Correspondence
Published Online August 5, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61301-5
For the list of signatories see appendix
us make sure we inoculate ourselves against the forces that demean these ideals. We declare no competing interests.
*Jeffrey J Goldberger, Richard L Popp, Douglas P Zipes, on behalf of 43 signatories [email protected] Northwestern Memorial Hospital, Northwestern University, Chicago, IL 60611, USA (JJG); Stanford University, Palo Alto, CA, USA (RLP); and Indiana University, Indiana University School of Medicine, Indianapolis, IN, USA (DPZ) 1
Published Online August 5, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61302-7 For the Gaza Mental Health Foundation see http://www. gazamentalhealth.org
Published Online August 6, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61304-0
Manduca P, Chalmers I, Summerfield D, Gilbert M, Ang S. An open letter for the people in Gaza. Lancet 2014; 384: 397–98.
As cofounder of the Gaza Mental Health Foundation in the USA, I thank The Lancet for publishing Paola Manduca and colleagues’ letter1 about the terrible effect of the Israeli attacks on the people of Gaza. Our foundation supports mental health work in Gaza. We recently learned that Dr Yasser Abu Jamei, Executive Director of the Gaza Community Mental Health Programme (our partner agency), lost 28 family members when the family home was bombed on July 21. Other staff members have also lost loved ones. It is difficult to see how the agency will be able to treat the traumatised population in view of the extent of its key staff’s trauma. On top of the devastation to homes and lives, hundreds of thousands of people are now being denied access to clean water with potentially lethal consequences. In their 2012 report, Gaza in 2020: a liveable place?,2 the UN warned that the Gaza Strip would soon be unliveable; that day now seems to be at hand. I declare no competing interests.
Nancy Murray [email protected] Gaza Mental Health Foundation, Cambridge, MA 02238, USA 1
2
578
Manduca P, Chalmers I, Summerfield D, Gilbert M, Ang S. An open letter for the people in Gaza. Lancet 2014; 384: 397–98. UNRWA. Gaza in 2020: a liveable place? 2012. http://www.unrwa.org/newsroom/pressreleases/gaza-2020-liveable-place (accessed Aug 4, 2014).
We strongly protest that The Lancet published the sadly prejudiced political diatribe by Paola Manduca and colleagues1 that, among other distortions, accuses 95% of Israeli physicians of being complicit of war crimes. Even during conflicts aimed to defend our existence, Israel and the Israeli Defense Forces (IDF) adhere to the highest moral standards, as one of few, or maybe the only country, that extend a helping hand to its enemies during conflict. The Israeli medical community and the IDF Medical Corps have a major role in this effort. Along the Syrian border, where 1700 innocent civilians were killed only this week, an ongoing and intended massacre of no interest to Manduca and colleagues, a specially dedicated military medical facility continues to treat more than 1000 Syrian victims of civil war. Acutely and chronically ill patients from Gaza and the West Bank are regularly admitted to Israeli hospitals and clinics. In the West Bank, Israeli military medical teams treated 369 Palestinian civilians during the past 18 months, according to the Medical Department of IDF, West Bank Division. Although most patients are evacuated to Palestinian hospitals, we insist on evacuating severe casualties to Israeli level one trauma centres. We are strengthening this effort with the deployment of a field hospital at Gaza border to provide medical care to Palestinian casualties. Dozens of patients treated there are the best answer to Manduca and colleagues. We work closely with our Palestinian colleagues, doing joint professional conferences and courses. In 2013, alone, 182 Palestinian physicians were trained as residents or fellows in Israeli hospitals. There is no border between medical professionals. We have no need for Manduca and colleagues’ perverse ethical code. We prefer to adhere with Moses Maimonides (the Rambam,
12th century): ”Preserve the strength of my body and of my soul that they ever be ready to cheerfully help and support rich and poor, good and bad, enemy as well as friend.”2 We declare no competing interests.
*Adi Leiba, Moshe Pinkert, Yitshak Kreiss [email protected] Central Medical Command, Israeli Medical Corps, Jerusalem, Israel (AL, MP); and Surgeon General Headquarters, Medical Corps, Ramat Gan, Israel (YK) 1
2
Manduca P, Chalmers I, Summerfield D, Gilbert M, Ang S. An open letter for the people in Gaza. Lancet 2014; 384: 397–98. Kaplan KJ, Schwartz MB. Hippocrates, Maimonides and the doctor’s responsibility. Omega (Westport) 1999–2000; 40: 17–26.
