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| Just one of hundreds maimed for life. |
The Honorable Joseph R. Biden
President of the United States
The White House
Washington, DC
United States of America
The Honorable Kamala D. Harris
Vice President of the United States
The White House
Washington, DC
United States of America
October 2, 2024
Dear President Biden and Vice President Harris,
We are 99 American physicians, surgeons, nurse practitioners, nurses, and midwives who have volunteered in the Gaza Strip since October 7, 2023. Combined, we spent 254 weeks volunteering in Gaza’s hospitals and clinics. We worked with various nongovernmental organizations and the World Health Organization in hospitals and clinics throughout the Strip. In addition to our medical and surgical expertise, many of us have a public health background, as well as experience working in humanitarian and conflict zones, including Ukraine during the brutal Russian invasion. Some of us are veterans and reservists. We are a multi-faith and multiethnic group. None of us support the horrors committed on October 7 by Palestinian armed groups and individuals in Israel.
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 in this open letter.
We are among the only neutral observers who have been permitted to enter the Gaza Strip since October 7. Given our broad expertise and direct experience of working throughout Gaza we are uniquely positioned to comment on several matters of importance to our government as it decides whether to continue supporting Israel’s attack on, and siege of, the Gaza Strip. Specifically, we believe we are well positioned to comment on the massive human toll from Israel’s attack on Gaza, especially the toll it has taken on women and children.
This letter collects and summarizes our own experiences and direct observations in Gaza. The letter is accompanied by a detailed appendix summarizing the publicly available information from media, humanitarian, and academic sources on key aspects of Israel’s invasion of Gaza. Both this letter and the appendix are available electronically at GazaHealthcareLetters.org. This website also houses letters from Canadian and British healthcare workers to their respective governments, making many similar observations to those herein.
This letter and the appendix show probative evidence that the human toll in Gaza since October is far higher than is understood in the United States. It is likely that the death toll from this conflict is already greater than 118,908, an astonishing 5.4% of Gaza’s population.
Our government must act immediately to prevent an even worse catastrophe than what has already befallen the people of Gaza and Israel. A ceasefire must be imposed on the warring parties by withholding military support for Israel and supporting an international arms embargo on Israel and all Palestinian armed groups. We believe our government is obligated to do this, both under American law and International Humanitarian Law. We also believe it is the right thing to do.
I’ve never seen such horrific injuries, on such a massive scale, with so few resources. Our bombs are cutting down women and children by the thousands. Their mutilated bodies are a monument to cruelty.
Dr. Feroze Sidhwa, trauma and critical care surgeon, Veterans Affairs general surgeon
With only marginal exceptions, everyone in Gaza is sick, injured, or both. This includes every national aid worker, every international volunteer, and probably every Israeli hostage: every man, woman, and child. While working in Gaza we saw widespread malnutrition in our patients and our Palestinian healthcare colleagues. Every one 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, especially children, that we are eager to share 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 diarrhea. We found cases of jaundice (indicating hepatitis A infection under such conditions) in nearly every room of the hospitals in which we served, and in many of our healthcare colleagues in Gaza. An astonishingly high percentage of our surgical incisions became infected from the combination of malnutrition, impossible operating conditions, lack of basic sanitation supplies such as soap, and lack of surgical supplies and medications, including antibiotics.
Malnutrition led to widespread spontaneous abortions, underweight newborns, and an inability of new mothers to breastfeed. This left their newborns at high risk of death given the lack of access to potable water anywhere in Gaza. Many of those infants died. In Gaza we watched malnourished mothers feed their underweight newborns infant formula made with poisonous water. We can never forget that the world abandoned these innocent women and babies.
Every day I saw babies die. They had been born healthy. Their mothers were so malnourished that they could not breastfeed, and we lacked formula or clean water to feed them, so they starved.
Asma Taha, pediatric nurse practitioner
We urge you to realize that epidemics are raging in Gaza. Israel’s continued, repeated displacement of the malnourished and sick population of Gaza, half of whom are children, to areas without running water or even toilets available is absolutely shocking. It was and remains guaranteed to result in widespread death from viral and bacterial diarrheal diseases and pneumonias, particularly in children under the age of five. Indeed, even the dreaded polio virus has reemerged in Gaza due to a combination of systematic destruction of the sanitation infrastructure, widespread malnutrition weakening immune systems, and young children having missed routine vaccinations for nearly an entire year. 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, especially with the onset of the winter rains in Gaza. Most of them will be young children.
