers cannot just tune down their work by one and a half hours if they’d prefer that much more leisure — employment hours aren’t that flexible, and doing away with that much pay is often untenable.
Critics will often deride programs that deliver unconditional benefits as “socialist,” but the irony is that such reforms can actually help shore up capitalism’s broken foundations. Market economies are based on the promotion of freedom through voluntary trade. But how voluntary is accepting an undesirable job when the alternative is eviction or food insecurity?
By providing a baseline of resources unconditionally — that is, to all citizens, whether or not they’re employed — people gain what the economist Albert Hirschman called an “exit option.” Not just the freedom to choose their flavor of misery, but the real possibility of saying no.
Putting a real leisure agenda on the table
There are other ways of promoting leisure time — more federal holidays, mandatory vacations, pumping up social security so people can actually retire. Some scholars believe that peasants of the late medieval period enjoyed more leisure time than today’s average American worker, largely because about half of the calendar year was occupied with festivals and celebrations.
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Hulton Archive/Stringer
But no leisure agenda is complete without significantly boosting worker power. This helps ensure not only the possibility of more leisure, but a more dynamic and adaptable economy that accommodates a variety of people with different values and different visions of what makes for a good life.
A useful way to orient the leisure agenda is to ask what it’s for. If the point is just to keep workers refreshed and happy enough to continue their productive contributions to economic growth, then maybe things are already on track. Results from the four-day experiments suggest it’s the kind of balm for workers that would sustain them as happier, better employees.
If the politics of leisure time is about raising the amount of control all people have over the kinds of time that fill their lives, then the present trajectory needs to angle toward power. Without more bargaining power, leisure will always have to justify itself in terms of productivity, placing a cap on how far the leisure agenda might go. With more power, leisure could break free from the hold of economic logic, expanding people’s freedom to lead a wider variety of lives.
The possibility of leisure is something that society — the collective action of all members — produces. But seizing it requires empowering those who would be its champions. And there are plenty. Anyone who endures the gnawing feeling that work is bending their life in service of a job they do not particularly enjoy is the potential beneficiary of a real leisure agenda.
The opportunity to spread the power of choosing more leisure is closer than ever before. Alongside the governments and businesses making decisions about the working week, we should equip workers with the tools to rein in the freedom of leisure, one of the oldest — and today, neglected — frontiers of progress.
“In terms of technological and economic conditions, we could do this,” said Benanav. “We have all the technical capacities. We just aren’t organized enough.”
Since October 7, settler radicals have been attacking Palestinians at an unprecedented rate — uprooting entire communities and threatening a wider war.
On Friday afternoon, I sat at home and waited to find out if Tariq Hathaleen was alive.
Tariq is an activist and English teacher in the Palestinian village of Umm al-Khair located in the West Bank, the land to the east of Israel that’s home to nearly 3 million Palestinians and would make up the heart of any future Palestinian state. He and I had just been connected by a mutual acquaintance, who suggested that Tariq would be a good person to talk to about the wave of violence unleashed against West Bank Palestinians while the world’s eyes were focused on Gaza.
Radical Israeli settlers, who intentionally build communities in the West Bank, routinely harass and assault their Palestinian neighbors. The settlers attack their herds, burn their property, beat them, and even kill them. This violence, paired with many more subtle techniques to pressure Palestinians to give up their land, has reached unprecedented levels in the month since the terrorist group Hamas’s massacre in southern Israel on October 7. At least 15 Palestinian communities have been fully displaced.
Many of these forcible transfers have happened to Palestinian communities in the South Hebron Hills, the West Bank region where Tariq lives. I was supposed to talk to him about what it was like to live through this at 4 pm on Friday, 11 pm his time. But when I texted, he didn’t answer. When I called, he didn’t answer again. Soon after, he sent me an ominous voice memo.
“I was about to answer and call you back, but now there’s military inside the community. We’ll see what happens,” he said.
The Israeli military, far from enforcing order, is a major part of the problem: Soldiers frequently abuse Palestinians, nearly always getting away with it. Data from the Israeli human rights group Yesh Din shows over 99 percent of official Palestinian allegations against soldiers between 2017 and 2021 did not yield an indictment, let alone a conviction. Since the war in Gaza began, sources on the ground have reported soldiers becoming even more hostile toward the Palestinians. While some Israeli military activity in the West Bank serves legitimate counterterrorism needs, the day-to-day reality is the Israeli government working hand-in-glove with the settlement movement to seize Palestinian land.
The most radical faction in Israel is, in effect, stepping up a longstanding campaign of dispossession: acting, both opportunistically and out of anger, to remove West Bank Palestinians from their homes. This escalation could lead to a deeper entrenchment of Israel’s occupation and, quite possibly, a violent Palestinian response that brings outright war to the West Bank. These developments threaten to further weaken the already-slim prospects of a negotiated solution to the Israeli-Palestinian conflict in the foreseeable future.
