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The Lancet:Health and human rights in the Palestinian West Bank and Gaza  

2009-01-13 18:19:39|  分类: review |  标签: |举报 |字号 订阅

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Palestine is split geographically into the West Bank and the Gaza strip. Gaza is the most densely populated area on earth: after first being crippled by blockade of its borders since 2007, Gaza is currently being bombed by the Israeli armed forces.1

Unlike Gaza, the West Bank does not threaten Israel with missiles, but nevertheless suffers widespread erosions of human rights which we witnessed on a fact-finding tour in November, 2008.

Restriction of movement due to the separation barrier and checkpoints, combined with the need for travel permits, delay access to hospitals for both patients and health workers. We saw 33-week-old triplets delayed for over 5 h while awaiting permits and finally transferred without their parents, and heard of hospital workers' commuting times increasing from 30 min to more than 2·5 h after the closure to them of nearby checkpoints. At the medical schools we heard of the immense difficulties staff and students face as a result of the paralysing restrictions on travel between institutions in the Occupied Territories.

The total blockade of Gaza meant our entry there was denied, as it has been for humanitarian workers and essential food, energy, and medical supplies since the closure of the border in early November. We heard from Physicians for Human Rights—Israel, of the reduction in exit permits being granted for treatment outside Gaza, and of the practice of denying exit to some patients unless they collaborate with the security service in intelligence gathering.2

We saw how the Palestinians' opportunities to make a living are being eroded, both by illegal Israeli settlements on their farmland and by discrimination against their industry.

Violence continues at all levels: we spoke with schoolchildren, injured in stone-throwing attacks by Israeli children occurring while Israeli soldiers looked on. Children as young as 12 years are prosecuted in the Israeli military courts. The most common charge against children in the military courts is for stone-throwing, which under military law carries a maximum penalty of 20 years.3

Our experience in the West Bank caused us grave concerns, which have been realised more rapidly and deva-statingly than any of us could have anticipated, in the current dispro-portionate attacks by Israeli forces on Gaza. Our personal insight into this includes the attack by the Israeli navy on the boat Dignity when underway to provide emergency health care to Gaza, and which was carrying a member of our tour group.4

This report is for our colleagues around the world who might be unaware of the deliberate erosion of human rights in both the West Bank and Gaza. We suggest that, in view of the failure of other measures to influence those in power, serious consideration be given to targeted academic and trade boycotts.

We declare that we have no conflict of interest.

David Worth aEmail Address, Su Metcalfe b, John Boyd c, Adrian Worrall d, Paola Canarutto e



Violent conflict: protecting the health of civilians

As the world watches the terrible events unfolding in Gaza, several other conflict zones around the globe continue to be ignored. Since Israel's air and ground offensive against the Hamas regime in Gaza captured international political and media attention, hundreds of people—400 in one day alone—have been killed in the Democratic Republic of the Congo and many more lack the medical attention they so desperately need.

Major difficulties in bringing assistance to people affected by conflict is a prominent feature of the top ten most neglected humanitarian disasters, compiled annually by Médecins Sans Frontières. According to the list, massive forced civilian displacements, violence, and unmet medical needs in Somalia, which is top of the list for the third consecutive year, the Democratic Republic of the Congo, Iraq, Sudan, and Pakistan are some of the worst humanitarian and medical emergencies in the world.

It is a scar on society that some lives are still deemed more important than others, especially when viewed through a lens distorted by politics, economics, religion, and history. The perceived worth of a country—including its economic, trading, and political value—and the degree of media coverage should not determine the value of the lives of its citizens lost to war. Unfortunately, few political leaders consistently share this view and the UN has failed miserably to uphold its founding principle—that every life has equal value.

In a recent speech, UN Secretary General, Ban Ki-moon said “we [the UN] have not been able to protect innocent people from violence”. Although such an admission is refreshingly honest, it does not make this deplorable fact any more acceptable. The UN Secretary General and political leaders have called repeatedly for ceasefires to such conflicts to no avail. The UN's credibility is seriously undermined by the complete lack of any mechanism to hold those who break international law to account. How can the UN system be fit for purpose when it does not even attempt to uphold agreed international codes such as protecting civilians, ensuring that those injured and sick during conflicts receive medical attention, and that medical personnel, establishments, transport, and equipment are spared? Governments involved in recent and current conflicts have repeatedly shown a flagrant disregard of such principles yet there have been no reprisals whatsoever. Additionally, the recent events in Gaza, and last year's uprising—and brutal quashing—in Burma, show that the organisation of the UN Security Council, where the powerful few are allowed to make unilateral decisions to suit their own political interests, is disgracefully inadequate.

Perhaps in the days to come, as the world continues to reel from the political and humanitarian fall-out of the situation in Gaza, the international community could use this catastrophe as catalyst for change to improve the medical and humanitarian response during conflicts. Global reaffirmation of the Universal Declaration of Human Rights, which enshrines the equal value of human life, and the Geneva Convention, which protects civilians and medical personnel during conflict, would be a good starting point. Although this suggestion does not require a reinvention, it is only worth doing if combined with the rather revolutionary notion that countries, territories, regions, and leaders that breach these codes should be held to account. Non-governmental organisations and civil society groups should play a crucial part in such a proposal. But perhaps it is time for a different group to step in and sign up to be the guardians of, and advocates for, the humanitarian health needs of civilians caught up in conflict. Who better to take up this role than the medical profession?

Just as the UN was founded in the spirit of shared humanity, so was medicine. The Hippocratic Oath, and its popular modern equivalents, puts caring for human beings and treating each life as equal at their very heart. Surely it is not just the brave few health professionals in the firing line who have the responsibility for meeting the health needs of civilians injured in conflict. Médecins Sans Frontières—doctors without borders—should not just be the name given to one medical humanitarian organisation. If the Hippocratic Oath means anything, all doctors whatever their situation, specialty, or seniority should live up to this name by calling on their national governments and the international community—perhaps through their national medical organisations—to ensure that civilians injured or affected by conflict receive the medical attention they need, wherever these people may be in the world. Such action is not being a so-called humanitarian—it is what being a member of the medical profession should be all about.


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