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Bulletin of Transcultural Special Interest Group (TSIG) of Royal College of Psychiatrists | Winter 2006


It has been frequently argued that doctors have a duty not only to their patients, but wider obligations not to ignore the social and political factors that operate to create suffering and poor health in the first place. Dr Vivienne Nathanson of the BMA International Committee wrote in a BMJ editorial a few years ago that it was a doctor’s duty to speak out. With this in mind, please read the article below. I appeal to those interested to contact me.

In 2004 nearly 60 of the most prominent academic, cultural and professional associations and trade unions in the Occupied Palestinian Territories, including the Federation of Unions of Palestinian Universities’ Professors and Employees and the umbrella organisation of Palestinian Non Governmental Associations, came together to issue an appeal to colleagues in the international community. This was for a comprehensive and consistent boycott of all Israeli academic and
cultural institutions as a contribution to the struggle to end Israel’s occupation,
colonisation and system of apartheid, with its concomitant breaches of international conventions of human rights, its refusal to accept UN resolutions or rulings of the International Court, and its persistent suppression of Palestinian
academic freedom. In November this year a broad range of health sector organisations and individual doctors in Gaza made the same call.

What of the medical profession? If I may start with a short personal account. I have been involved with the Occupied Territories for the past 14 years. One struggle, alongside Palestinian and Israeli colleagues, was to highlight the use of torture by Israel as an instrument of state policy, which Amnesty International and a slew of reputable international and regional human rights organisations had long since proved was institutionalised in the interrogation suites handling large numbers of Palestinian detainees every year. Amnesty also concluded that the
role being played by Israeli doctors working in and around these interrogation suites were fundamentally at odds with medical ethics. Amnesty, and others, who approached the Israeli Medical association (IMA) to urge them to take a stand were consistently rebuffed. This too has been my experience when I published articles in mainstream medical journals- notable the British Medical Journal and the Lancet. In response to one of these, published in the Lancet, the longstanding president of the IMA Dr Y Blachar actually justified the use of “moderate physical pressure”, the euphemism in Israel for torture!

The moral position and strategic line taken over many years by the IMA was well captured by a remark made by Professor Eran Dolev, then IMA Head of Ethics (yes, Ethics!) in an interview in 1999 with a visiting delegation from the Medical
Foundation for the Care of Victims of Torture, London (for whom I was principal psychiatrist for 9 years). Prof Dolev stated that that “a couple of broken fingers” during the interrogation of Palestinians was worthwhile for the information it might garner. When I published this in the Journal of the Royal Society of Medicine, verified by those present at the interview, Dr Blachar defended Prof Dolev.

Two years earlier I had written to Prof Dolev after a human rights conference in Gaza, when an Israeli physician had told me that a medical colleague had confessed to her that he had removed the intravenous drip from the arm of a seriously ill Palestinian prisoner, and told the man that if he wanted to live, he should co-operate with his interrogators. I asked Dolev to investigate but he
never replied, even after reminders.

When challenged in the BMJ or Lancet, the IMA continues to maintain that there are no medical ethical concerns arising out of the conduct of the Israeli army towards the Palestinian general population. Dr Blachar routinely labels me and
others as motivated by anti-Israel bias and by anti-semitism. Indeed after my BMJ review of Oct 2004 he wrote at “the lies and hatred he spews are reminiscent of some of the worst forms of anti-semitism ever espoused”, a response that directs open contempt towards the mass of documentation in the public domain- all from distinguished international human rights organisations like Amnesty International and Human Rights Watch, and regional ones like B’Tselem in Israel and Health, Development, Information, and Policy Institute in the Occupied West Bank- that I am citing. Yet the Israeli Defence force (IDF)
operates in a climate of near total impunity, with disproportionate force directed implacably towards the civilian population: over 4000 shot dead in the last 6 years, including around 850 children. These are truly shocking numbers, and ever growing. The recently published testimonies of the ‘Breaking the Silence’ group of ex-soldiers attest to shoot-to-kill policies that give the lie to official mantras about minimising the risk to civilians.