But most immediately, the consequences are being felt by the Palestinians under attack — like Tariq. When he told me that soldiers were in his village late at night, it meant something bad could happen — bad enough that I might never talk to him again.
I waited past sundown, the beginning of the Jewish Sabbath. I try not to work or use social media on Shabbat, but I had to know if Tariq was okay. Around 7 pm, he called me back: He was safe. This time around, the soldiers hadn’t bothered him — searching only outside Umm al-Khair’s homes rather than inside of them.
But the threat was real, based on both his recent experiences and those of other Palestinians. According to the United Nations, over 130 West Bank Palestinians have been killed in the weeks since October 7 — already nearing the entire total of Palestinians killed in the West Bank last year, itself the deadliest in nearly 20 years. Almost all were killed by the Israeli military, while “eight of them, including one child, were gunned down by settler militias, sometimes in army uniform,” per Mairav Zonszein, a senior analyst at the International Crisis Group.
“[In our village] you think about how to live that day, how to stay safe that day, how to stay alive that day,” Tariq told me. “You don’t think about the future.”
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Thomas Coex/AFP via Getty Images
Fanaticism, security, and the settlements
Israeli settlement in the West Bank, which started after Israel took the territory from Jordan during the 1967 Six-Day War, grew for two distinct reasons. Understanding their interconnections is crucial to understanding the violence plaguing the West Bank today.
In those early days, the settlers themselves tended to be religious radicals, firmly committed to the idea that all of the land from the Jordan River to the Mediterranean Sea had been biblically granted to Jews and (by extension) to the state of Israel. Israel’s government encouraged settlement for more pragmatic reasons. A few settlements, established in key places alongside military bases, could serve to protect Israeli control over Jerusalem and provide “strategic depth” in the event of a Jordanian invasion from the east, which was then a real possibility.
Today, the security situation is completely different. Israel has had a formal peace treaty with Jordan for nearly 30 years and, bolstered by its close relationship with the US, is so militarily powerful that neither Jordan nor any other neighboring Arab state would dream of trying to conquer it. Its greatest security threat comes from Iran and its non-state terrorist proxies, including both Hamas and Hezbollah in Lebanon.
But the settler movement has long taken on a life of its own. Religious nationalists streamed into the West Bank; quite a few less fanatical Israelis, lured by relatively cheap housing prices in the settlements, followed suit. While many of these settlers live close to the “Green Line” — the border between Israel proper and the West Bank — many others live farther out. Settlers established these far-flung communities, sometimes legally and other times illegally, with an eye toward cutting Palestinian communities off from each other.
The radical religious settlers make up a small percentage of the overall Israeli population, but they have allies on the mainstream right, including Prime Minister Benjamin Netanyahu. Netanyahu and many in his Likud Party oppose a Palestinian state on security grounds, worrying it would become a launching pad for rocket fire and terrorist incursions. Together, the settlers and their allies employ a laundry list of legalistic tools — ranging from housing subsidies to the national parks service — to assist in settler land grabs.
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And all Israeli governments, not just Netanyahu’s, have felt obligated to ensure their citizens’ security, settlers included. To protect them from Palestinian militants, Israel uses troops to block Palestinians from going near settlements, builds settler-only roads leading to and from Israel, and places hundreds of checkpoints and roadblocks impeding Palestinian movement around the West Bank.
Settlement, in short, is not merely isolated acts from individual radicals; it is a wholly owned project of the Israeli state. It is no surprise that Israeli soldiers have long turned a blind eye to settler violence against Palestinians; they’re there to protect the settlers, and sometimes even align with the settler agenda. The interplay of religious fanaticism and Israeli security concerns has created an ever-deepening colonial project in the West Bank.
“The relationship of military and settlers is so symbiotic that the system cannot go against itself,” says Yehuda Shaul, director of the left-wing Israeli Center for Public Affairs.
Over the past two years, things have gotten much worse — especially since Netanyahu returned to power in the very last days of 2022, helming one of the country’s most extreme right-wing coalitions.
According to a September UN report, there had been roughly two settler attacks on Palestinians per day in 2022, a doubling of the previous year’s average. In the first eight months of 2023, the daily average went up to three — the highest figure since the UN began recording data on the topic in 2006. The violence between 2022 and August 2023 displaced roughly 1,100 Palestinians and emptied four communities, with scant accountability. The UN found that while 81 percent of Palestinian communities reported incidents to Israeli authorities, only 6 percent said they were aware of Israel acting on the provided information.
In the current government, the minister in charge of settlement policy is Bezalel Smotrich, the leader of the far-right Religious Zionist party who is himself a settler extremist. After settlers attacked the Palestinian town of Huwara in February, Smotrich said, “I think that Huwara needs to be erased.”
So when the October 7 attacks happened, things were already getting worse. Since then, the dire situation has become a true crisis.
