The Israeli medical profession: collusion and complicity

in apartheid, military occupation and genocide

Submission to the World Organisation of Family Doctors (WONCA) ahead of the WONCA World Congress in Lisbon, 17-21 September 2025

A Palestinian family sits near destroyed houses following a strike in Rafah on the southern Gaza Strip on November 6, 2023. Mohammed Abed/AFP/Getty Images

1. Incitement to commit war crimes

More than 80 Israeli doctors signed an open letter to the media on 4 November 2023, stating it is the “right…and duty” of the Israeli military to attack and destroy hospitals in Gaza.  The letter refers to people as snakes and wasps, and says “The residents of Gaza, who saw fit to turn the hospitals into terrorist nests in an attempt to take advantage of Western morality, are the ones who brought their annihilation upon themselves”.   A copy of the letter and signatories is in Appendix 1 below.  The letter was published at a time when the Israeli military was preparing to attack Al-Shifa Hospital in Gaza City. It echoes the genocidal and dehumanising language of Israel’s political and military leadership, who referred to Palestinians as “human animals” among other things, but is all the more shocking as it comes from members of our own profession.  The letter arguably constitutes “direct and public incitement to genocide” under article 25 of the Rome Statute.  16 of the doctors who signed the letter are family doctors.

What was the response of the Israeli Association of Family Medicine to this letter?  Silence, even though 16 of the signatories are family doctors.  

Palestinian doctors in the city of Rafah in the south of the Gaza strip condemned the Israeli doctors’ letter, calling it “a betrayal of the noble profession of medicine and a breach of medical ethics.  Their request for the Israeli forces to destroy the hospitals upon those who are in them, including medical staff, wounded, sick and martyrs, is a grave breach of medical trust.”  (see Appendix 2 for statement)

Physicians for Human Rights Israel also condemned the letter stating, “This is not the logic of physicians; it is not even the logic of human beings. It is the logic of annihilation.”  (see Appendix 3 for statement)

A group of Palestinian doctors replied to the Israeli doctors’ letter in a statement in Al Jazeera, saying they were “sickened to the core” by it.  They said, “Regrettably, we cannot say we were surprised. As doctors trained and practising in this system, we are all too aware of its embedded racism, militarism and hypocrisy covered up by a false image of a medical sector where Arabs and Jews work together in harmony and respect.” (see appendix 4 for full statement.)  

The Israeli Medical Association said in response to the letter it is “committed to the principles of medical ethics, international law and the Geneva convention”, but is opposed to “deliberately endangering civilians … by housing military ordinance and military control and command operational centers under cover of medical facilities”. There was no condemnation of the doctors’ letter, nor any action taken against the doctors who signed it.

The justifications used by the Israeli military, endorsed by the IMA, for bombing Gaza’s hospitals, i.e. they were used by Hamas to store weapons and as military command and control centres, are baseless – see Appendix 5.

2. Militarism has no place in WONCA

The militarism of the Israeli medical system highlighted by the Palestinian doctors in Al Jazeera, has been brought into WONCA by the President of WONCA Europe, Prof Shlomo Vinker.  In the President’s message to WONCA Europe members in the October 2023 newsletter, he stated, “ I hope only for one thing – that all of you understand the  enemy my country, the State of Israel, faces. Those who do not comprehend now may never understand the war in which Israel is engaged – a war we are determined to win.”  When this was written (17 October 2023) Israel had already dropped over 6,000 bombs on Gaza, killing 2,750 people, including over 700 children and wounding nearly 10,000., 

This military jingoism directly contradicts WONCA’s core aims and has no place in an international association of family doctors.  None of Prof Vinker’s subsequent messages in the monthly newsletter contain any mention of the massive levels of death and destruction in Gaza and the killing and wounding of tens of thousands of innocent civilians trapped in the territory, or the enormous pain and suffering they are experiencing.  

 Vinker bullied and filmed some of the doctors in Dublin

3. Silence over the destruction of primary and secondary health care facilities and countless war crimes in the health sector

The Israeli Association of Family Medicine and other Israeli medical organisations have also remained silent about the systematic attacks on primary care health facilities and hospitals (where much primary care is delivered) in Gaza, all of which have now been destroyed or seriously damaged by the Israeli military.  For further details of the devastation of the health service in Gaza, see the United Nations Office for the Coordination of Humanitarian Assistance (OCHA) Reported Impact Snapshot for the Gaza Strip (19 June 2024).  Every university in Gaza, including the medical school at the Islamic University of Gaza, has been destroyed or severely damaged by the Israeli military.

Health care facilities, health care workers and patients have protected status in times of war; military attacks on them are war crimes under international humanitarian law.  These are too numerous to list here but include tanks shelling a maternity hospital, drones killing patients and health workers, a military bulldozer crushing injured patients in tents in a hospital courtyard, patients including premature babies dying in ICUs after the Israeli military cut off power to the hospital, the destruction of over 130 ambulances, the targeted assassination of wounded patients in their hospital beds, and countless others.  Wikipedia maintains a daily timeline which has details of hundreds of these attacks over the last 9 months.  

