Healthcare crisis in Gaza: the BMA respondsBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7553.1336-a (Published 01 June 2006) Cite this as: BMJ 2006;332:1336
All rapid responses
Dr Summerfield writes: "A further step, which a growing number of
British doctors now endorse, is to call for a boycott of the IMA."
How would this be implemented in practice, and what might it entail
for individual doctors and organisations? I need someone to remind me
about what happened during the 1980s in connection with Soviet
psychiatrists, the Campaign Against the Abuse of Psychiatry and the World
Medical Association. Wasn't there an expulsion of the Soviet association
or society? And did it work? - it certainly drew attention to the abuse
of psychiatry. Did it upset the Soviets enough to make the difference,
or were the changes in Soviet society (eventually) for other reasons? The
situation was no doubt very different.
The recent AUT and NATFHE experiences over the academic boycott calls
can't be seen, in my view, as auguries of success for a call from doctors
- motions in favour were indeed passed but in the AUT case it was soon
overturned, and with NATFHE I understand that the policy fell with the
merger of the two unions into UCU - though no doubt it could be re-
proposed and re-confirmed, though probably not without the new Union
almost tearing itself apart in the process.
How many doctors would support a call for a medical boycott? Would
it be of the IMA as an organisation, or its individual members, or both?
Would there be "exemptions" along the lines of the proposed academic
boycotts, that is, some kind of ideology test, whereby Israeli doctors
would have to disavow the actions of their government (and maybe other
things) in order that their non-Israeli colleagues could consult or confer
with them? I want to return to this point below.
One big question for me (there are lots) would be the purpose of the
boycott. Would it be simply a way of getting information into the public
domain to stir the conscience of the world, to mobilise public opinion to
pressure politicians to pressure the Israelis? Would it be (as well, or
alternatively) to change the minds of Israeli doctors and turn
indifference, or inaction, into positive action, or even reverse those
instances of unethical cooperation with the government to which Dr
But I'm still very uncertain about the implementation of a medical
boycott on the purely personal level. It may be because I don't know
precisely what it is that "a growing number of British doctors now
endorse" that I have trouble envisaging the following scenario. And if
I've totally misunderstood, I'd welcome being put right. It's simply
this, and arises out of a real clinical situation in which I was involved
I was called to an A & E department to assess a young Israeli
person here on holiday under the mental health act. I don't work at the
hospital, but if I had been in charge of the patient's subsequent care
following admission, I'm sure that at some stage I would have had to
liaise with the doctor who would have to continue the treatment following
the person's return to Israel. This might be to reduce things ad
absurdum, but if I participated in a boycott, or if the BMA did and I as a
member was expected to follow it, should I first ask my Israeli colleague,
say on the phone, whether he or she repudiated Israeli policy, or possibly
Zionist ideology, before discussing our mutual patient?
And if I would be required or encouraged to ask such questions of the
Israeli, wouldn't I also feel obligated to ask my colleague in, say,
Yorkshire or Gloucestershire, what they felt about Blair's (and Britain's)
participation in the invasion of Iraq? And why stop there? Why not ask
about our involvement in the wicked and immoral and dangerous arms trade?
What about American or Chinese colleagues, and so on?
Or would we be talking only about participation in conferences,
journal article submissions and suchlike? But it's not all that long
since a colleague refused to supervise a doctoral student, so it really
isn't clear to me how a call to boycott will be interpreted.
The serious point behind the reductio is, I think, that a call for a
medical boycott will be very likely to generate a colossal row with little
if any improvement in the lot of the Palestinians. One might bash on
regardless with the row, if one thought it resulted in the end of the
Israeli occupation, or brought a genuine Palestinian state nearer. The
big question is, would it? I'm open to being convinced, which is the
great thing about a democratic debate such as this one.
Competing interests: No competing interests
It is also important to support other not exclusively but including
medical, campaigners such as Jews for Justice for Palestinian (see web
site)in order to avoid some of the power games which go on in
organisations and which distract from the purpose of campaigning on behalf
of others especially those who cannot speak out at all.
Competing interests: No competing interests
I thank Dr Nathanson of the BMA for her response but I’m afraid it
avoids the heart of the matter (1). She writes that the BMA “has been
active in collecting information and liaising with medical human rights
groups, such as the International Federation for Health and Human Rights”.
Studiously omitted is any mention of the relevant national medical
association, the Israeli Medical Association (IMA). The IMA and BMA are co
-members of the World Medical Association (WMA), the official watchdog for
medical ethics internationally. When Dr Nathanson writes that the BMA “is
in close contact with colleagues in both Israel and Palestine who are
highlighting the problems”, does this include the IMA?
To recap, the IMA has over many years has refused to condemn and
indeed has defended the following medical ethical breaches:
1. Torture: At one point Israel was the only country in the world
where torture was state sanctioned (albeit called by its euphemism
“moderate physical pressure”). There is a near library of human rights
publications attesting to its use on an entirely institutionalised basis.