The consequences of conflict on health and provision of health-care services have been documented. 1 War and political violence are fundamental public health problems, therefore their prevention should be a central task of health professionals.2 Accordingly, health researchers and providers should, wherever and however possible, aid to alleviate the immediate consequences of political violence and advocate for the prevention of further violence and repression. Because of this mandate, the present situation in Gaza is distressing. As of Aug 1, 11 (of 32) hospitals and 14 clinics have been damaged by the Israeli attacks in Gaza, according to WHO situation report.3 Ten hospitals and 34 (of 75) clinics have closed. 1418 Palestinians have been killed, including 324 children, 166 women (aged 18–60 years), and 60 elderly people. According to Israel’s Ministry of Foreign Affairs, two Israeli civilians and one Thai civilian have been killed, 83 civilians have been wounded, and 64 Israeli Defense Force soldiers and officers have been killed.4 The present situation brings to light the need for international pressure to uphold international laws and codes of ethics that guarantee protection for civilians during war and political conflict. To impede the ability of www.thelancet.com Vol 384 August 16, 2014
Correspondence
The opinions expressed are solely those of the authors. We declare no competing interests.
www.thelancet.com Vol 384 August 16, 2014
*Cindy Sousa, Amy Hagopian, Nancy Stoller, and 17 signatories [email protected] Bryn Mawr College, Graduate School of Social Work and Social Research, Bryn Mawr, PA 19010, USA (CS); University of Washington School of Public Health, Seattle, WA, USA (AH); and Department of Community Studies, University of California, Santa Cruz, CA, USA (NS) 1 2
3
4
5
6
7
8
WHO. World report on violence and health. Geneva: World Health Organization; 2002. Hagopian A, Ratevosian J, deRiel E. Gathering in groups: peace advocacy in health professional associations. Acad Med 2009; 84: 1485. WHO. Situation report #6. Occupied Palestinian territory, conflict escalation in Gaza-complex emergency. http://www.emro. who.int/images/stories/palestine/documents/ WHO_Sitrep_on_Gaza___6_-_August_1. pdf?ua=1 (accessed Aug 5, 2014). Israel Ministry of Foreign Affairs. Israel under fire: July 2014—a diary. http://mfa.gov.il/MFA/ ForeignPolicy/Terrorism/Pages/Israel-underfire-July-2014-A-Diary.aspx (accessed Aug 5, 2014). International Committee of the Red Cross. Geneva Convention relative to the protection of civilian persons in time of war (fourth Geneva Convention). In: 75 UNTS 287; 1949. WHO. WHO calls for the creation of a humanitarian corridor in Gaza. http://www. emro.who.int/media/news/humanitariancorridor-gaza.html (accessed July 29, 2014). Giacaman R, Khatib R, Shabaneh L, et al. Health status and health services in the occupied Palestinian territory. Lancet 2009; 373: 837–49. Becker A, Al Ju’beh K, Watt G. Keys to health: justice, sovereignty, and self-determination. Lancet 2009; 373: 985–87.
