Failure to address the health toll of the Middle East crisis

Abstract

“We are witnessing a race to the bottom in terms of respect for human rights and international humanitarian law, with the danger that both communities will come to support continual violence as normal and acceptable.” This was the stark conclusion drawn by a delegation of doctors who travelled from the USA to the West Bank, Gaza, and Jerusalem at the end of last month, on behalf of the non-governmental organisation, Physicians for Human Rights. The horrific Palestinian suicide bombings in Israel and subsequent carnage inflicted by the Israeli Defence Force (IDF) in the West Bank represent what Physicians for Human Rights called a potential “endless cycle of mutual dehumanisation”. A striking component of this process of dehumanisation has been the flood of examples of blatant disregard for medical neutrality, and other internationally agreed rules of conflict, notably by the IDF during its relentless attacks in the West Bank ordered by Ariel Sharon, and continued despite overwhelming international condemnation. There are numerous independent reports of Palestinian ambulance personnel being killed by IDF fire, even after the attacked ambulances had been cleared by the IDF for safe passage. The International Committee of the Red Cross was just one of several aid agencies obliged to limit activities in the West Bank as a result of threats to-staff and attacks on vehicles and offices. Peter Hansen, Commissioner General of the United Nation's Relief and Works Agency for Palestine Refugees stated: “We are getting reports of pure horror … In the name of human decency the Israeli military must allow our ambulances safe passage to help evacuate the wounded and deliver emergency supplies of medicines and food.” The estimated casualties are only a fraction of the larger health toll of death and illness caused by Palestinians being denied access to routine health care. The instances of blatant disregard for the provisions of the Geneva Conventions also include the destruction of infrastructure necessary for the provision of food, water, and electricity, with direct and serious consequences for public health. As the World Bank has pointed out, many of the damaged hospitals and water and electricity systems were created with US$4·5 billion of long-term development aid invested in the West Bank and Gaza since 1993. And the high costs of destruction of the foundations of future stability are social as well as physical. As UNICEF Executive Director Carol Bellamy noted, Israelis and Palestinians alike have terrorised each other's children, increasing their acceptance of violence as a method for resolving problems, with “incalculable” consequences. The European Union, individual governments, and—most significantly—the USA, all rightly pressed for a halt to violence on both sides and the withdrawal of Israeli troops. But the international community signally failed to act with equal vigour to condemn the gross violations of international humanitarian law and to apply the pressure necessary to ensure that the law is upheld. A major United Nations agency confirmed to The Lancet that not one of the main governments involved attempted behind-the-scenes negotiations that might have helped to protect civilians and ensure medical neutrality. Clearly, those who have appointed themselves international peace brokers need to wake up from the lazy and naive thinking that health and access to health care are somehow luxuries that need be considered only after a ceasefire has been negotiated or aggression has been quelled. Conflicts, however seemingly unending and intractable, must at some point end, but the process towards reconciliation and reconstruction is hopelessly hindered when a civilian population is sick, battered, and traumatised. As Benjamin Disraeli noted in 1877: “The health of the people is really the foundation upon which all their happiness and all their powers as a state depend.” Protecting the health of ordinary people—and the activities of extraordinary humanitarian relief workers—during times of conflict is not an option, but the inescapable duty of any nation that considers itself to have any truly meaningful role in world affairs.