STATEMENT BY MEMBERS OF THE COLLEGE OF PUBLIC HEALTH MEDICINE ON THE HUMANITARIAN AND PUBLIC HEALTH CRISIS IN GAZA

30 November 2023

On the 28 November 2023, a spokesperson for the World Health Organization (Margaret Harris) said that "Eventually we will see more people dying from disease than we are even seeing from the bombardment if we are not able to put back (together) this health system”,(1) a health system devastated by attacks from the Israeli army on Gaza over the last 7 weeks.  While we condemn the attacks on civilians and healthcare workers in Israel on 7 October 2023, we are hugely disturbed by the response of the Israeli army to this attack in content and scale. As public health professionals, we are joining our health worker colleagues in South Africa and around the world in condemning the human rights violations by Israel on the Palestinian people in Gaza, including the consistent attacks on hospitals and civilians, and starving the city of basic necessities such as water, food and electricity (2,3). We are witnessing a humanitarian catastrophe unfold in Gaza and the West Bank. There is no ethical justification for the systematic and targeted attacks on Palestinian healthcare workers, facilities and patients, and deliberate destruction of the healthcare system in the occupied Palestinian territories of Gaza and the West Bank (2,4).

On 12 November 2023, the regional directors of United Nations Population Fund (UNFPA), UNICEF and WHO released a joint statement collectively calling for urgent international action to end the ongoing attacks on hospitals in Gaza (5). “We are horrified at the latest reports of attacks on and in the vicinity of Al-Shifa Hospital, Al-Rantisi Naser Paediatric Hospital, Al-Quds Hospital, and others in Gaza City and northern Gaza, killing many, including children.”(5) Between 7 October and 12 November, the WHO recorded at least 137 attacks on healthcare services in Gaza, which resulted in 521 deaths and 686 injuries, with 16 deaths and 38 injuries among healthcare workers on duty at the time (5). The Indonesian Hospital in Gaza was deliberately shelled by Israeli tanks and sniper fire leading to 12 deaths with patients and medical staff among those who were killed (6). Attacks on medical facilities and civilians are a violation of international humanitarian law (7), and this has been  completely disregarded in these blatant and targeted attacks. Furthermore, it is said that these attacks are conducted as a form of psychological warfare (8) – to prove a point to Palestinians that there is no safe space left for them. 

According to updates from Al Jazeera and the Gaza Ministry of Health (and regarded as reliable by the United Nations), as of 24 November approximately 15 000 people have been killed (with 75% being women and children) and almost 40 000 injured; among them were 210 deaths and 236 injuries among healthcare workers and more than a 100 United Nations employees; 1.7 million people have been displaced; only 1 major hospital in Gaza City remains functional, 56 clinics have been destroyed and 135 damaged, and 60 ambulances have been destroyed. Over and above the homes of people, there is widespread destruction of other essential infrastructure including schools, mosques and churches, UN and Red Cross facilities, water and sanitation infrastructure, other government buildings, with infrastructural damage estimated at > $3 billion. 

The right to seek medical assistance is a human right and should never be denied, especially in times of crisis. On 17 November, the WHO office for the Occupied Palestinian Territories confirmed that only 10 of 36 hospitals in Gaza were still functioning (9), with these hospitals experiencing massive strain and only able to provide very limited emergency services, 

lifesaving surgery and intensive care services. Shortages of water, food, and fuel are threatening the wellbeing of thousands of displaced people, most of whom are women and children. The unlawful blockade of water supply, sanitation services and overcrowding will fuel outbreaks of infectious diseases. The scale of the ongoing humanitarian crisis has also been highlighted by Médecins Sans Frontières. As public health practitioners, we understand acutely what the implications are of the lack of such basic services. A huge public health crisis is in progress that has the potential to get significantly worse with massive loss of life in a population currently estimated to be 2.2 million in Gaza. 

It is important to recognize that there is a historical context to this conflict. In 2009, Amnesty International published a 120-page research paper titled ‘Israel/Gaza: Operation Cast Lead: 22 Days of Death and Destruction’(10) and concluded, amongst other findings, breaching of the Fourth Geneva Convention and provided evidence of war crimes committed by Israel including the killing of children and attacks on healthcare workers. Similarly, in May 2023, the WHO launched two reports, ‘Right to Health: Barriers to health and attacks on healthcare in the occupied Palestinian territory, 2019-2021’(11) and ‘Right to Health: Palestinian Voices 2022-2023’.(12) These reports outline how fragmentation of the Palestinian people, implementation of a permit system, physical barriers to movement, and buffer zones have caused health inequities and created substantial barriers to healthcare provision and healthcare access in the occupied West Bank, including east Jerusalem, and in Gaza. 

Aside from the Israeli government and military, we are concerned at the complicity of certain Israeli healthcare professionals in selectively ignoring the Hippocratic Oath. Israel has dramatically increased its use of solitary confinement for Palestinian inmates (including political prisoners)(13). A report from Physicians for Human Rights–Israel (PHRI) found that Israeli healthcare professionals give solitary confinement “a medical stamp of approval”,(14) despite the World Medical Association Declaration of Tokyo prohibiting physicians from taking part in torture or cruel punishment (15). 

The nature of the blatant and targeted killing and attacks on the Palestinian people, including civilians, the cutting off of basic necessities and supplies, and the serious bodily and mental harm caused by the Israeli attacks on the people of Gaza and the West Bank is regarded by many as a genocide in progress, as defined by the Geneva Convention (16). 

A fundamental principle in public health is that health is inextricably linked to social, political, economic and commercial determinants. While these determinants have been long evidenced and established, we are increasingly calling upon public health practitioners to play a stewardship role in influencing these determinants if we are to impact on health and well-being outcomes. The unfolding catastrophe in Palestine brings this into a sharpest focus for public health practitioners. It would be inconceivable given our principles and teachings that we remain indifferent or silent in this instance. It is also right that we must condemn and take a stand on the killing of civilians, health workers and destruction of health infrastructure in any conflict anywhere in the world but we should not let this “whataboutism” paralyse us from an unequivocal stance on the disastrous situation in Palestine.  

As public health professionals, we are committed to upholding the integrity of our profession whilst advocating for human rights and we cannot remain silent whilst hospitals, healthcare workers, patients and civilians are systematically and violently targeted. We hereby call for: 

a)    an urgent and permanent ceasefire, 

b)    free passage of humanitarian aid and essential goods and services including food, water, fuel, electricity, 

c)     the release of all hostages and detainees from both sides in response to the permanent ceasefire,  

d)    political negotiations to bring a lasting peace through an end to the illegal occupation of Palestine and an end to the implementation of an apartheid system that has resulted in health inequity with unfair and unjust barriers to attaining health and wellbeing

e)    the ICC (International Criminal Court) to complete an independent investigation into war crimes committed including the killing of innocent civilians, women and children, health workers, aid workers, journalists and other service workers in Palestine and Israel, including the attacks on healthcare infrastructure, and hold those liable at the highest level accountable. 

 

Supported by:
Members of the Council of the College of Public Health Medicine: 

Dr Saiendhra Moodley, President, College of Public Health Medicine
A/Prof. Tracey Naledi, Honorary Secretary, College of Public Health Medicine
Prof. Hassan Mahomed
Prof. Flavia Senkubuge
Dr Shrikant Peters
Dr Harsha Somaroo
Dr Itumeleng Ntatamala
Dr Atiya Mosam
Dr Nompumelelo Ndaba
Dr Sujatha Hariparsad
Prof. Rene English

Members and registrars of the College of Public Heath Medicine:

Dr Masudah Paleker 
Prof. Leslie London
Dr Krishna Vallabhjee
Prof Gregory Hussey
Prof Mary-Ann Davies
Prof Mohamed Jeebhay
Prof Nisha Naicker
Prof Ozayr Mahomed
Prof Rajen Naidoo
Prof Saloshni Naidoo
Prof Shan Naidoo
Prof Susan Goldstein
Associate Professor Mary Kawonga
Associate Professor Nandi Louise Siegfried 
Associate Professor Shahieda adams
Associate Professor Virginia Zweigenthal 
Dr Adele Roxanne Govender
Dr Amilcar Juggernath
Dr Astrid Turner
Dr Bart Willems
Dr Belinda Jacobs
Dr Bernice N Harris
Dr Bhasker Nagindas Desai
Dr Blanche Andrews
Dr Chriselda Pillay 
Dr David Pienaar
Dr Erin von der Heyden 
Dr Gavin Reagon
Dr Gugu Dhlomo
Dr Haidee Williams
Dr Hannah Hussey
Dr Hashim Moomal 
Dr Indira Govender
Dr Inneke Laenen
Dr Jessica Gammon
Dr Jihada Cassim
Dr Karmani Chetty
Dr Kate Rees
Dr Kerrin Begg
Dr Leanya Jacob Mphatswe 
Dr Linda Mureithi
Dr Mehreen Hunter
Dr Mollen Magombo 
Dr Mosebi Thejane 
Dr Muzzammil Ismail
Dr Nadira Govender
Dr Nisha Jacob
Dr Patrick Madoda Hlangwane
Dr Pieter de Jager
Dr Reno Morar
Dr Sadiyya Sheik
Dr Sheila Lubega
Dr Shuaib Manjra
Dr Sikhumbuzo Mabunda 
Dr Stephen Knight
Dr Thameshree Naidu
Dr Tovhakale GE
Dr Vanessa Mudaly
Dr Velile Ngidi
Dr Vuyiswa Kumalo
Dr Waasila Jassat
Dr Xolelwa Ntsham 
Dr Yumna Wiliams
Dr Zahida Sonday
Dr Tabea Phashe 

In addition, this statement is supported by the following medical and public health colleagues, and organisation and concerned citizens from outside the College of Public Health Medicine:

South African Jews for a Free Palestine
Prof Ames Dhai
Prof Ebrahim Variava
Prof Glenda Gray
Prof Helen Schneider
Prof Laurel Baldwin-Ragaven
Prof Liesl Zuhlke
Prof Lucy Gilson
Prof Shabir Madhi
Prof Shabir Moosa
Prof Shakila Dada
Prof Sharon Prince 
Prof Sue Fawcus
Prof Uta Lehmann
Prof Vera Scott
Prof Wendy Stevens
A/Prof Alan Horn
A/Prof Lloyd Tooke
Adjunct Associate Professor Tim Tucker
Associate Professor Alecia Samuels
Associate Professor Shajila Singh
Associate Professor Sumaiya Adam 
Emeritus Professor Alan Meyers 
Dr A K Peer
Dr Aaliyah Mahomed
Dr Ahmed Manjra 
Dr Ahmed Moosa
Dr Amaal Abrahams 
Dr Anam Nyembezi
Dr Ashrah Mohamed Muhamed
Dr Asief Ahmed 
Dr Asma Salloo
Dr Ayesha Ryklief-Fakier
Dr Aysha Osman
Dr Azhar Parker
Dr Aziza Bawoodien
Dr Azra Ghoor 
Dr Bhavisha Lackhoo
Dr Bianca Sossen
Dr Bibi F Cader
Dr Bradley browne
Dr Carla Jardine 
Dr Cheryl Faro
Dr Claire Procter
Dr Dawood da Costa
Dr Essop Moosa
Dr Este Sauerman
Dr Farzana Baig
Dr Farzanah Laher 
Dr Fatima Khan
Dr Feizal Majiet
Dr Ghaalied Fakier 
Dr Hammaad Gamieldien
Dr I Appel
Dr Ilhaam Gabier
Dr Iman Petersen 
Dr Jeffrey Cloete
Dr Kaashifa Gathoo 
Dr Kaneez Sayed 
Dr Khadija Jaffer 
Dr Laylah Ryklief 
Dr Leanne Brady
Dr Liina Sikwaya
Dr Mahonlal Ranchod
Dr Malika Fakier
Dr Mariam Karjiker 
Dr Meera Abraham
Dr Meera Ooka
Dr Mikhail Kleinsmidt
Dr Mishqa Jakoet 
Dr Mohammed Elias Baig
Dr Mohammed Mayet
Dr Morna Cornell
Dr Morood Manie
Dr Muhammad Abou-zeid
Dr Muhammad Saadiq Moolla
Dr Najiba Sima
Dr Nasheeta Theunissen 
Dr Natasia Marques 
Dr Nawaal Gallie
Dr Nicola Williams
Dr Prince Chikezie 
Dr Rabia Cariem
Dr Raeesa Mahomed
Dr Raeesa Moolla
Dr Rahmat Bagus 
Dr Rasool Sheik 
Dr Refik Bismilla
Dr Renee Usdin 
Dr Rifqah Abeeda Roomaney
Dr Rosa Jansen
Dr Rubeena Cassim 
Dr Rushdah Lariza Khan 
Dr Sa-eeda Chippendale
Dr Saalikha Aziz 
Dr Sabeehah Vawda
Dr Sadick Saban
Dr Sadna Balton 
Dr Samah El-Boraei
Dr Samantha Camp
Dr Sameera Sheriff
Dr Sarah Day
Dr Shabir Moolla
Dr Shaegan Irusen
Dr Shakti Pillay
Dr Sham Moodley
Dr Shamiel Salie
Dr Shamila Fakie
Dr Shehnaz Moosa 
Dr Simon Pickstone-Taylor
Dr Sumaya Sayed
Dr Tannah Cleak
Dr Therese Fish
Dr Tim Wilson 
Dr Tisneem Mohamed 
Dr Veruschka José Bryant
Dr Yacoob AK Vahed 
Dr Yasmin Brey 
Dr Zahiera Ismail
Dr Zahraa saban 
Dr Zainab Karaan
Dr Zainab Waggie
Dr Zainub Jooma
Dr Thulani Masilela 
Sr Naseema Akburally
Mr Rezaan Suliman
Mr Sameer Rahim
Mrs Farieda Abrahams 
Ms Amiena Jardine 
Ms Emily Marshall
Ms Firoza
Ms Jani Uys
Ms Karessa Govender 
Ms Lisa Deyce
Ms Mary E Miller
Ms Mumtaz Sheik 
Ms Nabeela Cassim
Ms Naemah daye
Ms Nikki Schaay-Gaylard
Ms Nokwanda Themba
Ms Shamiela January 
Ms Shamim Hargovan 
Ms Taskeen Hayat 
Ms Zahra Rashid
Ms Zahraa Waja
Amy M Alpert
Elise Levendal 
Lamees Ras
Shehzaad Joosub
Verusha Mudaly
Weez Bramwell 

References

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2.             Qassem-Hassan L, Walden R. A Palestinian and an Israeli physician speak out for medical ethics. Lancet [Internet]. 2023 Nov 4;402(10413):1619–20. Available from: https://doi.org/10.1016/S0140-6736(23)02403-0

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6.             Subramaniam T, Guy J, Upright E, Hayes M, Chowdhury M, Vera A. World Health Organization “appalled” by attack on Indonesia Hospital in Gaza, director-general says [Internet]. November 20, 2023 Israel-Hamas war. 2023 [cited 2023 Nov 28]. Available from: https://edition.cnn.com/middleeast/live-news/israel-hamas-war-gaza-news-11-20-23/h_6d83b7b0714edbc4f0786c29fed4c72b

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13.           Addameer Prisoner Support and Human Rights Association. Isolation [Internet]. Key Issues: Isolation. 2017 [cited 2023 Nov 28]. Available from: https://www.addameer.org/key_issues/isolation

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