I would like to try and explain the very difficult situation in Gaza. The morals, ethics, and values of the Israeli people in general, and of the physicians in particular, are no different than values of British doctors. To see civilians, women, and especially children, wounded or killed during the fighting breaks our hearts. No one owns the monopoly on these universal human values, including the biased, anti-Israel, authors1 and editors of The Lancet, and it is disgraceful to slander 95% of Israeli academics. Where are your protests for an international investigation into the deaths of more than 170 000 Syrians by Syrians—most of them civilians. Where is your outcry to demand an end to the killing of innocent people in Iraq, to protest against the evil regime in Iran, against the massacre of Muslims in Burma, or Copts in Egypt;
there are endless examples. And we search in vain for your expressions of outrage against Hamas leaders, who flagrantly violated the most basic human rights. For an obscure reason, you gave a group of pro-Palestinians a platform to pour poisonous hatred on Israel. This is not the first time. It is an ongoing anti-Israeli and anti-semitic campaign, part of a well orchestrated struggle against Israeli physicians. Hamas, Al Qaeda, and other extreme Islamic fundamentalist organisations were declared by most democratic countries, including the UK, to be terrorist organisations. These groups’ covenant exhort that Jews be killed, because they are Jews. With regards to the number of Palestinian casualties, extremist groups such as Hamas do not seem to value civilian life. They intentionally position their headquarters beneath Shifa hospital and place weapons, rockets, and ammunition in schools, mosques, and shelters. UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) authorities discovered missiles in their schools in Gaza.2 3350 rockets fired so far on Israel were launched from populated areas. Those rockets were fired on Israeli villages and towns with the sole purpose of killing as many civilians as possible. Thanks to the development of the Iron Dome there were minimal casualties. We do not feel a need to apologise for the low number of Israelis killed. The use of civilians, women, and children, as human shields is a crime against humanity that should be condemned by The Lancet and the international community. This is the main cause for the high number of innocent people who are being killed. The repeated violations of Hamas of the ceasefires offered by Israel again and again increases their own casualties. Instead of disproportionately blaming Israel, the right thing to do would be to call for an international tribunal to
For the list of signatories see appendix
Getty images/Planet Observer/UIG
health workers in their attempts to deliver care, or to interrupt services that support health in other ways (such as electric and sanitation systems) is in direct conflict with the fourth Geneva Convention, which assures protection and respect for medical personnel and facilities in occupied territories and military zones.5 As public health professionals, we should be outraged by any violations to these essential guarantees; accountability for adherence to international covenants such as the 1949 Geneva Convention is a basic step in protecting civilians during war and conflict.1,5 We should support, for instance, calls from organisations such as WHO, which issued a plea to respect international law, particularly as it pertains to the obligation to guarantee that people can obtain medical care, and honouring the duty to protect hospitals.6 Health in the occupied Palestinian territory has long deteriorated under the continuous effects of Israeli policies.7 While we advocate for an end to the present bombardment of Gaza that affects civilians, we must also understand how justice, sovereignty, and self-determination for all individuals are fundamental foundations for health.8 We commend the commitment of The Lancet to publishing sound documentation from experts who detail the massive health consequences of the Israeli– Palestinian conflict on civilians. As public health workers and scholars, we need to make space in our journals and forums to share our diverse concerns, experience, and knowledge, especially in times of public health crisis, such as in Gaza today. Only through this sharing of ideas will we effectively understand the many factors affecting health and thereby appropriately uphold our obligations to protect public health.
Published Online August 8, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61310-6
579
Published Online August 5, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61301-5
For the list of signatories see appendix
us make sure we inoculate ourselves against the forces that demean these ideals. We declare no competing interests.
*Jeffrey J Goldberger, Richard L Popp, Douglas P Zipes, on behalf of 43 signatories [email protected] Northwestern Memorial Hospital, Northwestern University, Chicago, IL 60611, USA (JJG); Stanford University, Palo Alto, CA, USA (RLP); and Indiana University, Indiana University School of Medicine, Indianapolis, IN, USA (DPZ) 1
Published Online August 5, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61302-7 For the Gaza Mental Health Foundation see http://www. gazamentalhealth.org
Published Online August 6, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61304-0
Manduca P, Chalmers I, Summerfield D, Gilbert M, Ang S. An open letter for the people in Gaza. Lancet 2014; 384: 397–98.
As cofounder of the Gaza Mental Health Foundation in the USA, I thank The Lancet for publishing Paola Manduca and colleagues’ letter1 about the terrible effect of the Israeli attacks on the people of Gaza. Our foundation supports mental health work in Gaza. We recently learned that Dr Yasser Abu Jamei, Executive Director of the Gaza Community Mental Health Programme (our partner agency), lost 28 family members when the family home was bombed on July 21. Other staff members have also lost loved ones. It is difficult to see how the agency will be able to treat the traumatised population in view of the extent of its key staff’s trauma. On top of the devastation to homes and lives, hundreds of thousands of people are now being denied access to clean water with potentially lethal consequences. In their 2012 report, Gaza in 2020: a liveable place?,2 the UN warned that the Gaza Strip would soon be unliveable; that day now seems to be at hand. I declare no competing interests.
Nancy Murray [email protected] Gaza Mental Health Foundation, Cambridge, MA 02238, USA 1
2
578
Manduca P, Chalmers I, Summerfield D, Gilbert M, Ang S. An open letter for the people in Gaza. Lancet 2014; 384: 397–98. UNRWA. Gaza in 2020: a liveable place? 2012. http://www.unrwa.org/newsroom/pressreleases/gaza-2020-liveable-place (accessed Aug 4, 2014).