2. Doctors’ involvement in torture: In 1996 Amnesty International
concluded that Israeli doctors working with the security services “form
part of a system in which detainees are tortured, ill-treated, and
humiliated in ways that place prison medical practice in conflict with
medical ethics”. (2)
3. Damage by the Apartheid Wall to the Palestinian health system. The
Wall, nearing completion and in defiance of the International Court of
Justice, has made a coherent primary and secondary health system
impossible. 11 hospitals and nearly 100 primary health clinics are being
cut off from the populations they serve. (3)
4. Violations of the Fourth Geneva Convention: This relates to the
right of a civilian population to unimpeded access to food and medical
facilities, and the rights of medical workers to be immune from attacks or
interference by military forces. In 2002, Physicians for Human Rights
Israel (PHRI) – whose principled stand could not be more different from
that of the IMA – wrote that “we believed that the IMA might be able to
curb the appalling deterioration in the attitude of Israeli military
forces towards Palestine health and rescue services. Yet despite severe
injury to medical personal and to the ability of physicians to act in
safety to advance their patients interests, despite Israeli shells that
have fallen on Palestine hospitals, despite the killing of medical
personal on duty – the IMA has chosen to remain silent.” (4) PHRI
conclude that the IMA is merely an arm of the political establishment,
charged with putting a benign gloss on the atrocious realities of
occupation. Again, there is a mass of testimony, all pointing the same way
– from Amnesty International, Human Rights Watch, B’Tselem, PHRI, Health,
Development, Information and Policy Institute, and from aid agencies like
Medecins Sans Frontieres – attesting to systemic violations of these
Geneva Convention-guaranteed rights. These include malicious delays to
ambulances on active duty, firing on ambulances on several hundred
occasions, harrassment, assault or shooting of medical workers on duty,
the deaths of severely injured or ill Palestinians whose access to
hospital is blocked by army checkpoints, interruption of the safe passage
of emergency supplies, wilful destruction of public health and medical
The current health and humanitarian crisis must be set against World
Bank estimates of a tripling in the past few years of the numbers
subsisting at poverty level, and a rise in the proportion of malnourished
and anaemic children. When in 2004 I recorded some of this in the BMJ, IMA
President Yoram Blachar responded at bmj.com thus: “the lies and hatred he
spews in his piece is reminiscent of some of the worst forms of anti-
semitism ever espoused”. In the paper I specifically quoted Amnesty, the
World Bank, the UN, PHRI, Johns Hopkins and Al Quds Universities, and the
International Court of Justice (5). So the IMA President, and (since 2003)
Council Chair of the WMA, sees the output of these bodies as lies and
hatred, and yet remains uncensored and a postholder in international
medical ethics? When challenged, as I and others have done many times in
the BMJ and Lancet in the past decade, Dr Blachar has been entirely
consistent in unconditionally rejecting any validity to our concerns. Thus
Dr Blachar blithely reassures concerned citizens in Israel and abroad that
there is nothing much amiss and nothing that needs to be done.
WMA secretary general Delon Human replied to me in 2002 as follows “I
must come to the defence of the IMA in affirming that they are co-
signatories of the WMA Declaration of Tokyo. They have been active
collaborators in the WMA’s continuing struggle to eradicate torture of any
kind in prisons or other settings all over the world…” (6) What does this
extraordinary endorsement, which appears to come from a parallel world,
say about the judgement and independence of the WMA? What is the WMA for?
I contend that Dr Blachar is at the WMA to ensure that nothing critical of
The BMA too has stressed to me its collegiate and friendly
relationship with the IMA. I am forced to concede that between them the
WMA, IMA and BMA are controlling the medical ethics agenda as it applies
to the Occupied Palestinian Territories.
Dr Nathanson of the BMA describes their “grave concern” at the
present situation but my experience over several years is that BMA
responses to enquiries on this subject have been anodyne and dismissive.
Nothing is meant to change. How is it possible that the WMA and the BMA
can act as if all the work of Amnesty International etc. did not exist.
Surely, when Amnesty International or some other reputable human rights
organisation issues reports which point to noxious state practices with
implications for the integrity of individuals and their bodies (as with
torture), and to violations of medical ethical practice, the WMA has a
duty to react and to ask the relevant national medical association, here
the IMA, to account for itself. As it is, the WMA, BMA and IMA act as if
Amnesty etc does not exist! The raison d’etre of the WMA seems to be to
permit national medical associations to claim probity of practice on the
basis of membership per se, as the IMA has repeatedly done.
This is why the BMA and WMA are in effective collusion with the IMA,
and are part of the problem rather than the solution. There are many ways
in which we should seek to make a difference. We need to hold the BMA
International Committee to greater account. We can demonstrate our
solidarity with Palestinian health workers and a besieged public, and with
principled local organisations like PHRI and the Union of Palestinian
Medical Relief Charities. A further step, which a growing number of
British doctors now endorse, is to call for a boycott of the IMA.
1. Nathanson V. Healthcare crisis in Gaza: the BMA responds. BMJ
2. Amnesty International. “Under constant medical supervision”, torture,
ill-treatment and the health professions in Israel and the Occupied
Territories. London: Amnesty International, 1996.
3. Health, Development, Information, and Policy Institute. Health and
Segregation. The impact of the Israeli Separation Wall on access to health
care services.(ed. M.Barghouti). Ramallah: HDIP, 2004.
4. Physicians for Human Rights. A legacy of injustice: a critique of
approaches to the right to health of Palestinians in the Occupied
Territories. Israel:Physicians for Human Rights.
5. Summerfield D. Palestine: the assault on health and other war crimes.
6. Summerfield D. What is the WMA for? The case of the Israeli Medical
Association. Lancet 2003;361:424.
Competing interests: No competing interests
Natahanson’s letter and the related news article on the healthcare
crisis in Gaza generate two crucial points. First, why does the BMJ still
insist on calling Gaza ‘occupied’ and thus infer blame on the Israelis?
The Israelis carried out a much publicised withdrawal a year ago. Is the
BMJ suggesting that this did not in fact take place?
Secondly the BMJ once again absolves the Palestinians of all blame in
this scenario. If a dictator or a ‘regime’ elects to spend its money on
bombs, guns and ammunition (never seems to be a shortage of these in Gaza
or the West Bank) it should not then cry to the West that its people have
insufficient medicine. It’s what Saddam did in Iraq and what Hamas are
doing in Gaza. Incidentally, the Israeli’s have offered medicine to the
Palestinian people but Hamas has said it would prefer the cash. I wonder
Competing interests: No competing interests