Israeli forces attack medical facilities in Gaza and destroy brand new hospitalBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4865 (Published 28 July 2014) Cite this as: BMJ 2014;349:g4865
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We are a group of mental health clinicians and academics, working and / or trained in the UK and Ireland. We write to express our support and admiration for mental health professionals in Gaza, who have worked tirelessly to support children, women and men repeatedly exposed to the traumas of war and siege - even as they themselves have suffered. The Gaza Mental Health Foundation reported that Dr Mona El Farra, the founder of “Let the Children Play and Heal”, a therapy project based at a Gazan refugee camp, lost nine relatives (including five children) when Israeli shells reportedly destroyed their family home on August 1st 2014.1 They also reported that Dr Yasser Abu Jamei, a staff member of the Gaza Community Mental Health Program (GCMHP), lost more than twenty members of his extended family when Israel reportedly shelled the house they were sheltering in on July 21st 2014.1 The New York Times interviewed Dr Zeyada, a psychologist working at GCMHP, and reported that he had lost six family members in an Israeli strike, and that he planned to seek peer counselling before returning to work.2 We express our condolences for these terrible losses. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported that, as of 21/8/14, at least 140 families have lost three or more family members in the same incident, for a total of 735 fatalities.3 They stated that “such cases raise serious concerns about the targeting of civilians and civilian objects and the launching of indiscriminate attacks.” 4
As professionals who deal on a daily basis with the consequences of abuse and trauma, we empathise deeply with the terror and outrage of Gaza’s civilians, and with the difficult task of the professionals aiming to support them. Of course, we similarly empathise with the war-related suffering of Israeli civilians, but the focus of this letter reflects the greatly disproportionate burden of death, injury and displacement endured by the people of Gaza in the recent war. The OHCA estimated that, as of August 27th 2014, the war had led to the deaths of 1,462 Gazan civilians, including 495 children, and four Israeli civilians.3 During the Israeli assault on Gaza, which included the bombing of homes, schools and hospitals, 5,6 civilians were unable to shelter safely within Gaza. This was clearly demonstrated by Israel’s fatal shelling of UN schools housing the internally displaced; an action condemned by the UN Secretary General as a ‘moral outrage’ and a ‘criminal act’. 7 The impact of people’s inability to shelter safely within Gaza was compounded by their inability to flee across Gaza’s sealed borders. As mental health professionals, we understand that the combination of violent assaults with the absence of safe havens is particularly psychologically damaging. The OCHA estimated that the current war has left 373,000 Gazan children in need of psychosocial support and a 1000 facing life-long disability.4 We appreciate the uphill task facing Gaza’s mental health professionals, and write to applaud and support their difficult and courageous work. We call on other health professionals to join us in publicly supporting their Gazan colleagues.
For full list of co-signatories please contact corresponding author.
*Corresponding author: Dr Hind Khalifeh, Division of Psychiatry, UCL, London W1W 7EH email: firstname.lastname@example.org
None of the authors have any conflicts of interest.
1. http://www.gazamentalhealth.org (accessed on 4/8/14)
2. http://www.nytimes.com/2014/08/05/world/middleeast/gaza-strip-israel-psy... (‘In fatal flash Gaza psychologist switches roles, turning into a trauma victim’, posted on 4/8/14, accessed on 7/8/14)
3. http://www.ochaopt.org/content.aspx?id=1010361 (accessed on 28/8/14)
4. http://www.ochaopt.org/documents/ocha_opt_sitrep_06_08_2014.pdf (OHCA Occupied Palestinian Territory Situation report as of 6/8/14, 0800 hrs, accessed on 7/8/14)
5. http://www.emro.who.int/images/stories/palestine/documents/WHO_Sitrep_on... (WHO situation report #6, posted on 1/8/14, accessed on 7/8/14)
6. http://www.un.org/apps/news/story.asp?NewsID=48395#.U-MsfVYyBg1 (‘UN warns of 'rapidly unfolding' health disaster in Gaza’, posted on 2/8/14, accessed on Aug 7th 2014)
7. http://www.un.org/sg/statements/index.asp?nid=7904 (Statement attributable to the Spokesman for the Secretary-General on attack outside UNRWA shelter, posted 3/8/14, accessed on 7/8/14)
Competing interests: No competing interests
The Israeli army’s attacks on civilians lives and civilian infrastructure in the Gaza Strip, including health facilities, should be named correctly.