We strongly protest that The Lancet published the sadly prejudiced political diatribe by Paola Manduca and colleagues1 that, among other distortions, accuses 95% of Israeli physicians of being complicit of war crimes. Even during conflicts aimed to defend our existence, Israel and the Israeli Defense Forces (IDF) adhere to the highest moral standards, as one of few, or maybe the only country, that extend a helping hand to its enemies during conflict. The Israeli medical community and the IDF Medical Corps have a major role in this effort. Along the Syrian border, where 1700 innocent civilians were killed only this week, an ongoing and intended massacre of no interest to Manduca and colleagues, a specially dedicated military medical facility continues to treat more than 1000 Syrian victims of civil war. Acutely and chronically ill patients from Gaza and the West Bank are regularly admitted to Israeli hospitals and clinics. In the West Bank, Israeli military medical teams treated 369 Palestinian civilians during the past 18 months, according to the Medical Department of IDF, West Bank Division. Although most patients are evacuated to Palestinian hospitals, we insist on evacuating severe casualties to Israeli level one trauma centres. We are strengthening this effort with the deployment of a field hospital at Gaza border to provide medical care to Palestinian casualties. Dozens of patients treated there are the best answer to Manduca and colleagues. We work closely with our Palestinian colleagues, doing joint professional conferences and courses. In 2013, alone, 182 Palestinian physicians were trained as residents or fellows in Israeli hospitals. There is no border between medical professionals. We have no need for Manduca and colleagues’ perverse ethical code. We prefer to adhere with Moses Maimonides (the Rambam,
12th century): ”Preserve the strength of my body and of my soul that they ever be ready to cheerfully help and support rich and poor, good and bad, enemy as well as friend.”2 We declare no competing interests.
*Adi Leiba, Moshe Pinkert, Yitshak Kreiss [email protected] Central Medical Command, Israeli Medical Corps, Jerusalem, Israel (AL, MP); and Surgeon General Headquarters, Medical Corps, Ramat Gan, Israel (YK) 1
2
Manduca P, Chalmers I, Summerfield D, Gilbert M, Ang S. An open letter for the people in Gaza. Lancet 2014; 384: 397–98. Kaplan KJ, Schwartz MB. Hippocrates, Maimonides and the doctor’s responsibility. Omega (Westport) 1999–2000; 40: 17–26.
The consequences of conflict on health and provision of health-care services have been documented. 1 War and political violence are fundamental public health problems, therefore their prevention should be a central task of health professionals.2 Accordingly, health researchers and providers should, wherever and however possible, aid to alleviate the immediate consequences of political violence and advocate for the prevention of further violence and repression. Because of this mandate, the present situation in Gaza is distressing. As of Aug 1, 11 (of 32) hospitals and 14 clinics have been damaged by the Israeli attacks in Gaza, according to WHO situation report.3 Ten hospitals and 34 (of 75) clinics have closed. 1418 Palestinians have been killed, including 324 children, 166 women (aged 18–60 years), and 60 elderly people. According to Israel’s Ministry of Foreign Affairs, two Israeli civilians and one Thai civilian have been killed, 83 civilians have been wounded, and 64 Israeli Defense Force soldiers and officers have been killed.4 The present situation brings to light the need for international pressure to uphold international laws and codes of ethics that guarantee protection for civilians during war and political conflict. To impede the ability of www.thelancet.com Vol 384 August 16, 2014
Correspondence
The opinions expressed are solely those of the authors. We declare no competing interests.
www.thelancet.com Vol 384 August 16, 2014
*Cindy Sousa, Amy Hagopian, Nancy Stoller, and 17 signatories [email protected] Bryn Mawr College, Graduate School of Social Work and Social Research, Bryn Mawr, PA 19010, USA (CS); University of Washington School of Public Health, Seattle, WA, USA (AH); and Department of Community Studies, University of California, Santa Cruz, CA, USA (NS) 1 2
3
4
5
6
7
8
WHO. World report on violence and health. Geneva: World Health Organization; 2002. Hagopian A, Ratevosian J, deRiel E. Gathering in groups: peace advocacy in health professional associations. Acad Med 2009; 84: 1485. WHO. Situation report #6. Occupied Palestinian territory, conflict escalation in Gaza-complex emergency. http://www.emro. who.int/images/stories/palestine/documents/ WHO_Sitrep_on_Gaza___6_-_August_1. pdf?ua=1 (accessed Aug 5, 2014). Israel Ministry of Foreign Affairs. Israel under fire: July 2014—a diary. http://mfa.gov.il/MFA/ ForeignPolicy/Terrorism/Pages/Israel-underfire-July-2014-A-Diary.aspx (accessed Aug 5, 2014). International Committee of the Red Cross. Geneva Convention relative to the protection of civilian persons in time of war (fourth Geneva Convention). In: 75 UNTS 287; 1949. WHO. WHO calls for the creation of a humanitarian corridor in Gaza. http://www. emro.who.int/media/news/humanitariancorridor-gaza.html (accessed July 29, 2014). Giacaman R, Khatib R, Shabaneh L, et al. Health status and health services in the occupied Palestinian territory. Lancet 2009; 373: 837–49. Becker A, Al Ju’beh K, Watt G. Keys to health: justice, sovereignty, and self-determination. Lancet 2009; 373: 985–87.
