Introduction by Croakey: Both Israeli authorities and Palestinian armed groups are responsible for war crimes in Gaza, according to findings from a United Nations Independent International Commission of Inquiry on the Occupied Palestinian Territory released today.
In addition, the Commission of Inquiry found that Israeli authorities are responsible for crimes against humanity.
The Commission’s report – which makes for a harrowing read – is based on interviews with victims and witnesses conducted remotely and during a mission to Türkiye and Egypt, and open-source items verified through advanced forensic analysis, submissions, satellite imagery and forensic medical reports, covering the period from 7 October to 31 December 2023.
“Israel obstructed the Commission’s investigations and prevented its access to Israel and the Occupied Palestinian Territory,” the Commission said in a statement.
The UN’s Commission of Inquiry report said that: “The World Bank reported that health facilities have been significantly affected, with 84 percent of them damaged or destroyed, amounting to 554 million USD in damages”.
In another recent report, by the Safeguarding Health in Conflict Coalition, global incidents of violence against healthcare staff increased 25 percent from 2022 to 2023, largely due to conflict in the Occupied Palestinian Territory (761 out of 2,562 reported incidents), but also Myanmar, Sudan and Ukraine.
Attacks by drones armed with explosives “increasingly impacted healthcare” in 2023, the report stated.
Below, Dr Hailay Gesesew, infectious disease epidemiologist at Torrens University Australia, argues that ‘perilous medicine’ – damaged or disrupted healthcare in conflict/hostile zones – must be prioritised as a public health issue.
Hailay Gesesew writes:
The deaths of children and women, and targeted attacks of health facilities in several conflict sites such as Ethiopia’s Tigray and Gaza under the silence of global leaders is appalling.
In the past five years, the global community has been confronted with a series of devastating civil conflicts and wars, resulting in a humanitarian crisis that needs addressing.
More than 80 percent of health facilities were deliberately damaged or vandalised and used as a weapon of war during the 2020-2022 conflict in Tigray, according to findings in a systematic review recently published in the National Library of Medicine.
Documents reported that health workers in Tigray were denied savings and salary by the Ethiopian federal government for over a year, which led to the malnutrition of doctors.
Perilous medicine
As well as the conflict between the federal government of Ethiopia and its allies against Tigray regional government, the Russia-Ukraine war, the Israeli-Palestine war, and the South Sudan civil war are notable examples where the provision of healthcare and access to medical resources is severely limited due to ongoing hostilities and infrastructure disruptions.
Professor Leonard Rubenstein – Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health – defines this as perilous medicine in his book titled, Perilous Medicine: The Struggle to Protect Health Care from the Violence of War.
Perilous medicine is a public health priority issue. It relates to the impacts of conflict on personnel or facilities – including patients, health professionals or aid workers, ambulances or aid trucks and infrastructure – and the interruption of health services.
Armed conflicts often result in direct outcomes, including trauma-related mortality and morbidity, and indirect outcomes including mental health illnesses.
The tragedy of conflict on health and humanitarian crises is non-stop.
About 30 million conflict and war related deaths were recorded in the previous three decades. Those conflicts and wars were characterised by humanitarian blockade, medical siege, and targeting of health facilities and professionals.
This trend of tragedy of violating humanitarian declarations and resolutions continues until today, as witnessed in many conflict-affected settings such as in Tigray and Gaza.
There is also a need to prioritise HIV in perilous medicine, which is the limitation or denial of provision of HIV testing and counselling, treatment and care services and access to HIV medical resources in conflict zones.
Individuals with HIV in conflict or post-conflict settings such as in Ethiopia, South Sudan, the Democratic Republic of Congo and other conflict zone areas have suffered immensely and are at risk of negative HIV care and treatment outcomes due to medical siege or service interruptions.
Sustainable Development Goals
Furthermore, achieving the United Nations’ Sustainable Development Goals (SDGs) becomes an arduous task in conflict-affected regions as conflicts disrupt essential infrastructure, hinder access to education and healthcare, and exacerbate poverty and inequality.
Multisectoral attention is crucial to address the conflict-related health and humanitarian crises at the time and in the aftermath of conflict.
Evidence shows that the nature, intensity, and frequency of conflicts have evolved in recent years, shifting from wars fought directly between states to various forms of “internal” or intrastate violence, including insurgencies.
Coupled with several other conflicts between states such as Russia-Ukraine war and the Israeli-Palestine wars, the impact of conflict on health and health services in fragile states continue to be at risk.
The current conflict in Gaza and its catastrophic impact on the healthcare system should be the priority of perilous medicine experts.
Investigating health and other research in conflict zones requires local experts to underpin the contextual scenario, global experts to maintain neutrality, and collaborative approaches to address resource constraints.
Like in any other conflicts, it requires careful consideration of ethical issues, ensuring the safety and wellbeing of study participants while maintaining impartiality and avoiding bias.
Global partnerships
Collaboration and global partnerships, including substantial development assistance and human resources support, are essential to address the complex issue of conflict and health.
Here are some actions that could help prioritise perilous medicine in public health:
- Ensure humanitarian laws and resolutions are prioritised: UN agencies and world leaders need to urge the implementation of humanitarian laws and resolutions that particularly address the weaponisation of healthcare, rape, and food.
- Strengthen healthcare infrastructure: Aid agencies needed to design innovative and contextual interventions to strengthen the health facilities during conflict to support the vital healthcare services. Special priority should be given to countries with already fragile health care system.
- Ensure the availability of mental health services and support systems for those affected, promoting recovery and resilience: armed conflict related mental illness is long-standing and impacts the individual, family, and community at large. Special attention should be given to people from culturally and linguistically diverse populations who have lower access to the available healthcare.
- Adequate funding for research and post-conflict rehabilitation: Researchers are required to address those gaps in collaboration among relevant stakeholders in and outside the conflict area. Special attention should be given to low-resourced countries.
About the author
Dr Hailay Gesesew, infectious disease epidemiologist at Torrens University Australia, has conducted several studies on the impact conflict has on health using the case study of Northern Ethiopia’s Tigray.
See Croakey’s archive of articles on global health
