July 22, 2014
http://dx.doi.org/10.1016/
S0140-6736(14)61044-8
See World Report page 389
We are doctors and scientists, who
spend our lives developing means to
care and protect health and lives. We
are also informed people; we teach
the ethics of our professions, together
with the knowledge and practice of it.
We all have worked in and known the
situation of Gaza for years.
On the basis of our ethics and
practice, we are denouncing what we
witness in the aggression of Gaza by
Israel.
We ask our colleagues, old and
young professionals, to denounce
this Israeli aggression. We challenge
the perversity of a propaganda that
justifi es the creation of an emergency
to masquerade a massacre, a so-called
“defensive aggression”. In reality it is a
ruthless assault of unlimited duration,
extent, and intensity. We wish to report
the facts as we see them and their
implications on the lives of the people.
We are appalled by the military
onslaught on civilians in Gaza under
the guise of punishing terrorists. This is
the third large scale military assault on
Gaza since 2008. Each time the death
toll is borne mainly by innocent people
in Gaza, especially women and children
under the unacceptable pretext of
Israel eradicating political parties and
resistance to the occupation and siege
they impose.
This action also terrifi es those who
are not directly hit, and wounds the
soul, mind, and resilience of the young
generation. Our condemnation and
disgust are further compounded by
the denial and prohibition for Gaza to
receive external help and supplies to
alleviate the dire circumstances.
The blockade on Gaza has
tightened further since last year
and this has worsened the toll on
Gaza’s population. In Gaza, people
suff er from hunger, thirst, pollution,
shortage of medicines, electricity,
and any means to get an income, not
only by being bombed and shelled.
Power crisis, gasoline shortage, water
and food scarcity, sewage outflow
and ever decreasing resources
are disasters caused directly and
indirectly by the siege.1
People in Gaza are resisting this
aggression because they want a
better and normal life and, even
while crying in sorrow, pain, and
terror, they reject a temporary truce
that does not provide a real chance
for a better future. A voice under
the attacks in Gaza is that of Um Al
Ramlawi who speaks for all in Gaza:
“They are killing us all anyway—
either a slow death by the siege, or a
fast one by military attacks. We have
nothing left to lose—we must fi ght
for our rights, or die trying.”2
Gaza has been blockaded by sea and
land since 2006. Any individual of
Gaza, including fi shermen venturing
beyond 3 nautical miles of the coast
of Gaza, face being shot by the Israeli
Navy. No one from Gaza can leave
from the only two checkpoints, Erez
or Rafah, without special permission
from the Israelis and the Egyptians,
which is hard to come by for many,
if not impossible. People in Gaza are
unable to go abroad to study, work,
visit families, or do business. Wounded
and sick people cannot leave easily
to get specialised treatment outside
Gaza. Entries of food and medicines
into Gaza have been restricted and
many essential items for survival are
prohibited.3
Before the present assault,
medical stock items in Gaza were
already at an all time low because of
the blockade.3
They have run out now.
Likewise, Gaza is unable to export its
produce. Agriculture has been severely
impaired by the imposition of a buff er
zone, and agricultural products cannot
be exported due to the blockade. 80%
of Gaza’s population is dependent on
food rations from the UN.
Much of Gaza’s buildings and
infrastructure had been destroyed
during Operation Cast Lead, 2008–09,
and building materials have been
blockaded so that schools, homes, and
institutions cannot be properly rebuilt.
Factories destroyed by bombardment
have rarely been rebuilt adding
unemployment to destitution.
Despite the difficult conditions,
the people of Gaza and their political
leaders have recently moved to
resolve their confl icts “without arms
and harm” through the process of
reconciliation between factions,
their leadership renouncing titles and
positions, so that a unity government
can be formed abolishing the divisive
factional politics operating since
2007. This reconciliation, although
accepted by many in the international
community, was rejected by Israel.
The present Israeli attacks stop this
chance of political unity between
Gaza and the West Bank and single
out a part of the Palestinian society
by destroying the lives of people
of Gaza. Under the pretext of
eliminating terrorism, Israel is trying
to destroy the growing Palestinian
unity. Among other lies, it is stated
that civilians in Gaza are hostages of
Hamas whereas the truth is that the
Gaza Strip is sealed by the Israelis and
Egyptians.
Gaza has been bombed con-
tinuously for the past 14 days
followed now by invasion on land
by tanks and thousands of Israeli
troops. More than 60 000 civilians
from Northern Gaza were ordered to
leave their homes. These internally
displaced people have nowhere to
go since Central and Southern Gaza
are also subjected to heavy artillery
bombardment. The whole of Gaza is
under attack. The only shelters in Gaza
are the schools of the UN Relief and
Works Agency for Palestine Refugees
in the Near East (UNRWA), uncertain
shelters already targeted during Cast
Lead, killing many.
