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Amid ongoing health catastrophe in Gaza, why the silence?

Introduction by Croakey: Global health agencies and leaders have been loudly calling for ceasefire in Gaza for several weeks now, sounding the alarm about the extreme toll on civilians, health services, and health and humanitarian workers.

According to a UNICEF briefing on 22 November, more than 5,350 Palestinian children have reportedly been killed, although hundreds of thousands more remain in grave jeopardy from dangerous sanitary and living conditions, with inadequate health and support services.

Yet many health and medical organisations in Australia have remained silent in the face of World Health Organization pleas for “collective efforts to bring an end to the hostilities and humanitarian catastrophe in Gaza”.


Alison Barrett writes:

Catastrophic health threats to people in Gaza will continue despite the pause in fighting that has been agreed between Israel and Hamas, with children especially vulnerable to the risks of infectious diseases.

Nor will the four-day pause be sufficient to salvage devastated health facilities; the World Health Organization (WHO) and other agencies are maintaining calls for a sustained ceasefire.

The Indonesian Hospital in North Gaza was attacked on Monday resulting in at least 12 deaths and multiple injuries, according to a report by the World Health Organization Eastern Mediterranean Region.

The hospital is able only to provide basic services due to a lack of fuel, and severe water and medicine shortages, putting the lives of those with injuries and other medical emergencies at risk, according to a WHO statement on 20 November.

“Health workers and civilians should never have to be exposed to such horror, and especially while inside a hospital,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said on X/Twitter.

Tedros also expressed his personal devastation at the death of a WHO colleague, Dima Abdullatif Mohammed Alhaj, 29. She was killed alongside her baby, husband and other family members when her parents’ house in southern Gaza was bombed. She had evacuated there from Gaza City.

“I have no words to describe our grief,” he said.

Médecins Sans Frontières/Doctors Without Borders reported that two MSF doctors, Dr Mahmoud Abu Njuaila and Dr Ahmad Al Sahar, and a third doctor, Dr Ziad Al-Tatari,  were killed on Tuesday during a strike on Al Awda Hospital, one of the last remaining functional hospitals in Northern Gaza. Other medical staff including MSF staff were severely injured.

Jennifer Tierney, Executive Director of Médecins Sans Frontières Australia, told Croakey that MSF condemns “this strike in the strongest terms and yet again call for the respect and protection of medical facilities, staff and patients”.

“MSF has regularly shared information about Al Awda as a functioning hospital and the presence of its staff in Al Awda to warring parties.”

Tierney said MSF is calling for an “immediate ceasefire for all warring parties. This means no attacks on hospitals in Israel or Gaza”.

Australian emergency physician Dr Natalie Thurtle – who is currently providing humanitarian relief with MSF – said on Twitter on 22 November, following the attack:

“The situation is deteriorating daily. The injured cannot evacuate because of non-stop fighting. We need a ceasefire now.”

WHO tweet dated 22 November, 2023

College under pressure

Meanwhile, the Australasian College for Emergency Medicine has been criticised on social media and accused of censorship, after cancelling Thurtle’s pre-recorded keynote address at this week’s Annual Scientific Meeting, whose theme is ‘ACTion under pressure’.

According to an open letter to ACEM CEO Emily Wooden and Board, Thurtle was scheduled to deliver a keynote on people under pressure, and a second talk on Australia’s offshore refugee population.

The letter called for ACEM to return a platform for “Dr Thurtle to present virtually on both topics without censorship”.

ACEM issued a statement on 20 November stating: “The College is concerned that airing the presentation at this conference may inflame deeply felt sentiments from all sides, on what are already complex and incredibly distressing international events”.

The College said: “While ACEM does take an active interest in social and political factors that directly impact on presentations to emergency departments in Australia and Aotearoa New Zealand, it does not have the expertise to take, or promote, public positions on international conflicts. The College also does not offer commentary on international matters, outside its formal global emergency care partnerships.”

Following sustained criticism of its decision, ACEM updated the statement on 22 November, saying the decision was made by the ACEM board, in accord with legal advice provided to ACEM CEO Emily Wooden.

“The decision not to host the video was not an implicit alignment with any perspective, nor an indication of an absence of support for any perspective,” it said.

“No person who dedicates their lives to providing healthcare to people, or assisting those who do, supports the harm of innocent people, or the destruction of healthcare facilities.

“It is vital that the decision made by the Board is not personally attributed to ACEM President Dr Stephen Gourley, Immediate Past President Dr Clare Skinner, other ACEM officeholders or College staff.

“It is also important that feedback on this decision is not personally directed at these individuals. Since the decision was made public on Monday, Dr Gourley and Dr Skinner – and their loved ones­ – have received ongoing personal attacks and disturbing messages via various channels, and in-person.”

Regrettable

Former Australian Medical Association Vice President Dr Stephen Parnis told Croakey the outcome was regrettable.

“I had hoped a compromise would be reached where the vast majority of Dr Thurtle’s presentation could have been shown. Keynote speakers are invited to express expert opinions, not to please an interest group or toe a collective line. A keynote speaker is not a college spokesperson.”

Parnis told Croakey he has seen the recording and “regards it as highly relevant to the theme of this week’s meeting”.

“I hold Dr Thurtle, and my colleagues in the leadership of ACEM in the highest regard. I can only speculate as to the reasons for the ACEM acting in such an unprecedented way,” he said.

The ACEM imbroglio raises questions about the role of Australian health and medical organisations in speaking up publicly on conflicts and humanitarian disasters.