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How October 7 set the West Bank on fire
Since the Hamas attack, the pace of settler violence has more than doubled — reaching an average pace of seven attacks a day. The scale of displacement has escalated accordingly, with nearly four times as many communities depopulated in the past month as in the preceding year and eight months. Of the 29 Palestinians killed by settlers in 2023, eight have died in the past month alone.
Part of the reason is very simple: The settlers thrive on impunity. When fewer people are paying attention to them, they feel like they have a greater ability to act without pushback from their opponents inside Israel and around the world. Like all Israelis, they were infuriated by the attacks of October 7; unlike almost all other Israelis, they have both the motive and the opportunity to take out their anger on Palestinian neighbors.
“The focus on Gaza has created a fog that allows … settlers to create facts on the ground that they believe to be irreversible,” says Omar Shakir, the Israel and Palestine director at Human Rights Watch.
The government has condemned the violence but done little to stop it. If anything, some elements of the current Israeli leadership have encouraged their rampage.
During the war, a far-right parliamentarian named Zvi Sukkot became the new chair of the legislative subcommittee on West Bank affairs. Sukkot is an extremist settler who has been arrested at least four times on suspicion of radical activity, including lighting a mosque on fire. While he will have limited concrete powers, his appointment sends a signal that settler violence will be tolerated.
There’s another factor at work here, too, one that has to do with the nature of wartime mobilization.
Typically, the foot soldiers deployed to the West Bank are conscripts — young Israelis just out of high school fulfilling their mandatory military service. But during wartime, these conscripts are needed elsewhere. Currently, they’re deployed either in and around Gaza or else on the northern border with Lebanon, positioned in anticipation of potential escalation with Hezbollah.
To supplement its wartime forces, Israel has called up at least 360,000 reservists — roughly 4 percent of its entire population. Many of these reservists are directly involved in the war effort. But in at least some parts of the West Bank, the reservists are being drawn from local communities — which is to say, the settlements. As a result, some settlers who were assailing Palestinians as private citizens are now formally in charge of their security.
“It’s not that the military accompanies the settlers. Now the military is the settlers,” Shaul says.
These three factors — the focus on Gaza, the government’s indifference, and the settler penetration of the military — have created a kind of perfect storm leading to a spike in settler violence.
And now, Palestinians like Tariq Hathaleen are paying the price.
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How settler violence could ignite a wider war
There are a number of armed Palestinian militants in the West Bank, including both a smallish Hamas presence and the newly formed “Lions’ Den” faction. These groups’ activities are both a cause and consequence of settler violence; their attacks lead to settler retaliation, but their own incentives to violence arise in the wake of land grabs.
The more egregious the settlers’ actions become, the more likely Palestinian militants are to respond with brutal violence of their own. The more violent they get, the more settlers and the Israeli military will retaliate. And the more Israel inflicts violence on Palestinians, the more likely it is that violence erupts into a full-fledged uprising across the West Bank.
“I smell blood in the West Bank,” an unnamed Palestinian official told the Economist. “I don’t know where it will be, but it is coming: the settlers are going to do something terrible.”
The settler attacks on Palestinians, while occurring under the aegis of Israel’s military, are thus actually endangering the country’s security while it focuses on the tough task of fighting Hamas in Gaza.
“Hamas has a crucial ally in the West Bank: the settlers,” says Hussein Ibish, a senior resident scholar at the Arab Gulf States Institute.
Israel is aware of the risk here. The US government has become increasingly vocal about its fears of West Bank escalation; President Joe Biden has publicly and privately demanded that Israel do more to put a stop to the settler violence.
This is definitely within Israel’s power, but there’s a question of will. Netanyahu is on incredibly shaky political ground as resentment over October 7 and his response to it simmers; he remains in office by the grace of far-right settler parties, who care primarily about seizing West Bank land. If Netanyahu crosses them by ordering a crackdown on settler violence, there’s a real chance they’ll punish him by leaving the governing coalition — collapsing his government and costing him the position he seems to value above all else.
Israel today is in the exact opposite position it was in 1967. The interests of the state and settlers are no longer aligned; the settlers’ religious quest for land is increasingly jeopardizing Israeli security. The question is whether the settlers have become influential enough to override what is, in theory, the number one obligation of the Israeli state: keeping its citizens safe.
But security is not the only reason that some Israelis oppose the settlers. A minority, but a meaningfully sized one, care deeply about Palestinian rights and are willing to do something about it.
At the end of my conversation with Tariq, it was deep into the night in the West Bank. He told me something extraordinary: that, as we spoke, there were two Israelis still sleeping in his home, part of a contingent that voluntarily offers their bodies as protection from settler violence. They are not only his friends, but representatives of a different Israel than that of the settlers.
If there is to be a solution to both settler violence and the broader Israeli-Palestinian conflict, it will involve gestures like this: Israelis and Arabs working together against the extremists to build a common future. As dark as things look in the West Bank and Gaza today, we can at least take some comfort in the idea that this spirit isn’t entirely dead.