US president Joe Biden was betting that a whirlwind visit to the Middle East this week could help prevent the conflict between Israel and Hamas from spreading across the region, temper its ally’s response to the October 7 attacks and soothe fears in Arab capitals of a widening conflagration.

It was a diplomatic mission fraught with risk, and potential reward. Biden’s trip to Israel might associate him with a forthcoming ground invasion of Gaza, triggering more anger at the US.

But at a summit with regional leaders in Amman, Jordan, he could assure Arab allies that the US remained committed to their security, too, and keep a broader regional peace push — a central ambition of the administration — intact.

The US president’s gambit was at risk of backfiring on Tuesday after an explosion at a hospital in Gaza killed hundreds of people and threatened to demolish Biden’s delicate diplomatic mission before it had even begun.

First came Palestinian leader Mahmoud Abbas’s decision to pull out of the planned meeting with Biden. Then, just as Biden was departing for Tel Aviv on Air Force One, the White House announced that the entire second leg of his trip to meet King Abdullah II of Jordan and President Abdel Fattah al-Sisi of Egypt was cancelled.

It marked a stunning turn for a president who was willing to gamble that his powers of negotiation and empathy could help calm a region that King Abdullah says is now “on the brink of falling into the abyss” following Hamas’s attacks on Israel of October 7 — and Israel’s subsequent bombardment of Gaza.

Just weeks ago, the White House was closing in on a grand bargain to normalise ties between Israel and Saudi Arabia. The administration had also made progress with Iran, agreeing a prisoner swap that brought hopes of a further thawing in relations between Tehran and Washington. Now Biden is fighting to salvage any of that diplomatic progress.

US officials did not offer any immediate attribution to the hospital explosion on Tuesday, but in Tel Aviv on Wednesday Biden backed the Israeli version of events, saying the blast appeared to have been perpetrated by “the other team”. He added that he was “deeply saddened and outraged” by the explosion.

Officials in Gaza have blamed a strike by Israel, while Israeli authorities have rejected the claim and pinned it on a misfire by the militant group Palestinian Islamic Jihad.

John Kirby, the co-ordinator for strategic communications at the National Security Council, said Biden planned to speak on the phone with Abbas and Sisi on the way back to Washington on Wednesday.

“He would always prefer face-to-face diplomacy, that’s the president’s stock-in-trade. But he also understands in the wake of the explosion at the hospital that it’s not the appropriate thing to do, certainly for the leaders that are there, and he understands that,” Kirby said.

The diplomatic fallout from the carnage in Gaza may only just be starting for Biden.

Merissa Khurma, director of the Middle East Program at the Wilson Center, said Biden’s visit to Israel would now be read in many capitals in the region as the US “okaying the killing of people” in the hospital blast.

“This will be very hard to navigate for the US administration and almost impossible to balance,” Khurma said. “People in Ramallah, Amman and Tunis and elsewhere are already out in the street condemning Israel and calling for the killing of Palestinians to stop.”

To pave the way for the visit, US secretary of state Antony Blinken held marathon talks with Israel’s leader Benjamin Netanyahu, including about how to rush humanitarian aid into Gaza and how to create safe zones in the enclave ahead of any ground invasion by Israeli forces. The US also hoped to make progress in securing the release of American and other hostages held by Hamas and safe passage for foreign nationals out of Gaza into Egypt.

The hospital explosion has shattered that planning, leaving Biden to manage a one-sided visit in Israel that risks increasing tensions in the region rather than easing them — and damaging the US’s effort to project itself as an honest broker.

“The peril, of course, is a situation like this,” said Jonathan Panikoff, the director of the Scowcroft Middle East Security Initiative at the Atlantic Council’s Middle East Program. “If in general Israel isn’t amenable to American pressure to exercise restraint or bring the conflict to an end, it could harm US standing in the region.”

Images of Biden standing shoulder to shoulder with Netanyahu in Tel Aviv on Wednesday, just a day after the hospital devastation in Gaza, will also confirm — for US audiences and Middle Eastern ones — that American support for Israel remains steadfast.

Aaron David Miller of the Carnegie Endowment for International Peace said backing for Israel was “imprinted in [Biden’s] emotional DNA” after a half-century of public service in Washington. This would allow the president to have “the tough conversations” that were needed with Netanyahu on Israel’s response to Hamas and its consequences.

Kirby echoed that hope. Biden will be “asking some tough questions, but he’ll be asking them as a friend”, he said.

The president had already started to inject some words of warning to Netanyahu in his public remarks in recent days, stressing the importance of respecting international law and warning him not to aim for an occupation of Gaza.

But Middle East policy analysts said Biden also risked being too closely associated with any decision by Israel to launch a ground invasion of Gaza.

“If it occurs immediately after he leaves, it will appear that the US has blessed the operation,” said David Schenker, a senior fellow at the Washington Institute for Near East Policy and a previous assistant secretary of state for Near Eastern Affairs.

“The US position has been that Israel has to do what Israel has to do to defend itself and to support that, but not get involved in the operational details,” he said.

That is also risky for Biden, even at home. The president has benefited politically from his strong embrace of Israel in the wake of the Hamas attacks. That could change as the conflict deepens or spreads, and as the civilian death toll from Israel’s response rises.

“Biden is going to own the ground campaign, he probably already owns it,” said Miller. “Biden is entering a very complicated picture.”

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