Palestine: the assault on health and
other war crimes
There are consistent reports of ambulances containing gravely ill people being hit by gunfire, or detained at checkpoints while drivers and paramedics are interrogated, searched, threatened, humiliated, and assaulted. Wounded men are abducted from ambulances at checkpoints and sent directly to prison. Clearly marked clinics are fired on, and doctors and other health workers shot dead on duty.
Physicians for Human Rights (Israel) have lambasted the Israeli Medical Association (IMA) for its silence in the face of these systematic violations of the Fourth Geneva Convention, which guarantees the right to health care and the protection of health professionals as they do their duty. Remarkably, IMA president Dr Y Blachar is currently chairperson of the council of the World Medical Association (WMA), the official international watchdog on medical ethics. A supine BMA appears in collusion with this farce at the WMA. Others are silenced by a fear of being labelled "anti-semitic," a term used in a morally corrupt way by the pro-Israel lobby in order to silence. How are we to affect this shocking situation, one which to this South African-born doctor has gone further than the excesses of the apartheid era.
the state of despair
Letter to the BMJ by Dr Ismail Jalili, FRCS, DO, FRCOphth
Consultant Ophthalmologist, UK.
Summerfield's article 1 on Palestine adds to the previously
documented health crisis in this population 2-5 and demonstrates the
scale of this human tragedy. Indiscriminate obstruction damages an already vulnerable medical infrastructure resulting in increased morbidity, degraded health, premature deaths, and non-fulfillment of basic human needs 2. Repeated invasions cause extensive destruction, food shortages, internal civilian displacement and psychological distress 3. Poor socio-economic, demographic and environmental health conditions lead to over-crowding, affects drinking water sources and play a major role in the occurrence of intestinal parasites and diarrhoea with under 5s at highest risk.
Endemic parasitic infestations were found in 29.8% of women4, 24.1% in
1-4 years old; and 13.7% of diarrhoea admissions with 10.6% mainly in <1
Injuries rose sharply, a staggering 32 and 9-fold increases in the first and second Intifidas respectively. Before the Intifida, victims were men, there were no <10's; during the Intifida 9% were women and 12% under 14 years; injury patterns changed with 65% due to firearms or explosives, 19% to beating and 6% to gaseous substances. Among children, most firearm injuries involved the head, including eye injuries and brain damage 5.
After the 1967 war, Israel's labour market opened to workers from the Occupied Territories, with jobs in construction, agriculture etc; conditions were poor and exploitation rife6. By 1984, 87,000 Palestinians were employed in Israel - 36% of the total workforce. Since 1991, there has been a sharp decline, with Romanian and Thai workers recruited instead. Girls and young women increasingly risk illiteracy and families are marrying their daughters at younger ages for security 6.
Before 1987, the author witnessed the failure to provide treatment for 2
children with retinoblastoma; neglect and bureaucracy led to advanced,
metastasised presentation, causing excruciating pain and agony. They
were failed by a lack of initial treatment but also by denial of
terminal care 7, reflecting the neglect of poor and deprived pointed out
by Summerfield's and others 1,8.
1. Summerfield D. Palestine: the assault on health and other war
crimes. Br Med J 2004;329:924.
2. Quato D. The politics of deteriorating health: the case of
Palestine. Int J Health Serv 2004; 34:341-64.
3. Giacaman R, Husseini A, Gordon NH, Awartani F. Imprints on the
consciousness: the impact on Palestinian civilians of the Israeli Army
invasion of West Bank towns. Eur J Public Health 2004;14286-90.
4. Abu Mourad TA. Palestinian refugee conditions associated with
intestinal parasites and diarrhoea: Nuseirat refugee camp as a case
study. Public Health 2004;118:131-42.
5. Helweg-Larsen K, Abdel-Jabbar Al-Qadi AH, Al-Jabriri J,
Bronnum-Hansen H. Systematic medical data collection of intentional
injuries during armed conflicts: a pilot study conducted in West Bank,
Palestine. Scand J Public Health 2004;32:17-23.
