On Gaza, the silences, and the inadequacy of words

Melissa Sweet
Safiyyah Abbas
Thursday, May 23, 2024

Trauma, Conflict and war, Global health, WHO, Australian Medical Association, Hospitals

Introduction by Croakey: “What is happening in Gaza cannot be fully described in words.” So wrote Dr Muhammad Abu Salmiya in a “brief correspondence” to The Lancet, published on 15 May.

His article lists the large numbers of deaths of Palestinian children, healthcare workers and other civilians, the displacement of more than 85 percent of the population, and the destruction of infrastructure and educational and cultural sites. He also describes the targeting of civilians by the Israeli military.

“This brief Correspondence is a plea to every human being to help stop this genocide right now – we cannot live like this; the world should not be silent about the killing of civilians in the thousands,” he writes.

The Lancet lists his employment as director of the Al-Shifa Hospital, which was once the largest and most important referral hospital in Gaza but is now in ruins. Mass graves were found after the Israeli Defence Forces withdrew some weeks ago.

Writing for Aljazeera on 15 May, Dr Bahzad al Akhras, a Palestinian doctor and health policy researcher in Gaza, explains powerfully why Gaza lost much more than a hospital when it lost Al-Shifa.

“Its destruction was an indescribable loss,” he said. “For members of the healthcare community, Al-Shifa was home – it was where we trained, conducted research and learned. It was where we found the inspiration to become the best healers we could possibly be.”

Despite the difficulty of fully conveying the reality of life and death in Gaza in words, the voices of medical and other healthcare professionals have been important in describing the human and health impacts of the war in Gaza, to encourage a continuing focus on the need for ceasefire and accountability.

Organisations like the Medical Association for the Prevention of War, Médecins Sans Frontières (MSF), the World Health Organization and other humanitarian groups and agencies have also worked hard on this front.

Next Tuesday (28 May), the International President of MSF, Dr Christos Christou, accompanied by MSF Australia Executive Director Jennifer Tierney, is due to address the National Press Club. It will be interesting to see who attends from Canberra’s health and medical lobby groups, and the questions that are asked.

Last week, the Australian Medical Association wrote to Prime Minister Anthony Albanese urging the Australian Government to support the recommendations outlined in the World Medical Association’s Council Resolution on the Protection of Healthcare in Israel and Gaza.

According to Dr Safiyyah Abbas, a paediatric rehabilitation and general paediatrics trainee, the AMA’s letter did not go far enough.

Abbas, who has been advocating for the AMA and other medical organisations to take stronger action, writes below they must demand real political and military pressure from Australia to end Israel’s assaults on civilians and healthcare in Palestine.

Safiyyah Abbas writes:

The world has witnessed seven months of humanitarian catastrophe in Gaza. Each day brings fresh horrors of violence, suffering, and death upon innocent people, with no reprieve from the previous day’s grief.

James Elder, UNICEF Global Spokesperson, has called Gaza “the most dangerous place in the world to be a child”. United Nations (UN) Special Rapporteur, Francesca Albanese, has concluded that Israel’s actions meet the threshold for the crime of genocide.

Global health and humanitarian organisations – including the World Health Organization (WHO), UN, and Médecins Sans Frontières (MSF) – have been vocal in calling for an immediate ceasefire, unfettered entry of humanitarian aid, and protection of healthcare under international humanitarian law since October 2023.

One would expect attacks on healthcare, at the very least, to galvanise the medical community into action; yet Australian medical leadership’s efforts to this end remain grossly inadequate.

A timeline

The Australian Medical Association (AMA) has published statements regarding Israel and Gaza in line with the World Medical Association (WMA). WMA’s leadership includes representatives from Israel and its strongest ally, the United States, but its membership does not include Palestine.

Whether or not WMA policy has been unduly influenced by political pressures, it is deeply regrettable that whilst WMA rightly condemned Hamas’ attack on Israeli civilians on October 7, 2023, they have made no similar condemnation of Israel’s attacks on Palestinian civilians, healthcare workers, and hospitals, nor its blockade of medical supplies and humanitarian aid in Gaza.

