Health Professionals Should Not Fuel Hatred; They Should Work for Peace
Response to BMJ letter: “Gaza: Israeli airstrikes kill doctors and damage healthcare facilities”
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1300
(20 May 2021 — Amy Hagopian, Univ. of Washington School of Public Health, Seattle; Rita Giacaman, Birzeit University, Ramallah; Leonard Rubenstein, John Hopkins Univ. et al)
The medical community, in particular, has the moral obligation to raise its voice in opposition to the tragic and destructive events in Gaza and Israel (May 2021). And in order to contribute positively, it is necessary to establish the basic facts on which to build an effective response, as in the case of clinical practice.
To begin with, key questions must be asked and answered. In this conflict, 4300 rockets and missiles were launched from Gaza towards Israel (each one a war crime), killing, wounding and traumatizing millions, including the Palestinians in Gaza in areas where many projectiles fell short. According to most estimates, over 30,000 such weapons – an enormous and destructive arsenal by any measure — were stockpiled in Gaza prior to the war.
These events raise key questions: How and why was this destructive arsenal assembled for use in the first place? Who is the aggressor, seeking to use violence and destruction, and for what objectives? Who is the defender, using force as required in order to protect the lives of innocent civilians under attack?
To explore these questions, it is necessary to note that the May 2021 conflict followed similar deadly exchanges between Hamas and other militias in Gaza and Israel, including in December 2008/January 2009, 2011, and 2014. The first such conflict took place after August 2005, when Israel entirely ended its military and civilian presence in Gaza, which began during the 1967 war (launched by Egypt, Jordan, and Syrian.) On leaving, Israel transferred control to the Palestinian Authority (PA) but in 2007, Hamas forces staged a violent coup that expelled the PA from Gaza. Shortly afterwards, Hamas and other armed militias such as Palestinian Islamic Jihad, used rockets and missiles made from diverted aid materials and in some cases, acquired from Syria and Iran, to attack Israel across the border. The tragic events of May 2021 did not occur de novo but were a direct continuation of these developments.
In parallel, the Hamas rulers in Gaza used tons of diverted aid materials (cement, pipes and other equipment) to build a network of underground tunnels where rockets and missile were manufactured, stored and controlled. Over 100 kilometers of military tunnels were constructed by Hamas directly beneath Gaza’s civilian infrastructure, including high-rises, power plants, telephone towers, press offices, roads, agricultural lands, schools and mosques. Other command and communication centers were located in high-rise buildings that were also used for civilian purposes. This co-location of major military capabilities in close proximity to civilian structures also constitutes a war crime.
In the May conflict, after the Hamas forces initiated the rocket attacks (according to their own very clear public statements, ostensibly in support of Palestinians engaged in violent clashes with Israeli police in Jerusalem as part of the 100 year ongoing conflict) the Israeli military responded against these military targets in order to prevent civilian deaths and destruction from the hundreds of daily strikes from Gaza. The co-location of military equipment and non-military locations led inevitably to destruction of civilian structures, including hi-rise buildings. In one case, a tunnel that apparently housed a Hamas command center was hit and inadvertently led to the collapse of such a building.
These basic facts highlight the importance of constructive dialogue. In contrast, false and biased narratives fuel the conflict and violate the basic Hippocratic requirement to do no harm.
Joseph S. Alpert, MD
Steven Albert PhD
Charles Antzelevitch, PhD, FACC, FAHA, FHRS
Mark Clarfield MD
Brian Englander MD
Edward P. Gerstenfeld, MD
Jeffrey Goldberger, M.D.
Phil Greenland MD
Linda Landesman DRPH, MSW
Rita J Lourie MSN, MPH, RN
Raul Mitrani MD
Stanley Nattel, MD
Richard L. Popp, MD
Jack A. Stroh MD
Stuart Sprague MD
Gerald Steinberg PhD
Ted Tulchinsky MD, MPH, Life member APHA
Arthur Weinstein, MD, FACP, FRCP, MACR
Douglas P. Zipes MD