Pretty damning, and an important update on the dire situation for people trapped in the Gaza concentration camp. It will take generations to recover from a whole society trauma like this...

*****

https://acrobat.adobe.com/id/urn:aaid:sc:EU:27002754-dd92-4a5f-9293-e36d3b0c19ff
https://www.jewishvoiceforlabour.org.uk/article/uk-doctors-who-have-volunteered-in-gaza-demand-the-uk-stop-arming-israel/

[To Keir Starmer and David Lammy]

We are 30 qualified doctors, surgeons, nurses and medical professionals, based in the UK, who have volunteered in Gaza since October 7, 2023. We worked with various non-governmental organisations and the World Health Organization in hospitals throughout Gaza. In addition to our medical and surgical expertise, many of us hold current roles within the NHS, as well as having worked in humanitarian crises and conflict zones across the world. Many of us also have long standing experience working with British charities in Gaza and across the occupied Palestinian territory (oPt). We have seen the deliberate targeting of civilians on a mass scale, and a total lack of resources, due to the destruction of Gaza’s healthcare system and deliberate restriction of aid. The deleterious effects of Israeli occupation on the Palestinian healthcare system are something many of us have seen before– but never to this extent.

We are a multi-faith and multi-ethnic group, united not by any political motivation, but by the desire to care for those who are suffering. The Constitution of the World Health Organization states: ‘The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and States.’ It is in this spirit that we write to you, and it is in this spirit that we realise that we cannot remain silent about what we saw in Gaza. We are among the only neutral observers who have been permitted to enter the Gaza Strip since 7 October. With international journalists being targeted and denied access to Gaza, our eyewitness experiences have had to serve in place of journalistic or investigatory accounts.

Given our broad expertise and unique first-hand experience of working in Gaza in recent months, we are uniquely positioned to comment on several matters of importance to our new government, as it considers its methods of engagements with Israel, the oPt (and specifically Gaza), and international actors.

Specifically, we believe we are well positioned to comment on the massive human toll from Israel’s attack on Gaza, on Palestinian men, women and children, as well as the long term and systematic destruction of the healthcare system, which will impact the sick as well as the wounded for years to come.

It is impossible to know the true death toll in Gaza. The Ministry of Health figure of approximately 40,000 Palestinians killed refers only to the number of identified bodies, but while working in Gaza we bore witness to untold numbers of unidentified bodies, many of them truly unidentifiable due to the extent of damage caused. A correspondence piece in The Lancet, one of Britain’s leading medical journals, estimated that the true figure could be 186,000, reflecting the scale of indirect and unrecorded deaths that have inevitably occurred due to the destruction of the healthcare system. Those suffering from malnutrition due to Israel’s use of starvation as a weapon of war, and those suffering from water-borne diseases from Israel’s restriction of water and aid has increased the Gaza population’s suffering further.

Demanding immediate action by the UK Government to stop military support for Israel, as obligated by international law, the letter goes on to paint its devastating picture of life and death in Gaza.

With only marginal exceptions, everyone in Gaza is sick, injured, or both. This includes every national aid worker, every international volunteer, and every man, woman, and child. While working in Gaza we saw widespread malnutrition in our patients and our Palestinian healthcare colleagues. Many of us lost weight rapidly in Gaza despite having privileged access to food and having taken our own supplementary nutrient-dense food with us. We have photographic evidence of life-threatening malnutrition in our patients, from babies to the elderly, that we are willing or have already shared with you.

Virtually every child under the age of five whom we encountered, both inside and outside of the hospital, had both a cough and watery diarrhoea. Jaundice and hepatitis A infection were widespread in the hospitals in which we worked, while the surgical complication rate was near 100%. Surgical incisions were almost certain to become infected, due to the hospitals’ impossible operating conditions- including a lack of supplies, water, and medications including antibiotics- overcrowding, and due to patients’ malnutrition. We were forced to use household supplies including vinegar for antiseptic purposes, or went without.

Pregnant women gave birth in unsanitary and overcrowded conditions, as there is simply nowhere left which is not unsanitary and overcrowded. These women face serious risk of complications, ill health, and death. Those of us who worked with pregnant women regularly saw still-births and maternal deaths that would be easily preventable in any functioning healthcare system. The rate of infection in C-section incisions was astonishing, and these were often delivered to women going without anaesthesia or painkillers. Their infants were born underweight, while mothers are likely to be unable to breastfeed due to malnutrition. Potable water is unavailable across Gaza. Very few babies born under these conditions are likely to survive, and those who do will have their health permanently impaired.

We urge you to realise that epidemics are raging in Gaza. In addition to that, Israel has not stopped bombarding civilians in their tents or displacing the malnourished and sick population of Gaza, approximately half of whom are children, to areas with no running water or even toilets available. This is a horrifying reality. It is virtually guaranteed to result in widespread death from viral and bacterial diarrheal diseases and pneumonias, particularly in children under the age of five.

They warn about polio, now clearly infecting children in Gaza. This adds another disastrous factor: We worry that unknown thousands have already died from the lethal combination of malnutrition and disease, and that tens of thousands more will die in the coming months. Most of them will be young children. Many of those who survive contracting polio will face lifelong consequences.

We condemn the use of infectious agents and the destruction of health care infrastructure as a means of warfare to be responsible for far more deaths of civilians compared to all combat arms combined.

All of us treated children who seemed to have been deliberately targeted by military violence. Bullet wounds to children’s heads and torsos and amputations of limbs and eyes of children were commonplace. Facilities serving Gaza’s children have been destroyed, including the Al-Rantisi Children’s hospital and the Gaza European Hospital’s Paediatric Intensive Care Unit. Much of the equipment for both facilities has been damaged during evacuation and both are currently inoperative.

