A PALESTINIAN MAN WOUNDED AT THE ISRAEL-GAZA BORDER LIES ON A BED TO RECEIVE TREATMENT AT THE SHIFA HOSPITAL IN GAZA CITY, ON APRIL 2, 2018. PHOTO BY DAWOUD ABO ALKAS. (C) APA IMAGES.
Academic journals and research in the medical, social and political sciences have highlighted a renewed understanding of structural racism, implicit bias, and the personal and public health costs of bigotry and chronic stress. It is now considered mainstream to examine societies suffering from such ills, to look at African Americans in the U.S., for instance, and make the links between hypertension, diabetes, coronary artery disease, and a shorter lifespan with the institutional racism that African Americans confront on a daily basis. It is understood that while these multigenerational problems are related to cigarette use, poor nutrition, lack of physical activity, etc, they are also diseases of chronic oppression. It is increasingly recognized that human-made inequalities produce complex structural changes that diminish disadvantaged populations’ chances for survival.
There is also a long public health tradition calling out nuclear war and more traditional wars as the ultimate health risk and advocating for harm reduction and political solutions. Thus, when International Physicians for the Prevention of Nuclear War urged an end to the nuclear arms race, they received a million signatures of support and were awarded The Nobel Peace Prize in 1985. In the twenty-first century, we see active appeals to decolonize scholarship, to ask questions and to come to conclusions that go outside the traditional white power structure, to use evidence-based research as a form of solidarity within the academy to resist settler colonialism, racism, and apartheid.
Problematically, the idea that there are two equally-weighted sides to a story when it comes to health in Palestine ignores this power imbalance between the Israeli settler colonial state and colonized Palestinians and is thus a form of “epistemicide” of Palestinian realities. Articles on Israel are never compelled to include the “Palestinian side,” as that is deemed inconsequential, irrelevant, or biased. Thus, the narrative of the powerful and the exceptionalism of Israel are usually seen as normative and defining.
A recent article titled “Are there ‘two sides’ to attacks on healthcare? Evidence from Palestine,” in The European Journal of Public Health raised just these issues.
The systemic violence towards health care in West Bank and Gaza was well documented and in violation of international Geneva Conventions. In response to these charges, Israelis claimed medical facilities housed insurgents or were merely collateral damage. The authors stated, “[M]edical and public health professionals tasked with protecting human life should take the lead in questioning whether Israel’s aggressive use of military force against medical infrastructure and personnel, under the guise of self-defense, is acceptable…Israel’s duty to protect Palestinians under occupation has a much stronger legal basis than any purported right to self-defense, particularly one that in practice leads to killing those who require said protection.” The authors urged members of the international medical community to speak out on these egregious issues.
The history of attacks on and suppression of physicians and medical groups that report on health-care realities in the occupied territories is long and troublesome. In 1981, Karl Sabbaghwrotea column in World Medicine. When Israeli authorities announced a tourism promotion to Israel for British doctors, he wrote about the Deir Yassin Massacre in 1948 as an important moment in understanding the creation of the state. The British branch of the Israel Medical Association organized a protest, accusing the magazine of “PLO [Palestine Liberation Organisation] propaganda,” urged readers to send back their copies and for drug advertisers to withdraw support. The magazine ultimately was closed down (as a consequence of that pressure), but Israeli and Palestinian historians have since validated the massacre based on Israeli military archives and Palestinian oral history.
Starting in the 1990s there were a number of highly critical articles, many by Dr. Derek Summerfield, published in medical journals examining the role of the Israeli Medical Association, the participation in torture by Israeli doctors, and violations of the fourth Geneva Convention by the Israeli army in Gaza. In 2009, the British Medical Journal published a personal analysis, “The perils of criticizing Israel,” where the acting editor noted that the journal had received 1000 emails after publishing such an article criticizing Israel in 2004 . The BMJ also received hundreds of responses, mostly published as rapid responses. Many were hostile, many “abusive and obscene,” many rudely insulted the BMJ or the editor personally and were unsigned. Much of the angry emails resulted in a call from HonestReporting [sic] a group that purportedly monitors mainstream and social media and combats “ideological prejudice in journalism and the media, as it impacts Israel.” They also sponsor newsletters, speakers, webinars, and missions to Israel, “providing you with the opportunity to observe [their version of] the real facts on the ground.”
