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I don't think it is an appropriate thing to be written, but we will sort it out. -- Anglo-Jewish Lord Robert Winston
British Medical Journal

Jerusalem, Sunday, October 31, 2004

Palestine: the assault on health and other war crimes

by Prof Derek Summerfield

DOES the death of an Arab weigh the same as that of a US or Israeli citizen? The Israeli army, with utter impunity, has killed more unarmed Palestinian civilians since September 2000 than the number of people who died [in the United States] on September 11, 2001.

In conducting 238 extrajudicial executions the army has also killed 186 bystanders (including 26 women and 39 children). Two thirds of the 621 children (two thirds under 15 years) killed at checkpoints, in the street, on the way to school, in their homes, died from small arms fire, directed in over half of cases to the head, neck and chest -- the sniper's wound. Clearly, soldiers are routinely authorised to shoot to kill children in situations of minimal or no threat. These statistics attract far less publicity than suicide bombings, atrocious though these are too.

Amnesty International has called for an investigation into the killing of Asma al-Mughayr (16 years) and her brother Ahmad (13 years) on the roof terrace of their home in Rafah on 18 May, each with a single bullet to the head. Asma had been taking clothes off the drying line and Ahmad feeding pigeons. Amnesty noted that the firing appeared to have come from the top floor of a nearby house, which had been taken over by Israeli soldiers shortly before. Amnesty suspects that this is not "caught in crossfire," this is murder.

The Wall

Israeli military reoccupation of the West Bank and Gaza -- a system of military checkpoints splitting towns and villages into ghettos, curfews, closures, raids, mass demolition and destruction of houses (more than 60 000), and land expropriations -- has made ordinary life impossible for everyone, and is driving Palestinian society and its institutions towards destitution. Moreover, Israel has been constructing a grotesque barrier that, when completed, will total over 400 miles -- four times longer than the Berlin Wall. Extending up to 15 miles into Palestinian territory, the real purpose of the wall is permanently to lock more than 50 illegal Israeli settlements into Israel proper. This is expansive, aggressive colonisation, in defiance of the International Court of Justice in The Hague and the United Nations General Assembly resolution of last July.

Last year a UN rapporteur concluded that Gaza and the West Bank were "on the brink of a humanitarian catastrophe." The World Bank estimates that 60% of the population are subsisting at poverty level (£1.12; $2; €1.6 per day), a tripling in only three years. Half a million people are now completely dependent upon food aid, and Amnesty International has expressed concern that the Israeli army has been hampering distribution in Gaza. Over half of all households are eating only one meal per day.

A study by Johns Hopkins and Al Quds universities found that 20% of children under 5 years old were anaemic, 9.3% were acutely malnourished, and a further 13.2% chronically malnourished.

The doctors I met on a professional visit in March pointed to a rising prevalence of anaemia in pregnant women and low birthweight babies.

The coherence of the Palestinian health system is being destroyed. The wall will isolate 97 primary health clinics and 11 hospitals from the populations they serve. Qalqilya hospital, which primarily serves refugees, has seen a 40% fall in follow up appointments because patients cannot enter the city. There have been at least 87 documented cases (including 30 children) in which denial of access to medical treatment has led directly to deaths, including those of babies born while women were held up at checkpoints. The checkpoint at the entrance to some villages closes at 7 pm and not even ambulances can pass after this time. As a recent example, a man in a now fenced in village near Qalqilya approached the gate with his seriously ill daughter in his arms, and begged the soldiers on duty to let him pass so that he could take her to hospital. The soldiers refused, and a Palestinian doctor summoned from the other side was also refused access to the child. The doctor was obliged to attempt a physical examination, and to give the girl an injection, through the wire.

There are consistent reports of ambulances containing gravely ill people being hit by gunfire, or detained at checkpoints while drivers and paramedics are interrogated, searched, threatened, humiliated, and assaulted. Wounded men are abducted from ambulances at checkpoints and sent directly to prison. Clearly marked clinics are fired on, and doctors and other health workers shot dead on duty.

Physicians for Human Rights (Israel) have lambasted the Israeli Medical Association (IMA) for its silence in the face of these systematic violations of the Fourth Geneva Convention, which guarantees the right to health care and the protection of health professionals as they do their duty. Remarkably, IMA president Dr Y Blachar is currently chairperson of the council of the World Medical Association (WMA), the official international watchdog on medical ethics.

A supine BMA appears in collusion with this farce at the WMA. Others are silenced by a fear of being labelled "anti-semitic," a term used in a morally corrupt way by the pro-Israel lobby in order to silence. How are we to affect this shocking situation, one which to this South African-born doctor has gone further than the excesses of the apartheid era.