The letter documents much further detail concerning the destruction of Gaza’s healthcare system and the consequences thereof: such as the rejection of insulin needles and other medical equipment at border crossings under ‘dual use’ prohibitions, and how cancer treatment is now unavailable. And that Israel has … killed one out of every 40 healthcare workers in Gaza.

And here the final picture of destruction:

The hospitals where we worked were starved of basic supplies from surgical material to soap. They were regularly cut off from electricity and internet access, denied clean water, and operated at four to seven times their bed capacity. Every hospital was overwhelmed beyond the breaking point by displaced persons seeking safety, by the constant stream of patients whose treatment of chronic conditions had been interrupted by the war, by the huge influx of seriously wounded patients who typically arrived in mass casualty events, and by the sick and malnourished seeking medical care.

Prime Minister Starmer, Foreign Secretary Lammy, it is difficult for many of us to recount the scenes we witnessed in Gaza, not least of all in the knowledge that many of the injuries we treated may have resulted from the use of weapons systems and components supplied from Britain. This includes the victims of the daily airstrikes conducted using F-16 and F-35 aircraft part-produced in the UK.

Being some of the few UK citizens and residents able to travel to Gaza since October, we write to you in certainty that if you had seen, heard, and experienced the things we have, there would be no question [about] placing an arms embargo on Israel. […]

Tens of thousands face catastrophic injury of a type only inflicted by deliberate targeting of or wilful neglect for civilian life. What we have outlined to you amounts to probative evidence of widespread violations of British laws, International Humanitarian Law and the UK Government’s own rules on arms exports, namely the Strategic Export Licensing Criteria.

The letter goes on to document the unbelievable trauma of their medical colleagues in Gaza, who work on in the face ‘unimaginable living conditions’ and of the killing of their own families and friends: All were acutely aware that their work as healthcare providers had marked them as targets for Israel.

Many of our Palestinian healthcare colleagues were kidnapped by Israeli forces. During their detention, which lasted for weeks or months, almost all reported experience of physical and psychological abuse, mistreatment including torture and sexual abuse including being stripped naked, and other cruel and inhumane punishments- punishments given them solely for their being doctors.

Documenting attacks on themselves, both in Israel and also harassment and threats on their return to the UK, the letter goes on:

We urge you to see that Israel has directly targeted and deliberately devastated Gaza’s entire healthcare system, and that Israel has targeted our colleagues in Gaza for death, disappearance, and torture. These unconscionable acts are entirely at odds with British law, British values, and International Humanitarian Law. Prime Minister Starmer and Foreign Secretary Lammy, with your respective extensive legal backgrounds, you must acknowledge the widespread breaches of British and International Law that continue to be committed in this conflict. […] The UK government is impeding international procedures and has gone against its own standards that it has applied in other crises around the world. We sincerely hope to see these standards replicated in Gaza without hypocrisy to stop what is being done to innocent Palestinian men, women and children.

It concludes with an eloquent, detailed and extensive description of the steps that must immediately be taken by the UK Government, summarised as follows.

Any solution to this problem requires the withholding of military, economic, and diplomatic support from Israel, and participating in a full arms embargo of Israel, until a permanent ceasefire is established, and until good faith negotiations between Israel and the Palestinians lead to a permanent resolution of the conflict. In the meantime:
All land crossings between Gaza and Israel as well as the Rafah Crossing must be opened to unfettered aid delivery by recognised international humanitarian organisations.
Full and unrestricted access to the Gaza Strip must be created for medical and surgical professionals, including those of Palestinian descent who are currently barred by Israel from entering or working in Gaza.
The delivery of community care including immunisation programmes must be ensured, to help prevent communicable diseases including measles, polio, COVID-19, and skin disease.
A bare minimum water allocation of 20L of potable water per person per day must be allocated to the population of Gaza, as verified by UN Water. This is vital in mitigating the spread of water-borne diseases.
Respect and support for international and domestic accountability mechanisms from the UK government must be ensured.

The final entreaty:

We repeat: we are not politicians driven by political agendas. We are simply medical professionals who feel duty bound to speak out about what we saw in Gaza. Our duty is to our patients, to our fellow healthcare workers still in Gaza and to humanity. It is the same principle of duty many of us apply to our day-to-day work in the NHS as we did in Gaza as well. Every day that the United Kingdom continues supplying weapons and munitions to Israel is another day that the Palestinian men, women and children of Gaza are killed and maimed by weapons, including those manufactured in the UK.

Prime Minister Starmer and Foreign Secretary Lammy, we urge and implore you to end our role in this unimaginable cruelty now.

Yours sincerely: Dr. Muhammad Junaid Sultan Consultant Vascular Surgeon National Health Service, UK European Gaza Hospital (3 April 2024- 15 April 2024)

James Smith MBBS MA MSc MSc Emergency Medicine Lecturer in Humanitarian Policy & Practice, UCL Shuhada Al-Aqsa Hospital (26 December 2023- 8th January 2024) Al Mawasi, Rafah, Al Awda Nuseirat, Al Aqsa, patient evacuations from North Gaza and Gaza City (16th April 2024- 6th June 2024)

Victoria Rose MBBS FRCS plast LLM Plastic Surgeon, Ideals Charity since 2019, Chair of RCSE Special Advisory Committee for Plastic Surgery European Gaza Hospital (March 2024) Nasser Hospital (August 2024)

Alan Frederick Graeme Groom MA MB FRCS Trauma and Orthopaedic Surgeon Co-Chair of IDEALS charity , European Gaza Hospital (25 December 20239 January 2024, 24 March 2024- 9 April 2024) Nasser Hospital (5 August 2024 to Present)

and 26 others.