Palestine: The Assault On Health And Other War Crimes

Dr. Derek Summerfield*

Does the death of an Arab weigh the same as that of a US or Israeli citizen? The Israeli army, with utter impunity, has killed more unarmed Palestinian civilians since September 2000 than the number of people who died on September 11, 2001. In conducting 238 extrajudicial executions the army has also killed 186 bystanders (including 26 women and 39 children). Two thirds of the 621 children (two thirds under 15 years) killed at checkpoints, in the street, on the way to school, in their homes, died from small arms fire, directed in over half of cases to the head, neck and chest—the sniper's wound. Clearly, soldiers are routinely authorised to shoot to kill children in situations of minimal or no threat. These statistics attract far less publicity than suicide bombings, atrocious though these are too.

Amnesty International has called for an investigation into the killing of Asma al-Mughayr (16 years) and her brother Ahmad (13 years) on the roof terrace of their home in Rafah on 18 May, each with a single bullet to the head. Asma had been taking clothes off the drying line and Ahmad feeding pigeons. Amnesty noted that the firing appeared to have come from the top floor of a nearby house, which had been taken over by Israeli soldiers shortly before. Amnesty suspects that this is not "caught in crossfire," this is murder.

Israeli military reoccupation of the West Bank and Gaza—a system of military checkpoints splitting towns and villages into ghettos, curfews, closures, raids, mass demolition and destruction of houses (more than 60 000), and land expropriations—has made ordinary life impossible for everyone, and is driving Palestinian society and its institutions towards destitution. Moreover, Israel has been constructing a grotesque barrier that, when completed, will total over 400 miles—four times longer than the Berlin Wall. Extending up to 15 miles into Palestinian territory, the real purpose of the wall is permanently to lock more than 50 illegal Israeli settlements into Israel proper. This is expansive, aggressive colonisation, in defiance of the International Court of Justice in The Hague and the United Nations General Assembly resolution of last July.

Last year a UN rapporteur concluded that Gaza and the West Bank were "on the brink of a humanitarian catastrophe." The World Bank estimates that 60% of the population are subsisting at poverty level (£1.12; $2;  1.6 per day), a tripling in only three years. Half a million people are now completely dependent upon food aid, and Amnesty International has expressed concern that the Israeli army has been hampering distribution in Gaza. Over half of all households are eating only one meal per day. A study by Johns Hopkins and Al Quds universities found that 20% of children under 5 years old were anaemic, 9.3% were acutely malnourished, and a further 13.2% chronically malnourished. The doctors I met on a professional visit in March pointed to a rising prevalence of anaemia in pregnant women and low birthweight babies.

The coherence of the Palestinian health system is being destroyed. The wall will isolate 97 primary health clinics and 11 hospitals from the populations they serve. Qalqilya hospital, which primarily serves refugees, has seen a 40% fall in follow up appointments because patients cannot enter the city. There have been at least 87 documented cases (including 30 children) in which denial of access to medical treatment has led directly to deaths, including those of babies born while women were held up at checkpoints. The checkpoint at the entrance to some villages closes at 7 pm and not even ambulances can pass after this time. As a recent example, a man in a now fenced in village near Qalqilya approached the gate with his seriously ill daughter in his arms, and begged the soldiers on duty to let him pass so that he could take her to hospital. The soldiers refused, and a Palestinian doctor summoned from the other side was also refused access to the child. The doctor was obliged to attempt a physical examination, and to give the girl an injection, through the wire.

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.

• Honorary senior lecturer, Institute of Psychiatry, London This article first appeared in the BMJ  2004;329:924 (16 October).