The population of Gaza (2.3 million people) has had extremely limited access to medical care for months now; this includes nearly 90,000 people wounded by the Israeli military, and many others with chronic medical conditions requiring ongoing care such as renal failure, diabetes, heart failure etc.  People are dying needlessly from things like postoperative infections because of the lack of care, according to surgeons working in Gaza

4. Impacts on Palestinian families

The OHCHR report referred to above says that by 29 April 2024, 14,500 children and 9,500 women had been killed by the Israeli military, comprising 42% and 28% respectively of the total of 34,448 killed, and that 17,000 children had been orphaned. 75% of the 77,643 people injured are female.  Two months earlier the UNRWA Commissioner-General Philippe Lazzarini said “This war is a war on children. It is a war on their childhood and their future”.

In an interview on CBS Sunday, Dr Mark Perlmutter, President of the World Surgical Foundation, said that the “level of carnage against civilians” he had seen in his first week in Gaza in April 2024, was greater than he had seen on 40 missions to wars and disaster areas over the last 30 years combined, and that the victims were “almost exclusively children”.  He said he had seen “more incinerated children, more shredded children” than in his entire life before that. He also stated that children in Gaza are “definitively” being shot by snipers, including toddlers being shot twice with “dead centre shots” to the chest and  head, and he has photographs of these children. Dr Junaid Sultan a UK Vascular Surgeon, who went to Gaza in April, said in an interview with ITV News he operated on patients without anaesthetic. “And the worst thing was the gunshot wounds in kids which makes absolutely no sense”. These are the images he says “I can’t take out of my head”.

According to the OHCHR report, the treatment of pregnant, birthing and lactating women “continues to be appalling”, with the lack of health care placing an estimated 50,000 pregnant Palestinian women and 20,000 new-born babies at high risk. Over 180 women a day are giving birth without pain relief, while hundreds of babies have died because of a lack of electricity to power incubators.  Miscarriages have increased by 300 percent and almost all pregnant and breastfeeding women face “severe food poverty”.

The declaration of the Global Anti-Apartheid Conference on Palestine in Johannesburg, in May 2024 stated that Israel is “deliberately murdering children and women, women who create, sustain and defend life. We oppose Israel’s reproductive genocide.”  In December 2023 the Israeli military destroyed Gaza's Al Basma IVF centre, reportedly storing thousands of frozen embryos, “dashing the hopes of parenthood” of countless Gazan couples. The denial of reproductive rights and the imposition of measures designed to prevent births are also covered by the Genocide Convention

The IAFM has had nothing to say about this war on women and children and  the destruction of family life in Gaza

5. Silence over the abduction, torture and killing of Palestinian family doctors and other health care professionals

There is also silence about their 541 Palestinian healthcare colleagues in Gaza and the occupied West Bank, who are known to have been killed, the 259 health workers who have been detained, the 35 disappeared health workers or those who have been tortured (at least 31) by the Israeli military since October 7th.   Of these killed, eighteen were Palestinian family doctors and five family doctors have been illegally detained.  Details, including their names, can be found in Appendix 6, along with the numbers in the other health professions who have been killed or detained.  Doctors released from detention, like Dr Said Abdulrahman Maarouf and Dr Mohammed Abu Salmiya give accounts of systematic torture and abuse they and other prisoners have been subjected to.  

The Israeli Medical Association, which has said nothing about the killing, abduction and torture of hundreds of Palestinian health workers, including doctors, however protested vehemently to the government when an Israeli doctor was violently arrested recently by police during an anti-government demonstration in Tel Aviv.  The head of the IMA, Professor Zion Hagay, said “red lines” had been crossed and demanded the incident be investigated.  He told the Israeli health minister that doctors would go on strike if no action was taken against the police officers involved.  

The double standard is glaring: for the IMA, the lives of Israelis are clearly valued far

more than the lives of Palestinians.  This is the definition of racism.

6. Failure to speak out about the torture of Palestinian prisoners in Israeli jails, or act over medical complicity and participation by doctors in torture

There are long standing concerns going back nearly 30 years about the complicity of doctors and the Israeli Medical Association in the torture of Palestinian detainees in Israeli prisons.  These include certifying people fit for torture, and failing to document or report torture.  Freedom From Torture, Amnesty International and Physicians for Human Right (USA) have all expressed such concerns.  The Israeli Medical Association has always denied torture occurs or that there is any medical collusion in it.

There has been a surge in reports of torture recently, as some of the thousands of Palestinians who have been rounded up in Gaza and the West Bank and detained since October 7th, have been released from prisons. Images and videos posted on social media of the injuries and trauma suffered by prisoners are harrowing.  In May the UN Special Rapporteur on Torture, Alice Jill Edwards, urged the Government of Israel to investigate multiple allegations of torture and other cruel, inhuman or degrading treatment or punishment against detained Palestinians since 7 October.

In April and May 972 Magazine and CNN reported accounts from whistleblowers, including doctors, of widespread, systematic abuse of Palestinian detainees at SdeTeiman military camp.  Detainees suffered beatings,and starvation, and sick and injured prisoners were held 24 hours a day blindfolded, handcuffed by all 4 limbs and wearing only diapers in the clinic area of the camp.  Haaretz newspaper reported that amputations were being done on prisoners due to the severity of handcuff injuries according to one of the doctors who worked there.