Around the world many health and medical leaders, including WHO Director-General Dr Tedros Adhanom Ghebreyesus, have repeatedly called for a ceasefire in Gaza, an end to Israel’s attacks on health facilities, and the release of hostages held by Hamas.

However, it seems that many health and medical organisations in Australia have not spoken up publicly, although some individual health professionals and doctors are calling for them to support a ceasefire and to urge the Australian Government to do more to promote peace-making (see previous Croakey stories here and here).

Dr Hina Shahid and Professor Paul Wallace from the Foundation for Family Medicine in Palestine, Sheffield UK, recently wrote in the BMJ that “as healthcare professionals committed to principles of dignity, compassion, respect for life and alleviating human suffering, we should be at the forefront of these discussions”.

The conflict in Gaza transcends faith, race and nationality – “we need to have the moral courage to rise above divisive identity politics and polarising narratives to recognise our shared human values and hold space for each other”, Shahid and Wallace wrote.

Vital discussions

This is a view shared by Dr Sue Wareham, National President of Medical Association for Prevention of War, who told Croakey that health and medical organisations should definitely be speaking up.

“We are witnessing the virtual destruction of a whole healthcare system in Gaza by military attack, along with the simultaneous blocking of everything that healthcare – and life itself – needs,” she said.

“To portray the situation – as some have – as being too ‘political’ is to allow health professions to be driven by politics, rather than by the protection of human health and welfare.

“It means the loudest and most powerful voices will succeed in silencing vital discussions about human welfare and healthcare.”

Wareham said another reason for healthcare organisations to speak up now is to “support the desperate efforts of all our professional colleagues who are working in the midst of this catastrophe. Their stories must be reported, not censored”.

Similarly, Parnis told Croakey that health professions have an “ethical imperative to speak on humanitarian issues”.

“The caring professions are often those best placed to highlight the plight and needs of those who are suffering, and to do so without fear or favour. Its value only increases when conflict results in lies being promulgated by the belligerents to secure advantage”.

He told Croakey there has been a long tradition of respecting those who provide care – even during conflict – and enshrined in international covenants including the Geneva Conventions.

With that comes responsibility, Parnis said: “To put the interests of the suffering person or populations over self-interest, to critically appraise evidence and to not cause harm in the process”.

“Many of us who take this obligation seriously are accused of straying into the realm of politics. But this is nothing new,” he said.

Parnis added in regard to the Israel-Palestine situation that “the cycle of violence and the creation and exacerbation of trauma reverberates around the globe”.

“If we deny ourselves careful measured discussion on the most contentious of topics – and emergency physicians ARE capable of extreme care in our communication, and do so every day – then we, and the communities we serve are diminished.”

Tierney from MSF told Croakey that while the organisation recognises the “complexity of the conflict,” and that it can be challenging for people and organisations to “publicly position themselves and still appear neutral and focused on people’s right to health and medicine alone”, speaking up “can and must be done”.

“If leaders in the health sector and beyond don’t speak up about the indiscriminate nature of the attacks, how do we protect people caught in conflict and those delivering medical aid in the next conflict, and the next?

“It becomes impossible and the protections for patients enshrined in International Humanitarian Law become obsolete,” Tierney said.

She told Croakey that people in Gaza are “dying in huge numbers and in horrific ways due to the unrelenting bombing of this small, enclosed territory”, the health system has collapsed, and hospitals and ambulances are under attack.

Tierney said the MSF does not work in Israel, despite their offers to do so, as it has a strong and capable medical and emergency system in place – which is not the case in Gaza.

The MSF teams in Gaza over the last six weeks have “witnessed and experienced indiscriminate bombings and attacks on hospitals, medical facilities and medical staff”, Tierney told Croakey.

Disappointed

Wareham said MAPW is disappointed by silence from Australian health and medical organisations.

“We realise that organisations in Australia don’t all have the capacity to respond to every attack on healthcare in warfare, and nor is it their purpose, but what we’re seeing in Gaza is unprecedented and is setting a dramatically and dangerously reduced standard of respect for healthcare.

“We cannot stand by silently while this happens. In fact, we are being begged to speak up by the UN, the ICRC, by our colleagues on the ground.

“If the repeated destruction of hospitals, and the deprivation of food and water to civilians, are not worthy of condemnation by health professionals, then we’ve really lost sight of what our professions are all about.”

Croakey asked Australian health and medical organisations for their views on public statements in humanitarian crises and whether they had issued one in relation to the Gaza-Israel conflict. At time of publication we had not heard from the Royal Australasian College of Physicians, the Royal Australian College of Surgeons, or the Royal Australian College of General Practitioners.

RANZCOG said they didn’t wish to comment, although they published a statement calling for protection of civilians and healthcare on 23 October 2023.

The Australian Medical Association published a statement on 31 October 2023 calling for healthcare personnel and facilities to be protected.

AMA President Professor Steve Robson said that the “AMA supports many of the World Medical Association’s policies in relation to armed conflicts” including that all parties involved in the conflict must:

  • respect established International Humanitarian Law (IHL) and not use health facilities as military quarters or depots, nor to target health personnel facilities and vehicles
  • provide to health personnel the adequate conditions to treat all patients with humanity and in compliance with the ethical values of their professions, including medical neutrality
  • use humanitarian corridors to permit the safe provision of health equipment and humanitarian supplies required in Gaza.

Similarly, the Public Health Association of Australia said they are “active members of the World Federation of Public Health Associations, which as an international body, offers a global perspective on the conflict”.

Read the four most recent statements by WFPHA on the Gaza-Israel conflict: