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Rapid response to:

News

Gaza: Israeli airstrikes kill doctors and damage healthcare facilities

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1300 (Published 20 May 2021) Cite this as: BMJ 2021;373:n1300

Rapid Response:

A call on academics and humanitarian workers to speak up for a Palestinian right to health and an end to the Israeli military occupation

Dear Editor

Since April, Israeli forces have used (1) rubber-coated steel bullets, beatings, tear gas and sound grenades against Palestinians in East Jerusalem resisting attempts to expel them from their homes. In May, we watched for 11 days as Israeli authorities launched airstrikes on Gaza’s infrastructure (2)--high-rises, power plants, telephone towers, press offices, roads, agricultural lands, schools and mosques. In return, Hamas forces in Gaza fired indiscriminate rockets into civilian areas in Israel, a violation of international law. The numbers of casualties (3) escalated rapidly, killing 256 Palestinians (among them 66 children) and 13 Israelis (including two children). These events were consistent with long-standing Israeli actions, fueled by U.S. government aid, a timid European response, and collusion by a number of Arab countries. Recent conflicts in Myanmar and Tigray, and continued wars in Syria, Afghanistan, Yemen and elsewhere have also been accompanied by vicious assaults on health care, including, in Myanmar, occupation of hospitals and arrests of health workers.

Our call to action is connected with our association with the Global Alliance on War, Conflict and Health, a burgeoning movement among academic health, humanitarian and conflict researchers, practitioners and advocates. We seek to put war, violence against health care, settler colonialism, apartheid (4) and occupation, wherever it occurs, on the global health agenda. Nowhere is this agenda more urgent today than in a setting such as the occupied Palestinian territory.

The military attacks on health (5) and civilian infrastructures are especially egregious; the World Medical Association and the American Public Health Association, among many other health organizations, have established policy (6) opposing such attacks as they violate International Humanitarian Law and Geneva Conventions. The BMJ has reported (7) on damage done by Israeli airstrikes to six hospitals, nine primary health care centres, and a desalination plant supplying clean water to 250 000 people; further, Gaza’s main COVID-19 laboratory and the Palestinian Ministry of Health offices were hit, and two prominent doctors were killed. Palestinian Health Work Committee headquarters have been raided (8) in recent days by Israeli Occupying Forces, and the general director arrested (9) at her home in Ramallah.

We stand with a growing number of health, humanitarian and human rights organizations and academic platforms, including the British Medical Association (10), Human Rights Watch (11), Physicians for Human Rights (12), Physicians for Human Rights Israel (12), Physicians for Human Rights Israel (13), Médecins Sans Frontières (14), ICRC (15), People’s Health Movement (16), Palestine Mental Health Network (17), Medical Aid for Palestinians (18), and signatories to a Scientific American letter (19) and the Scholars for Palestinian Freedom (20), among many others, in condemning the violence and calling for end to the recurring cycle of violence.

Researchers, especially those in health and humanitarian fields, carry a responsibility to amplify the voices of those experiencing the lived burden of wars and armed conflicts, while upholding the values of justice and accountability. It is not enough to simply characterize the suffering--we must also work to prevent and mitigate the harms of war.

Until now, the role of humanitarian and public health workers has largely been limited to heroically sustaining essential services (21) in chaotic settings, and post-carnage cleanup. The limitations of humanitarian service in Gaza Strip are captured in the words of MSF medical coordinator Dr. Natalie Thurtle (22) in Jerusalem May 13, 2021: “After each war, each ‘escalation’, each wave of protests, we treat people who have been injured by the Israeli armed forces in our clinics and hospitals…Yet every few years (we are) called on to deal with a huge influx of wounded: 11,000 injured during the 2014 war; more than 7,000 shot during protests in 2018 and 2019; and now already hundreds injured in bombings and dozens dead since Monday.”

The academic and practitioner community must step up, collect the evidence and speak out against the Israeli and other governments that assault health care while erasing populations through blockade, displacement, humiliation, and assault. Particularly in Israel, one of the world’s most powerful and well-funded militaries is battling an indigenous population of Palestinians that has been occupied, dispossessed, displaced, and exiled for decades.

It is our role to document the health effects of food shortages, stifling overcrowding, contaminated water, health service shortages, near-constant electrical outages, crippling poverty, endemic unemployment, fear and despair. We have a responsibility to ask questions, to challenge silence and to reflect on our own moral and ethical duties as researchers. We must also speak out for the longer-term structural changes required to prevent more harm: dismantling the occupation, creating democratic institutions that fairly distribute power and resources, and ending racist policies.

Note about authors: The authors are members of the Steering Group of the Global Alliance on War, Conflict & Health but this piece represent their views and not necessarily the Global Alliance or its Steering Group:

• Amy Hagopian, Professor, University of Washington School of Public Health, Seattle, Washington, USA
• Rita H Giacaman, Professor of public health at the Institute of Community and Public Health, Birzeit University, West Bank, Palestine
• Marian Abouzeid, Senior Research Fellow, Alfred Deakin Institute for Citizenship and Globalisation, Melbourne, Australia
• Karl Blanchet, Professor and Director, Université de Genève’s Geneva Centre of Humanitarian Studies, Geneva, Switzerland
• Marion Birch, Editor, Medicine, Conflict and Survival Journal, Taylor & Francis, London UK.
• Natasha Howard, Associate Professor, National University of Singapore Saw Swee Hock School of Public Health, Singapore
• David McCoy, Professor of Global Public Health at the Centre for Primary Care and Public Health at Queen Mary University of London, England
• Christopher Garimoi Orach, Professor, Department of Community Health and Behavioural Science, Makerere University School of Public Health, Kampala, Uganda
• Leonard Rubenstein, Professor of the Practice, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
• Sameen Siddiqi, Professor and Chair, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
• Samer Jabbour, Professor of Public Health Practice, Faculty of Health Sciences, American University of Beirut, Lebanon