Owen Dyer reports in the British Medical Journal ( BMJ) on the Israeli attacks on medical facilities in the Gaza Strip during the ongoing excessive military offensive ironically named ‘Operation Protective Edge’ (OPE) , and attempts to cover his story from the sides of both the victims and the aggressor. In the context of the neglect of health journals in giving sufficient attention to the humanitarian and health crisis in the Gaza Strip, which have been ongoing since the 8th of July 2014 , we appreciate any kind of coverage from medical and health journals, especially from the BMJ. However, we, as Palestinian doctors working in the Gaza Strip, found that relying on details provided by the public relation officers of the Israeli army gives the aggressor, and the occupying power in the Gaza Strip, an appreciable advantage.
Our experience and documented evidence show that the Israeli Army deliberately and systematically targets civilians and the foundations of civilian lives, including health facilities, in its onslaught on the Gaza Strip. According to the United Nation’s Office of Coordination of Humanitarian Affairs (OCHA), the majority of Palestinians killed by the Israeli army during the last onslaught were civilians[ 2]. The Israeli army targeted health facilities, including Alaqsa hospital, as confirmed by the World Health Organization, and Al-shifa - the largest hospital in the Gaza Strip was not spared Israeli attacks. As we write our response, the Israeli army is attacking Al-Najjar hospital in Rafah. In addition to targeting civilians and health facilities, the Israeli Army shelled Gaza’s only power plant resulting in its shut down, making the daily electrical supply to the various locales in the strip range from zero to three hours. The absence of electricity in the most of the Gaza Strip localities has led to the inability to pump water to those localities, which could pave the way for increasing the burden of communicable diseases in the overcrowded Strip.
More than 450,000 ( 25%) of the 1.8 million Palestinians who live in Gaza Strip have been forcibly displaced, including 280,000 who are sheltered in the schools of the United Nations ( UN) and other formal shelters . Even those who sought shelter in UN schools were not spared from Israeli attacks with UN schools targets at least three times.
Making false excuses to justify targeting the civilians lives and infrastructures which support life and health, and negatively affecting the determinants of health is absolutely unacceptable, and serves only as a failed plea to defend Israel’s disproportionate attacks on the civilians lives and to blame the victims for their own sufferings.
Our experience as health professionals in the Gaza Strip indicates that Israeli attacks on health facilities, including hospitals, are neither incidental nor accidental; instead, Israel has a long history of targeting civilians and civilian infrastructure, including hospitals, making these attacks part of the Israeli military doctrine. The collective memory of Palestinians in the Gaza Strip and elsewhere will keep the atrocities and mass killing of civilians by the Israeli army alive for years to come.
One of several example of mass killing of civilians includes an incident when dozens of people in Khan Younis were machine-gunned by the Israeli army against a wall and others were shot with pistols in 1956 [4,5 ]. More recently, Operation Cast Lead, conducted by the Israeli army in the Gaza Strip from the 27th of December 2008 to the 17th of January 2009, hospitals, including Al-Quds and Al-Wafa, were not spared from the Israeli military activities and destruction. According to the UN Fact Finding Mission , on the 15th of January 2009, the Israeli army attacked directly and intentionally Al-Quds hospital in Gaza City and the adjacent ambulance depot with white phosphorous shells; and the mission rejected the Israeli allegations that fire was directed at the Israeli army from the hospital .
Targeting the lives of civilians and civilian infrastructure intentionally and repeatedly constitutes an integral part of the Israeli military doctrine. Therefore, it is the right time now, more than ever, to name these actions correctly: War Crimes.
 BMJ 2014;349:g4865
 Office of Coordination of Humanitarian Affairs in the Occupied Palestinian Territory- Occupied Palestinian Territory:
Gaza Emergency Situation Report (as of 1 august 2014, 1500 hrs): http://www.ochaopt.org/documents/ocha_opt_sitrep_02_08_2014.pdf (last retrieved on the 3rd of August 2014)
 WHO Regional Office for the Eastern Mediterranean. Situation report 6. The 1st of August 2014. http://www.emro.who.int/images/stories/palestine/documents/WHO_Sitrep_on... ( Last retrieved on the 3rd of August 2014)
 Jean-Pierre Filiu, Histoire de Gaza (The History of Gaza), Fayard, Paris, 2012.
 Joe Sacco, Footnotes in Gaza, Metropolitan Books, New York, 2009.