In April, the WMA passed a resolution saying it was “gravely concerned by the deepening healthcare and humanitarian crisis in Gaza, the growing starvation and the lack of medical care and deeply concerned about the continued imprisonment and abuse of hostages.” WMA’s resolution called for a “bilateral, negotiated and sustainable ceasefire”, a motion put forward by the British Medical Association (BMA).

AMA has historically commented on international conflicts independently of WMA, such as Russia’s attacks on Ukraine in 2022, but has remained markedly restrained in its response to Israel’s attacks on civilians and healthcare in Palestine. In January, AMA called for medical neutrality to be respected, without mentioning almost 600 attacks on healthcare in Gaza and the West Bank reported by the UN almost a week earlier.

In March, AMA called for a humanitarian pause to allow entry of aid and the release of hostages, but abstained from acknowledging the updated death toll of over 31,000 Palestinians – including 9,000 women and 13,000 children – a few days prior. In April, AMA supported the WMA resolution calling for ceasefire – half a year following WHO, UN, and MSF. No mention was made of the disturbing reports of mass graves at Nasser and Al-Shifa Hospitals a day earlier, which raised renewed concerns about possible war crimes.

Given little had changed since Lucy Mitchell and I wrote in The Lancet in March on the moral failure of Australian medical leadership on Gaza, we submitted an open letter calling on AMA to back our requests to the Federal Government. These included supporting the WHO, UN Security Council (UNSC), and MSF’s calls for an immediate and permanent ceasefire; ending Australia’s partnership with Israel; condemning Israel’s disregard of UNSC resolutions; and prioritising support for Palestinian refugees, echoing AMA’s previous advocacy for Ukrainians.

I thank Professor Steve Robson, AMA President, for responding with ongoing support for the aforementioned WMA resolution, but remain disappointed in the persistent refrain from firmer advocacy in the face of overwhelming and preventable human suffering.

Stronger action needed

Stronger action from Australia is particularly important because Australia maintains a close relationship with Israel.

As Jennifer Tierney, the executive director of MSF Australia, stated: “All states that continue to support Israel’s reckless and disproportionate attacks in Gaza are morally and politically complicit in the atrocities being committed … Australia needs to stand on the right side of history, the side that upholds rather than undermines international humanitarian law.”

The responsibility – and failure – to speak up for Palestinians’ right to life and healthcare extends to Australian medical colleges.

In 2022, the president of the Royal Australasian College of Physicians (RACP) publicly shared his correspondence with a Ukrainian cardiologist: “please know that we stand in absolute solidarity with you and your colleagues and that we deplore and condemn the actions of Russian invadors [sic].”

Regarding the situation in Gaza, RACP released a general statement on “human rights and medical care in the Middle East” and resolved not to comment further, despite hundreds of RACP members writing in request of stronger advocacy.

Furthermore, Australian colleges have silenced doctors calling for the safety and protection of Palestinians.

Dr Natalie Thurtle, an emergency physician, had her pre-recorded keynote speech for the Australasian College for Emergency Medicine’s (ACEM) Annual Scientific Meeting cancelled in November 2023. Dr Thurtle shared that the reason given was that her talk, which discussed the healthcare situation in Gaza, was “too political”, after it was played at an event organised by the Network of Women in Emergency medicine (NoWEM) last week.

Core principles

The WMA Declaration of Geneva highlights the physician’s duty to serve humanity without demographic factors such as ethnicity and nationality to intervene in one’s duty to their patient.

If the suffering of Palestinians, decimation of their healthcare system, and killing of healthcare workers does not spur us to action, we must question whether our profession is neglecting its core principles. As Dr Francis W Peabody stated: “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”

The appeal of our open letter, signed by over 1,000 doctors and medical students, to AMA – and, by extension, all medical leaders – remains: they must demand real political and military pressure from Australia to end Israel’s assaults on civilians and healthcare in Palestine.

In the words of Dr Tedros Adhanom Ghebreyesus, WHO Director-General: “The fact that over 70 percent of deaths in Gaza are women and children should be a compelling reason to halt the war.” I can only hope.

• Dr Safiyyah Abbas is a paediatric rehabilitation and general paediatrics trainee

Comments by WHO and other agencies

Briefing to the Security Council on the humanitarian situation in Rafah by Edem Wosornu, Director of Operations and Advocacy, OCHA, on behalf of Martin Griffiths, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, 20 May.