REFERENCES
1. Medical Aid for Palestine (MAP) provides emergency aid for Palestinian hospitals in East Jerusalem, 28 June 2021. https://www.map.org.uk/news/archive/post/1260-map-provides-emergency-aid...
2. World Health Organization, Issue 2 on Escalation in Occupied Palestinian Territory, 17 May 2021. https://reliefweb.int/sites/reliefweb.int/files/resources/WHO_oPt_flash_...
3. United Nations Office for the Coordination of Humanitarian Affairs, Response to the escalation in the oPt | Situation Report No. 2, 28 May - 3 June 2021. https://www.ochaopt.org/content/response-escalation-opt-situation-report...
4. Human Rights Watch, A Threshold Crossed—Israeli Authorities and the Crimes of Apartheid and Persecution, 27 April 2021. https://www.hrw.org/report/2021/04/27/threshold-crossed/israeli-authorit...
5. Trew, B. Independent. Gaza medical services impacted after Israeli airstrikes damage clinics and hospitals, say health officials, 16 May 2021. https://www.independent.co.uk/news/world/middle-east/gaza-israel-airstri...
6. American Public Health Association, A Call to End Violent Attacks on Health Workers and Health Facilities in War and Armed Conflict Settings, 5 November 2019. https://www.apha.org/policies-and-advocacy/public-health-policy-statemen...
7. BMJ 2021;373:n1300, http://dx.doi.org/10.1136/bmj.n1300, Published 20 May 2021.
8 Jyotsna Sing, People’s Health Movement, Condemn the Attack on Palestinian Health Work Committees, 11 June 2021. https://phmovement.org/condemn-the-attack-on-palestinian-health-work-com...
9. Palestinian Centre for Human Rights, Shrinking Palestinian Civic Space: IOF Close UAWC and Arrest UHWC General Director, 7 July 2021. https://www.pchrgaza.org/en/shrinking-palestinian-civic-space-iof-close-...
10. British Medical Association, Statement of solidarity with Myanmar, 27 April 2021. https://www.bma.org.uk/news-and-opinion/statement-of-solidarity-with-mya...
11. Human Rights Watch, UN Security Council Needs to Act on Ethiopia’s Tigray Region, 15 April 2021. https://www.hrw.org/news/2021/04/15/un-security-council-needs-act-ethiop...
12. Physicians for Human Rights, Myanmar Military Must Cease Occupation of Hospitals and Excessive Force Against Civilians, 7 March 2021. https://phr.org/news/myanmar-military-must-cease-occupation-of-hospitals...
13. Physicians for Human Rights – Israel, These Days While the Country is Burning, 12 May 2021. https://www.phr.org.il/en/these-days-while-the-country-is-burning/
14. Medecins Sans Frontieres, Heavy bombing by Israel is causing a catastrophic situation in Gaza, 13 May 2021. https://www.doctorswithoutborders.org/what-we-do/news-stories/news/heavy...
15. International Committee of the Red Cross, Israel and the occupied territories: Hostilities between Gaza and Israel must stop and much-needed humanitarian activities must start now, 16 May 2021. https://www.icrc.org/en/document/israel-and-occupied-territory-hostiliti...
16. People’s Health Movement Statement of Solidarity with People of Palestine, 19 May 2021. https://phmovement.org/statement-of-solidarity-with-people-of-palestine/
17. Palestine-Global Mental Health Network, A statement addressing the escalation and resistance of colonial violence, 15 May 2021. https://www.pgmhn.org/announcement/a-statement-addressing-the-escalation...
18. Medical Aid for Palestine (MAP), Palestine emergency situation updates, 18 June 2021. https://www.map.org.uk/about-map/-palestine-emergency-updates
19. Alser O, El-Taher A, Rimawi A, Akhter S, Ameenuddin N, Chukka A, Hussein Q, Leyva B. As Health Care Workers, We Stand in Solidarity with Palestine. Scientific American, 2 June 2021.
Palestine https://drive.google.com/file/d/15Lh5bu2TpT5WT_bESMz5R7zufkm0F4Ky/view
20. Palestine and Praxis: Open letter and call to action. Scholars for Palestinian Freedom sign-on letter, 2021. https://palestineandpraxis.weebly.com/
21. Bseiso J and Whittall J. The disease of settler colonialism and apartheid. Aljazeera opinion, 17 May 2021. https://www.aljazeera.com/opinions/2021/5/17/the-malady-of-settler-colon...
22. Heavy bombing by Israel is causing a catastrophic situation in Gaza, Medecins Sans Frontieres, May 13, 2021. https://www.doctorswithoutborders.org/what-we-do/news-stories/news/heavy...

Competing interests: No competing interests

09 July 2021
Amy Hagopian
Professor
Rita Giacaman, Marian Abouzeid, Karl Blanchet, Marion Birch, Natasha Howard, David McCoy, Christopher Garimoi Orach, Leonard Rubenstein, Sameen Siddiqi, Samer Jabbour
University of Washington
Box 357660 Seattle WA 98195