Below are two reports: the first compiled by Croakey gives an overview of current health issues in Gaza; and the second by Dr Sue Wareham OAM, president of the Medical Association for the Prevention of War, explores the ethical issues for health and medical organisations, urging colleagues to resist pressures to stay silent.
Wareham wrote yesterday to Foreign Affairs Minister Senator Penny Wong urging her to condemn the Israeli military’s storming of Gaza’s main hospital, the Al-Shifa hospital.
Meanwhile, the International Network for Epidemiology in Policy, representing a consortium of 24 epidemiological societies across the globe, released a detailed statement “condemning the attacks by Hamas and the taking of civilian hostages; the subsequent widespread, disproportionate, and indiscriminate attacks by Israel in Gaza; the blockade of food, water, energy, internet, and humanitarian aid by Israel to the civilians in Gaza; and the control of movement and denial or delay of adequate humanitarian corridors by Israel in Gaza”.
Calls to protect healthcare
Israel’s military incursion into Al-Shifa hospital in Gaza City is “totally unacceptable”, the Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, told a media briefing on 16 November.
“Hospitals are not battlegrounds,” he said. “We are extremely worried for the safety of staff and patients. Protecting them is paramount. WHO has lost contact with health workers at Al-Shifa. But one thing is clear: under international humanitarian law, health facilities, health workers, ambulances and patients must be safeguarded and protected against all acts of war.”
WHO has not received updates on the number of deaths or injuries in Gaza for the past three days, but only one quarter of Gaza’s hospitals are still functioning – 26 out of 36 hospitals are now closed, either due to damage, attacks or because they have run out of fuel.
Prior to the conflict there were around 3,500 hospital beds across Gaza; today there are an estimated 1,400. “Doctors and nurses are having to make impossible decisions on who lives, and who dies,” Dr Tedros said.
On 13 November, the UNFPA, UNICEF and WHO Regional Directors called for immediate action to halt attacks on healthcare in Gaza.
Over the past 36 days, WHO has recorded at least 137 attacks on healthcare in Gaza, resulting in 521 deaths and 686 injuries, including 16 deaths and 38 injuries of health workers on duty. “Attacks on medical facilities and civilians are unacceptable and are a violation of International Humanitarian and Human Rights Law and Conventions,” they said.
“The world cannot stand silent while hospitals, which should be safe havens, are transformed into scenes of death, devastation, and despair. Decisive international action is needed now to secure an immediate humanitarian ceasefire and prevent further loss of life, and preserve what’s left of the health care system in Gaza. Unimpeded, safe and sustained access is needed now to provide fuel, medical supplies and water for these lifesaving services. The violence must end now.”
Martin Griffiths, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, has called for international support for a 10-point plan to “rein in the carnage”.
“As the carnage in Gaza reaches new levels of horror every day, the world continues to watch in shock as hospitals come under fire, premature babies die, and an entire population is deprived of the basic means of survival,” he said in a statement on 15 November. “The world must act before it is too late.”
UNRWA condemned Israeli restrictions on fuel supplies, allowing it only to be used for transport and not for the overall humanitarian response, including for medical and water facilities or the work of the UNRWA.
“It is appalling that fuel continues to be used as a weapon of war,” UNRWA said in a statement on 15 November.
”By the end of today, around 70 percent of people in Gaza will not have clean water. Key services including water desalination plants, sewage treatments and hospitals have ceased to operate.”
After visiting the Gaza Strip on 15 November, UNICEF Executive Director Catherine Russell said that what she saw and heard was devastating, and that “there is nowhere safe for Gaza’s one million children to turn”.
“The parties to the conflict are committing grave violations against children; these include killing, maiming, abductions, attacks on schools and hospitals, and the denial of humanitarian access – all of which UNICEF condemns,” she said in a statement.
“In Gaza, more than 4,600 children have reportedly been killed, with nearly 9,000 reportedly injured. Many children are missing and believed buried under the rubble of collapsed buildings and homes, the tragic result of the use of explosive weapons in populated areas. Meanwhile, newborn babies who require specialised care have died in one of Gaza’s hospitals as power and medical supplies run out, and violence continues with indiscriminate effect.”
This week, the UN flag was lowered at agencies around the world to recognise the deaths of more than 100 staff members in Gaza, including school principals, teachers, health workers, including a gynaecologist and psychologist, engineers and support staff.
For more details, see this 14 November update from the United Nations Office for the Coordination of Humanitarian Affairs.
Sue Wareham writes:
Even as the moral abyss that is the war in Gaza seemed as if it could not deepen, it has. It is reported that about 100 medical doctors belonging to a group called ‘Doctors for the Rights of Israeli Soldiers’ signed a letter recently stating that it is an “obligation” for the army to target hospitals in Gaza allegedly used to shelter Hamas.