That same article noted that since the establishment of Israel, efforts to document Palestinian history and rights has usually been met by well-organized protests that include hundreds of letters to journals and media outlets. These campaigns share messaging that is supplied by various central monitoring organizations, use denial rather than actual arguments, demand apologies and resignations, enlist people unfamiliar with the topic but responding to the call, and often resort to obscenity and the accusation of anti-Semitism. This is far from the kind of intellectual scientific debate that characterizes the tone and rigor of scientific or medical journals and it is far from a discourse that leads to greater understanding and the exchange of ideas based in actual facts. These efforts are about shutting down conversation, vilifying one side, destroying careers, and making editors afraid to enter the fray in the future.
As an example, Mads Gilbert, a Norwegian anesthesiologist and author of Eyes in Gaza (2009) and Night in Gaza (2014), coauthored many articles and academic letters highly critical of Israel. He has been met with scathing criticism and has been banned by Israel from entering the region despite his dedicated work treating the injured at Shifa Hospital in Gaza over several decades.
In 2013 The Lancetpublished a report on the involvement of Israeli doctors in the death of a young Palestinian detainee who died in custody from torture according to a Palestinian Authority pathologist, which was disputed by Israel’s chief pathologist. Despite the denials from the Israeli Medical Association, human rights groups have long documented “beatings, sleep deprivation, prolonged and painful handcuffing, humiliation, and medical neglect—considered torture under international standards.” The prisoner died after being questioned for several days by the Shin Bet, the Israeli internal security, and had bruising on his body and broken ribs. The question remained: he was seen two days earlier by Israeli doctors; was that to assess his ability to withstand further torture? Was that collusion in torture? The Public Committee against Torture in Israel reviewed the autopsy data and concurred with the diagnoses of torture as the cause of death. Data reveals that there has not been a single criminal investigation in Israel alleging torture, despite over 1,000 complaints by victims, their families, and advocates, since 2001.
In August 2014, The Lancet was targeted after publishing a piece on extensive Israeli human rights violations and aggression, “An open letter for the people in Gaza,” followed by many letters both pro and con on the “Israel-Gaza conflict”. But editor-in-chief, Richard Horton then refused to publish the authors’ response to criticisms in that correspondence. Horton was worried that The Lancet could not tolerate another threat of boycott, as well as traumatic personal attacks. The Lancet later published “a special edition on Israeli healthcare,” clearly meant to calm its detractors.
In March 2020 The Lancet published a letter warning of a looming outbreak of Covid-19 in Gaza and the negative impact of Israeli structural violence which has brought the Gaza healthcare system to the edge of failure. Three days later the letter was removed after a similar pressure campaign. The Lancet was “threatened with a boycott of the journal.” Six months later it published a letter in reply to the now-deleted letter which accused the authors of propaganda. The Lancet refused to publish an authors’ reply to the first letter, so the authors submitted a commentary to another Lancet journal and later reported that they were told that the journal “[had] been subjected to ‘very damaging boycotts’ when publishing content critical of Israeli policies and practices without a ‘counterpoint from the Israeli perspective.’ Since an attempt to solicit such a counterpoint had proved unsuccessful, the publication of our commentary could not go ahead.” Because formal retraction in academia is reserved for erroneous research, misconduct, and plagiarism, this precedent represented a threat to free speech, academic freedom, and to unpopular views being disappeared into an “academic ‘no-man’s-land,” not really retracted but not readily available.
The Lancetdid publish a correspondence which challenged the idea that critiquing Israeli actions is inherently antisemitic.
