Correspondence
The Palestinian
challenge to US medical
ethics
For the past 7 months, the world has
been witnessing the murder of health
workers, as well as their abduction,
torture, execution, and the dumping
of their bodies in mass graves;1 killing
of patients in their hospital beds;
deliberate bombing of hospitals
and clinics; targeted destruction of
health and sanitation infrastructure;
blockades to humanitarian aid
and essential medications during
a historic famine manufactured to
serve as a weapon of war; and the
infliction of conditions designed to be
incompatible with life on Palestinians
in Gaza.
These facts have been documented
in orders issued by the International
Court of Justice on Jan 26, 2024, and
March 28, 2024, and in a detailed
report entitled Anatomy of a Genocide,
published on March 25, 2024, by
the UN rapporteur on the situation
of human rights in the Palestinian
territory occupied since 1967. 2–4
Addressed to the UN Human Rights
Council, the report concluded that
“there are reasonable grounds to
believe that the threshold indicating
Israel’s commission of genocide is
met”.4
And yet, in the USA, the most
influential medical professional
organisations, journals, and lobbies
have been disturbingly reluctant to
take any meaningful stand against
the systematic obliteration of
health systems in Gaza, including
the killing of at least 491 of our
Palestinian colleagues by Israeli forces
since Oct 7, 2023.5 This inaction is
particularly notable as it is the US
Government’s provision of arms,
diplomatic cover, and financial
resources that makes Israel’s campaign
against Palestinians possible.6
Historical reflection on leading
medical institutions’ choices to
remain silent during past atrocities,
www.thelancet.com Vol 403 May 25, 2024
including the Holocaust, teaches
us that omission and apathy
within the medical profession
enable institutional forces that
perpetuate injustices, including the
dehumanisation and racism on which
genocide depends.7 As the Doctors’
Trial at Nuremberg and more recent
scenes of physicians’ participation in
US Government torture programmes
at Abu Ghraib and elsewhere have
made clear, medical doctors are no
less vulnerable than others to being
absorbed into violent, nationalistic
ideologies and misusing their training
and power to inflict suffering rather
than to support care and justice.
The psychiatrist, Frantz Fanon, who
practised in colonial French Algeria,
reminds us in Medicine and Colonialism
that, although we doctors present
ourselves as healers of “the wounds
of humanity”, we often instead serve
as “an integral part of colonisation, of
domination, of exploitation”.8 To do
otherwise requires constant vigilance,
critical institutional and individual
self-reflection, and dedication
to aligning ourselves with those
who are most affected by existing
systems of power and inequality.
The US, European, and Israeli
medical establishments’ responses to
ongoing violence against Palestinian
health and health care make clear
that Fanon’s observations regarding
our potential for complicity with
colonial and state violence remain as
relevant as ever.
ER declares having received honoraria for lectures
from the Association of State and Territorial Health
Officials. JMA-R declares having received royalties
from MIT Press and Princeton University Press,
and honoraria for lectures from MIT and Cornell
University.
Editorial note: The Lancet Group takes a neutral
position with respect to territorial claims in
published text and institutional affiliations.
Joelle M Abi-Rached, *Eric Reinhart
ericreinhart@northwestern.edu
Department of the History of Science and the
Radcliffe Institute for Advanced Study, Harvard
University, Cambridge, MA, USA (JMA-R);
Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of
Medicine, Chicago, IL 60611, USA (ER)
1 United Nations. Mass graves in Gaza show
victims’ hands were tied, says UN rights office.
UN News, April 23, 2024. https://news.un.org/
en/story/2024/04/1148876 (accessed Published Online
April 30, 2024). May 14, 2024
2 International Court of Justice. Summary of the https://doi.org/10.1016/
Order of 26 January 2024. Jan 26, 2024. S0140-6736(24)00877-8
https://www.icj-cij.org/node/203454
(accessed April 18, 2024).
3 International Court of Justice. Order of
28 March 2024. March 28, 2024. https://www.
icj-cij.org/node/203847 (accessed
April 18, 2024).
