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We are a group of nurses and RCN members who have come together through our concern at the events in Gaza and the occupied Palestinian territories to discuss what we as individuals, nursing unions and the wider nursing profession can do to protect life and alleviate suffering in relation to the attack on the civilian population of the Gaza strip and ensure protection of healthcare workers. 
 
We are writing to register our horror at the ongoing military assault on civilians in Gaza and Palestine, which has led to an extreme humanitarian crisis. People are living through unimaginable suffering – injured, starving, and traumatised. We implore the RCN to urgently escalate its efforts in response to the lack of progress on safeguarding civilian and healthcare worker safety and wellbeing.  
 
We acknowledge that the events of October 7th were incredibly shocking, and the ongoing trauma and pain caused on this day must continue to be held in mind. The rise in islamophobia and antisemitism in the UK and around the world since October 7th has been alarming. As nurses, we recognise the impact this is having on Palestinians, Arab, and Jewish communities in the UK, and it is the duty of organisations such as the RCN to speak up against hate and support one another. 
 
The current siege on Gaza, coming on top of a 17-year air, sea, and land blockade which has cut off food, water, medical, electricity, and fuel supplies. The UN has stated that such measures amount to a form of collective punishment which is prohibited under the Fourth Geneva Convention. This is in addition to the ongoing war and exchange of fire between Israeli military and Palestinian armed resistance groups, which is leading to death through injuries, starvation, and disease: a man-made humanitarian disaster.  
 
On the 26th of January 2024 the International Court of Justice judged that Palestinians have a right to be protected from Genocide (Casciani, 2024). On the 25th of March 2024 the UN Security Council demanded a ceasefire, calling for the immediate release of hostages and a surge of humanitarian aid. On 5th April the Special Rapporteur’s report concluded that there are “reasonable grounds to believe that the threshold indicating Israel’s commission of genocide is met” (HRC, April 2024). To date, there has been no ceasefire. There is also mounting evidence that atrocities and crimes against humanity may have been perpetrated by the Israeli armed forces, including the killing of hundreds of civilians, healthcare workers, and patients whilst in their custody.  
 
Over 35,000 people have been killed in the war so far. As of 5th April 2024, 457 of deaths were in the Occupied West Bank, 1,139 in Israel, and 33,037 in Gaza. At least  85% of the population in Gaza is internally displaced. The World Health Organization has reported over 238 attacks on healthcare facilities. Only 10 of the 35 hospitals in Gaza are even partially functional, and several ambulances have been damaged – often through direct attacks. Multiple hospitals have been systematically besieged and ultimately destroyed to the point they have been unable to function over the last 7 months. The healthcare system has been described as at breaking point, with testimonies of surgery being delivered without any anaesthetic or electricity. In March Hundreds of healthcare workers were reported to have been killed and 52 have been abducted; many remain in detention these numbers are likely to have increased since (Hanbali et al., 2024).  Healthcare workers are having to try to care for patients in the most extreme conditions imaginable, with serious risk to – and in some cases, at the cost of – their own lives. At least 10 mass graves including the remains of healthcare workers and other civilians have been discovered in and around the sites of Al Shifa, Al Nasser and Al Amal hospitals following Israeli army withdrawal from those areas. 
 
Nurses around the UK are deeply disturbed by the escalating violence and unfolding humanitarian crisis. The NMC Code states that nurses have a duty to “Respect and uphold people’s human rights”, “Act as an advocate for the vulnerable […] challenging discriminatory attitudes” and “Act without delay if you believe there is a risk to patient safety or public protection” (NMC, 2018). We therefore have a duty to act to protect fellow healthcare workers and patients; indeed, several letters and petitions have already been signed by nurses urging the government to call for an immediate ceasefire (Church, 2023; Devereux, 2023).  
 
On 15th December ‘Workers in Palestine’ – a coalition of Palestinian trade unions including the Palestinian Association for Nursing and Midwifery – released an urgent call to action. On the 21st of February 2024, the RCN issued a statement condemning attacks on healthcare workers and patients and called for an immediate ceasefire. This was very welcome. However, since then, Israel’s assault on Gaza has continued unabated. No further action has been taken to ensure the safety of healthcare workers and civilians. In fact, the situation has deteriorated.

The RCN must continue to speak up and take action to try to help civilians and healthcare workers affected by this humanitarian crisis. We call on the RCN to do the following as a minimum:

• Reiterate a demand for an immediate and permanent ceasefire. 
• Take all actions within the law to lobby government and regional assemblies to act to prevent Genocide, including immediate cessation of arms trading with Israel and other appropriate economic, political, cultural, and educational sanctions. 
• Actively subscribe to the Boycott, Divestment and Sanction (BDS) movement by disclosing current investments and immediately divesting from those investments that provide funds to Israel, and lobby the NHS to do so.  
• Call for an immediate restoration of all the pre-requisites for health protection and disease prevention: food, water, medical supplies, electricity, shelter, and sanitation. 
• Demand the full protection of all healthcare facilities, healthcare workers, and patients undergoing treatment. 
• Send a message of solidarity to all healthcare workers in Gaza and the occupied Palestinian territories. 
• Create safe spaces/places for RCN members to talk freely about their grief and any other impact this may be having on them. 
• Offer support and protection to RCN members who wish to protest the war.
• Work with national and international partners such as the International Council of Nurses (ICN) to ensure that the principle of healthcare worker and patient protection in times of armed aggression is adhered to now and in the future. 

Individuals and organisations have a moral duty to act on the disproportionate suffering that is being inflicted on the people of Gaza. As the largest nursing union and professional body in the world, the RCN needs to redouble its efforts now to step up and play its part. 

In hope and solidarity,