Health workers have a moral and professional obligation to call for medical neutrality in Gaza - ABC Religion & Ethics (2024)

Gaza’s health system, like so much else in the Strip, is in ruins. No hospital remains fully functional, andover half of Gaza’s 36 hospitals are now completely out of service. Severe shortages of vital medical supplies, adequate nutrition and clean water areexacerbating the healthcare catastrophe. Doctors have described being forced to practice“medieval medicine” while they also deal with“eighteenth-century illnesses”.

As the war goes on, health workers in Gaza face daily choices between their own survival and staying to care for their patients. They often remain to provide whatever care they can in a decimated healthcare system and work with almost no salaries, despite having been repeatedly displaced themselves and grieving the loss of family members.

Alarming numbers of health workers have been killed or detained as they attempt to carry out their jobs. According to updated figures released by Healthcare Workers Watch, since 7 October 2023 nearly600 Palestinian health workers have been killed and300 have been detained. Many of these are Gaza’s most senior and experienced health workers. At least four health workers have died while in Israeli detention.

“Practicing medicine has become a crime … and the penalty for saving people’s lives has become detention and being tortured to death”,messaged one surgeon in Gaza in early May following the death of Dr Adnan Al-Bursh, a renowned orthopaedic surgeon and the head of the orthopaedic department at Al-Shifa Hospital. Dr Al-Bursh was detained in December by Israeli military forces while working in Al-Awda Hospital. Four months later, he was announced deadwith his body reportedly showing signs of torture. UN Special Rapporteur Tlaleng Mofokengsaid:

He was detained while undertaking his duty to patients and caring for them according to the oath he took as a medical practitioner. He died for trying to protect the rights to life and health of his patients.

The rise of a global movement of health workers

Amid these harrowing realities, a global mobilisation of health workers (of which the three of us are a part) has emerged. The movement advocates — through public vigils, rallies, social media platforms and traditional media — for an immediate end to the violence in Gaza, and for the meaningful application of international human rights and humanitarian law, including rights to health, peace and freedom. Some in this movement, both Palestinian and non-Palestinian, have worked in Gaza in the very facilities that are nowdestroyed.Others without such personal connections are compelled to participate through a shared sense of vocation and duty towards the pursuit of good health for all.

Healthworkers 4 Palestine, a global non-partisan group of health workers, began with a vigil of more than 300 health professionalsoutside 10 Downing Street in London in November 2023. The names of health workers killed were read, and calls were made to uphold the principle of medical neutrality and for the UK government to support an immediate ceasefire in Gaza. As the conflict escalated over the ensuing months, the coalition rapidly expanded across towns and countries, with vigils held in over forty cities across five continents. Healthworkers 4 Palestine teams continue to unite and rally across many Australian states.

Gaza Medic Voices, launched onX andInstagram in October 2023 by international doctors who have previously worked in Gaza, shares personal testimonies from Palestinian colleagues still working there. With more than 130,000 followers, this global health movement promotes truth-telling and the humanisation of the Palestinian experience inthe face ofIsrael’s attempts to censor international media, which includes the killing and detention of Palestinian journalists.

Healthcare Workers Watch – Palestine (of which Dr Muath Alser is a co-founder) was launched in early November 2023, as an entirely voluntary research initiative of Palestinian health workers aiming to shine a light on attacks against healthcare facilities and workers by Israeli forces. The organisation works to fill gaps in data collection and reporting due to the collapse of Gaza’s healthcare system, primarily through gathering and validating social media accounts of relatives and colleagues of victims as they mourn the death, injury, detention or torture of loved ones.

At the end of August, on theInternational Day of the Disappeared, all three groups collaborated with Amnesty International UK tostage a mass solidarity protest in London calling for the release of Palestinian health workers detained by Israeli forces.

Each of these initiatives brings its own defined but complementary role to the tasks of data collection, documentation and reporting, social organising, and advocacy and media, and together represent an innovative and independent global health movementin the face of the failure of usual humanitarian and legal mechanisms that seek to ensure the protection of health workers and civilians.

The guiding principles of the movement

This worldwide health movement is guided by the core principles of medical ethics — do no harm, beneficence, and justice without discrimination. When a doctor adopts an ethical code rooted inthe values of theHippocratic Oath and the Declaration of Geneva, they never imagine having to amputate the leg of a child without anaesthetic or dousing wounds with vinegar instead of antiseptic. Yetthat is what is happening in Gaza.

This health movement is also guided by the fundamental belief in the inviolable dignity and humanity of every individual. Medical doctorspledge their professional lives to the service of humanity. As such, their professions give assent to the preamble of theUniversal Declaration of Human Rights and other such post-war prefaces to international law.

The work of the movement is grounded in the recognition that medical neutralityhas a fundamental legal claim under international law as a protection for health workers and health infrastructure in conflict and in peacetime, and for unencumbered access to emergency healthcare for all.When hospitals are targeted in conflict — such Al-Shifa, Al-Quds and Nasser hospitals in Gaza —these violations of medical neutrality should, in our view, be considered breaches of international law.

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The health movement is further guided by international legal principles enshrined in a series ofcore treaties that make clear all people are entitled to (among other things) health, freedom of association, assembly and movement, and freedom from torture, arbitrary detention and unlawful killings. One of these treaties offerschildren special legal protection. TheConvention on the Rights of the Child sets out that all parties to the treaty should take measures, for instance, to ensure appropriate prenatal and postnatal health care for mothers; and “to promote and encourage international co-operation” to achieve children’s right to health.

