Intended for healthcare professionals

Rapid response to:

Letters Health in Gaza

The maiming fields of Gaza

BMJ 2018; 362 doi: (Published 13 August 2018) Cite this as: BMJ 2018;362:k3299

Rapid Response:

The way forward for the reconstruction of a viable health service in Gaza

Dear Editor

Gazan society is enduring its fifth health emergency in 12 years, and the biggest since 2014 (when Operation Protective Edge caused 2,200 deaths, destroyed 80,000 homes, and rendered 500,000 people homeless). (1) This time as before the main Shifa hospital has been overwhelmed - it received 1,948 wounded people, of whom 25% needed emergency surgery and intensive care. The Ministry of Health building, 9 hospitals, 19 clinics and the only Covid testing laboratory were all bombed and damaged or totally destroyed. (2) (3) (4) Targeting health facilities and staff is a breach of the Fourth Geneva Convention. Moreover health services continue to experience the debilitating effects of Israeli blockade, now 14 years old, which operates as a form of societal de-development.

So what future for Gazan health services? Comprehensive public health care run by the Ministry of Health remains the basis for everyday specialist and emergency treatment. Access to medications, instruments, reliable fuel sources, support of personnel, and training have been hindered and not funded during these years of blockade, a collective punishment for the people of Gaza. This time the reconstruction of Gaza cannot be dealt with as before and the denial of a properly functioning health system for the people of Gaza must end.

It seems that finally the governments of some leading countries, the UN, and the EU representatives are stating that now is the time to confront the root causes of Gaza’s tragedy. They identify the occupation and blockade of Gaza as the central issue. In 2013 the UN Secretary-General found that “the blockade and related restrictions contravene international humanitarian law as they target and impose hardship on the civilian population, effectively penalizing them for acts they have not committed”. However, nothing has been done to date. Indeed, last week UK foreign secretary Dominic Raab has been in Tel Aviv shaking Israeli premier Benjamin Netanyahu’s hand, as if for a job well done, and in Geneva the UK and 3 EU states have voted against a proposed UN enquiry into the conflict.

As doctors and academics, we call again for an immediate first step: the ending of the Israeli blockade of Gaza, starting with the depleted health sector. While funding is needed now to bolster the health service on an emergency basis, the key issue is the development of a viable health system based on local experience and the often heroic efforts of Gazan health professionals who because of the blockade have been denied the opportunity to upgrade their skills, including abroad. Moreover, these recurrent health emergencies in Gaza have increased dependence on a diverse network of international, costly and far from perfect functioning private health services. International health-related aid has been largely channelled through the Palestinian Authority in the West Bank, which has no land bridge to Gaza, with the Gazan Ministry of Health often excluded from direct planning. We strongly recommend that the Ministry in Gaza is afforded the central role in all plans to facilitate the reconstruction of a viable health service

The signatories to this appeal include 200 UK doctors.

The signatories declare no conflicts of interest.