6.Diamond J. Demography of the Arab World. Lecture. ST203, 21.10.02.
7. Jalili IK. Childhood visual impairment in the West Bank and Gaza
Strip. Thesis - in preparation.
8. World Health Organisation. Health conditions of, and assistance to,
the Arab population in the occupied Arab territories, including
Palestine. The 54th World Health Assembly, Agenda item 17, 22 May 2001.
Published on line: http://bmj.bmjjournals.com/cgi/eletters/329/7471/924?ehom#81170
by Richard Horton. The
NW1 7BY, UK
present conflict in Iraq signals a contrast of paradoxical proportions. The
Iraqi people, their interim government, and their largely US and British
occupiers are preparing for landmark elections early in the new year. Yet a
ruthlessly violent insurgency is successfully destabilising these arrangements,
murdering foreign civilians and Iraqi law enforcement officers in the most
brutal ways imaginable, and exploiting the world’s media in doing so. Amid
this deep national uncertainty, it is hard to judge what is happening among
Iraqis themselves. This week
the first scientific study of the effects of this war on Iraqi civilians.
a unique US-Iraqi collaboration, Les Roberts and his colleagues report
substantially more deaths in Iraq since the war began than during the period
immediately before the conflict. Much of this increased mortality is a
consequence of the prevailing climate of violence in the country, and many of
the civilian casualties that are described were attributed to the actions of
coalition forces. These findings—and the tentative countrywide mortality
projections they support— have immediately translatable policy implications
for those charged with managing the aftermath of invasion.
research we publish today was completed under the most testing of
circumstances—an ongoing war. And therefore certain limitations were
inevitable and need to be acknowledged right away. The number of population
clusters chosen for sampling is small; the confidence intervals around the point
estimates of mortality are wide; the Falluja cluster has an especially high
mortality and so is atypical of the rest of the sample; and there is clearly the
potential for recall bias among those interviewed. This remarkable piece of work
represents the efforts of a courageous team of scientists. To have included more
clusters would have improved the precision of their findings, but at an enormous
and unacceptable risk to the team of interviewers who gathered the primary data.
Despite these unusual challenges, the central observation—namely, that
civilian mortality since the war has risen due to the effects of aerial
weaponry—is convincing. This result requires an urgent political and military
response if the confidence of ordinary Iraqis in the mostly American-British
occupation is to be restored.
and his colleagues submitted their work to us at the beginning of October. Their
paper has been extensively peer-reviewed, revised, edited, and fast-tracked to
publication because of its importance to the evolving security situation in
Iraq. But these findings also raise questions for those far removed from
Iraq—in the governments of the countries responsible for launching a
pre-emptive war. In planning this war, the coalition forces—especially those
of the US and UK—must have considered the likely effects of their actions for
civilians. And these consequences presumably influenced deployments of armed
forces, provision of supplies, and investments in building a safe and secure
physical and human infrastructure in the post-war setting.
the admitted benefit of hindsight and from a purely public health perspective,
it is clear that whatever planning did take place was grievously in error. The
invasion of Iraq, the displacement of a cruel dictator, and the attempt to
impose a liberal democracy by force have, by themselves, been insufficient to
bring peace and security to the civilian population. Democratic imperialism has
led to more deaths not fewer. This political and military failure continues to
cause scores of casualties among non-combatants. It is a failure that deserves
to be a serious subject for research.
this report is more than a piece of academic investigation. A vital principle of
public health is harm reduction. But harm cannot be diminished by individual
members of society alone. The lives of Iraqis are currently being shaped by the
policies of the occupying forces and the militant insurgents. For the occupiers,
winning the peace now demands a thorough reappraisal of strategy and tactics to
prevent further unnecessary human casualties. For the sake of a country in
crisis and for a people under daily threat of violence, the evidence that we
publish today must change heads as well as pierce hearts.
Published online October 29, 2004 http://image.thelancet.com/extras/04cmt384web.pdf