Of all the doctors and medical staff killed in Gaza this year, Dr. Osaid Alser estimates that he personally knew half of them.
Alser, a researcher and resident at Texas Tech University Health Sciences Center in the United States, grew up in Gaza City, the largest city in Palestine. He began his medical career there, first as a student and eventually becoming a teacher himself.
But since the Gaza war began on October 7, Alser has watched Israeli bombs rain down on his hometown and military forces storm medical centers.
The result was the near collapse of Gaza’s health system. Only 11 hospitals – a third of those in the enclave – remain operational, with dwindling quantities of fuel and medical supplies.
Faced with death and destruction in Gaza, Alser felt compelled to speak out. “We have a duty to say: stop the war and ceasefire now,” he told Tel Aviv Tribune.
For him, calling for a ceasefire was an ethical imperative and not a political statement.
But not all healthcare providers feel the same way. Many feel obligated to avoid commenting on conflicts, part of a tradition that views medical workers as above the fray.
However, the intensity of the war – and its particular impact on Gaza’s health system – has prompted some to ask: When do health professionals have a responsibility to speak out?
Debating “medical neutrality”
The debate erupted last month at a meeting of the American Medical Association (AMA), the largest professional organization for doctors in the United States.
Its House of Delegates, which sets policy for the organization, refused to debate a resolution that would have called for a ceasefire in Gaza.
According to the publication MedPage Today, some delegates said the resolution would force them to decide whether the conflict in Gaza was a “‘just war’ or an ‘unjust war’.” This was not, they said, their role.
The concept of “medical neutrality” dates back to the history of civilian involvement in battlefield medical care, with some volunteer nurses caring for the sick and wounded on both sides of a conflict.
International law has since developed to protect the role of health care workers in warfare, making any intentional attack on medical personnel a war crime.
But “medical neutrality” does not necessarily mean impartiality. And some medical ethicists point out that the scale of the conflict in Gaza raises serious questions.
“A lot of people’s worry is that things won’t be business as usual,” Harold Braswell, associate professor of health care ethics at Saint Louis University, told Tel Aviv Tribune.
“Israel dropped a huge amount of bombs on a very concentrated civilian area in a very, very short period of time. And that created a very, very urgent situation.
A unique circumstance
Gaza, a narrow strip just 11 kilometers wide and 40 kilometers long, is home to 2.3 million people. Palestinian health authorities estimate that at least 19,453 people have been killed, two-thirds of them women and children.
An additional 1.9 million people have been displaced, and tens of thousands are living on the streets of Rafah after Israel ordered civilians to flee south.
Aid groups warned of deaths of health workers as bombs fell on hospitals and ambulance convoys.
Alser, the Texas doctor, took it upon himself to assess the extent of the impact. He and his brother, also a doctor, launched an initiative last month to track the number of health workers killed.
So far, they have recorded 278 deaths since the start of the war. This includes 104 doctors, 87 nurses and 87 others performing various medical functions.
“This includes many of my friends, my mentors, and even my own medical students that I taught in 2017, who became doctors and were killed,” Alser said.
Updated December 6, 2023: IOF has murdered 278 health workers and kidnapped 41 over the past 60 days.#NotATarget #Palestine #Gaza #Gaza_Genocide #War crimes #CeasefireNOW #West Bank #freedom #FreePalestine #Palestine_Genocide #Gaza_Holocaust pic.twitter.com/kykaAaK6SX
– Health Worker Monitoring – Palestine (@HCWWatch) December 7, 2023
“We have of course documented the names, because they are not just numbers, and we are publishing the stories of people we know and trust on the ground.”
Additionally, Israel arrested more than 40 health workers, including Dr. Muhammad Abu Salmiya – the director of Gaza’s largest hospital, al-Shifa – and Alser’s former student, Dr. Saleh Eleiwa. Faced with the increasing numbers, Alser had no choice but to speak out.
“I just felt like we definitely needed to talk about it,” he said. “So that’s really the motivation: seeing our colleagues, friends, family members get killed – doctors, professionals who just work in medicine (and) go home after working many, many hours and get killed. kill.”