Derek Summerfield is honorary senior lecturer Institute of Psychiatry, London



mail Brian J Murray, SpR/ locum consultant Aylesbury [England]

Critics of Summerfield, by and large are saying either

  1. There are no civilian casualties to speak of in the occupied territories
  2. That he has his facts basically correct, but is guilty of bias.
  3. That his article is political and should not be in a medical journal
  4. That he is somehow being anti-semitic


Respondents have insisted that 'some', 'virtually all' or 'all' (depending on who you read) of the 3000+ casualties in the Occupied Territories are suicide bombers/armed militants - interesting that they cannot even agree amongst themselves.

Firstly, I am not sure which is more racist: the idea that 'some' innocent Palestinians get killed, so that's OK, or the implication of the 'all' lobby, who are clearly suggesting that there can be no such thing as an innocent Arab.

I counted two supporting references in total, one being the Israeli Embassy. Summerfield and his supporters, meanwhile, can point to several Humanitarian Agencies with no axe to grind who support the assertion that there ARE significant civilian casualties in the Occupied Territories. The International Red Cross ( gives information on the humanitarian crisis, whilst studiously observing its policy of neutrality. (No mention of the alleged abuse of Red Cross ambulances, by the way, so hopefully that myth can be laid to rest). The Israeli Army itself freely admits to targetting radio stations, hospitals and market places. Even if you believe the IDF's assertion that there might have been a Hamas militant somewhere in there, you cannot deny that attacks such as this will inevitably cause numerous innocent casualties. There is no such thing as 'precision bombing'.


Summerfield's opening line asks us whether a Palestinian life is worth the same as an Israeli or a US life. Therefore, right from the word go, there is an implicit assumption in his article that an Israeli life DOES have value, a fact which he also makes explicit later in the article. This point seems to have been lost on Bower who believes that Summerfield's question means that 'Israeli citizens have no weight in Dr. Summerfield's balance' - a disturbing reflection on Bower's attitude to Arab life.

One side of the anti-Summerfield camp denies the existence of innocent Arab deaths, whilst the other acknowledges them but asks why Summerfield needs to spend so much time discussing them. I would have thought the very existence of each point of view gives an eloquent answer to the other.

The very fact that so many of the rapid respondents have called for censorship on this issue tells us why we need people like Summerfield to speak out. If Summerfield's critics had their way, no one would be allowed to discuss a Palestinian death. Summerfield's article is not there to distort the balance but to redress it.


Summerfield's article was about preventable deaths, attempts to administer healthcare and blocks to those attempts. That sounds pretty medical to me. Yes, there is a political angle, but surely that is feature of the situation, not Summerfield.

The BMJ has been printing political articles for years. I am not aware of anyone calling for the editor's resignation because of the existence of the 'News Roundup' section, so what justification is there for this sudden sensitivity to a bit of politics relevant to healthcare ?(Apart from the fact that this particular article does not square with the world view of a few extremists, of course).

The only people I find unnecessarily political are Summerfield's critics. There seems to be a grudging acknowledgement of what is going on in Occupied Territories, but it is rapidly followed up by some appeal that it is justified for political purposes. This is what people mean when they insist that the suffering in the Occupied Territories has to be seen in its 'historical context'. Politicians might get away with this sort of argument, but it should be beneath the dignity of anyone with a medical degree.


No one has really explained exactly how Summerfield's comments amount to antisemitism. There is no incitement in his article, and he makes no sweeping assertions based on the race or nationality of the protagnonists in his article. Would that I could say the same for his critics. The following are just a selection:

Roth " The so called Palestinians, which in itself is a ludicrous term because there is no nationality or people prior to 1948... were given opportunity upon opportunity to better themselves and their situation, but continue to slide lower and lower because they have no value for life".

Kovachev "Still, nowhere in your jeremiads can one find an objective analysis of the problems caused by the Pal Arab's own social and political leadership, their cultural norms, family customs...".

Wolfe "Arabs are unable to be honest in the Western sense of honesty: that is, a truth being acknowledged and existing independently of the needs and demands of the Tribe or Hive Mind".

Ben Joseph says that Summerfield's claims are' abhorrent and absurd' but then states that it is 'well known' that Palestinians shoot their own children just to give the IDF a bad name (the phrase 'well known' here presumably translates as "I'd rather you didn't ask for me any evidence, thanks"). If you do not see anything wrong with these statements, then try this simple experiment: replace the word 'Arab' with 'Jew', the word ' Palestinian' with 'Israeli'.

When the protest is this shrill, you have to realise Summerfield must be on to something. The majority of his critics do not want simply to add their two cents' worth - something they are entitled to do - but to silence him altogether. How would that achieve the 'balance' that his critics claim they want? And what about the freedom of speech that doctors like Dr Ilangaratne say they 'generally' support? Summerfield has been criticised not because his views are extremist, but because they do not conform to the extremism of his critics. The only shame on the BMJ is if it caves in to this unjustified attempt at censorship.

Competing interests: I have no religious affiliation. I have not been directed to respond by another website.


Israeli and Jewish outrage at opinion piece, 'Palestine: The Assault on Health and Other War Crimes,' by British professor Derek Summerfield in British Medical Journal
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