A veritable mass of documentation now confirms systematic and ongoing violations of the medical ethical sections of the Fourth Geneva Convention. There have been many deaths of seriously ill Palestinians, and of newborn infants, at army checkpoints because they were denied access to hospital. Ambulance drivers on duty are interrogated, searched, threatened, humiliated and assaulted. Wounded men have been taken from ambulances at checkpoints and sentdirectly to prison, and on other occasions Israeli soldiers have commandeered ambulances as transport. On numerous occasions the clearly marked ambulances of the Palestinian Red Crescent society have been hit by IDF gunfire. 2 years ago the IDF fired missiles at Bethlehem psychiatric hospital,
which had 250 patients and 75 staff present at the time. There was extensive damage and staff were arrested. Clearly identified medical clinics, including those run by the aid agency Medecins Sans Frontieres, have been hit by gunfire. The
International Committee of the Red Cross and other aid agencies have at times been forced to limit their work in the West Bank because of threats to staff and attacks on vehicles by the IDF. There has been wilful hampering of the distribution of food aid, on which half a million people are now dependent. A study by Johns Hopkins and Al Quds Universities found that 20% of Palestinian
children under 5 years old were anaemic and 22% malnourished. The IDF has also wilfully destroyed water supplies, electric power and other elements of the public health infrastructure. The continued building of the apartheid wall and fence has hugely damaged the coherence of the Palestinian health system.

Life in Gaza has become almost impossible this year, following Israeli blockade of goods (including medical supplies) and of funds to pay public sector workers. Patients died in Gaza hospitals as a direct consequence- for example, because dialysis fluids and chemotherapeutic drugs had run out. The commendable Israeli doctors of Physicians for Human Rights Israel (PHRI) published a new report on Gaza-, which they call a “humanitarian disaster”- based on a field trip last September. They quote Jan Egeland, the UN Under Secretary-General for Humanitarian Affairs as saying “there is no hope” in Gaza. Women and children now present with palpable malnutrition, barely supplied hospitals are overwhelmed by casualties, many with terrible wounds, from continued Israeli bombing (nearly 300 dead, including 66 children, since June- and virtually
unreported), and their morgues fill up with charcoaled and shredded bodies. There are interruptions of power supplies due to Israeli bombing and hospitals must save their generators for operating theatres and emergency rooms only,
patients with medical problems for which there is no treatment in Gaza are “condemned to a slow death” (as the report puts it) because they are blocked from seeking treatment in Egypt or Israel, and even people who were not initially critically ill have died from blood loss after Israeli bombing because the movement of ambulances and medical staff requires permission from the IDF-
often not forthcoming or very delayed.

It has been evident for several years that Palestinian medical staff on duty could not count on the immunity afforded them by the Fourth Geneva Convention. They too are targets. To give just 2 recent examples, 11 people were killed (murdered,
more precisely) on June 13 when 2 missiles were delivered from the air at a car. This included 2 paramedics who ran from a nearly medical facility to attend to the victims of the first missile and were killed by the second, which appears to have
been fired despite a clear view of the scene. The Red Cross has been highlighting the most recent instance, on November 5, when 2 paramedics wearing “clearly marked fluorescent jackets” were shot dead when they got out of an ambulance (with siren and flashing lights) to evacuate wounded civilians.

Similar and persistent violations of the Fourth Geneva Convention have been widely reported following Israel’s grotesque attack and destruction of a neighbouring sovereign state, Lebanon, with over 1000 civilians murdered.
Reportedly as many as one million cluster bombs, which are essentially anti-personnel devices aimed at civilians, were seeded in defiance of the Geneva Convention, prompting UN protests. Israel has now admitted that phosphorus containing weapons were used, also illegal against civilians, as they were in their 1982 invasion of Lebanon (the journalist Robert Fisk remembers seeing the
bodies of 2 children re-igniting when taken out of the mortuary). Furthermore, the Secretary of the European Committee on Radiation Risk states that samples taken from blast sites suggest that uranium- based bombs may have been used as well. Hospitals were hit and UK newspapers carried photographs of a wrecked ambulance, with the point of entry of the missile at the very centre of the large Red Cross painted on the roof. The Lancet carried a letter on September 2 in which a physician in the Family Medicine Programme, American University of Beirut, describes his attempts to recruit colleagues to help staff a hospital several kilometres away. He reports that volunteers did not want to go in an ambulance
“because such vehicles were targets”.