The Israeli human rights group B’Tselem has recently released a report entitled “Welcome to Hell” which says that “more than a dozen Israeli prison facilities, military and civilian, were (converted) into a network of camps dedicated to the abuse of inmates as a matter of policy. Facilities in which every inmate is deliberately subjected to harsh, relentless pain and suffering operate as de-facto torture camps.”  More than 60 prisoners have died since October 7th in these camps.  Prisoners said they were subjected to regular severe, arbitrary violence, including sexual assault.  The Guardian reported on 5 August 2024 that Israeli guards told prisoners they were live streaming such torture for Itamar Ben Gvir, the Israeli National Security Minister.

The Israeli medical profession has said nothing about the torture, even though doctors and other health professionals work in these facilities.  Worse still, reports are now also emerging of Israeli doctors participating in torture: according to recently released detainees including Dr Mohammed Abu Salmiya, head of Al-Shifa Hospital, himself subjected to torture.  According to the British Medical Journal, Dr Abu Salmiya said that “medical staff in Israel’s military-run detention centre at Sde Teiman are participating in beatings and denying essential medical care to detainees, leading to amputations and deaths”.  A report by UNRWA in November last year stated that released detainees said they had been beaten by doctors when seeking medical care for their injuries.

How Israeli prison doctors assist in the torture of Palestinian prisoners is discussed at length in this article in Mondoweiss.

This widespread use of torture by the Israeli state is common knowledge in Israel. Much of the information on torture in Israeli jails comes from Israeli media outlets, including mainstream papers like Haaretz and human rights groups like B’Tselem and .  Physicians for Human Rights Israel.  Yet the organised medical profession remains silent about this most egregious violation of medical ethics and human rights.

7. Failure to denounce the near total siege of Gaza, including food, water, electricity and fuel

The Israeli Medical Association or the Israeli Association of Family Medicine have said nothing about this collective punishment of the people of Gaza, (which is also a war crime) announced by the Israeli Defence Minister Yoav Gallant on 9 October 2023. This has predictably resulted in hundreds of thousands of people especially women and children suffering malnutrition, weakened immunity, and infectious diseases. Pregnant women, are also severely malnourished leading to severe complications for themselves and their babies.  On 9 July 2024 eleven UN experts issued a report stating that children are dying from starvation in all areas of Gaza indicating that famine has now spread to all parts of the territory.  They said:

“We declare that Israel’s intentional and targeted starvation campaign against the Palestinian people is a form of genocidal violence and has resulted in famine across all of Gaza. We call upon the international community to prioritise the delivery of humanitarian aid by land by any means necessary, end Israel’s siege, and establish a ceasefire.”

There are hundreds of thousands of cases of diarrhoeal and respiratory illnesses among the Gazan population as a result of malnutrition, lack of basic infrastructure including clean water, and massive overcrowding of displaced people.  

Women and children are the majority of patients we as family doctors care for.  Do Palestinian women and children matter at all to the IAFM?  Doctors have a duty to speak out when the basic necessities of life are withheld from populations, especially in the same territory, and especially when it impacts the most vulnerable amongst them.

The overall death toll from the war on Gaza and the impact of starvation and disease is likely to be in the hundreds of thousands, according to the Lancet.  On 5 July 2024 the Lancet reported that: 

“Applying a conservative estimate of four indirect deaths per one direct death

 to the 37 396 deaths reported, it is not implausible to estimate that up to 186 000 or   even more deaths could be attributable to the current conflict in Gaza.”

8. Collusion in Medical Apartheid and gross disparities in health status

Israeli government policies of ethnic cleansing, military occupation and apartheid against Palestinians over many decades prior to October 7th, have unsurprisingly led to gross disparities in the lives and health of Palestinians and Israelis.  Successive UN Special Rapporteurs on Human Rights in the OPT, Amnesty International and Human Rights Watch have all concluded that the Israeli authorities have been responsible for the crime against humanity of apartheid against the Palestinian people.  On 19 July 2024 the International Court of Justice confirmed that Israel was guilty of apartheid against the Palestinian people as well as illegal occupation of Gaza, the West Bank and East Jerusalem.  Medical apartheid naturally follows this, i.e. pervasive segregation and discrimination in health care provision based on race or ethnicity.

The impact of these policies is set out in detail in a position paper published in November 2021 by Medical Aid for Palestinians.

“This position paper describes how systematic discrimination and the fragmentation of the Palestinian people by Israel present a fundamental challenge to Palestinians’ rights to health and dignity, and inhibit the delivery and development of a Palestinian healthcare system to meet the needs, in terms of availability, accessibility, acceptability and quality, of Palestinians in the areas where MAP operates. It exposes how this has resulted in stark health inequalities between Palestinians and Israelis, which have accelerated as a result of recent military offensives and the COVID-19 pandemic.”

Palestinians in the occupied Palestinian territories (oPt) face delays and obstacles in leaving Gaza or the West Bank to access specialist medical care within Israel.  This is not available in the oPt of course because of restrictions imposed by Israel on the development of health services within the oPt, including denial of imaging equipment, crucial to investigating patients.  Palestinians are required to obtain permits for their medical treatment in Israel and also need to pass through military checkpoints to get there.  Permits are often delayed, leading to delayed treatments for patients with cancer and other critical illnesses; in 2017 54 patients died while awaiting Israeli permits, 46 of whom had cancer.  A Lancet study reported that between 2000 and 2007 delays at military checkpoints had resulted in 69 women giving birth at checkpoints; of which 35 infants and five women died.  Reports of women forced to give birth at checkpoints have continued up until the present.

