The global health community must call for an immediate ceasefire and unrestricted humanitarian aid in Gaza
BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q782 (Published 02 April 2024) Cite this as: BMJ 2024;385:q782
The scale of the devastation and humanitarian crisis currently happening in Gaza is undeniable. Tens of thousands of civilians have been killed, including at least 14 000 children.1 But we’re also witnessing an unprecedented, deliberate, and targeted destruction of Gaza’s healthcare service—and it’s time for more of us from the global health community to speak out.
Global health is about recognising how global inequalities in power result in inequity in health. It involves grappling with the brutal consequences of power imbalances and colonisation. So, why hasn’t there been more concerted outrage from global health experts, from racism and decolonisation practitioners, from reproductive health organisations, women’s rights advocates, universities, professional associations, and academic bodies, regarding the annihilation of the Gazan health system?
The devastation of that health system is destroying lives and making living unsustainable in Gaza. Humanitarian services have been decimated, with persistent military attacks on UN and medical facilities.23 Some western countries shamefully paused their funding of the UN Relief and Works Agency last month, undermining its aid and relief operations, after unverified allegations that employees had been involved in attacks on Israel on 7 October.4 The EU has since announced that it will resume funding.5
The Relief and Works Agency provides a critical aid lifeline to Gaza and beyond.6 The UN’s special rapporteur on the right to health warned months ago that Gaza’s healthcare system was “under attack.”7 Hundreds of health, aid, and UN workers have been killed in Israel’s bombardment of Gaza. The BBC reported that healthcare staff were mistreated and assaulted by Israeli soldiers.8 Médecins Sans Frontières has recently announced that Gaza has no health system left.9
Psychological warfare
Targeting health facilities, which have been consistent places of refuge for displaced people in Gaza, is part of psychological warfare.10 People in Gaza have had to relocate multiple times during this war and face unremitting anxiety about whether they may be bombed where they live or killed while they flee. Areas that are designated safe one week become combat zones a week later. By ensuring that the population experiences no place as safe, the ongoing attacks strip Gaza’s people of their security and agency.
The destruction of the health system is being exacerbated by the blocking of aid, supplies, and electricity in Gaza. Palestinians of all ages have died from a lack of access to healthcare, equipment, and treatment options because of the blockade. In many cases it’s not possible to run a hospital or operate on patients because of damage to generators, and the lack of electricity makes it impossible to run critical equipment in intensive care units or neonatal incubators. Surgeons are having to conduct caesarean sections and amputate children’s limbs without anaesthetic, electricity, or essential medical supplies, using vinegar to dress wounds in the absence of antiseptics and11 conducting surgery without anaesthesia on kitchen tables because nowhere else is available.1213
Gaza’s only paediatric cancer ward was destroyed by Israeli attacks, leaving children without cancer treatment.14 Harrowing testimonies have detailed attempts to evacuate critically ill patients and premature babies from hospitals. In at least one instance at Al Nasr Hospital, horrific video footage shows decomposing bodies of babies who couldn’t be safely evacuated from intensive care units.15
Furthermore, with the destruction of water and sanitation infrastructure, infectious disease epidemics are inevitable. The Palestinian medical relief agency has reported an outbreak of hepatitis A in the Gaza Strip due to poor sanitary conditions and a lack of clean water.16
Despite facing enormous odds stacked against the survival of their patients and themselves, frontline health workers have remained in Gaza to do the best they can, showing courage that many of us can’t begin to imagine.17
Long term effects
This war is harming the current generation of people living in Gaza, and it will also have long term consequences. Miscarriages have reportedly skyrocketed,18 and women and girls don’t have proper or sufficient sanitary products, let alone healthcare. At least 50 000 pregnant women are facing extreme hunger and the absence of obstetric care.19
In the long term, tens of thousands of Gazans will need physical rehabilitation and psychological support. Many injured children have lost their parents and entire families, creating a humanitarian crisis in care, support, trauma, education, mental health, and even adoption for years to come. For the traumatised children who have survived this onslaught, emergency staff have had to coin a chilling new acronym: WCNSF, meaning “wounded child, no surviving family.”20
Researchers modelling projections of mortality in Gaza in the next six months have noted that, even if there were an immediate ceasefire, deaths from infectious disease would be two to four times as high as deaths from injury. If conflict persists, they predict, as many as 85 000 further lives could be lost.2122
The global health community must demand an immediate ceasefire. We must call for an immediate stop to the destruction of the health system, protection and support for our colleagues in healthcare, and provision of unrestricted humanitarian aid to Gaza. We must support the rebuilding of the entire health system in Gaza and its civilian infrastructure so that rehabilitation of the population can begin. And we must ensure that our institutions and professional bodies are held accountable for asserting the protection of the health system in this and other wars.
Global health starts at home.23 We all have a duty to intervene. If we remain silent, the inequities we’re supposed to challenge in our work will be exacerbated—and that will only make the global health community complicit in the suffering of Gaza’s people.
Footnotes
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.