Effects of armed conflict on access to emergency health care in Palestinian West Bank: systematic collection of data in emergency departments

Dr Haselton asks how the BMJ took the decision to publish this paper.
In common with all the research papers published in the BMJ, this paper was
submitted and sent out for external peer review. The reviewers and the
editors handling the paper felt that it was a legitimate attempt to
quantify the impact of the Israeli blockade on the health of the people
living in the Palestinian Territories. As the authors say in their
introduction, the World Health Organisation has recommended collection of
data in emergency departments as a tool to assess the health consequences
of armed conflicts. Based on positive comments from our reviewers, the
paper was discussed at our main editorial meeting at which one editor and
up to five external clinical and methodological advisors debate whether a
paper should be published. This committee decided that the paper should be
published. I was not part of that decision as I did not attend the meeting
on that occasion. However, like Richard Smith and our predecessors, I am
the editor of the BMJ and accountable for all that it contains.

It is worth noting a few things about the decision to publish this paper and the way in which it was published.

First, as I am sure you understand, we can only choose which research
papers to publish from among those that are submitted to us. We are keen
to publish well performed research addressing health issues that will
interest our readers and that have the potential to improve health and
health care globally. If we were to be sent a well performed study on the
implications of the interfada for the health of Israeli children, for
example, we would be only too pleased to publish it. And we have rejected
even in my time as editor, a number of research articles and opinion
pieces from the Palestinian view point because they were too poorly done
or too poorly argued. So the fact that we have published this piece should
not be taken as indicating a bias against Israel or in favour of
Palestine.

Second, we are under no illusions that what we publish will always
(or one might say, ever) represent perfect truth. Peer review is a human
process and as such vulnerable to subjectivity and error. This is why we
have rapid responses and letters to the editor, to allow readers to
continue the peer review process after publication. The BMJ is almost
uniquely (among medical journals) transparent in its openness to such
critical comment through its rapid responses, and as you can see, we have
posted a number of criticisms of the paper on bmj.com and published what
we saw as the most critical and cogent of these as letters in the journal.

Finally, I tend to agree with you that, given the polarised nature of
the issues surrounding the Palestinian situation, it would have been
sensible to commission a commentary to set the paper in context and to
highlight some of the paper's limitations. The fact that we did not do
this is regrettable.

I don't believe this is a case of editorial misconduct, nor one in
which retraction or an apology is indicated. I reiterate that the BMJ is
very willing to consider publishing any well written, well argued, well
performed research or opinion articles from the Israeli perspective in
this tragic conflict.

Fiona Godlee

Competing interests:
None declared