4 Albanese F. Anatomy of a genocide—report of
the special rapporteur on the situation of
human rights in the Palestinian territory
occupied since 1967 to Human Rights
Council—advance unedited version
(A/HRC/55/73). March 25, 2024. https://www.
un.org/unispal/document/anatomy-of-a-
genocide-report-of-the-special-rapporteur-
on-the-situation-of-human-rights-in-the-
palestinian-territory-occupied-since-1967-to-
human-rights-council-advance-unedited-
version-a-hrc-55/ (accessed April 23, 2024).
5 United Nations Office for the Coordination of
Humanitarian Affairs. Hostilities in the Gaza
Strip and Israel—reported impact. Day 206.
April 29, 2024. https://www.ochaopt.org/
content/hostilities-gaza-strip-and-israel-
reported-impact-day-206 (accessed
April 30, 2024).
6 Crowley M, Wong E. Gaza war turns spotlight
on long pipeline of US weapons to Israel.
New York Times, April 6, 2024. https://www.
nytimes.com/2024/04/06/us/politics/israel-
us-weapons.html (accessed April 30, 2024).
7 Abi-Rached JM, Brandt AM. Nazism and the
journal. N Engl J Med 2024; 390: 1157–61.
8 Fanon F. Medicine and colonialism. In: A
dying colonialism. Translated by Haakon
Chevalier. New York, NY: Grove Press,
1965: 121–45.
Medical voices against
Dr Muhammad Abu Published Online
Salmiya’s detention May 14, 2024
https://doi.org/10.1016/
S0140-6736(24)00768-2
As a nurse, one of my most
concerning patient presentations
is one where a patient has urgently
sought care and then suddenly
gone silent. Right now, that person
is Dr Muhammad Abu Salmiya, the
Director of the Al Shifa Hospital, Gaza.
When his latest Correspondence was
published on Nov 26, 2023,1 he had
already been arrested and detained by
Israeli forces.2,3
Concerningly, WHO has urged
in a statement for his legal and Submissions should be
made via our electronic
humanitarian rights to be observed submission system at
during his detention. 4 However, http://ees.elsevier.com/
I am writing this today because thelancet/
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 Correspondence
the returning volley of silence
between the medical community
and Dr Abu Salmiya is perhaps the
most frightening of all. Do we live
in a time where the most credible
members of society, physicians and
physician executives, are arrested
and detained without international
outrage? Where clinicians working
in war zones and sharing updates
with the world are detained without
the medical community applying
pressure to those in power? I think
not. I suspect this turn of events is
largely unknown.
I am not a published author. I do
not work for a prestigious institution.
But I am a nurse. And if I am only
allowed to use my voice for those
who are silenced in designated US
postal codes, I might as well turn in
my licence.
I declare no competing interests.
Jessica Smith-Amara
jessica.smithamara@gmail.com
Wexford, PA, USA
Editorial note: The Lancet Group takes a neutral
position with respect to territorial claims in
published text and institutional affiliations.
1 Salmiya, MA. Gaza hospitals: military siege and
bombings. Lancet 2023; 402: 2191.
2 The Times of Israel. IDF arrests Gaza’s Shifa
Hospital head, sends him for questioning as
terror suspect. Nov 23, 2023. https://www.
timesofisrael.com/head-of-gazas-shifa-
hospital-said-detained-by-idf-while-
evacuating-northern-strip/ (accessed
Nov 30, 2023).
3 Salman, A. Israel arrests Al-Shifa Hospital
director, Hamas-run Gaza Ministry of Health
says. Nov 23, 2023. https://edition.cnn.com/
middleeast/live-news/israel-hamas-was-gaza-
news-11-23-23/h_951e2cbb2a9629f50dd1c7
af39202bfc (accessed Nov 30, 2023).
4 WHO. Joint UN mission transfers critical
patients from Al-Shifa Hospital in Gaza,
under intense fighting. Nov 24, 2023.
https://www.who.int/news/item/24-11-
2023-joint-un-mission-transfers-critical-
patients-from-al-shifa-hospital-in-gaza--
under-intense-fighting (accessed
Nov 30, 2023).