According to Gaza Ministry of Health
and UN Office for the Coordination
of Humanitarian Affairs (OCHA),1
as of July 21, 149 of the 558 killed in
Gaza and 1100 of the 3504 wounded
are children. Those buried under
the rubble are not counted yet. As
we write, the BBC reports of the
bombing of another hospital, hitting
the intensive care unit and operating
theatres, with deaths of patients and
staff . There are now fears for the main
hospital Al Shifa. Moreover, most
people are psychologically traumatised
in Gaza. Anyone older than 6 years
has already lived through their third
military assault by Israel.
The massacre in Gaza spares no
one, and includes the disabled and
sick in hospitals, children playing on
the beach or on the roof top, with a
large majority of non-combatants.
Hospitals, clinics, ambulances,
mosques, schools, and press
buildings have all been attacked,
with thousands of private homes
bombed, clearly directing fi re to target
whole families killing them within
their homes, depriving families of
their homes by chasing them out
a few minutes before destruction.
An entire area was destroyed on
July 20, leaving thousands of displaced
people homeless, beside wounding
hundreds and killing at least 70—
this is way beyond the purpose of
finding tunnels. None of these are
military objectives. These attacks aim
to terrorise, wound the soul and the
body of the people, and make their
life impossible in the future, as well
as also demolishing their homes and
prohibiting the means to rebuild.
Weaponry known to cause long-
term damages on health of the whole
population are used; particularly non
fragmentation weaponry and hard-
head bombs.4,5 We witnessed targeted
weaponry used indiscriminately and
on children and we constantly see that
so-called intelligent weapons fail to
be precise, unless they are deliberately
used to destroy innocent lives.
We denounce the myth propagated
by Israel that the aggression is done
caring about saving civilian lives and
children’s wellbeing.
Israel’s behaviour has insulted our
humanity, intelligence, and dignity
as well as our professional ethics and
eff orts. Even those of us who want to
go and help are unable to reach Gaza
due to the blockade.
This “defensive aggression” of
unlimited duration, extent, and
intensity must be stopped.
Additionally, should the use of
gas be further confirmed, this is
unequivocally a war crime for which,
before anything else, high sanctions
will have to be taken immediately on
Israel with cessation of any trade and
collaborative agreements with Europe.
As we write, other massacres and
threats to the medical personnel in
emergency services and denial of
entry for international humanitarian
convoys are reported.6
We as
scientists and doctors cannot keep
silent while this crime against
humanity continues. We urge
readers not to be silent too. Gaza
trapped under siege, is being killed
by one of the world’s largest and
most sophisticated modern military
machines. The land is poisoned by
weapon debris, with consequences
for future generations. If those of
us capable of speaking up fail to do
so and take a stand against this war
crime, we are also complicit in the
destruction of the lives and homes of
1·8 million people in Gaza.
We register with dismay that only
5% of our Israeli academic colleagues
signed an appeal to their government
to stop the military operation against
Gaza. We are tempted to conclude that
with the exception of this 5%, the rest of
the Israeli academics are complicit in the
massacre and destruction of Gaza. We
also see the complicity of our countries
in Europe and North America in this
massacre and the impotence once
again of the international institutions
and organisations to stop this massacre.
We declare no competing interests.
*Paola Manduca, Iain Chalmers,
Derek Summerfi eld, Mads Gilbert,
Swee Ang, on behalf of 24 signatories
paolamanduca@gmail.com
New Weapons Research Group and University of
Genoa, Genoa, Italy (PM); James Lind Library,
Oxford, UK (IC); Institute of Psychiatry, King’s
College,London, UK (DS); Clinic of Emergency
Medicine, University Hospital of North Norway,
Tromso, Norway (MG); and Barts and the Royal
London Hospital, London, UK (SA).
1 United Nations Offi ce for the Coordination of
Humanitarian Aff airs (OCHA). Occupied
Palestinian Territory: Gaza emergency
situation report (as of 21 July 2014, 1500 hrs).
http://www.ochaopt.org/documents/ocha_
opt_sitrep_22_07_2014.pdf (accessed
July 22, 2014).
2 Webb-Pullman J. Dignity or death—we cannot
give up now. http://gaza.scoop.ps/2014/07/
dignity-or-death-we-cannot-give-up-now/
(accessed July 22, 2014).
3 Gilbert M. Brief report to UNRWA: The Gaza
Health Sector as of June 2014. http://www.
unrwa.org/sites/default/fi les/fi nal_report_-_
gaza_health_sector_june-july_2014_-_mads_
gilbert_2.pdf (accessed July 22, 2014).
4 Naim A, Al Dalies H, El Balawi M, et al. Birth
defects in Gaza: prevalence, types, familiarity
and correlation with environmental factors.
Int J Environ Res Public Health 2012; 9: 1732–47.
5 Manduca P, Naim A, Signoriello S. Specifi c
association of teratogen and toxicant metals in
hair of newborns with congenital birth defects
or developmentally premature birth in a cohort
of couples with documented parental exposure
to military attacks: observational study at
Al Shifa Hospital, Gaza, Palestine.
Int J Environ Res Public Health 2014; 11: 5208–23.
6 Ma’an News Agency. 4 killed, over 50 injured
as Israel targets al-Aqsa hospital. http://www.
maannews.net/eng/ViewDetails.
aspx?ID=715087 (accessed July 22, 2014).
