Gaza: Working under fire 

The devastating impact of the war in Gaza on healthcare workers and health facilities has sparked solidarity from some Irish doctors. David Lynch reports

On 6 November, the World Health Organisation and United Nations Children’s Fund released a joint statement confirming that the second round of the polio vaccination campaign in Gaza had been completed.

Administrative data confirmed around 94 per cent of the target population of 591,714 children aged under 10 received a second dose of nOPV2 (novel oral poliomyelitis [polio] vaccine type 2) across the Gaza Strip. This was a “remarkable achievement given the extremely difficult circumstances the campaign was executed under”.

“While the first two phases proceeded as planned, the third phase in northern Gaza had to be temporarily postponed on 23 October because of intense bombardments, mass displacements, lack of assured humanitarian pauses and access.”

The vaccination campaign, conducted against the backdrop of continued Israeli army actions, is part of emergency efforts to stop a polio outbreak which was detected in July.

The outbreak is just one of the most recent health consequences of over a year of destruction in Gaza.

Last month, marking a year of the war in Gaza, Ms Isabel Simpson, Executive Director of Médecins Sans Frontières (MSF) Ireland, wrote that “Israel’s all-out war on the people of Gaza has been marked by brutal violence, a complete disregard for human dignity and near daily violations of international humanitarian law”.

Atrocities

MSF Ireland noted that since the “atrocities committed by Hamas on 7 October 2023”,  which resulted in the deaths of 1,200 people and 250 taken hostages, Israeli forces had pursued “an all-out war” on people in the Gaza Strip, killing more than 41,500 people, and wounding over 96,000.

MSF Ireland said that since the beginning of the war, its teams in Gaza had treated over 27,500 patients for violence-related injuries, with more than 80 per cent of the wounds linked to shelling.

“Israeli bombardments of densely populated areas have repeatedly caused injuries on a massive scale. Our teams have been forced to perform surgeries without anaesthesia, witness children die on hospital floors due to a lack of resources, and even treat their own colleagues and family members,” said Dr Amber Alayyan, MSF Medical Programme Manager. “Meanwhile, the healthcare system in Gaza has been systematically dismantled by Israeli forces.”

According to MSF figures, only 17 out of 36 hospitals in Gaza are now partially functional.

The impact on people in Gaza, including healthcare workers, has sparked a significant amount of activism by some Irish doctors.

Irish Healthcare Workers for Palestine

“We want our Government, our professional bodies and our colleagues to support human rights and our [medical] colleagues in Gaza doing everything [they] can to bring about a ceasefire to stop the genocide,” Dr Angela Skuce, GP and member of Irish Healthcare Workers for Palestine, told the Medical Independent (MI).

In recent months, the group has lobbied politicians, held street protests, and taken their message to medical gatherings such as the IHCA Annual Conference in Co Kilkenny.

Dr Skuce stated that the campaign is advocating for a boycott, divestment, and sanctions against Israel.

“We want doctors to push for an academic boycott of Israeli representatives, we want the Department of Health and the HSE to implement ethical procurement policies so that our health service is not funding the genocide in Gaza… by buying Israeli products.”

Dr Skuce said that the group aims to “raise awareness” among doctors. She also noted a certain reluctance by some doctors “to speak out”.

“Although they believe what is happening is wrong, they tend to be reluctant to speak out, because they feel that it’s political to do so, or that they are taking sides.”

Ethical responsibility

Dr Skuce referenced the World Medical Association’s statement on armed conflict, emphasising that it clearly outlines the ethical responsibilities of doctors.

She highlighted the four core principles: Justice, autonomy, beneficence – meaning to do good – and non-maleficence, which means to avoid causing harm.

“Those obligations are not just to our patients; they are to the whole of humanity. So when we see wrong being done on such a scale, we have to speak out against it.”

Dr Skuce said that doctors should email the Minister for Heath and HSE CEO “asking them to implement an ethical procurement policy” in regard to Israeli products.

IHCA

During her first address as IHCA President at its recent Annual Conference, Prof Gabrielle Colleran highlighted the “humanitarian crisis” in the Middle East.

“The targeting of medical staff and hospital infrastructure in plain sight is both sobering and shocking, especially given the lack of impactful intervention by the international community to protect children, civilians, and medical staff.”

Prof Colleran also praised the work of the Gaza Paediatric Care Initiative (GPCI), which is a team of medical professionals based in Ireland who have raised money to help children in Gaza.

In a subsequent statement, issued earlier this month, the IHCA said it “stands ready to provide our support” as part of the GPCI.

It called on the Irish Government to work with Egyptian and Israeli authorities to expedite the evacuation of critically ill children from Gaza to Ireland for urgent medical treatment.

The Association also “strongly” condemned “grave violations of international humanitarian law” through the targeting of healthcare facilities and personnel in Gaza, and called for an immediate ceasefire in the region. The IHCA described the ongoing assaults on healthcare facilities and workers as “deeply distressing”.

“Doctors, nurses, and all healthcare workers, must be able to provide care free from the threat of violence, and those responsible for targeting healthcare professionals and facilities must be held accountable.”

College of GPs and IMO

During the summer, the Irish College of GPs expressed its “deep concern” at the huge loss of life in Gaza and urged all sides in this conflict to respect international law. The College called for the protection of healthcare facilities and personnel and the reopening of crossings to ensure humanitarian aid can be delivered safely.

At the IMO AGM in April, doctors passed a motion on the situation in Gaza, condemning in the “strongest possible terms the ongoing attacks by the Israeli government on civilians, healthcare settings and on those seeking to provide care and aid to the people of Gaza”. 

In a recent message to members, the IMO said that it wished to “reiterate our support for UNWRA [United Nations Relief and Works Agency for Palestine Refugees in the Near East]”.

“We call for both reinstatement and enhancement of funding so that the agency can continue to deliver humanitarian relief to the population of Gaza”.

In the email message seen by MI, the IMO also called for the protection of healthcare facilities and the “protection of all healthcare personnel who struggle to provide care to patients suffering from the horrors of war”. It repeated its call for an immediate ceasefire and the return of hostages. The IMO also informed members that it made a monetary contribution to the GPCI to “help cover the cost of transfer and healthcare for a group of children” from Gaza.

Individual consultants in Ireland “can talk to their junior staff and their management team in the hospital about highlighting what is going on”, Dr George Little, member of Irish Healthcare Workers for Palestine, told MI.

Dr Little was also in attendance at the recent IHCA Annual Conference.

He said that consultants should raise “the fact that healthcare workers in Palestine and the Lebanon now are working in incredibly difficult circumstances and they are being targeted”. They should also raise the issue of medical neutrality and that medical care and hospitals should not be targeted, regardless of “justification”.

“Healthcare workers should never be targeted,” he stated.