Competing interests: No competing interests

03 June 2021
Derek Summerfield
Honorary Senior Clinical Lecturer
Prof Paola Manduca, Italy Dr Swee Ang, UK Victoria Brittain, UK Prof Nabil Barqouni, Gaza Dr Ruchama Marton, Israel Dr Mohammed Khanji, UK Dr Derek Summerfield, UK Prof. Colin Green, UK Dr Iain Chalmers, UK Prof Ann Barrett, UK Dr Suhail Hussein, UK Dr Syeda Hussain, UK Dr Ajmal Sherif, UK Dr Roger Allen, UK Dr Bilal Hussein, UK Dr Ghias Khaja, UK Dr Naila Aslam, UK Dr Syed Haider, UK Dr Nida Suri, UK Dr Maryam Zulaftar, UK Dr Bilal Ela Bourquin, UK Dr Asad Luqmani, UK Dr Mustafa Alachkar, UK Dr May Jay Ali, UK Dr Bob Johnson, UK Dr Salman Bodla, UK Dr Adisa Shah, UK Dr Kiran Rahim, UK Dr Imrana Siddiqui, UK Dr Zohra Ismail-Panju, UK Dr Hamed Lawal, UK Dr Leigh Bissett, UK Dr Wajeeha Jaffer, UK Dr Zainab Leftah, UK Dr Zahra Khan, UK Dr Umar, Ahmad, UK Dr Nur Ozyilmaz, UK Dr Alia Nasir, UK Dr Shahla Ahmad, UK Dr Farah Hussein, UK Dr Suhail Hussain, UK Dr Faraz Imran, UK Dr Irial Eno, UK Dr Shimaila Ali, UK Dr Aeishah Griffiths-Williamson, UK Dr Ayaan Farah, UK Dr Nizar Merali, Uk Dr Akber Mohamedali, UK Dr Rukyya Hassan, UK Dr Perviz Asaria, UK Dr Hibba Soomro, UK Dr Saania Bhatti, UK Dr AunAli Sibtain, UK Dr Andleeb Ahmed, UK Dr Sumera Sharif, UK Dr Tahira Batool, UK Dr Pam Wortley, UK Dr Dena Ettehad, UK Dr Emma Young, UK Dr Carlitos Reyes, UK Dr Mansoor Patil, UK Dr Rui Providencia, UK Dr Kula Ranjadayalan, UK Dr Aung Minn, UK Dr Farogh Mahmood, UK Dr Masoma Shaukat, UK Dr Syed Burney, UK Dr Mehmood Butt, UK Dr Hafiz Syed, UK Mr Wael Awad, UK Dr Muhammad Qasim Dr Syed Abbas, UK Dr Khayal Asghar, UK Dr Muhammad Ishtiyaq, UK Dr Muhammad Jawad ul Qamar, UK Dr Tamar Saeed, UK Dr Muhammad Ashfaq, UK Dr Jawad Bashir, UK Dr Fawad Hameed, UK Dr Bashistraj Chooneea, UK Dr Anum Azhar, UK Dr Sabrina Munir, UK Dr Mohammed Akhtar, UK Dr Majid Ali, UK Dr Tajvur Saber, UK Dr Khudyja Cheema, UK Dr Layan Akijian, UK Dr Emer O’Connor, UK Dr Nevil Pavithran, UK Dr Hannah Naasan, UK Dr Helai Osmani, UK Dr Ala Ali, UK Dr Layal El Asir, UK Dr Zurina Ali, UK Dr Asiya Abedin, UK Dr Asjid Qureshi, UK Dr Kamiliae El Farra, UK Dr Ghada Karmi, UK Dr Tomasz Pierscionek, UK Prof Sushrut Jadhav, UK Martin Kemp, UK Dr David Bell, UK Prof Gene Feder, UK Dr Tom Gilberthorpe, UK Chris Blacktop, Uk Dr Daniel McQueen, UK Prof Tess Harris, UK Dr David Halpin, Uk Prof Jo Moncrieff, UK Dr Sukaina Hirji, UK Dr Philip Thomas, UK Prof Chris Evans, UK Dr Roger Allen, UK Dr Marco Chiesa, UK Dr Pauline Cutting, UK Dr John Puntis, UK Dr Majid Katme, UK Dr Tia Iqbal, UK Prof Steven Rose, UK Dr Felicity De Zulueta, UK Dr Sebastiao Viola, UK Dr Faddy Kamel, UK Dr Laura Benjamin, UK Dr Vinojini Vivekanandam, UK Dr Souhad Yousef, UK Dr Tayyub Yasin, UK Mr Amir Sheikh, UK Dr Nida Ahmed, UK Dr Sabahat Ahmed, UK Dr Fizzah Choudry, UK