In solidarity with Gaza.

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Correspondence
www.thelancet.com Vol 373 January 24, 2009 295
In solidarity with Gaza
With sadness and urgency we, medical
students, express our outrage at the
brutal Israeli attacks and subsequent
human itarian disaster that is occurring
in Gaza. As we write, more than
600 Palestinians have been killed and
more than 2700 wounded in Israel’s
dis proportionate assault that began
on Dec 27, 2008. Not just as medical
students, but as Christians, Jews, and
Mus lims; as Arabs, Americans, Israelis,
and Palestinians, we write in solidarity
with the people of Gaza as they suff er
yet another major humanitarian
disaster.
On Dec 10, 1948, the General
Assembly of the UN proclaimed that
access to medical care is an inalienable
human right. More than 60 years
later, as medical supplies in Gaza’s
overstretched and underequipped
hospitals dwindle, this right is far from
realised. The international community
has been slow to respond with aid
and even that which is off ered is not
reaching those in need.
Hospitals scramble to operate with-
out power, medicines, and clean
water as medical equipment and
health workers are prevented from
crossing the border. WHO reports that
health personnel have been targeted
in breach of medical neutrality and
in violation of international human-
itarian law. Testimonies gathered by
Physicians for Human Rights—Israel
report that patients wait in vain for
treatment that cannot be provided
by overwhelmed medical personnel in
paralysed clinics. This massive infl ux
of seriously injured civilians would
overwhelm even the best of the
hospitals in which we train.
Meanwhile, the bombardment of
Gaza—one of the most densely popu-
lated regions in the world—continues
un abated and the international com-
mun ity refuses to address Israel’s ab-
horrent policy of collective punishment.
Israel claims only to target militants, yet
the lists of wounded and dead are rife
with civilians, many of them children.
Irrespective of the complex dynamics
of this confl ict, human rights, medical
neutrality, and the protection of non-
combatants always demand respect.
Israeli “high-precision” weapons have
destroyed a UN school in Jabaliya,
which was being used to house
refugees, killing 40 civilians alone.
We do not dismiss Hamas’s role, nor
condone its targeting of Israeli civilians.
How will the slaughter of Israeli or
Palestinian civilians bring peace to this
region? We fear this will instead breed
new generations of hate, distrust, and
misunderstanding. Yet the numbers of
lives lost tell the story: Israel’s response
is disproportionate and unacceptable.
We cannot sit idly in silence as this
violent assault on a civilian population
kills and maims hundreds of people.
The principles we accepted on entering
the medical profession compel us
to speak out in the face of these
gross violations of basic decency and
respect for human life. We implore the
international community to shoulder
its responsibility to the people of Gaza.
We are embarrassed at US complicity
and regret that many of the weapons
fi red come from our own country.
As members of the medical pro-
fession, we call for an immediate ces-
sation of hostilities, the immediate and
com prehensive provision of human-
itarian aid, and recognition of the neu-
trality guaranteed to medical pro viders
by international law. Israel has only
now approved limited human itarian
corridors, but this is insuffi cient and has
proven ineff ective. We stand united in
opposing the health and hu man rights
disaster infl icted on the citi zens of
Gaza. As we hope for a return to civility,
dialogue, compromise, and resolution,
our hearts go out to all of the victims of
this tragedy. The violence must stop.
We declare that we have no confl ict of interest.
Rami Abdou, Iyah Romm,
Davida Schiff , Kirsten Austad,
Sam Dubal, *Simeon Kimmel,
Eugene Schiff , on behalf of 753 other
medical students
simeon_kimmel@hms.harvard.edu
Boston University School of Medicine, Boston, MA,
USA (RA, IR, DS); Harvard Medical School, Boston,
MA 02115, USA (KA, SD, SK); and Tufts University
School of Medicine, Boston, MA, USA (ES)
Published Online
January 9, 2009
DOI:10.1016/S0140-
6736(09)60013-1
Health and human
rights in the Palestinian
West Bank and Gaza
Palestine is split geographically into
the West Bank and the Gaza strip.
Gaza is the most densely populated
area on earth: after fi rst 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 never-
theless suff ers widespread erosions of
human rights which we witnessed on a
fact-fi nding 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 fi nally 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 diffi culties staff and students
face as a result of the paralysing
restrictions on
institutions in the Occupied Territories.
The total blockade of Gaza meant
our entry there was denied, as it has
been for humanitarian workers and
es sential food, energy, and medical
sup plies since the closure of the border
in early November. We heard from
Physicians for Human Rights—Israel,
of the reduction in exit permits being
grant ed 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’
oppor tunities to make a living are
travel between
See Online for 753 other
signatories
Published Online
January 12, 2009
DOI:10.1016/S0140-
6736(09)60042-8

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Correspondence
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www.thelancet.com Vol 373 January 24, 2009
Tuberculosis and Malaria (GFATM)
technical review panels which, if
incor porated into country malaria
proposals, would increase coverage of
long-lasting insecticidal bednets and
access to antimalarials, and ultimately
reduce morbidity and mortality due to
malaria.
