The Electronic Intifada 20 June 2025
Doctors perform funeral prayers for the director of Wafaa Hospital, Medhat Muhaisen, who was killed in an Israeli air strike, at Al-Aqsa Hospital in Deir Al-Balah on 18 November 2023.
APA imagesOn 13 July 2024, nine months after Israel’s genocidal assault on Gaza had begun, one of the world’s most prestigious medical journals, The Lancet, published a letter from Zion Hagay, Chairman of the Israeli Medical Association (IMA), and Malke Borow, the head of the IMA legal department.
Part of it read as follows:
“There is no question that many in Gaza have died, although the exact numbers are unverified and sometimes misreported. Furthermore, other voices present an entirely different view…”
“The number of health workers killed in Gaza is high because Hamas appropriated several healthcare facilities as command centres … where they stored and launched weapons, and even held hostages. In such a case, the hospital loses any protection afforded it by the Geneva Convention.”
In response, I and others submitted the following letter, as an ethically necessary corrective.
“In casting the Israeli military as essentially blameless, Hagay and Borow seek to use the international stature of The Lancet to distort the public record of the Gaza crisis. They dismiss en bloc the International Court of Justice regarding a finding of genocide, the International Criminal Court, United Nations, WHO and major humanitarian agencies.”
The letter continued:
“Pitiless slaughter of helpless, trapped civilians en masse, Geneva Convention violations like recurrent bombings of hospitals and murder of health care staff, Israeli doctors collaborating with interrogators in torture suites, whose victims include abducted doctors, the destruction of all Gazan universities including Gaza’s medical schools, a manufactured famine, and a Gazan landscape rendered uninhabitable.”
In justifying all this, we concluded, “and as chairman and head of the legal department respectively of the Israeli Medical Association (IMA), Hagay and Borow demonstrate the ethical gulf between the IMA and the rest of the international medical community, and why its ongoing membership of bodies like the World Medical Association is untenable.”
Having been “carefully read and discussed,” The Lancet declined publication.
2014
How could The Lancet have agreed to publish a letter from medical leaders in Israel justifying bombing hospitals and yet deny an authoritative rebuttal?
The answer to this question goes back over 10 years.
In August 2014, written while Israeli bombs were falling on Gaza in “Operation Protective Edge,” a 1,484-word “Open Letter for the People in Gaza” was published in The Lancet, signed by 24 doctors and academics from the UK, Italy and Norway.
It began: “We are doctors and scientists, who spend our lives developing means to care and protect health and lives … On the basis of our ethics and practice, we are denouncing what we witness in the aggression of Gaza by Israel … a ruthless assault of unlimited duration, extent and intensity.”
Our letter was an appeal to the international community to speak out. It lamented the complicit silence of most Israeli doctors and academics, as well as of Israel’s western allies.
The publication of this letter triggered a highly public furor with editor Dr. Richard Horton at its center.
Horton had become chief editor of The Lancet in 1995 and since then had acquired a considerable reputation as an effective and socially progressive leader. He had published an article in The New York Review of Books in 2007 that was sympathetic to the Palestinian plight.
In 2009, The Lancet published a series of five reports about health in the occupied Palestinian territories , involving more than 30 researchers, half of whom were based in occupied Palestinian trritory.
In 2013, Horton founded the Lancet Palestinian Health Alliance, a network of Palestinian, regional and international researchers “committed to the highest scientific standards in describing, analyzing and evaluating the health and healthcare of Palestinians.”
Backlash
All this may have made Horton and The Lancet more of a target.
An international group of more than 500 doctors and academics, including five Nobel laureates, launched a highly public attack on The Lancet and on Horton for publishing the open letter, which they described as “extremist hate propaganda” and the “grossly irresponsible misuse of [the journal] for political purposes,” while others described it as “anti-Jewish bigotry.”
Reported in newspapers and across the internet, these charges were broad-brush smears. They threatened an academic boycott of publishers Reed Elsevier if they did not take action against Horton.
Horton did not redact the letter but his broader reaction was to strike a note of regret and near-apology, accepting an offer to visit Ramban hospital in Israel and, as if in reparation, he promised a series on “Health in Israel.” This came out in 2017.
In August 2019, five years on, The Lancet agreed to publish a letter from Israel by Rosenstock et al which showed the enduring impact the 2014 attack has had on the journal. The letter claimed that the 2014 open letter was a “clear manifestation of anti-Semitism,” smeared the authors’ correspondence as “profoundly anti-Semitic and anti-Israel,” and boasted of an international medical journal tamed.
We, signatories to the open letter, surely had a right of reply to being slandered as anti-Semites in a high-visibility medical journal.
The Lancet refused us this.
Scars remain
The trial by fire to which Horton and The Lancet were subjected did not arise from alleged lapses of publishing standards by accepted academic criteria. It arose from a political imperative to unconditionally defend Israel and its policies.
In 2014, pro-Israel pressures brought to heel a principled editor and global health leader, and endangered his journal and publishing house. Horton’s hitherto exemplary reputation was besmirched.
More than 10 years on and the scars remain, seemingly still able to influence The Lancet’s editorial decisions. The journal has published some relevant material on Gaza since 2023, but the scarring is evident in the domain of medical ethics, surely foundational for a medical journal.
The Lancet appears willing to publish much of what is submitted by Israeli doctors, including their public support for bombing hospitals, but will not publish evidence-based corrective letters from other doctors and academics.
For defenders of Israel this has been a successful campaign, a famous medical journal and editor brought to heel. As Rosenstock et al put it: “Horton now better understands the realities on the ground.”
This political distortion is not confined to the UK, moreover, but is also evident in the reporting on Gaza by similarly eminent US journals, notably The New England Journal of Medicine and the Journal of the American Medical Association.
A key theme in all this is that no critics, including doctors and academics, ever sought to engage with the evidence base cited in the articles they found so offensive. No academic chose to interrogate, say, a report from Human Rights Watch, or Amnesty International or Physicians for Human Rights-Israel.
The attacks were crudely ad hominem, with “anti-Semitism” generally depicted as the basic motivation of the authors.
The “taming” of the The Lancet shows how even in the age of evidence-based medicine, doctors and academics can still ignore evidence placed in the public domain by reputable organizations and go on to attack those who publish it.
Political affinity or social identity trumps medical ethics, posing basic questions about the academic freedom of medical journals to publish on Israel-Palestine.
Derek Summerfield is a London-based medical academic involved in human rights campaigning on Israel/Palestine for 33 years.
Add new comment