B’Tselem, the Israeli human rights organisation, reports that thousands of Palestinians were prevented by Israel from leaving Gaza for medical treatment  each year. In a report dated 4 April 2023 it says:

“The blockade Israel has been imposing on the Gaza Strip for more than 15 years has crushed Gaza’s healthcare system. The level of medical services available falls far short of residents’ needs, and there is a constant shortage of medicines and medical equipment. In 2022, as in previous years, patients who need medical care unavailable in Gaza are the ones to pay the price: Israel forces them  to file for permits to leave the Gaza Strip in an exhausting bureaucratic process, extending also to the persons accompanying them. The criteria for approving these requests are unknown and the grounds for rejection are never disclosed. Many of the requests go unanswered, and patients must apply time and again without knowing whether they will ever get the permit they desperately need to reach hospital in the West Bank, East Jerusalem or Israel.”

It is worth stating here that under international law (Geneva Convention IV, article 55), Israel, as the occupying military power, has responsibility “to the fullest extent of the means available to it” to provide health services to Gaza

The report contains the graphic below: (ISA questioning = Israeli Security Agency)

8a.  Differences in life expectancy, mortality rates and health care provision

These are stark, as the table below shows.

Health disparities between Palestinians and Israelis

Note: all these figures are from before the current conflict since October 7th 2023

9. The teaching and studying of medicine at Ariel University in occupied West Bank

International humanitarian law (Article 49 of the Fourth Geneva Convention) makes it illegal to establish settlements on occupied territory, as these involve population transfers into the occupied territory.  The ICRC says,  “Such transfers are often carried out in order to alter the demographic composition of the population of the occupied territory, and constitute a grave breach of Additional Protocol I, as well as being listed as a war crime under the Statute of the International Criminal Court.”

Since 2018 medicine has been taught at Ariel university in the illegal Israeli settlement of Ariel in the occupied West Bank.  The fact that Israeli doctors are being trained on illegally occupied land has gone unremarked by the Israeli medical establishment, including the IAFM.

10. Double standard over Ukraine and Gaza

We ask that WONCA rectify the very different approaches it has taken to the conflicts in Ukraine and in Gaza.  Both territories have been subjected to a military invasion resulting in the deaths of many innocent civilians. WONCA called for an immediate end to the conflict in Ukraine, and made several statements and took initiatives to support healthcare in Ukraine and our colleagues there.  In WONCA's Newsletter in April 2022 for example, “WONCA encourages members to take action” to help Ukraine and suggested practical help they could offer and what organisations to support.  It also said WONCA colleagues “salute” and applaud ‘the bravery of your colleagues” and acknowledged their “despair” in Ukraine.

In contrast WONCA issued this statement on Gaza which simply expresses “dismay at the loss of life and liberty of innocent civilians…and call for the protection of healthcare workers in areas of conflict”.  

Casualties in Ukraine have been far fewer than in Gaza, and as a proportion of the two territories’ populations, orders of magnitude less, yet there has been no statement of solidarity or support from WONCA for the people of Gaza, or indeed for our health worker colleagues there who have paid such a terrible price while they remained at work in the face of such death and destruction.  Such statements are important, not only as expressions of solidarity and support, but also because they may act as a brake on the perpetrators of violence, who see that the international community is watching events and is very concerned about them.  WONCA could also offer practical support to Palestinian doctors and medical students to help them continue their training, which is vital for the reconstruction of the health sector in Gaza once the violence comes to an end.

Appendix 1

Israeli doctors urge the bombing of Gaza hospitals

Mondoweiss 5th November 2023

“We, the undersigned, doctors who work in the healthcare system responsibly and professionally, hereby urge:

The moment that murderous terrorist organizations built murder and terrorism headquarters as an integral part of hospitals, they turned the hospitals into legitimate targets by their own hands.

For years the citizens of Israel have suffered murderous terror, while the head of the snake and head murderers enjoy complete shelter and protection, as they built terror headquarters within the hospitals, understanding that no harm would come to them.

After the Simhat Torah [Oct. 7] massacre, the many murdered and kidnapped, and the hair-raising atrocities, which we have no room here to detail and write, there is complete agreement in the Israeli security forces that the terror organization Hamas should be eradicated to dust, which is worse than ISIS.

This is the same terror organization that isn’t above cruel murder and unprecedented atrocities towards men, women, and children — therefore, any place where its men hide and/or is used for terrorist activity is a legitimate target for annihilation, including hospitals. 

Whoever mixes hospitals with terrorism must understand that he has no safe place and cannot seek refuge in hospitals in order to produce terror and enjoy protection.

Ambulances that are evacuating patients to the south in order to be treated elsewhere are at their disposal. 

No more! The residents of Gaza, who saw fit to turn the hospitals into terrorist nests in an attempt to take advantage of Western morality, are the ones who brought their annihilation upon themselves — terrorism must be eliminated everywhere and in any way.

Attacking terrorist headquarters located inside of a hospital is the right of the IDF [Israeli army] and its duty.

It is unthinkable that the citizens of Israel are abandoned, and arch-murderers are protected only because they are hiding in hospitals.

After the IDF repeatedly warned the hospitals to stop the cynical use made of them for terrorism, and after all citizens were asked to evacuate the area in light of the presence of terrorists, there is an obligation to destroy the wasps’ nests and the hospitals they use to shelter them, the sooner, the better.”