Evidence from a multi country study
in Nigeria, Cameroon, and Uganda4
showed that, in districts where home
management of malaria was inte-
grated with a community-directed
inter vention (based on the ivermectin
an nual distribution strategy for oncho-
cerciasis control), more than twice
as many children with fever received
anti malarial treatment than with
home manage ment alone. Moreover,
pos ses sion and use of insecticidal
or long-lasting insecticidal bednets
were twice as high in districts with
the community-direct ed intervention
than in control districts.4
The numbers of distribution net-
works and the high mass drug ad min-
istration coverage achieved through
the community-directed ap proach in
the many countries and thousands
of communities in Africa where these
pro grammes operate4–6 need to be
recog nised as an ideal plat form for
the delivery of malaria con trol inter-
ventions. The African Pro gramme for
Onchocerciasis Control, in partner-
ship with national health ser vices
and non-governmental organ isa tions,
has sup ported the dis tri bution of iver-
mectin (donated by Merck) in areas
hyper endemic and
for onchocerciasis in 19 African
coun tries using a network of more
than 350 000 community-directed
dis tributors work ing in more than
117 000 com munities.7 In 2006, more
than 46 million annual treat ments
were de li vered to com munities, many
of which were remote (several km
away from formal frontline health
services) or in areas of confl ict.7 Most
of these projects have proved sustain-
able at the community level.5
The Global Programme to Eliminate
Lymphatic Filariasis has a similar
meso endemic
Neglected tropical
diseases and the
Global Fund
There is a recognised need to scale
up malaria interventions rapidly if
the inter national community is to
meet the targets established in the
Global Malaria Plan,1 which include
im proved access to artemisinin-based
com bination therapy, intermittent
pre ventive treatment for pregnant
wo men, and universal coverage with
long-lasting insecticidal bednets.
Although progress has been made
towards these targets, Abdisalan Noor
and colleagues (Jan 3, p 58)2 report
that, in the case of bednets, several
high-population coun tries have major
defi cits in reaching the targets for
universal coverage by 2010.2 Only
18·5% of African children in stable
malaria transmission
protected by a net in 2007, leaving
nearly 90 million unprotected.2
Since 2004, we have identifi ed po-
tential synergies between control
pro grammes for malaria and for
neg lected tropical diseases;3 to date,
such op portunities have gone large-
ly untapped. These diseases are co-
endemic geographically with malaria
and can aff ect patients con currently;
delivery systems can be shared by in-
volving community health workers;
and inter ventions for neglected tropical
diseases are highly cost eff ective.3
Additional studies have re inforced
these points, suggesting that a
new para digm for intervention is
available to the Global Fund for AIDS,
areas were
being eroded, both by illegal Israeli
settlements on their farmland and by
discrimination against their industry.
Violence continues at all levels:
we spoke with
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 mili tary 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 dis pro-
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 infl uence those in power, serious
consideration be given to targeted
academic and trade boycotts.
schoolchildren,
We declare that we have no confl ict of interest.
*David Worth, Su Metcalfe,
John Boyd, Adrian Worrall,
Paola Canarutto
dworth@doctors.org.uk
York Hospital, York YO31 8HE, UK (DW);
Department of Surgery, University of Cambridge
Clinical School, Addenbrookes Hospital,
Cambridge, UK (SM); St George’s Medical School,
London, UK (JB); Royal College of Psychiatrists’
Centre for Quality Improvement, London, UK
(AW); and Ospedale S Giovanni Bosco, Turin,
Italy (PC)
1 Falk R. Report of the Special Rapporteur on
the situation of human rights in the
Palestinian territories occupied by Israel
since 1967. http://domino.un.org/UNISPAL.
NSF/9a798adbf322aff38525617b
006d88d7/061f1f4fbdecffe
5852574d60065b4ba!OpenDocument
(accessed Dec 8, 2008).
2 Physicians for Human Rights—Israel. Holding
health to ransom: GSS interrogation and
extortion of Palestinian patients at Erez
crossing. http://www.phr.org.il/phr/fi les/
articlefi le_1217866249125.pdf (accessed
Jan 5, 2009).
Defence for Children International. Palestinian
child political prisoners: semi annual report 2007.
http://www.dci-pal.org/english/display.cfm?Doc
Id=605&CategoryId=2 (accessed Dec 8, 2008).
Tran M. Israel accused of ramming Gaza aid
boat. The Guardian Dec 30, 2008. http://www.
guardian.co.uk/world/2008/dec/30/israel-
gaza-aid-ship (accessed Jan 4, 2009).
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