Stop the Gaza genocide
Published Online
immediately
May 15, 2024 Since the attacks by Hamas against
https://doi.org/10.1016/
S0140-6736(24)00135-1
Israel on Oct 7, 2023, 1 the Israeli
retaliatory strikes, bombings,
2286
and strict sieges have almost
never stopped. So far, more than
85% of Gaza’s population have been
displaced,2 and as of April 13, 2024, at
least 33 000 Palestinians have been
killed (more than a third of them
are children) 3 and 70 000 civilians
have been injured. 4 Approximately
7000 Palestinians are reportedly
missing—most are likely dead. 3,4
This massacre has taken place in
just 180 days and is still ongoing. 3
Gaza has now been described as a
graveyard of children by the UN.4
According to WHO and Médecins
Sans Frontières, hospitals in southern
Gaza are at “breaking point” while
all the hospitals in northern Gaza
have been destroyed and are out of
service.5 There is very limited access
to ambulances, electricity, and clean
drinking water, and injured patients
are being transferred to medical
institutes by donkey carts. 6 The
UN announced that the number of
health-care workers killed by Israeli
strikes is the highest in any single
conflict in the organisation’s history.7
Josep Borrell, a High Representative
for the European Union for Foreign
Affairs and Security Policy, has
described the destruction in Gaza as
being proportionally greater than
that which Germany experienced in
World War 2.8
A key aspect of this war is the
deliberate targeting of civilians by
the Israeli military—for example, in
just one investigation by Amnesty
International, US-made munitions
were found to be used by the Israeli
military in two deadly, unlawful air
strikes on homes containing civilians
in Gaza.9 These air strikes were either
direct attacks on civilians or civilian
objects or indiscriminate attacks
and Amnesty International is calling
for them to be investigated as war
crimes.9
The heinous acts described
previously are not the only ones.
Two shelter schools, one of them
run by the UN, were attacked by the
Israeli military: several men were shot
with live ammunition at point-blank
range; children and other civilians
were arrested and stripped of their
clothes; and women were arrested
and threatened to be raped. 10,11
Some detainees have been used by
the Israeli army as human shields to
storm residential homes and ground
tunnels and the fate of hundreds of
detainees—including men, women,
and children—remains unknown.10,11
Even educational and cultural sites
in Gaza have not been spared from
the Israeli strikes; so far, at least
104 archaeological sites have been
badly damaged, including the Jabaliya
Byzantine Church that has origins
dating back to 444 BCE.12
What is happening in Gaza cannot
be fully described in words. This
brief Correspondence is a plea to
every human being to help stop this
genocide right now—we cannot live
like this; the world should not be
silent about the killing of civilians in
the thousands.
I am employed as the Director of Al-Shifa Hospital.
Editorial note: The Lancet Group takes a neutral
position with respect to territorial claims in
published text and institutional affiliations.
Muhammad Abu Salmiya
dr.abusalmiya@gmail.com
Al-Shifa Hospital, Gaza 986115, occupied
Palestinian territory
1 Forey S. Hamas attack: October 7, a day of hell
on earth in Israel. Oct 30, 2023. https://www.
lemonde.fr/en/international/
article/2023/10/30/hamas-attack-october-7-
a-day-of-hell-on-earth-in-israel_6213560_4.
html (accessed Jan 25, 2024).
2 United Nations Relief and Works Agency for
Palestine Refugees. Resilience amidst chaos:
100 days of UNRWA’s health response to the
humanitarian crisis in the Gaza Strip.
Jan 24, 2024. https://www.unrwa.org/
resources/reports/resilience-amidst-chaos-
100-days-unrwas-health-response-
humanitarian-crisis-gaza (accessed
Jan 25, 2024).
3 Sawafta A. More than 15,900 Palestinians
killed in Gaza since Oct 7—Palestinian health
minister. Dec 5, 2023. https://www.reuters.
com/world/middle-east/more-than-15900-
palestinians-killed-gaza-since-oct-7-
palestinian-health-minister-2023-12-05/
4
(accessed Jan 25, 2024).
UNICEF. Gaza has become a graveyard for
thousands of children. Oct 31, 2023. https://
www.unicef.org/press-releases/gaza-has-
become-graveyard-thousands-children
(accessed Jan 25, 2024).
www.thelancet.com Vol 403 May 25, 2024