We, the undersigned:  (see over for list of signatories)

Doctors who signed the “bomb the hospitals” letter, by medical specialty

APPENDIX 2

Statement by Dr Marwan Shafiq al-Hams, Director of Mohammad Yusuf Al-Najjar Hospital, Rafah, on behalf of all doctors in Gaza. 

6th November 2023, in response to the letter by “Israeli doctors for the rights of IDF soldiers”

https://x.com/ytirawi/status/1721572760806146349?s=20

 “In the name of God, the most gracious, the most merciful.

We the doctors of the Gaza strip, and on behalf of all the doctors of the world, are ambassadors of peace and the saviours of lives.  We have sworn to protect human lives.  Therefore, it is not permissible to betray the oath and the noble profession of medicine.

What the Israeli doctors have done inside the Zionist state, is a betrayal of the noble profession of medicine and a breach of medical ethics.  Their request for the Israeli forces to destroy the hospitals upon those who are in them, including medical staff, wounded, sick and martyrs, is a grave breach of medical trust.  We hold them fully responsible, if God forbid, something happens to the hospitals. 

We therefore urge and demand that every organisation related to medicine and health, including the World Health Organisation, hold accountable those who want to destroy the hospitals and those who are in them, the hospital staff, the wounded and patients.  We would specifically like to point out that their licenses and everything related to their profession should be revoked. 

This is on behalf of all the doctors across Gaza’s hospitals, Dr Marwan Shafiq al-Hams, Director of Mohammad Yusuf Al-Najjar Hospital.”

________________________________________________________________________

Appendix 3

Statement by Physicians for Human Rights Israel   6.11.23

In response to the Israeli doctors’ letter calling for the bombing of hospitals in Gaza

https://www.phr.org.il/en/physicians-call-eng/ 

“The letter that outraged us

We, physicians and health professionals working in hospitals and the community, are currently coping with the daily overload resulting from the war in Gaza, including the many physical and mental injuries, missing staff, and team members who themselves have been deeply traumatized and whose friends and family were murdered and abducted. What keeps us going even in these awful times is our primary mission of saving lives and maintaining civilians and medical facilities outside the conflict zone. Therefore, we consider it necessary to address the physicians’ letter calling for the destruction of Al Shifa Hospital.

No person with a conscience can remain indifferent to the massacre of civilians, including men, women, and children, carried out on October 7, 2023, by Hamas militants – the scale of which has yet to be fully revealed. However, our deep outrage must not be transformed into a carte blanche for killing civilians in the Gaza Strip, where residents are also counting the wounded and dead – certainly not when physicians are the ones demanding this. Fortunately, the letter’s signatories represent only a small minority of the health community, while the vast majority remains busy saving lives – no matter whose lives it may be.

The physicians who signed the letter use annihilation rhetoric not only toward Hamas militants but also toward the men, women, and children inhabiting the buildings in which Hamas is allegedly hiding, even if these are hospitals. Indeed, Hamas bears a heavy responsibility for taking shelter under civilian structures and, in some cases, for conducting fighting from those positions. The physicians who signed the letter do not even address the minimum requirement under international law to not only offer warnings but to take all precautions to reduce civilian casualties when responding to threats posed in hospital settings. They are clearly and blatantly calling for nothing less than the destruction of the hospital.

What wrong has been done by a newborn in an incubator or a person whose legs were amputated in the bombing of their apartment that they deserve to be killed? The letter argues that patients can be moved south to another location. Yet, in the Gaza Strip – whether in the north or the south – there are no hospitals that can receive them, no ambulances equipped to transport complex patients, no incubators for premature newborns, and no physicians to accompany them. Without all these, the call to evacuate patients is not a humanitarian appeal. The veil of deception must be lifted: it is a death sentence for the patients.

The authors of the letter do not only blame Hamas; they blame all Gazan residents “who saw fit to turn hospitals into terror nests” and, therefore, they claim, ” brought their annihilation upon themselves.” This is not the logic of physicians; it is not even the logic of human beings. It is the logic of annihilation.

The citizens of Israel can and must be protected through various means. Annihilating civilians in Gaza is not one of them.

These dreadful recent weeks have cost many lives, and humane values are being shattered amid this violent reality. The medical community will withstand this dark breach in history without allowing its core values to be destroyed.”

APPENDIX 4

Israel is bombing hospitals in Gaza with Israeli doctors’ approval

Al Jazeera 11 Nov 2023

“We, Palestinian doctors in Israel, are forced to watch in silence massacres unfolding,

which some of our Israeli colleagues are encouraging.

‘The residents of Gaza, who saw fit to turn the hospitals into terrorist nests in an attempt to take advantage of Western morality, are the ones who brought their destruction upon themselves – terrorism must be eliminated everywhere and in any way. Attacking terrorist headquarters located inside a hospital is the right, and even the duty of the IDF.’

Upon initial examination, one might think these are sentences written by extremists or fanatics, giving an army permission and encouragement to bomb hospitals. What is shocking is not only the statement itself, but that it is signed publicly by dozens of Israeli doctors and shared widely on various social media platforms.

Instead of immediate outrage and condemnation, the statement resulted in what some called a “legitimate” public debate within the Israeli medical community, to bomb or not to bomb Palestinian hospitals.

We, six Palestinian physicians working within the Israeli healthcare system, are sickened to our core by the statements made by some of our colleagues, Israeli doctors we work with, calling on the Israeli army to bomb hospitals in the Gaza Strip.