The most recent example of erasure of Palestinian experience was well documented by Murtaza Hussain in an extensive analysis in The Intercept and by my personal conversations with the authors of a censored article. On June 2, 2021 an article in the Scientific American, “As Health Care Workers, We Stand in Support of Palestine,” was retracted. Stimulated by the eleven day Israeli assault in May 2021, a group of health workers and public health professionals began communicating via social media about the impact of the attacks on Palestinians and the Palestinian healthcare infrastructure, and the silencing and macro- as well as micro-aggressions they experienced working within the healthcare system. This resulted in a Policy & Ethics Opinion piece published in Scientific Americanon June 2 originally titled “As Health Care Workers, We Stand in Solidarity with Palestine.” The essay documented the impact of Israeli state violence towards Palestinians in Gaza, Jerusalem, the West Bank and Israel, the devastating impact of the latest Israeli attack, the violations of international law, and the complicity of the US government. The authors called on US health care systems, institutions, and workers to condemn Israeli aggression, the continued destruction of Palestinian health care, and the ongoing blockade. They noted the disproportionality of deaths (257 Palestinian vs 12 Israeli) and the “structural violence of the Israeli occupation.” They called out the impact of over seventy years of settler colonial rule, violence, human rights violations and the resultant impact on health outcomes, now painfully visible during the pandemic and the Israeli policy of vaccine apartheid.
The essay was thoroughly and assiduously fact checked and vetted prior to publication.
Nine days later, the entire piece was removed from the website with the statement: “This article fell outside the scope of Scientific American and has been removed.” Thereafter, the title of the piece–now, nothing more than a disclaimer– was changed to “Health Care Workers Call for Support of Palestinians,” effectively erasing the concept of Palestine as a recognized, legitimate place.A source told the Intercept that the editor’s language intended to convey that the retraction “was not due to any factual errors in the article itself.” It is unusual to retract an opinion piece if the information is accurate, so this was a clear example of directly silencing uncomfortable discourse on Palestine. Authors of the article were also at the receiving end of numerous personal, hostile emails and messages.
One of the op ed’s authors noted on Twitter that it was probably the call for BDS that triggered the removal of the statement. She found it ironic that a nonviolent resistance strategy to end oppression (BDS) was the same tool used to “pressure scientific journals to violate academic freedom and allow censorship.”
Pro-Israel organizations publicly claimed victory over the scrubbing. Two board members from Voice4Israel organized a letter signed by over 106 physicians and scientists calling the essay inaccurate, anti-Israel political indoctrination. CAMERA(Committee for Accuracy in Middle East Reporting and Analysis) [irony noted] joined the backlash and denounced the piece as an “anti-Israel screed parroting Palestinian terror groups’ lies and incitement.” They accused Scientific American of, “shill[ing] for terrorists.” And ended with the accusation that pro-BDS activists are actually anti-Zionists and antisemites.
These are the classic talking points of the organized multimillion dollar Israeli hasbara (propaganda) industry that works to control the messaging on Israel, weaponizing accusations of terrorism and antisemitism and aggressively attacking anyone who frames the conversation based on anti-colonialism, human rights, and international law. Academics and other professionals have lost their jobs, tenure, scholarships and careers through the actions of these groups and others like the Canary Mission, NGO Monitor, AMCHA, Hillel U Center for Community Outreach (formerly the David Project), Stand with US, Campus Maccabees, the Lawfare Project, and a host of local, national, and front groups with support from wealthy donors and the Israeli government. There is also a relentless campaign on the local and federal level to criminalize the BDS movement and to claim that any criticism of Israel is inherently antisemitic, as currently seen in the State Department definition of antisemitism.
In June 2021, the Journal of Medical Ethics published an article by Derek Summerfield reviewing a twelve year saga that began with an appeal by 725 doctors from 43 countries concerned with the complicity of the Israeli medical community in the torture of Palestinian detainees. This led to a very public, bruising battle of accountability with the World Medical Association. “This campaign has been a litmus test of whether international medical codes regarding doctors and torture actually matter, and are applied rigorously and even-handed,” Summerfield later wrote. “Our findings in the case of Israel suggest that this is not true, and that impunity largely operates.” This opinion was supported by Physicians for Human Rights Israel.
The Israeli Medical Association responded to the article, condemning torture and denying that any Israeli doctors have been accused of participating in torture. The IMA charged the author with rabble rousing and stimulating Israel and Jew hatred, and it claimed that the IMA and the Israeli Defense Force work diligently to support humanitarian efforts to assist Palestinians.