 Human Rights in Palestine and other occupied Arab territories- Report of the United Nations Fact-Finding Mission on the Gaza Conflict: www2.ohchr.org/english/bodies/hrcouncil/docs/.../A-HRC-12-48.pdf (last retrieved on the 2nd of August 2014 )
Competing interests: Both authors of this response letter are Palestinian physicians who practice medicine in the Gaza Strip; both of them oppose the occupation of their Palestinian territory, including the Gaza Strip, and the repeated Israeli onslaughts on the Palestinian people, especially in the Gaza Strip. Khamis El-essi was the ex-director of Al-Wafa hospital till 2010 when he launched the Evidence Based Medicine Unit at Faculty of Medicine, Islamic University, Gaza City, occupied Palestinian territory.
Owen Dyer’s report from Montreal on attacks on medical facilities in Gaza gives readers insight into the care that the Israeli armed forces have taken to spare the lives of hospitalized innocents. In contrast, Hamas has embedded its terror operations in hospitals and schools, thus endangering their own people, and activists have encouraged them.
Sadly, there have been many deaths in Gaza. Nonetheless, despite all the attacks, Dyer is able to report a total of six patient casualties. He describes in detail the scenario at the al-Wafa Hospital, where staff initially refused to evacuate, and activists further endangered the patients by supporting staff in this choice. Israeli forces held off until the hospital was finally evacuated. Mr. Dyer reports no casualties from that attack, and only a “fear” that new hospital equipment was damaged. There have been repeated reports of tunnel entrances in this hospital, which is likely why it was targeted, and a rocket firing site nearby. Dyer also reports that al-Shifa, Gaza’s largest hospital, is a well-known shelter for Hamas leaders, both now and during previous conflicts.
Mr. Dyer also includes the unfortunate deaths of 16 civilians at a UN school. This took place when Israeli soldiers responded to antitank missiles shot from the school area. While at first Israeli sources were unable to say whether their mortars struck the school, video footage since released led to reports in the left-wing newspaper Haaretz that the Israeli response was not responsible for the casualties (1).
Finally, Mr. Dyer quotes Navi Pillay on international law and war crimes. In a July 9th interview on Palestinian television, the Palestinian representative to the UN, Ambassador Ibrahim Khraishi ,made the following remarkably honest comments: “The missiles that are now being launched against Israel, each and every missile constitutes a crime against humanity, whether it hits or misses, because it is directed at civilian targets….Please note that many of our people in Gaza appeared on TV and said that the Israelis warned them to evacuate their homes before the bombardment. In such a case, if someone is killed, the law considers it a mistake rather than an intentional killing because [the Israelis] followed the legal procedures. As for the missiles launched from our side, we never warn anyone about where these missiles are about to fall or about the operations we carry out. Therefore, people should know more before they talk emotionally about appealing to the ICC.” (2).
I hope that a careful reading of Mr. Dyer’s article, and the information I have provided, allow BMJ readers to “know more” before they decide who is responsible for causing harm to the people of Gaza.
(1).Haaretz, July 27, 2014. IDF: UN school yard was empty at time of Israeli strike. Retrieved July 30, 2014 http://www.haaretz.com/news/diplomacy-defense/1.607384
(2). UN Watch, July 13, 2014. Palestinian UN rep: “Each and every missile launched against Israel constitutes a crime against humanity.”. Retrieved July 30, 2014 http://blog.unwatch.org/index.php/2014/07/13/palestinian-un-rep-each-and...
Competing interests: No competing interests
War is horrible. This is especially troubling when much of the violence could have been prevented if rockets weren't sent into Israel targeting nondiscriminatory civilian populations including women and children.
That a Hospital and schools in Gaza served as command safety centers for Hamas leaders makes them guilty of putting their own private citizens and Critical structures like a major hospital in harms way. I think most of us would like to see peace between the Palestinians and Israelis. How this can be achieved is beyond my imagination. I can imagine there will be many more dead, before the two sides exhaust the violence and come to a peaceful agreement.
Competing interests: No competing interests
Despite its high profile, the Israeli-Palestinian conflict is not unique. Like other iconic conflicts, the Israeli-Palestinian conflict is an intractable feud impervious to negotiation and in need of a new perspective. So let's stop the polarizing, stigmatizing rhetoric, and redefine these chronic conflicts as humanitarian health crises due to global dehydration, malnutrition, and addiction, all of which cause conflict by making people frustrated, angry, and violent. To stop a feud, change the food.
Competing interests: No competing interests
I would like to clarify that damage to the Al-Quds hospital has been reported by the Palestinian Ma'an News Agency but not confirmed by international sources. Damage to the Beit Hanoun, Al-Wafa, Al-Aqsa, and Balsam hospitals, and to the Beit Lahiya clinic and 11 other clinics, has been confirmed by the Eastern Mediterranean Regional Office of the World Health Organization.
Competing interests: Author of article