The IMA have been entirely silent about such events, as they have always been. This is in fundamental breach of their mandate- not least as members of the World Medical Association (WMA), the official international body charged with
overseeing medical ethics. Incredibly, IMA President Blachar has been for 3 years Chair of Council of the WMA!

Bar PHRI, a minority group, these grave matters have attracted no condemnation from the medical profession in Israel, with their academic bases in Israeli medical schools and research institutes. Many of these doctors have international
academic connections, and unlike their Palestinian counterparts their movements are unhampered, their respectability and probity unchallenged. Why is this? Indeed Israeli universities have maintained a studied silence about the tremendous harm done over many years to the capacity of their Palestinian counterparts to run as universities should run: the restrictions, the prolonged
closures, the damage to property, the campus incursions by the IDF, the arbitrary expulsions, the harassment and shooting of students on their way to lectures.

We must sadly conclude that with honourable exceptions most doctors and medical academics are in active or passive collusion with an aggressive
colonisation, with the control and, increasingly, the frank crushing of every sector of Palestinian civil society, and with a self-justifying discourse that trades on a dehumanising contempt for Palestinian as people in a different moral universe.

One central thread to the work of both Edward Said and Noam Chomsky, both truth tellers of our times, concerns the role of the academic and professional
institutions of the Western world. These have seemed to embody the promise of an independent moral authority within a society, but in practice have generally acted to confer legitimacy to the dominant order and its interests. We see this
starkly in Israel (though also, it might be added, in USA and UK). I might add that Noam Chomsky described the IMA to me as demonstrating “utter moral degeneration”.

So what are we to do? Firstly, repeated efforts to reach out to the IMA has been unavailing, as my own experience bears out unambiguously. Secondly, the WMA have refused to challenge the IMA; or even to acknowledge the problem. They are unmoved by the mountain of material by Amnesty and others. Indeed in a telephone conversation with me 3 years ago WMA Secretary General Delon Human defended the IMA, saying “they have been active collaborators in the WMA’s continued struggle to eradicate torture…all over the world”. This is utterly
preposterous. Thirdly, British doctors might expect some action from their own association, the BMA, whose International Committee deal with ethical matters, but they have hidden behind platitudes (“we believe in education”, as if the IMA had not been making choices with its eyes open over many years). The BMA has consistently declined to challenge the IMA record at the WMA and has stressed its collegiate links with the IMA: does this refusal reflect the power of the Israeli lobby? I even appealed, via a long letter, to the recently knighted UK Chief Rabbi, Sir Jonathan Sachs, but he did not deign to reply.

We do not lightly call for stigmatisation via an academic boycott but things have surely come to this. If not now, when? It was at a moment like this that calls went out (and there was considerable opposition then too) for the academic isolation of South Africa during the apartheid era. This rightly included a boycott of the
medical profession for collusion of a very similar nature to what we see today in Israel. For instance, the Medical Association of South Africa was for a time suspended from membership of the WMA. On visits out there in recent years (I
am South African born) I have heard it said more than once that the boycott played a distinct role in bringing the profession to its senses. As in South Africa, the Israeli medical profession, and the establishment generally, is sensitive to
opinion in the Western world, not least from fellow doctors.

An academic boycott in an extreme situation is a moral and ethical imperative when all else has failed, for otherwise we are in effect turning away. It is not contrary to “academic freedom”, as some assert, but in its very spirit. Any Israeli
doctor who publicly disassociates him or herself from state practice becomes part of the solution rather than part of the problem. The place to start is a boycott of the IMA, who have made their decisions with their eyes open over many years, and should be held to account for them. This is how.

Dr Derek Summerfield is Hon Senior Lecturer, Institute of Psychiatry(London);Teaching Associate Refugee Studies Centre, University of Oxford.

Posted on 02-02-2007

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