Friday, August 1, 2014

Physicians in Wartime

“Here is a hand-to-hand struggle in all its horror and frightfulness,” wrote Henri Dunant, a nineteenth-century international activist, in his book A Memory of Solferino. The book concerns the Battle of Solferino in June of 1859 between the Austrians and the French. Dunant describes the combatants “trampling each other under foot, killing one another on piles of bleeding corpses, felling their enemies with their rifle butts, crushing skulls, ripping bellies open with sabre and bayonet.”

An 1897 illustration depicting ambulance corps from
Russia (left) and England (right).
Image via Shutterstock
But amidst these horrors, Dunant gives us at least some hope in the form of the field hospitals. As a volunteer there, he points out that French surgeons did not rest for more than twenty-four hours, amputating legs and taking care of soldiers, eventually fainting from exhaustion. And this was not just done for French soldiers. Dunant observes that many wounded Austrians and Hungarians were “given the same food as the French officers, and their wounded were treated by the same doctors.” In the hospitals only the soldiers’ uniforms on the shelves above their beds, not the quality of the care they received, indicated which side they fought for.

After witnessing this, Dunant proposed that the international community establish relief societies composed of volunteers and sanctioned by a convention that would govern the treatment of the wounded during wartime. His proposal drew huge international support and on August 22, 1864, 16 countries signed onto the first treaty of the Geneva Conventions which, in its first article, reads that “Ambulances and military hospitals shall be recognized as neutral, and as such, protected and respected by the belligerents as long as they accommodate wounded and sick. Neutrality shall end if the said ambulances or hospitals should be held by a military force.”

Implied in this law is a principal far more ancient, one embodied in the physician’s Hippocratic Oath. In it, the doctor swears, “in every house where I come I will enter only for the good of my patients, keeping myself from all intentional ill-doing....” The physician, therefore, is responsible only for the good of the patient no matter what uniform that patient may wear. The Oath makes no exception for wartime or for the treatment of an enemy. Even if physicians disagree about who bears the blame for a conflict, they must abide by this ancient promise and its nineteenth-century ideological successor.

But what if one side in the conflict obstructs or prevents physicians from following this code? On July 23, during the latest war between Hamas and Israel in Gaza, more than twenty leading physicians and scientists from the U.K. and Italy sent a letter to the distinguished British medical journal The Lancet, claiming that Israel does exactly that. This letter is filled with accusations leveled against Israel regarding the political origins and conduct of this conflict, but I’ll let others in the medical field and outside the medical field cover that ground. There is one aspect of the letter I would like to address — specifically, the role of medicine in this conflict. On the basis of their “ethics and practice,” the physicians go on to claim:

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.... As we write, other massacres and threats to the medical personnel in emergency services and denial of entry for international humanitarian convoys are reported. We as scientists and doctors cannot keep silent while this crime against humanity continues....

Though there is death and destruction in every war, the physicians want to point out that Israel, and not Hamas, is particularly bad in trampling on the inviolability of the medical profession and its principled goal to care for all, Israeli or Palestinian.

And yet, this accusation glosses over some very important information. Financial Times reporter John Reed tweeted that rockets are being fired by Hamas from Gaza’s main hospital, Al Shifa. William Booth at the Washington Post reported that Hamas has been using Shifa Hospital as “de facto headquarters for Hamas leaders, who can be seen in the hallways and offices.” In another article in the Washington Post, Adam Taylor reports that the Israeli military targeted Gaza City’s el-Wafa Rehabilitation Center (after calling the hospital and telling them to evacuate), because they believed that rockets “were being fired from the vicinity of the hospital” and that there were “militants firing from the building.” In an al Jazeera article describing an Israeli attack on al-Aqsa hospital in Gaza, Israeli officials claim that there was a weapons cache near the hospital which the military was targeting.

There are those who doubt these reports. But Hamas has a history of doing this. The United Nations Relief and Works Agency (UNRWA) recently released a statement saying that its inspectors had found rockets, for a second time, in a UNRWA school for Palestinian children. As Adam Taylor points out in the Washington Post, “If Hamas is hiding missiles in schools, why not in hospitals?” And Hamas has a long track record of exploiting civilians and civilian infrastructure in this way. In an article for the New York Times in 2009, Steven Erlanger wrote that “Weapons are hidden in mosques, schoolyards and civilian houses, and the leadership’s war room is a bunker beneath Gaza’s largest hospital, Israeli intelligence officials say. Unwilling to take Israel’s bait and come into the open, Hamas militants are fighting in civilian clothes.”

And what of the Israeli hospitals? Israeli physicians recently treated the mother-in-law of Ismail Haniyeh, the leader of Hamas, for cancer in a Jerusalem hospital. Israeli physicians also treated, though unsuccessfully, the granddaughter of Haniyeh in a children’s hospital in Israel. Even as the fighting started, Israeli physicians were operating on Palestinian children with heart defects. As Dr. Akiva Tamir, head of pediatric cardiology at Wolfson Medical Center in Holon, stated, “It does not matter what side of the political map you are on. The parents of these children want them to live — just like parents [in Israel].” Indeed. And, as ABC News has reported, Israel opened up a field hospital at the Gaza border to treat Palestinians wounded in the conflict. CNN reports that Barzilai Hospital in Israel, which treats soldiers, civilians, and injured Palestinians, is “frequently hit by rocket attacks from Gaza.”

These facts make the letter from the international physicians and scientists incomprehensible: the signatories support an organization that defies the very principles integral to the job of the physician. While Israeli physicians hold to the oath of Hippocrates and to the principles of Henri Dunant, Hamas uses the very place where lives are supposed to be saved as a place to plan the end of human life. This renders their hospitals in clear violation of the original Geneva text: “Neutrality shall end if the said ambulances or hospitals should be held by a military force.” And the consequences have been devastating for Palestinians in need of medical care. Physicians, in the spirit of Dunant, must seek to treat enemies and friends, combatants and noncombatants. Hamas and its defenders are obfuscating this principle.

0 comments:

Post a Comment

[Basic HTML tags can be used in this comment field. Comments are moderated for civility and relevance and will not appear until the blog's editors have approved them.]