Regrettably, we cannot say we were surprised. As doctors trained and practising in this system, we are all too aware of its embedded racism, militarism and hypocrisy covered up by a false image of a medical sector where Arabs and Jews work together in harmony and respect.

The recent letter by our Israeli colleagues issued at a time of an unfolding massacres is a telling example of what the Israeli health system is really like. It is a system where some doctors, shamelessly and publicly, adopt the role of consultants to the army.

They use their position and profession, not to save lives, not to preach about the devastating effects of war on civilians on both sides and the necessity of finding a peaceful political solution, but actually to validate attacks on medical facilities, knowing full well that this means the killing of fellow doctors and patients.

At the same time, this health system has adopted a distinctly McCarthyist witch hunt approach towards us, Palestinian physicians. As a result, we cannot engage in any intellectual or moral conversation about the war. We are expected to condemn Hamas and join the patriotic Israeli military frenzy, while watching silently our Jewish colleagues cheering for the killing of innocent Palestinian civilians and endorsing the tightening of the blockade.

We drive to work every day, listening to the devastating news about the death toll and destruction in the Gaza Strip and the West Bank. When we arrive, we put on that mask of “everything is fine” and endure the daily loyalty test and scrutinising eyes of our colleagues. During coffee breaks, we are forced to listen with a straight face to our Israeli colleagues casually dropping phrases like “flattening Gaza” and discussing the merits of displacing its people.

We are also seeing our Palestinian colleagues being interrogated, fired and shamed without a valid reason. We are very aware of how the hospitals and clinics we work in have become disciplining arenas. In a “normal” place, we would be in the streets, demanding an end to the war and massacres and advocating for a peaceful solution. We would use our profession and position to denounce the inhumane attacks on healthcare workers, facilities and civilian infrastructure.

We are deeply aware that the situation is much more complex than choosing sides and we know that every life lost is a tragedy, whether it is Israeli or Palestinian. But precisely because of this, we also know that history did not begin on October 7 and that our people have been displaced, killed, injured and humiliated for decades, with the full endorsement and involvement of our fellow Israeli doctors.

We come to work every day, knowing that our people are killed, tortured and maimed by illegal Israeli settlers and the Israeli army in the occupied West Bank land. However, we also know that we cannot ask our fellow Israeli doctors “Do you condemn?”

We have been forced to live in a coercive environment where Palestinian death is normalised and often celebrated, but Israeli Jewish death is seen as a tragedy that cannot be accepted and necessitates revenge.

This is the reality, where Israeli national security is of high value but Palestinian national security is a dark joke. It is Jewish supremacy in life and death that is so normalised, particularly at such tragic times when it explodes to uncover the true face of our Israeli colleagues and sadly also of the Western world and its medical institutions.

The normalisation of Palestinian dehumanisation reflects the complicity of the entire world in the massacres which are taking place in the Gaza Strip.

The medical profession has a long and rich history of opposing war and its devastating effects on health. It has stood up against racism, colonialism and imperial expansion, which have driven deadly wars.

We can vividly remember the massive organising of doctors against the US wars in Vietnam, Iraq and Afghanistan. We saw how doctors in the US, in the aftermath of 9/11, organised to oppose and lobby against the invasion of Iraq and Afghanistan, knowing it would lead to more deaths and not security.

But we are also aware that the majority of our fellow Israeli Jewish colleagues are on the opposite side of this urge to protect civilians, as the entire Israeli health system has been mobilised to join the war effort and support it.

The Israeli health system not only does not oppose Israel’s war, occupation and apartheid but also prevents Palestinian doctors living in Israel from speaking up and organising against them.

In this tragic and regrettable environment we live and work in, we need to hide our names and write anonymously to state the obvious, following our professional duty and oath. We have reached such a level of demoralisation and dehumanisation that we are forced to watch massacres, with Palestinian children burned by Israeli phosphorus bombs and entire populations starved of food and water, without batting an eye, as if everything is just “normal”.

Not only are we barred from volunteering to provide medical aid to the innocent Palestinian civilians, but we are also not allowed to speak up against those state crimes without risking our jobs and safety.

We want this letter to serve as an apology to our Palestinian people and colleagues in the Gaza Strip, exposing our profound powerlessness and complete impotence.

We and the world have failed you.

We can only hope that in future calmer days, we can bear witness and speak and write about the conditions that have allowed for massacres to unfold and to take part in healing those who survived.”

Editor’s note: Suad, Layla and Samir are pseudonyms. This op-ed has been written by them along with three other Palestinian doctors working in Israel. They are writing anonymously for fear of physical and professional retribution.

APPENDIX 5

Israel’s evidence that Gaza’s hospitals are Hamas command and control centres, and the legal status of hospitals in times of war

Well before the siege and subsequent invasion of Al-Shifa Hospital in November 2023, the Israelis embarked on a large-scale propaganda campaign to try to convince the world that Hamas was using hospitals as military bases in Gaza.  A Guardian article on 17 November 2023 was highly sceptical of the evidence provided by the IDF, and concluded it “fell well short of Al-Shifa hospital being a Hamas HQ”.  The article described how videos provided by the IDF were edited and the number of guns ostensibly found and shown to journalists had later increased in number.  The tunnels beneath the hospital “proving a Hamas HQ was there” were in fact basement areas linked by corridors built by the Israelis themselves when they last occupied Gaza up until 2005. Many hospitals all over the world of course have underground basements.

