With a fresh spike in the number of coronavirus infections, Gaza is yet again facing the very real prospect that its healthcare system will be overwhelmed.
Gaza is not just fighting a global pandemic. Under an Israeli blockade and successive military attacks since 2007, the coastal strip is fighting one of the highest levels of poverty and unemployment in the world as well as a crumbling infrastructure, including in its health sector.
A severe shortage of medicine and medical equipment that is directly linked to the Israeli siege could, combined with the ravages of a pandemic, threaten the health service with complete collapse.
At least one of those things can be remedied fairly quickly should Israel ease or end its blockade.
But pointing that out is not as simple as it might seem, as four medical and human rights professionals from around the world have found to their dismay.
Back in March, when the pandemic first hit Gaza, David Mills of Boston’s Children’s Hospital, Bram Wispelwey of Boston’s Brigham and Women’s Hospital, Rania Muhareb formerly of the Palestinian human rights group Al-Haq, and Mads Gilbert of University Hospital of North Norway, wrote a short letter to The Lancet, one of the world’s foremost medical journals.
Pandemics will cause more damage to “populations burdened by poverty, military occupation, discrimination and institutionalized oppression,” the authors pointed out. They urged the international community to act to end the “structural violence” that is being inflicted on Palestinians in Gaza.
“A COVID-19 pandemic that further cripples the Gaza Strip’s healthcare system should not be viewed as an inevitable biomedical phenomenon experienced equally by the world’s population, but as a preventable biosocial injustice rooted in decades of Israeli oppression and international complicity,” they concluded.
The letter – “Structural violence in the era of a new pandemic: the case of the Gaza Strip” – was duly published online on 27 March.
Just three days later, however, in a move unusual if not unprecedented for The Lancet, the letter was taken down without comment. (It can still be read, on an academic publishing search engine site, here.)
“Once we noticed, we reached out to The Lancet for an explanation,” said Wispelwey, who is also an instructor at Harvard Medical School.
According to Wispelwey, The Lancet would only say that “our commentary had precipitated a serious crisis,” but offered no detail, no further comment and no published explanation for readers.
The authors did note that the letter had caused a stir among Israel’s supporters in the medical community.
One prominent activist, Daniel Drucker, a renowned Canadian endocrinologist, took to Twitter on 29 March to excoriate The Lancet and its editor, Richard Horton.
“As the world battles COVID-19,” he wrote, The Lancet and Richard Horton “seize the opportunity” to publish letters “bashing Israel.”
In a blog post Drucker commended Horton for his “swift decision” to remove the “blame Israel” letter from The Lancet.
That drew a swift response from Palestine Legal, lamenting that Drucker had forced The Lancet to censor itself.
Drucker also compared anti-Semitism to a virus, claiming that “anti-Semitism, anti-Zionism and anti-Israel invective, are highly related strains.”
Drucker is not new to this kind of pro-Israel advocacy. He was part of a highly effective campaign against The Lancet in 2014, after the publication ran “An open letter for the people of Gaza” protesting the effect of Israel’s military assault that year.
The assault left more than 2,200 people dead, mostly civilians, among them 550 children.
By the end of July 2014, and in the middle of Israel’s offensive, that letter had received more than 20,000 signatures whose names The Lancet announced it would not publish after “several threatening statements to those signatories.”
Among the threatening statements, it was later revealed, were personal attacks against Horton accusing him of anti-Semitism and depiciting him in a Nazi uniform. His wife was verbally attacked and his daughter was told by classmates that her father was an anti-Semite.
In response to that letter, Drucker started a petition to keep medicine and science publications “free of divisive political opinions.”
The petition attracted more than 5,000 signatures, and caused pro-Israel medical professionals the world over, but especially in North America, to boycott The Lancet for five years.
Eventually, and after The Lancet in 2017 dedicated an entire issue to Israel’s healthcare system, the boycott was rescinded.
But the fear is, said Wispelwey, that medical journals are now subject to indirect censorship or self-censorship on Palestine as a result of the “overall chilling effect” of the campaign against The Lancet.
“The extremeness of the response suggests an understanding that this is a space – academic medical journals – that is off limits to even mainstream ideas, documentation and discourse on the Palestinian health context that contain criticism of Israel,” Wispelwey said.