I would like to try and explain the very difficult situation in Gaza. The morals, ethics, and values of the Israeli people in general, and of the physicians in particular, are no different than values of British doctors. To see civilians, women, and especially children, wounded or killed during the fighting breaks our hearts. No one owns the monopoly on these universal human values, including the biased, anti-Israel, authors1 and editors of The Lancet, and it is disgraceful to slander 95% of Israeli academics. Where are your protests for an international investigation into the deaths of more than 170 000 Syrians by Syrians—most of them civilians. Where is your outcry to demand an end to the killing of innocent people in Iraq, to protest against the evil regime in Iran, against the massacre of Muslims in Burma, or Copts in Egypt;
there are endless examples. And we search in vain for your expressions of outrage against Hamas leaders, who flagrantly violated the most basic human rights. For an obscure reason, you gave a group of pro-Palestinians a platform to pour poisonous hatred on Israel. This is not the first time. It is an ongoing anti-Israeli and anti-semitic campaign, part of a well orchestrated struggle against Israeli physicians. Hamas, Al Qaeda, and other extreme Islamic fundamentalist organisations were declared by most democratic countries, including the UK, to be terrorist organisations. These groups’ covenant exhort that Jews be killed, because they are Jews. With regards to the number of Palestinian casualties, extremist groups such as Hamas do not seem to value civilian life. They intentionally position their headquarters beneath Shifa hospital and place weapons, rockets, and ammunition in schools, mosques, and shelters. UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) authorities discovered missiles in their schools in Gaza.2 3350 rockets fired so far on Israel were launched from populated areas. Those rockets were fired on Israeli villages and towns with the sole purpose of killing as many civilians as possible. Thanks to the development of the Iron Dome there were minimal casualties. We do not feel a need to apologise for the low number of Israelis killed. The use of civilians, women, and children, as human shields is a crime against humanity that should be condemned by The Lancet and the international community. This is the main cause for the high number of innocent people who are being killed. The repeated violations of Hamas of the ceasefires offered by Israel again and again increases their own casualties. Instead of disproportionately blaming Israel, the right thing to do would be to call for an international tribunal to
For the list of signatories see appendix
Getty images/Planet Observer/UIG
health workers in their attempts to deliver care, or to interrupt services that support health in other ways (such as electric and sanitation systems) is in direct conflict with the fourth Geneva Convention, which assures protection and respect for medical personnel and facilities in occupied territories and military zones.5 As public health professionals, we should be outraged by any violations to these essential guarantees; accountability for adherence to international covenants such as the 1949 Geneva Convention is a basic step in protecting civilians during war and conflict.1,5 We should support, for instance, calls from organisations such as WHO, which issued a plea to respect international law, particularly as it pertains to the obligation to guarantee that people can obtain medical care, and honouring the duty to protect hospitals.6 Health in the occupied Palestinian territory has long deteriorated under the continuous effects of Israeli policies.7 While we advocate for an end to the present bombardment of Gaza that affects civilians, we must also understand how justice, sovereignty, and self-determination for all individuals are fundamental foundations for health.8 We commend the commitment of The Lancet to publishing sound documentation from experts who detail the massive health consequences of the Israeli– Palestinian conflict on civilians. As public health workers and scholars, we need to make space in our journals and forums to share our diverse concerns, experience, and knowledge, especially in times of public health crisis, such as in Gaza today. Only through this sharing of ideas will we effectively understand the many factors affecting health and thereby appropriately uphold our obligations to protect public health.
Published Online August 8, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)61310-6
579