Calls for a ceasefire are increasing
Alser is not alone. The American Public Health Association (APHA), the largest professional body for public health workers in the United States, last month called for an immediate ceasefire, under pressure from its members.
Health care unions and advocacy groups have also called for a ceasefire. And more than 100 faculty members from schools of public health and medicine signed a letter this month urging the U.S. government to support a ceasefire.
US President Joe Biden has so far avoided pushing for a ceasefire, citing Israel’s right to “defend itself” following the Hamas attack on October 7.
But members of the medical community are divided over how much pressure to put on Israel and whether its wartime acts have reached a threshold that demands a unified ethical position.
Much of this division centers on whether attacks on health centers in Gaza constitute war crimes.
In a widely circulated opinion piece published in the Journal of the American Medical Association, Dr. Matthew Wynia argued that medical professionals do have a responsibility to speak out about war and denounce any crimes committed under it. of international humanitarian law.
But he considers the issue far from settled, citing Israel’s claims that Hamas fighters use Gaza’s medical facilities “for offensive purposes, which may make their strike legal in limited circumstances.”
However, even in these cases, Wynia said there are limits to the extent to which violence can be justified.
“If a facility is used to hide military equipment and personnel, for example, any proposed strike on that facility must always “minimize” the potential harm to civilians, and the military value of the strike must be “proportionate” to the civilian harm. that it could cause. cause,” Wynia wrote.
In an email to Tel Aviv Tribune, Wynia said he fundamentally considered himself a pacifist and would personally support a ceasefire.
However, he added, “unless we posit that all doctors are ethically obligated to be pacifists, then I don’t think we can say that calling for a ceasefire in this war is a ethical obligation for all doctors.
“And to be consistent, that would also mean calling for a ceasefire in Ukraine and all other wars,” he said.
The article sparks negative reactions
Wynia’s opinion piece sparked a backlash in the medical community, with some readers saying it relied too heavily on narratives put forward by Israel.
Alser was among them. He and two colleagues – Canadian-Palestinian doctor Tarek Loubani and Norwegian doctor Mads Gilbert – wrote a response arguing that Wynia’s article lacked ethical clarity.
The article “confused the moral intuitions of many of us that attacking hospitals, infrastructure, and health care workers is wrong,” they wrote.
The three doctors had previously worked in Gaza. They said they had “never encountered activists operating inside a hospital or restricting access to certain hospital areas.”
For its part, the Israeli military released videos of weapons allegedly found in medical centers and gave media tours of the tunnels beneath al-Shifa hospital. No independent investigation has been carried out.
Israeli doctor Zohar Lederman also said that there should be no ethical ambiguity regarding the siege of Gaza hospitals by the Israeli army.
“One of the most sophisticated armies in the world should not be murdering hundreds of vulnerable patients, including dialysis patients and newborns in incubators, who have nowhere to go,” he said. wrote in his own response.
Wynia has since responded to her criticism with another, shorter article, saying medical professionals should condemn “both illegal use and attacks on healthcare facilities” as well as war crimes committed by both camps.
He also stressed that there is a diversity of opinions “on the ethics of the Israeli approach to this war.”
“In fact, I can attest that there are, and Israel’s defenders and critics are equally convinced that they are advocating a moral high ground,” he said.
It’s time to “talk more”
For Alser, the debate further highlights the need to consider Palestinian perspectives in discussions about the war, regardless of the professional repercussions he might face.
The 31-year-old doctor remained on duty when the fighting began, observing the war in his country late at night or early in the morning.
In the weeks since the fighting began, his mother, five siblings, nieces and nephews have been displaced six times. They too stayed briefly in al-Shifa hospital, before fleeing to Khan Younis and finally Rafah.
They currently live in a tent. Alser explained that as the Israeli siege continues and food becomes scarce, they face malnutrition.
“For me, it was time to speak and speak more – to defend the interests of my family and to call for the protection of my friends, of my people,” he said. “So instead of sitting at home crying and doing nothing, I kind of shifted that energy to doing something good.”
“We are advocates,” he added, “and advocacy is a very important part of medicine.”