The Electronic Intifada reported in March that the widely used dashboard for COVID-19 published by Johns Hopkins University’s Center for Systems Science and Engineering had effectively erased Palestinians by merging data for Israel and the occupied West Bank and Gaza Strip.
It is an effort that shows little sign of abating.
Just last month, major social media companies – Zoom, Facebook and YouTube – pulled out the stops to prevent an event organized by San Francisco State University with Leila Khaled, a Palestinian icon of resistance and former fighter with the Popular Front for the Liberation of Palestine, now in her 70s.
The argument for silencing criticism of Israel’s treatment of Palestinians in medical and science publications is that these should be void of “divisive” political content.
But that, said Rania Muhareb, a scholar and legal researcher with Al-Haq when the March letter was written, is disingenuous.
Questions of public health are very clearly political – universal healthcare being one obvious example – with social and political inequalities recognized as root causes of ill health. In conflict zones they are impossible to separate.
“Realization of the right to health is closely linked to the fulfilment of other fundamental rights,” Muhareb told The Electronic Intifada.
Lives at stake
In Gaza, politics is most certainly at play when it comes to health.
Exercising total control over all imports into Gaza, including humanitarian aid, the Israeli military has nevertheless failed to establish any contingency plan for Gaza as the impoverished region tries to cope with COVID-19.
Israel’s refusal to act is despite the fact that it remains the occupying power under international law, and thus is legally responsible for the basic welfare of everyone in Gaza.
And it has not been for a lack of warning. Palestinian, Israeli and international human rights groups have repeatedly appealed for Israel to formulate a plan or, more effectively, lift the siege altogether before it is too late.
The numbers tell a foreboding tale: When the pandemic first hit Gaza in March, it was confined to the few travelers making their way in and out of the besieged coastal strip.
They were easy to identify and quarantine.
The first death linked to COVID-19 came in May, some two months after the first confirmed cases, and was also in an isolation facility.
But once community transmission started in late August, numbers surged.
“The healthcare system in Gaza has been pushed to the brink of collapse,” said Mads Gilbert, a surgeon who for many years worked in Gaza.
Israel’s blockade and repeated military assaults have fatally undermined healthcare provision in Gaza, he said, and left hospitals and clinics unable and unprepared to cope with a pandemic.
“The fear is that an uncontrolled COVID-19 outbreak in the Gaza Strip will completely overburden Gaza’s healthcare system, thereby compounding Palestinians’ susceptibility to the pandemic under conditions of structural violence,” Gilbert told The Electronic Intifada.
Fair comment for medical professionals? Not according to Zion Hagay of the Israeli Medical Association, whose letter in response to the now nonexistent letter written by Gilbert et al was published in the latest online edition of The Lancet.
Hagay denounced the March letter as “political rhetoric,” and defended Israel’s blockade as “a necessary response to arms smuggling and non-ceasing violence against Israel.”
He lauded Israel for “allowing” Palestinian patients to “continue to enter Israel to receive life-saving medical treatment.”
But Palestinians in Gaza face a widely criticized and onerous process to obtain permits from the Israeli military to travel for treatment or any other reason.
Hagay also omitted to note that UN Secretary-General António Guterres – whom he otherwise quotes lauding cooperation between Israel and the Palestinian Authority in response to COVID-19 – has long described Gaza as one of the world’s most “dramatic” humanitarian crises and called for the siege to be lifted.
But beyond that, said Wispelwey, it was “astounding” that The Lancet decided to publish a letter in response to an article that had already been taken down.
“It just makes the whole situation more bizarre,” Wispelwey said. “Publishing a response to a now ‘disappeared’ piece and allowing him to comment on its removal?”
“Censorship and surveillance are classic methods of settler-colonial control,” Wispelwey added.
Rather than aiming for a false “balance” of viewpoints that fails to account for power differentials, Wispelwey said, we must “start recognizing, naming and resisting these forces in academic medicine and beyond.”
The Lancet did not wish to comment.
Omar Karmi is an independent journalist and former Jerusalem and Washington, DC, correspondent for The National newspaper.