The Lancet, Early Online Publication, 4 August 2014
doi:10.1016/S0140-6736(14)61297-6Cite or Link Using DOI
Copyright © 2014 Elsevier Ltd All rights reserved.
The Lancet is a general medical journal that publishes research, news, and opinion about all aspects of human health and wellbeing. In situations of war and conflict—such as in Iraq, Syria, Afghanistan, and elsewhere—our perspective has always been to put the interests of civilian lives ahead of the politics of military engagement. In the conflict taking place in Gaza, our position is very clear. We do not support any side whose actions lead to civilian casualties. The role of the doctor is to protect, serve, and speak up for life. That, too, is the role of a medical journal.
Our view of the conflict in Gaza comes from first-hand experience of Gaza itself. When one enters Gaza, it is as if one is entering a prison. At the Erez crossing point in north Gaza, one first passes through an armed passport check, followed by a first set of gates. One walks on through another gate, with a further 150 yards to still another gate. A final 150 yards follow to a last exit. Then one is confronted by a landscape of destroyed roads, buildings, and bridges. Debris lies everywhere. When one reaches a nearby town or Gaza City itself, the first impression one will have is not only the crowded nature of life in Gaza, but also the children, children everywhere. 45% of Gaza's population is younger than 14 years of age.
On July 7, 2014, the Government of Israel launched “Operation Protective Edge”. Israel's Ministry of Foreign Affairs states on its website that, “Operation Protective Edge will continue until its goals are reached—restoring sustained peace and quiet to the citizens of Israel, while striking hard at the terrorist infrastructure of Hamas and other Palestinian terrorist groups in Gaza”. Israel, as any country, has the right to defend its citizens. International Humanitarian Law requires three principles to be upheld during such a defence. The Principle of Distinction states that, “parties to the conflict shall at all times distinguish between the civilian population and combatants”. The Principle of Precautions in Attack states that, “parties to the conflict must take all feasible precautions to protect the civilian population and civilian objects under their control against the effects of attacks”. The Principle of Proportionality states that, “Launching an attack which may be expected to cause incidental loss of civilian life, injury to civilians, damage to civilian objects, or a combination thereof, which would be excessive in relation to the concrete and direct military advantage anticipated, is prohibited”.
Now return to life in Gaza. A land that no-one can escape from. A crowded land in which children are the largest single group of the population. These are the conditions in which attacks on Gaza combatants are taking place. One does not have to be a military expert or a scholar of International Humanitarian Law to realise the extreme risk to civilians in Gaza if conflict does not follow very strictly the Principles of Distinction, Precaution, and Proportionality. Palestinian civilian populations have no Iron Dome, the Israeli air defence system designed to intercept and destroy Hamas rockets. The children, women, and men of Gaza have had no protection from shelling that has so far claimed 852 civilian lives. The UN's Office for the Coordination of Humanitarian Affairs reports that 252 Palestinian children and 181 Palestinian women have been killed since July 7. 1949 children and 1160 women have been injured. 23 Gazan hospitals or clinics have been damaged. 250 000 Gazans have been displaced from their homes. 1·8 million people have reduced or no access to safe water. Epidemics of lice and scabies have broken out in shelters.
On July 22, we published a letter from Paola Manduca, Sir Iain Chalmers, Derek Summerfield, Mads Gilbert, Swee Ang, and colleagues drawing attention to the terrifying events taking place in Gaza these past weeks. Their letter has led to a debate about the appropriateness of a medical journal giving space to opinions about an issue that lies at the intersection between health and politics. But here is a war that is having far-reaching effects on the survival, health, and wellbeing of Gaza's and Israel's civilian residents. It is surely the duty of doctors to have informed views, even strong views, about these matters; to give a voice to those who have no voice; and to invite society to address the actions and injustices that have led to this conflict. Our responsibility is to promote an open and diverse discussion about the effects of this war on civilian health.
An opportunity for peace and justice surely beckons. For the health and wellbeing of civilians in both Gaza and Israel, we encourage both parties to have the courage to seize this moment.