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THIS STATEMENT IS A RESPONSE TO BMJ LETTER AND COMMENTS: “Gaza: Israeli airstrikes kill doctors and damage healthcare facilities”
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1300
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.
Steven M. Albert, PhD, University of Pittsburgh
Brian S. Englander, MD, University of Pennsylvania
Linda Landesman, DRPH, MSW, University of Massachusetts-Amherst
Marian Levy, DrPH, RD, University of Memphis
Richard L. Popp, MD, Stanford University
Joseph Alpert, Professor/Editor in Chief, University of Arizona College of Medicine
Charles Antzelevitch, Distinguished Professor, Cardiovascular Research, Lankenau Institute for Medical Research
Boaz Arzi, Professor, Surgical and Radiological Sciences, University of California Davis
Ami Attali, Assistant Professor and Director, Division of High Risk Obstetrical Anesthesiology, Anesthesiology, Pain Management and Peri-Operative Medicine, Henry Ford Health System
Jonathan Balcombe, Director of Computed Tomography, Assuta Medical Centers, Israel
Ilan Benjamin, Associate Professor, Family Medicine, McGill
A. Mark Clarfield, Professor (Emeritus), Geriatrics and the Centre for Global Health, Ben-Gurion University of the Negev and McGill University (Adjunct)
Seymour Cohen, Associate Clinical Professor, Ichan School of Medicine @ Mt. Sinai
Richard Cohn, Professor Emeritus, Pediatrics, Northwestern University Feinberg School of Medicine
Arthur Eidelman, Professor Emeritus, Share Zedek Medical Center
Arleen Eidelman, Professor Emeritus, Hebrew Unversity School of Medicine
Guy Genin, Professor, Neurological Surgery and Mechanical Engineering, Washington University in St. Louis
Edward Gerstenfeld, Professor of Medicine, Medicine/CardiologyUniversity of California, San Francisco
Nancy Gilbert, Assistant Clinical Professor, Nursing, University of Massachusetts
Jeffrey Goldberger, Chief, Cardiac Electrophysiology, University of Miami
Philip Greenland, Professor, Preventive Medicine, Northwestern University
Jeffrey Grinblatt, MD, Internal Medicine, Northshore University Healthsystem
Amber Gum, Professor, Department of Mental Health Law & Policy, University of South Florida
David Kareken, Professor, Neurology, Indiana University School of Medicine
Ben Katz, MD/Professor, Pediatrics, Northwestern University
Richard Kravitz, Professor, Internal Medicine, University of California Davis
Nathan Kuppermann, Professor and Chair, Emergency Medicine and Pediatrics, UC Davis
Peretz Lavie, Prof. (Emer.), Technion-Israel Institute of Technology
Moshe Levi, Professor, Biochemistry and Molecular and Cellular Biology, Georgetown University
Michael Lewis, Professor, Anesthesiology, Michigan State University
Rita Lourie, Retired, Nursing, Temple University
Shimon Marom, Professor, Technion - Israel Institute of Technology
Raphael Melmed, Professor Emeritus, Hebrew University School of Medicine
Evan D. Morris, Professor, Radiology and Biomedical Imaging, Yale
Dianne Moses, Medical Practitioner and Educator, Griffith University
Benjamin Movsas, Professor, Radiation Oncology, WSU
Theodore Tulchinsky MPH, Emeritus, Braun School of Public Health, Hebrew University, Jerusalem
Stanley Nattel, Professor, Medicine, University of Montreal
Mark Pepys, Professor Sir, Medicine, University College London
Manfred Philipp, Professor Emeritus, Biochemistry, Graduate Center, City University of New York
Matan Shelomi, Associate Professor, National Taiwan University
Yosef Refaeli, Associate Professor, University of Colorado
Elihu D Richter, Assoc. Prof., Unit of Occupational and Environmental Medicine, Hebrew University - Hadassah
Stuart Sprague, Clinical Professor, Medicine, NorthShore University HealthSystem-University of Chicago
Gerald Steinberg, Professor Emeritus, Political Science, Bar Ilan University
David Stone, Emeritus Professor, University of Glasgow
Jack Stroh, Associate Clinical Professor of Medicine, RWJ-Rutgers Medical School
Jerome Teitel, Professor, Medicine, University of Toronto
Isaac Teitelbaum, Professor, Medicine, University of Colorado School of Medicine
Richard Tresley, Adjunct Attending Neurologist, Department of Neurology, University of Illinois Medical Center of Chicago
Dr. Arthur Weinstein, Clinical Professor Emeritus, Medicine/Rheumatology, Georgetown University
Gary Whittaker, Professor, Microbiology + Immunology, Cornell University
Joshua Younger, Assistant Professor, Anesthesiology, Henry Ford Health System, Wayne State University School of Medicine
Douglas Zipes, Professor Emeritus, Cardiology, Indiana University School of Medicine