On 21 December 2023 the Washington Post carried a detailed report of its investigation into Israel’s claims that Al Shifa was being used by Hamas as a command centre to direct rocket attacks and command fighters, and that the tunnels could be accessed from hospital wards.  The newspaper stated:

“… the evidence presented by the Israeli government falls short of showing that Hamas had been using the hospital as a command and control center, according to a Washington Post analysis of open-source visuals, satellite imagery and all of the publicly released IDF materials. That raises critical questions, legal and humanitarian experts say, about whether the civilian harm caused by Israel’s military operations against the hospital — encircling, besieging and ultimately raiding the facility and the tunnel beneath it — were proportionate to the assessed threat.

Meanwhile Almayadeen English reported on 18 November 2023 that CNN said that Israel “may have planted weapons at Al Shifa hospital” before a tour of the hospital conducted for journalists.  “Numerous discrepancies have surfaced surrounding an Israeli occupation forces (IOF) video released on November 15, showcasing a tour of alleged Palestinian Resistance weaponry reportedly found at Al-Shifa hospital, according to CNN.”

The arrest, detention and torture of the Director of Al-Shifa Hospital, Dr Mohammed Abu Salmiya, is further evidence that the Israeli military were fabricating evidence of the hospital being used as a military base.  Dr Abu Salmiya was detained on 23 November 2023 while he was in a WHO convoy escorting patients south to another hospital; the Israeli military said as hospital director he knew about and was therefore complicit in the use of the hospital as a military command centre.  Dr Abu-Salmiya was released in early July this year after being held for over 7 months, during which time he says he was interrogated and “tortured almost daily”.  Despite 3 court appearances during his detention, he was released without being charged with any crime.  Dr Abu Salmiya also said that his torture “occurred after he refused to appear in a video and declare that his hospital had been a secret Hamas headquarters”, according to an article in the British Medical Journal.  

Using another hospital to try to justify their war crimes, on 13 November 2023 the IDF’s military spokesperson Daniel Hagari appeared in a video providing “evidence” of a military headquarters holding of Israeli hostages in the basement of the Rantisi children’s hospital in Gaza. In the video Hagari pointed to a notice on the wall which he said had “handwritten names of Hamas terrorists guarding Israeli hostages”.  This was however a calendar with the days of the week written in Arabic.  The claim became the source of much derision on social media.

Having provided no proof of Hamas using hospitals as military bases, it turns out that it is the Israeli military which has been using hospitals and schools as military bases in its ongoing war on Gaza.  The  Washington Post published satellite imagery of this at the Turkish-Palestinian Friendship hospital south of Gaza City.  The hospital, which was Gaza’s only cancer hospital, was forced to close in early November after military attacks and being denied any further fuel.  The images also showed the nearby school in Juhor ad Dik was being used by Israeli soldiers in March 2024.

The status of hospitals in times of war

 Legally in times of war hospitals have protected status under the Geneva Conventions, and attacking “hospitals and places where the sick and wounded are collected” is a war crime under article 8 of the Rome statute (which established the International Criminal Court).  If a civilian hospital is used for acts “harmful to the enemy”, the hospital can lose its protected status under international law and be considered a legitimate target.  However, if there is doubt as to whether a hospital is being used for acts harmful to the enemy, the presumption, under international humanitarian law, is that it is not.  And if a hospital is being used in such a way, those attacking the hospital must act proportionately and not simply, for example bombard the hospital or fire on civilians, patients and healthcare staff inside the hospital.

Mai El-Sadany, a human rights lawyer and the executive director of the Tahrir Institute for Middle East Policy in Washington, is quoted in the Guardian as saying in relation to Al-Shifa Hospital: “Israel has failed to provide anywhere even close to the level of evidence required to justify the narrow exception under which hospitals can be targeted under the laws of war …..  In the rare case that protection is lifted, Israel would have to provide civilians with a meaningful chance to evacuate and even still, any civilians who remain in the hospital following an evacuation order would still be protected by the rules of proportionality….. At every stage of this legal assessment, Israel has fallen abysmally short.”

This has not stopped the IDF from making more of these unsubstantiated claims, usually around the time they are conducting military attacks on major hospitals.  According to Jewish News the IDF said on 15 February 2024 that “over 85% of major medical facilities in Gaza have been used by Hamas for terror operations, according to “intelligence assessments and information gathered on the ground”.  Hagari also said the IDF has “credible intelligence” that Hamas held hostages in the hospitals.  At this time the IDF was laying siege to Nasser Hospital in Khan Younis, using “loitering” drones to shoot people entering and leaving the hospital, which it later shelled, cut off the electricity and drove out patients and staff, and then arrested the Director of the Hospital, Dr Atef Al-Hout.  Once more the only “evidence” provided is the word of the IDF.

This attempted propaganda effort by the Israeli military has been crucial to its efforts to justify attacking Gaza’s hospitals, all 36 of which have now been severely damaged or destroyed.  As time has gone by the true intention of the Israelis has become clear: to completely destroy the health infrastructure (alongside schools, universities, mosques, churches, water and sewerage infrastructure, housing and everything else) in the Gaza strip, in order to make it uninhabitable for Palestinians, and achieve its goal of ethnically cleansing the territory.

We saw the horrific results of this justification process in early April 2024, after a further siege and occupation of Al-Shifa hospital by the Israeli military lasting more than two weeks.  They totally destroyed the hospital and killed hundreds of patients, healthcare staff and people taking refuge in the hospital, burying them in mass graves.  Doaa Shaheen, a journalist from Gaza, referred to the events at Al-Shifa as “one of the worst massacres in Palestinian history”

It is important to note that attacks on Palestinian healthcare facilities are not new, they have been a constant feature of the Israeli occupation. For example, in 2022, the WHO documented 187 attacks on healthcare facilities in the occupied Palestinian territories (oPt).  In its report “Right to Health, Barriers to Health and Attacks on Health Care in the OPT, 2019 to 2021” the WHO reported that “between 2019 and 2021, there were 563 attacks on health care in the oPt”.

Appendix 6

Killing, detention and torture of Healthcare Workers by Israeli Occupation Forces in Palestine since October 7, 2023

June 14, 2024 Update, Health Workers Watch

https://healthcareworkerswatch.org/

1. Total killed: 541

• Nurses: 161
• Physicians: 87
• Paramedics: 55
• Pharmacists: 47
• Dentists: 42
• Occupational/Physiotherapists: 39
• Medical/dental students: 34
• Administration staff: 31
• Lab technicians: 18
• Optometrists: 11
• Medical scientists: 7
• Psychologists: 5
• Anaesthesia technicians: 2
• Dental Technician: 1
• Radiology technicians: 1  

2. Names of family/general practitioners killed by Israeli military attacks, many along with their families:

1. Dr Aya Ferwana (Dr Omar Ferwana’s daughter), Family Medicine Specialist, Gaza.

2. Dr Amal Al-Maqadma, Family Medicine Specialist, Rafah

3. Dr Rani Muammar, Family Medicine Specialist, Algerian Specialized Hospital, Khan Younis.

4. Dr Abdallah El-Helou, General Practitioner, The Indonesian Hospital, North Gaza

5. Dr Muhannad Ezzo Afana, General Practitioner, Gaza

6. Dr Mohammed Refaat Mekki, General Practitioner, Gaza

7. Dr Maisara Azmi Al Rayyes, a junior doctor (General Practitioner) and Chevening scholar, MSc in Child and Maternal Health at King's College London, UK

8. Dr Omar Ziara, General Practitioner and Entrepreneur, Gaza

9. Dr Ahmed Hassan Jarbou', General Practitioner, Al-Shifa Hospital, Gaza

10. Dr Shamekh Abu Alrub, General Practitioner, Jenin Government Hospital, Jenin, West Bank

11. Dr Osama Tayeh, General Practitioner, North Gaza

12. Dr Dina Kamal Aldurra, General Practitioner, Al-Aqsa Hospital, Deir Al-Balah, Middle area of Gaza Strip

13. Dr Mohammed Hammouda, General Practitioner, The Indonesian Hospital, North Gaza (Dr Ahmed Hammouda’s son)

14. Dr Rawand Khilla, General Practitioner, Gaza

15. Dr Heba Jamal Al-Za’neen, General Practitioner, Beit Hanoun Hospital, North Gaza

16. Dr Badr Jamal Al-Za’neen, General Practitioner, Beit Hanoun Hospital, North Gaza (Dr Heba’s twin brother)

17. Dr Ahmed Jamal Nabhan Abdelhadi, General Practitioner, Khan Younis Clinic, UNRWA, Khan Younis.

18. Dr Yusra Al-Maqadmeh, General Practitioner working at Al-Shifa Hospital, killed with her son Dr Ahmad Al-Maqadmeh, Plastic Surgeon  (not in HWW list – source here)

3. Unlawful Detention of Healthcare Workers by Israeli Occupation Forces in Palestine since October 7, 2023.  

As of June 14, 2024, HWW documented 259 cases of unlawful detention of healthcare workers in Palestine by Israeli Occupation Forces since October 7, 2023.

• 77 physicians, 2 dentists, 72 nurses, 42 paramedics, 5 pharmacists, 1 optometrist, 18 technicians, 20 healthcare administrative staff, 8 healthcare students, 3 volunteers, 1 nutritionist, 1 community healthcare worker, and 9 others

• 138 healthcare workers are currently in-detention, 35 are missing, and 35 released (two were detained twice then released). Two doctors have been killed in detention after being tortured (Dr Iyad Al-Rantisi and Dr Adnan Al-Bursh);

• 237 unlawfully detained from Gaza strip, and 22 from West Bank.

• 31 video, audio, or written testimonies of torture were taken.

• Majority of the physicians are directors of a hospital, Head of Department or specialists in their field.

4. Names of family/general practitioners unlawfully detained by Israel:

1. Dr Mohammed Jamil Jabr Abu AlJubain, General Practitioner, The Indonesian Hospital, North Gaza

2. Dr Ahmed Abu Aita, General Practitioner, The Indonesian Hospital, North Gaza

3. Dr Wadee Fayez Qasem, General Practitioner, Kamal Adwan Hospital, North Gaza

4. Dr Haytham Kullab, General Practitioner, Nasser Medical Complex, Khan Younis

5. Dr Anwar Al-Sheikh Khalil, Dean of Faculty of Medicine, The Islamic University of Gaza, Gaza