This convention — along with the other sixcore human rights treaties — has been ratified by Israel, meaning Israel has voluntarily accepted these legal obligations under international law. But the disparity between Israel’s stated commitment to human rights and life on the ground in Gaza, is stark. And women and children continue to beara disproportionate share of the burden of Israel’smilitary operations.

Why the conspicuous silence from medical and health institutions?

Advocacy and other forms ofpressure exerted by medical organisations have historically played a part in securing healthcare delivery and rights amid geopolitical conflicts. But whereas Russia’s invasion of Ukraine in 2022 and its targeting of hospitals hasreceived widespread condemnation from representativemedical bodies, these same institutions have been relatively muted in their response to Israel’s disregard for medical neutrality inGaza. This is often justified by the purported need for “balance”, or to remain “apolitical”. Take, for example, thisstatement from the British Medical Association (BMA) from January 2024:

We do not generally comment on the wider political context of health-related human rights violations as this is not within the Association’s expertise and decisions on which conflicts to comment on could lead to accusations of bias and discrimination.

In April, after it was learned that Dr Ahmed Almaqadma, a young Palestinian plastic surgeon,had been killed alongside his doctor mother as Israeli forces withdrew from the besieged Al-Shifa Hospital, the Royal College of Surgeons of England (of which Dr Almaqadma was a fellow),issued the following statement:

We are deeply saddened to hear of the death of surgeon Dr Ahmed Almaqadma. Our thoughts are with his family and dedicated medical colleagues caring for those injured during conflict, and trying to maintain services, under such terrible circumstances. The Royal College of Surgeons of England supports the World Health Organization’s call for the protection of health facilities, health workers, patients and civilians in accordance with international humanitarian law.

But notably, no mention was made of the circumstances or cause of his death.

Despite having completed his medical training in England,Dr Adnan Al-Bursh received no such statement in the wake of his death in Israeli detention. Asa colleague of his wrote:

What never leaves my mind is how the Israeli army’s torture damaged the sturdy body and strong constitution of my friend Dr Adnan Al-Bursh … But perhaps what is more painful is the official silence of the unions and medical bodies that have not spoken out against the targeting of doctors, especially since the crime of killing Adnan is so heinous that no one could disagree about its magnitude.

It is acknowledged that the BMA proposed a resolution to a meeting of the World Medical Association Council in April 2024, calling for, among other things: a “sustainable ceasefire”, “parties to abide by international humanitarian law and the principle of medical neutrality”, and “investigations into alleged gross violations and abuses of human rights and international humanitarian law including attacks on healthcare staff and facilities and the misuse of those facilities for military purposes”. The resolution passed unanimously.But there needs to be sustained pressure from our medical and health establishments where such calls are not heeded, and the actions of these institutions must be consistent with, and should reinforce, these principles and commitments.

The strength of collective action

When individual health workers speak out about the situation in Gaza, they often do so at the risk of significant personal and professional costs. Health workers across the world have told of facing an“employment detriment” and ofbeing reported to national regulation agencies over their advocacy for health and human rights protections for Palestinians, with accusations of overstepping boundaries into political advocacy that has little to do with the concerns of everyday clinical work.

In December 2023, primary care doctor Dr Yiping Geresigned as Board Director of the Canadian Medical Association (CMA) after “bullying, harassment, and intimidation from multiple people within CMA leadership” concerning his social media statements on Gaza, which Dr Yiping described as “founded in anti-racism and respect for international human rights to health equity”. In May 2024, British-Palestinian surgeon Dr Ghassan Abu-Sittasaid he was denied entry into France where he was due to address theupper house of the French Parliament about Israel’s attacks on the Gazan healthcare system, less than a month after he was barred from entering Germany to speak at a medical conference.

History tells us that apathy on the part of — or worse, the censorship or collusion of — the medical and health establishment can perpetuate power imbalances and grant cover to egregious injustices and the dehumanisation of the people for whom physicians have pledged to care. By contrast, there is strength in solidarity. That is the conviction that underpins our collective determination to uniteas a global health movement to fight for justice, accountability and the protection of health systems and workers.

Palestinian surgeon Dr Fadel Naim posted an urgent petition on 28 May from Al-Ahli Baptist Hospital in Gaza:

I urge all global health organizations to intervene to save the medical sector and help us save lives that are being lost, not just due to injuries, but because of the total collapse of the healthcare system in Gaza!

Unless health workers and the organisations who represent them heed Dr Naim’s plea, the violence in Palestine is unlikely to stop— and the healthcare catastrophe in Gaza will only worsen.

Dr Rachel Coghlan is a global health and humanitarian researcher and practitioner, and a palliative care physiotherapist, based in Melbourne.

Dr Brenda Kelly is a consultant obstetrician at Oxford University Hospitals Trust, United Kingdom.

Dr Muath Alser is a Gazan doctor and co-founder ofHealthcare Workers Watch – Palestine.

All authors have spent time working in Gaza healthcare settings in recent years.

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Health workers have a moral and professional obligation to call for medical neutrality in Gaza - ABC Religion & Ethics (2024)
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