Dr Qaiser Malik, UK Dr Ammara Choudry, UK Dr Rohail Malik, UK Dr Shairana Naleem, UK Dr Nadia Bashir, UK Dr Fareedoon Ahmed, UK Mr Mohammed Gara, UK Dr Abid Shoaib, UK Dr Mohammed Shafiq, UK Dr Afrosa Ahmed, UK Dr Umer Malik, UK Dr Faran Akbar, UK Dr Emaad Alauddin, UK Dr Qassim Malik, UK Dr Jalal Alam, UK Dr S Khan, UK Dr Mohammed Mustafa, UK Dr Imran Dean, UK Dr Umer Siddique, UK Dr Fauziah Salimullah, UK Dr Badrul Hussain, UK Dr Ikram Ullah Shah, UK Dr Aysha Ahmed-Kibria, UK Dr Almas Rehman, UK Dr Attia Rizvi, UK Dr Ammaarah Said, UK Dr Umar Patel, UK Dr Ghazala Mir, UK Dr Awais Alvi, UK Dr Samreen Nasim, UK Dr Josephine Shakur, UK Dr Yasmeen Kousar, UK Dr Imran Ilyas, UK Dr Amer Hamed, UK Dr Qasim Malik, UK Dr Nadeem Bhatti, UK Dr Amara Arfan Naseem, UK Dr Nabila Irshad, UK Dr Shahid Akhtar, UK Dr Sabahat Ahmed, UK Dr Muhammad Quraishi, UK Dr Jamila Begum, UK Dr Rabia Quraish, UK Dr Omar Taha, UK Dr Mozam Hussain, UK Dr Sarah Alam, UK Dr Sabriye Mehmood, UK Dr Samira Bawany, UK Dr Wajid Khan, UK Dr Aroona Arfan, UK Dr Kasim Ramzan, UK Dr Soma Meran, UK Dr Ambreen Hussain, UK Dr Shameela Islam-Zulfiqar, UK Dr Rizwana Hamid, UK Dr Maria Wasty, UK Dr Taiba Abbas, UK Dr Amal Elkafrawy, UK Dr Abida Cathcart, UK Dr Supple Neelam, UK Dr Sameena Hassan, UK Dr Ahmed Khan, UK Dr Nazia Mohammed, UK Dr Ahmed Abufouda, UK Dr Ula El- Kafrawy, UK Dr Shazia Hanif, UK Mr Ahmed Alani, UK Dr Allvia Hamid, UK Dr Shams Mustafa, UK Dr Nazia Kausar, UK Dr Nazir Hussein, UK Dr Sahira Dar, UK Dr O Fakayh, UK Dr Syeda Siddiqui, UK Dr Abdulla Alhasso, UK Dr Farah Alhafid, UK Dr Hosney Yosef, UK Dr Rukhsana Salim, UK Dr Thomas Bourinaris, UK Prof Shabbir Wadee, South Africa Brian Lewis, France. Prof Raija-Leena Punamäki, Finland Dr Angelo Stefanini, Italy Dr Hanne Heszlein-Lossius, Norway Dr Vittorio Agnoletto, Italy Dr Vincenzo Luisi, Italy Dr Ireo Bono, Italy Prof Guido Veronese, Italy. Dr Nozomi Takahashi, Belgium Dr Trude Bennett, USA Dr Alice Rothchild, USA Maxine Fookson, USA Dr Pierina Del Carlo, Italy Dr Ernesto Burgio, Italy Dr Tarek Meguid, Tanzania Dr Gianni Tognoni, Italy Dr Rachel Rubin, USA Prof Alan Meyers, USA Dr Jon Jureidini, Australia Dr Alison Payne, New Zealand Dr Anne Collins, New Zealand Dr Caitriona Logan, Eire Dr Naisrin Elsafty, Eire Dr Norbert Andersch, Italy Prof A Padela, USA Dr Silvana Agatone, Italy Dr Mariagiulia Agnoletto, Italy Dr Nunziatina De Tommasi, Italy Dr Marc De Meyere, Belgium Dr. Loes van Schie, Belgium Dr Amy Alpert, USA Dr Sergio Dagostino, Italy Dr Bruno Cigliano, Italy Prof Stefania Papa, Italy Dr Carla Ciccone, Italy Dr Filippo Bianchetti, Italy Dr Fabrizio Ricci, Italy Dr Taroub Khoury, Jordan Dr George Akijian, Jordan Dr Mae Al Ghawas, Canada Dr Aia Mohammed, Eire
Institute of Psychiatry, Psychology & Neuroscience, King's College
de Crespigny Rd London SE5 8BB