The Israeli doctors’ letter said “The residents of Gaza saw fit to turn hospitals into terrorist nests to take advantage of western morality, they are the ones who brought destruction upon themselves…attacking terrorist headquarters is the right and the duty of the Israeli army.”
This letter represents a flagrant rejection of the most fundamental ethics of the medical profession, namely our common humanity and commitment to the provision of health care, regardless of who needs it.
The Declaration of Geneva, also known as the ‘modern Hippocratic oath’, is one of the oldest policies of the World Medical Association, having been adopted in Geneva in September 1948. It states, in part, that:
“As a member of the medical profession:
I will maintain the utmost respect for human life;
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.”
Regardless of whether the Declaration is applied to individual doctor-patient relationships or more broadly to the provision and delivery of healthcare to communities, the intent is clear: healthcare must not be denied on the basis of nationality, race, background, ethnicity, culture, religion, beliefs or any other markers of identity.
Once we lose sight of our professional ethics that are intended to protect healthcare, including in times of war, we are on a very dark path.
While a small group of doctors in Israel are beckoning us down such a path, they do not reflect the many courageous and compelling voices for peace, including from within Israel. Among them, ‘Physicians for Human Rights Israel’ have issued an urgent “Call for a Ceasefire and an End to the Attacks against Hospitals in Gaza”.
There have been very many other calls from leading health and humanitarian organisations globally for an urgent ceasefire in this war, many of them reported in Croakey.
In Australia, a petition from healthcare workers to Prime Minister Albanese and Foreign Minister Wong, urging that they demand an immediate humanitarian ceasefire, has attracted nearly 35,000 signatures. It will be presented to federal parliament on Thursday November 16.
The calls for a ceasefire, however, even as we continue to witness an unprecedented health catastrophe unfolding in Gaza continue to be undermined, including from within the medical profession. Young Australian early-career doctors, with loved ones in Palestine, are feeling intimidated into silence and anonymity for opposing the bombing of hospitals in Gaza, fearful to speak out publicly lest they be reported to AHPRA as others have been (personal communications).
Such silencing of health professionals on a critical matter of healthcare and its protection is totally unacceptable. On the contrary, their actions should be supported, not suppressed.
In the USA, the ‘American Medical Association’ (AMA) recently refused to debate a resolution urging the association to support “a ceasefire in Israel and Palestine in order to protect civilian lives and healthcare personnel.” (See also here.)
Such a stance contrasts with its statements from March 2022 after Russia’s invasion of Ukraine, when the association’s president said “the Russian military targeting of health care facilities violates every standard of decency”, and he called for an end to the war. No reason has been given for the apparently different standards being applied.
On 21 October, the BMJ Global Health journal published an editorial which detailed the horrendous consequences of the ongoing conflict in Gaza for health and healthcare, drawing attention also to the historical context. Relentless calls for the journal’s editor-in-chief to step down followed.
Other apparent attempts to silence critics of the current Israeli-Palestinian war include Israel’s call for the sacking of UN Secretary General António Guterres, after Guterres drew attention to the historical context of Hamas’ attacks on Israeli civilians on October 7.
While we’ve heard many times of Israel’s “right to defend itself”, self-defence does not make the bombing of hospitals lawful or legitimate. Civilians are not suddenly rendered non-people, irrelevant or dispensable, simply on the basis of whether combatants might use the same building. (This also sets aside the important question of whether claims of hospitals harbouring Hamas fighters are all correct, such claims being easy to make but often impossible for independent observers to verify.)
On Tuesday, Francesca Albanese, the UN Special Rapporteur on the occupied Palestinian territories told the National Press Club that there was a need to work on the “re-humanisation of the discourse”.
She gave particular attention to the plight of children in Palestine, reminding us that “half of the Palestinian population under martial rule is made of children”. “I am saying this in the interest of both Palestinians and Israelis,” she added.
For health professionals, one would hope that there is no need to re-humanise any discourse. Our common humanity is fundamental to what we do.
Unfortunately, recent events have shown that we must be ever vigilant against attempts to suppress concern for human suffering and the need to prevent it. Health organisations must resist pressures to silence such concerns.
• Dr Sue Wareham OAM is President of the Medical Association for Prevention of War. This is an updated version of an article that first appeared at Pearls & Irritations.
Read the statement
Read the ANMJ article: Bombing hospitals, destroying ambulances and the ethics of (un)just war American Public Health Association Peace Caucus statement
Previously at Croakey
- 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”