Introduction by Croakey: As the Israeli Defence Force continues to attack civilians, healthcare facilities and humanitarian workers in Gaza, a recent panel discussion in Naarm/Melbourne highlighted the imperative for health professionals to advocate for human rights.
A report of the discussion follows below, and beneath it are updates from health and humanitarian agencies on the situation in Gaza, which is described as “beyond catastrophic”.
Meanwhile, as Israeli Prime Minister Benjamin Netanyahu’s address to the United States Congress on 24 July was met by both standing ovation and protest, Médecins Sans Frontières’ (MSF) issued a statement warning that “all states supporting Israel’s prosecution of this war are morally and politically complicit”.
Alison Barrett writes:
Health and medical organisations have been urged to take note of a statement released last month by emergency medicine and nursing organisations calling for an immediate and sustainable ceasefire to end the escalating health crisis in Gaza.
The statement was highlighted at an event in Naarm/Melbourne last week on human rights advocacy during times of conflict, which heard powerful calls urging healthcare professionals to lead the way on discussions about the atrocities in Gaza.
Signatories to the statement are the Australasian College for Emergency Medicine (ACEM) President Dr Stephen Gourley, College of Emergency Nursing Australasia (CENA) President Dr Wayne Varndell, New Zealand Nurses Organisation (NZNO) President Anne Daniels/ Kaiwhakahaere Kerri Nuku, and College of Emergency Nurses New Zealand (CENNZ) Chairperson Lauren Miller.
“I hope that that statement can be meaningful for other medical organisations, and help other medical organisations get to a position where they can also understand that silence is also a political act,” said Dr Natalie Thurtle, emergency physician and former Médecins Sans Frontières coordinator for Palestine.
Thurtle believes many medical organisations and healthcare professionals have “addressed this difficult matter by being silent”, which she said was not a neutral stance.
“As doctors we are generally privileged, highly educated, schooled in critical thinking, powerful people, and we therefore have more of a burden on us to be able to talk about difficult things than people who are in a much more vulnerable position,” she told the Network of Women in Emergency Medicine event.
“I think that we have responsibilities to healthcare worker colleagues in places where they cannot speak for themselves or the speaking that they do for themselves is ignored or not valued as communication.
“We should not ignore it. That is not acceptable. And it’s certainly not acceptable for me as someone who is a witness to this conflict.”
However, Thurtle added that she is not surprised by the silence. Organisations have to negotiate many different members saying different things, financial risks including grant and government funding, and concerns about reputational damage.
While “genuinely difficult things”, they are all navigable, Thurtle said.
It is also important to remember that colleges are not “faceless institutions” – people in medical colleges have fears and responsibilities as everyone does. She called on the audience to support their colleges and associations in getting statements like this over the line.
The event in Naarm/Melbourne was held just two days before the International Court of Justice (ICJ) determined that Israel’s occupation of Palestinian Territory is unlawful and that it is obligated to bring an end to its “unlawful presence” rapidly. In addition, the ICJ urged United Nations members and other international organisations to put pressure on Israel to leave.
The Melbourne event included a screening of Thurtle’s cancelled keynote presentation to last years’ ACEM annual scientific meeting. A panel discussion about “conflict, humanitarian aid and difficult conversations” in healthcare was moderated by neurosurgeon Dr Ruth Mitchell, with physician Dr Sarah Abdo, emergency physician Dr Kristin Boyle, and human rights and discrimination lawyer Rita Jabri Markwell.
Professional responsibility
While acknowledging conversations about the ongoing conflict in Gaza can be challenging, the panel of experts agreed it is the professional responsibility of healthcare workers to speak up.
The media also needs to do a better job in enabling the environment for the important and nuanced conversations required.
Abdo said one of the fundamental barriers for holding conversations about Gaza is the framing of the story – “we’ve already been told; these are the two groups. You’re either on this side or that side”.
But you cannot frame this issue with a group mentality, she said. “Not everybody in a group is good, and not everybody in a group is bad.”
The environment and structures have not been provided to enable effective communication on the topic, according to Abdo. News on hospital bombings in Gaza, for example, is not in the headlines.
She said the second challenge is that “if you do speak, you suffer the consequences”.
Mitchell said we have to “acknowledge and recognise that active silencing has occurred”, whether it be in the form of colleagues being doxed, or medical students and residents being warned about future job prospects if they speak up. (See also this letter to University of Melbourne on active silencing of students).
From a legal perspective, Jabri Markwell said that while it is against the law to incite hatred toward a group of people on the basis of race or religion, health advocacy is “absolutely essential” in terms of human rights and freedom of speech rights.
Health professionals have a responsibility to engage in health advocacy, she said. “Without health advocacy…international human rights will have no future. It just can’t be achieved across the board for all peoples without health advocacy.”
With their power, expertise and credibility, doctors can play an important role in advocating for governments to impose sanctions on Israel, Jabri Markwell said.
“You just need to have courage in this moment because people are dying, and they won’t…stop dying without more people speaking up,” she said.
Boyle told the audience that she begins conversations from a neutral starting point – “there’s no sides, it’s not a football game”.
“This is about healthcare. This is about human rights,” she said.
Abdo said healthcare professionals should be looking at the evidence, as well as respecting colleagues with lived experience.
“We just need a chance to look at the evidence, present the evidence and have respectful conversations,” she said.
Thurtle said creating space for these conversations is important – there are many different opinions, as well as different types of advocacy.
Working under pressure
As well as creating space for important conversations, Thurtle’s keynote highlighted the importance of creating space for intense emotions – it’s OK to “ugly cry” during extreme times, she said.
She said the hardest thing that she was hearing in October last year was “how the majority of the world was denying, dehumanising, othering and erasing” what was happening in Gaza.
Reflecting on her experiences working in emergency medicine including in the Middle East and the 2021-22 Gaza conflict, Thurtle said that following experiences with war, trauma and other extreme occupational trauma, she has noticed post-traumatic growth.
For Thurtle, this displayed itself as a clarity of human purpose during periods of exposure to high occupational trauma.
On advice for working under pressure, she suggested working within one’s sphere of control, asking “what can be done in this moment?”, accept and regulate emotions, hold your team close and prioritise patients.
She acknowledged this comes from a very privileged lens. For her colleagues in Palestine, “there is no opportunity for post traumatic growth” – the occupational trauma is ongoing.
Titled ‘Every storm runs out of rain’, Thurtle’s presentation was pre-recorded prior to going back to Palestine with the Médecins Sans Frontières last year. A few days before ACEM’s meeting, Thurtle said ACEM informed her they would be cancelling the talk as it was “too political”. In a statement, ACEM said the decision was made in accordance with legal advice provided to ACEM CEO Emily Wooden.
Thurtle told the audience last week she has been involved in ongoing conversations with the College and is grateful for its recent statement calling for a ceasefire in Gaza.
Updates
MSF statement, 24 July
- There are no safe places in Gaza.
- People are dying because medical and humanitarian aid is being blocked.
- Hospitals, health workers, and humanitarians are under attack.
- All states supporting Israel’s prosecution of this war are morally and politically complicit.
- We need an immediate and sustained ceasefire.
UNICEF statement, 24 July
With each passing week, children and families face new horrors in the Gaza Strip. The devastating attacks on schools and internally displaced sites continue, reportedly killing hundreds more Palestinians, many of them women and children, and leaving already overwhelmed hospitals buckling under the strain.
We see children who withstood previous injuries only to be hurt again. Doctors and nurses with no resources, struggling to save lives. Thousands of boys and girls sick, hungry, injured, or separated from their families. The violence and deprivation are leaving permanent scars on their vulnerable bodies and minds. And now, with a breakdown in sanitation and sewage treatment, the polio virus joins the list of threats, especially for the thousands of unvaccinated children.
As families are repeatedly forced to move to escape the immediate violence, the humanitarian situation is beyond catastrophic.
Humanitarian agencies, including UNICEF, are doing everything we can to respond, but the dire situation and attacks against humanitarian personnel continue to obstruct our efforts. Just yesterday, a clearly marked UNICEF vehicle was hit by bullets while waiting at a designated holding point near the Wadi Gaza checkpoint. It was one of two vehicles on the way to pick up five young children to reunite them with their father after their mother was killed. Fortunately, no one was injured, and the team managed to reunite the family. Yet in this incident, like others before it, the humanitarian consequences could have been horrific, for the children we serve, and for our teams.
Simply put – we do not have the necessary conditions in the Gaza Strip for a robust humanitarian response. The flow of aid must be unimpeded and access must be regular and safe.
For almost nine months, aid has trickled into Gaza. Civilians have been deprived of supplies. The commercial sector has been decimated. This has led to growing competition for what little is available, the smuggling of goods into the Gaza Strip, and now the increasingly organized looting of aid supplies. This not only impedes our efforts to reach vulnerable families but puts our teams and the civilians we are supporting at risk.
The challenge is exacerbated by the operating conditions on the ground. At least 278 aid workers in the Gaza Strip have already been killed – a record number – while others are put in harm’s way, or prevented from doing their jobs.
We need an immediate improved security environment, including security for aid delivery trucks, to allow aid workers to safely reach the communities they intend to serve.
Most critically, we need an immediate and sustainable ceasefire. We call on all parties to this conflict to respect their obligations under international humanitarian law. They must protect civilians and the infrastructure they rely on. This includes ensuring civilians receive the essentials they need to survive – food, water, nutrition treatment, shelter, and healthcare – through safe and unimpeded humanitarian operations.
https://x.com/RnaudBertrand/status/1815494340635963690
Also see a statement by The Elders on 24 July urging world leaders to end Israel’s unlawful occupation of Palestinian territory.
“World leaders now need to make it clear whether they believe in the rule of law or not. The people of the world are watching, waiting and willing justice to prevail,” says the statement.
Signatories include Mary Robinson, former President of Ireland and Chair of The Elders; Ban Ki-moon, former UN Secretary-General and Deputy Chair of The Elders; Graça Machel, Founder of the Graça Machel Trust, Co-founder and Deputy Chair of The Elders ; Gro Harlem Brundtland, former Prime Minister of Norway and former Director-General of the WHO; and Helen Clark, former Prime Minister of New Zealand and former head of the UN Development Programme.
Previously at Croakey
- Polio in Gaza: what does this mean for the region and the world?
- Health leaders call for University of Melbourne to drop disciplinary action against students
- Famine declared as full Gaza toll now estimated at 186,000
- Gaza really is hell on earth: heat and water shortages add to the unbearable toll
- New reports document an “unconscionable level of death and suffering” among children and civilians in Gaza
- Counting the environmental toll of war – and why peace is a climate solution
- Protecting healthcare from the violence of war must become a public health priority
- From Gaza: “We did not have time to bury them”
- Urgent calls for Gaza aid crossings to reopen as humanitarian access disintegrates
- Doctors call for greater pressure on Israel over Gaza
- Calls to stop the siege of Gaza, halt the arms supply, and end the health sector’s silence
- Gaza medical staff working under ‘profound psychological strain’ as further threats loom
- World medical leaders call for Gaza ceasefire amid mass graves horror
- New publication documents the terrible toll on women in Gaza
- “Silence becomes complicity”: MPs and other health professionals urged to take stand on Gaza
- “The question is no longer whether Palestinians will starve to death in a famine, but how many will do so”
- World leaders put on notice over Gaza, amid “war on children”
- As children starve to death in Gaza, health and medical academics urge colleagues to speak up
- Australian academics call on their universities to demand ceasefire, amid fears about famine, disease and scholasticide in Gaza
- “To those speaking out for the people of Gaza – thank you for not looking the other way”: Dr Sophie Scamps
- As Australia and other countries put pressure on Israel, health and medical organisations describe horrific conditions in Gaza
- As humanitarian nightmare escalates in Gaza, and the world enters “an age of chaos”, we must work harder for peace
- As global leaders and aid groups speak up about “catastrophic crisis” in Gaza, health professionals are under pressure to remain silent
- Health workers and agencies document the war’s wide-ranging impacts on people in Gaza
- From Gaza: finding words for the unimaginable
- Health leaders join growing calls for permanent ceasefire in Gaza and Israel
- As the people in Gaza experience a “living hell”, medical and humanitarian leaders step up pressure for a permanent ceasefire
- This doctor is urging medical leadership on ceasefire in Gaza and Israel, as United Nations warns of threat to global security
- Amid catastrophic health threats in Gaza, health leaders urge a permanent ceasefire
- Amid ongoing health catastrophe in Gaza, why the silence?
- As Gaza hospitals become “scenes of death, devastation, and despair”, global community urged to act for peace
- Doctors who work with refugees urge medical organisations to speak up for a ceasefire in Gaza
- “Worse every day”: toll mounts in Gaza, including for children and health workers
- “This cannot go on” – a cry for an end to intolerable suffering
- Medical organisation publishes open letter expressing “extreme concern” at Australia’s failure to support ceasefire in Gaza
- Health sector urged to speak out for ceasefire in Gaza
- Calls for ceasefire amid catastrophe in Gaza – “every child everywhere deserves peace”