The original 2021 article was followed by an in depth Blog entry in the same journal exploring how the medical profession and academia handle incriminating evidence against powerful Western powers (for instance, Israel) regarding the collusion of physicians in torture, and the experience of engaging with the national medical associations, (for instance, The Israeli Medical Association), the World Medical Association, and UN Rapporteurs.
It is obvious from this review that articles on Palestinian health do get published, and it is important to note, that some do not meet such bitter recriminations. In 2009, The Lancet published a series of articles on the status of health in the occupied Palestinian territories and this led to the founding of the Lancet Palestinian Health Alliance which organizes conferences in the region and publishes abstracts from Palestinian and international researchers. The conferences do not share the financial backing and mainstream respectability that characterize many medical events, but they make that up in enthusiasm, solidarity, and the uplifting of voices and information that are not usually heard.
Reviewing the literature, there are occasional technical articles that are published without controversy, such as the September 9, 2020, “It Takes Time to Unravel the Ecology of War in Gaza, Palestine: Long-Term Changes in Maternal, Newborn and Toddlers’ Heavy Metal Loads, and Infant and Toddler Developmental Milestones in the Aftermath of the 2014 Military Attacks.” This research examined the persistence of heavy metal contamination in Gazan children secondary to toxic contamination from war. The political implications were clear, but stated in dry scientific language.
“Severe environmental factors, metal contamination and food insecurity put Gaza’s infant health at risk.”
On May 24, 2021 the British Medical Journal published a Rapid Response article titled “Gaza: Israeli airstrikes kill doctors and damage healthcare facilities.” Interestingly this essay documented the impact of occupation, siege, and assault on Gaza and called on health care workers to uphold the right to health, demanded that Israel lift the siege to allow medical supplies and the movement of patients, and assume its responsibilities as an occupying power under international law. There was no mention of BDS. The article remains online.
In June 2021, the British Medical Journal published a Rapid response signed by 200 UK doctors, in response to a 2018 piece titled, “The maiming fields of Gaza,” outlining, “The way forward for the reconstruction of a viable health service in Gaza,” after assaults and the pandemic. The authors urged a different approach to reconstruction that entailed confronting root causes, occupation and blockade, which are forms of collective punishment that violate international law. They urged an end to the Israeli siege, development of a local viable health care system, and support for the Ministry of Health in Gaza rather than channeling efforts through the Palestinian Authority in Ramallah.
The Lancet Palestine Health Alliance recently promoted its YouTube of the eleventh LPHA conference held virtually in July 2021. Scientific sessions covered a broad range of topics on the health of Palestinians and the health impact of the political climate, from the Great March of Return, women’s health, environmental degradation, and mental health, to a variety of diseases and medical procedures. The existence of these presentations is both normative in the medical world and somewhat revolutionary, given the frequent suppression of health information from occupied Palestine.
The Covid-19 pandemic and repeated Israeli assaults have made it abundantly clear that the health of Palestinians is dependent on their liberation and the end of the Israeli colonization, occupation, and siege. The World Health Organization (WHO’s) annual report, “Right to Health: Crossing Barriers to Access Health in the Occupied Palestinian Territory 2017,” stated clearly that Israeli restrictions were the major obstacle to health access for patients in Gaza. Even Medecins Sans Frontieres, which assiduously maintains a neutral humanitarian tone in its reports, in 2021 called out the Israeli siege and “the escalation of violence” as the source of the constant state of catastrophe in Gaza.
We must not let campaigns in or out of academia aimed at silencing the truth about Palestinian experiences succeed, not only because stifling reporting is wrong and dishonest, but also because such campaigns seek to erase the realities of Palestinians through intimidation and outright censorship. Medicine and public health are fundamentally political because people live and die in a social and economic context. The state of wellness and dis-ease for Palestinians thus is intimately connected to Israeli settler colonialism, repeated aggression, dispossession, erasure, and neoliberal economic policies that all impact the level of poverty, malnutrition, health care, hope and hopelessness in this occupied population. It is our responsibility as members of the health care system and the academy to raise our voices in protest of any suppression of these truths and to call out the powerful forces that seek to obliterate this reality.
A condensed version of this essay was published in the Health and Human Rights Journal in July, 2021.