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Will the US’s Largest Medical Body Remain Silent After Al-Shifa’s Destruction?

The American Medical Association condemned Russia’s attack on medical workers in Ukraine but has been silent on Gaza.

A United Nations team visits as Palestinian civil defense recovers human remains from the grounds of Al-Shifa hospital, Gaza's largest hospital, which was reduced to ruins by a two-week Israeli raid, on April 8, 2024.

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On March 25, the United Nations Security Council passed a resolution for an immediate ceasefire in Gaza for the month of Ramadan. Now that President Joe Biden has reportedly told Prime Minister Benjamin Netanyahu that he wants an “immediate ceasefire,” will the American Medical Association (AMA) finally support a call for a permanent ceasefire and the immediate provision of humanitarian and medical aid to the thousands of injured individuals, including health care workers in Gaza?

The AMA is the largest and most powerful medical body in the United States and is “engaged in targeted areas of international activity” under the guidance and direction of the Office of International Relations. For example, the AMA works with other countries to learn how they structure their health care systems and address issues such as shortages of physicians and health disparities. However, since October 7, the AMA has remained silent in the face of demands by medical constituents calling for a permanent ceasefire and condemnation of the attacks on health care facilities and the killing of hundreds of health care workers in Gaza.

In a November statement advocating for medical neutrality, the AMA ignored a number of its existing policies that allow it to stand up for health care workers. An example of such existing policy condemns “the military targeting of healthcare facilities and personnel and using denial of medical services as a weapon of war, by any party, wherever and whenever it occurs.”

According to the World Health Organization’s April 2 emergency situation update, Israel has conducted 435 health attacks in Gaza, targeting hospitals and health care workers (doctors, nurses and paramedics) and leaving 28 percent of hospitals partially functional and only 30 percent of primary care facilities functional. In addition, 722 health care workers have been killed, 902 injured in attacks, and 118 healthcare workers detained or arrested.

Israel continues to block aid from the United Nations to Gaza and prevent the delivery of essential provisions, including food and medical supplies. With the lack of fully functioning health care facilities, there are an estimated 8,000 patients that need to be medically evacuated out of Gaza, including 6,000 trauma-related patients. The Integrated Food Security Phase Classification, an internationally recognized scientific standard and multi-partner initiative that determines the severity and magnitude of acute and chronic food insecurity and malnutrition in a country, recently warned that famine in Gaza is imminent, with immediate and long-term health consequences. The World Health Organization has already reported that 28 children have died from malnutrition. Alex De Waal, the executive director of the World Peace Foundation said, “We are about to witness in Gaza the most intense famine since the Second World War.”

After a two-week intensive operation on Al-Shifa, northern Gaza’s biggest hospital, Israel left the facility on Monday in complete horrifying ruin with hundreds of bodies, including medical staff, scattered across the hospital. “It’s no longer able to function in any shape or form as a hospital. … Destroying Al Shifa means ripping the heart out of the health system,” said Margaret Harris, the WHO representative.

“If you want to take out the health care system, you take out the beating heart [Al Shifa hospital] of the health care system,” said Tanya Haj-Hassan, an intensive care pediatrician in Gaza. On April 1, Israeli airstrikes killed seven aid workers for World Central Kitchen, in a targeted attack, in the middle of the man-made famine.

Israel is taking out the beating heart of Gaza.

The AMA has always supported medical neutrality; however, in April 2022, the AMA statement was very different in response to the Russian attacks on health care workers in Ukraine: “The AMA is outraged by the brutal assault of the Russian military in Ukraine, and we stand with the World Medical Association and our other international partners in calling for an immediate ceasefire and an end to all attacks on health care workers and facilities.” In addition, the AMA issued a policy on humanitarian and medical aid support to Ukraine to improve the outcomes for war-affected people.

The AMA foundation provided $100,000 in aid to Ukraine in 2022, “to deliver much-needed medical supplies, such as medicine, hygiene kits and basic PPE, as well as health care personnel in some of the hardest hit regions.”

Why isn’t the AMA similarly outraged by the decades-long attacks by Israel on Gaza’s health care system or Israel’s systematic restrictions of the entry and distribution of humanitarian aid, safe water and electricity? Does the AMA value Ukrainian lives more than Palestinian lives? Why is the AMA using a double standard approach to “do no harm?” The AMA’s hypocrisy in their application of “medical neutrality” is shameful and does not represent the medical community it purports to.

Healthcare Workers for Palestine, a group of health care workers who stand in solidarity with the Palestinian people and denounce Israeli violence, have been protesting since October around the country and in Chicago at the AMA building to demand that the AMA join other health and humanitarian organizations, including Doctors Without Borders and the World Health Organization, to call for a permanent ceasefire in Gaza and to provide immediate humanitarian aid. They have called on and provided instructions to health care workers to demand a ceasefire from the AMA; they provided teach-ins on “Do No Harm: Medical Apartheid in Palestine”; and wrote statements of solidarity. The AMA has responded with silence, and silence is complicity.

Although medical neutrality is crucial to health care professions, we have a moral imperative as health care professionals to engage in political activism in the face of a long history of human rights violation, dehumanizing narratives, and the ongoing genocide and war crimes committed by Israel. A recent opinion piece in the British Medical Journal by members of Health Justice Initiative and People’s Health Movement, urged the global health community to call for an immediate ceasefire and unrestricted humanitarian aid in Gaza. “If we remain silent, the inequities we’re supposed to challenge in our work will be exacerbated — and that will only make the global health community complicit in the suffering of Gaza’s people,” argued Fatima Hassan and her colleagues.

I urge the AMA, and other health professions, such as the American Nurses Association and American Psychological Association, to break their complicit silence and employ their moral and ethical principles to advocate for humanity and fight for the safety, dignity and rights of the Palestinian people. I urge all health care professionals to do the same.