Gaza was the first time I held a baby’s brains in my hand. The first of many.
Dr. Mark Perlmutter, orthopedic and hand surgeon
Children are universally considered innocents in armed conflict. However, every single signatory to this letter saw children in Gaza who suffered violence that must have been deliberately directed at them. Specifically, every one of us who worked in an emergency, intensive care, or surgical setting treated pre-teen children who were shot in the head or chest on a regular or even a daily basis. It is impossible that such widespread shooting of young children throughout Gaza, sustained over the course of an entire year is accidental or unknown to the highest Israeli civilian and military authorities.
President Biden and Vice President Harris, we wish you could see the nightmares that plague so many of us since we have returned: dreams of children maimed and mutilated by our weapons, and their inconsolable mothers begging us to save them. We wish you could hear the cries and screams our consciences will not let us forget. We cannot fathom why you continue arming the country that is deliberately killing these children en masse.
I saw so many stillbirths and maternal deaths that could have been easily prevented if the hospitals had been functioning normally.
Dr. Thalia Pachiyannakis, obstetrician and gynecologist
The pregnant and breastfeeding women we treated were particularly malnourished. Those of us who worked with pregnant women regularly saw stillbirths and maternal deaths that were easily preventable in any developing country’s healthcare system. The rate of infection in C-section incisions was astonishing. Women underwent vaginal deliveries and even C-sections without anesthesia and were given nothing but Tylenol afterwards because no other pain medications were available.
We all observed emergency departments overwhelmed by patients seeking treatment for chronic medical conditions such as renal failure, hypertension, and diabetes. Aside from trauma patients, most ICU beds were occupied by patients with type 1 diabetes who no longer had access to insulin. The lack of medication availability, the widespread loss of electricity and refrigeration, and inconsistent access to food made managing this disease impossible. Israel has destroyed more than half of Gaza’s healthcare resources and has killed nearly one thousand Palestinian healthcare workers, more than one out of every 20 healthcare workers in Gaza. At the same time healthcare needs have increased massively from the lethal combination of military violence, malnutrition, disease, and displacement.
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 sick and malnourished patients seeking care, and by the huge influx of seriously wounded patients who typically arrived in mass casualty events.
These observations and the publicly available material detailed in the appendix lead us to believe that the death toll from this conflict is many times higher than what is reported by the Gaza Ministry of Health. We also believe this is probative evidence of widespread violations of American laws governing the use of American weapons abroad, and of International Humanitarian Law. We cannot forget scenes of unbearable cruelty directed at women and children that our government is a direct participant in.
As we met our healthcare colleagues in Gaza it was clear that they were malnourished, and both physically and mentally devastated. We quickly learned that our Palestinian healthcare colleagues were among the most traumatized people in Gaza, and perhaps in the entire world. Like virtually all people in Gaza they had lost family members and their homes. Most lived in and around their hospitals with their surviving family in unimaginable conditions. Although they continued working a grueling schedule, they had not been paid since October 7. All were acutely aware that their work as healthcare providers had marked them as targets for Israel. This makes a mockery of the protected status hospitals and healthcare providers are granted under the oldest and most widely accepted provisions of International Humanitarian Law.
We met healthcare personnel in Gaza who worked at hospitals that had been raided and destroyed by Israel. Many of these colleagues of ours were taken by Israel during the attacks. They all told us a slightly different version of the same story: in captivity they were barely fed, continuously physically and psychologically abused, and finally dumped naked on the side of a road. Many told us they were subjected to mock executions and other forms of mistreatment and torture. Far too many of our healthcare colleagues told us they were simply waiting to die.
The 99 signatories to this letter spent a combined 254 weeks inside Gaza’s largest hospitals and clinics. We wish to be absolutely clear: not once did any of us see any type of Palestinian militant activity in any of Gaza’s hospitals or other healthcare facilities.
We urge you to see that Israel has systematically and deliberately devastated Gaza’s entire healthcare system, and that Israel has targeted our colleagues in Gaza for torture, disappearance, and murder.
President Biden and Vice President Harris, any solution to this problem must begin with an immediate and permanent ceasefire. We appreciate that you are working on a ceasefire agreement between Israel and Hamas, but you have overlooked an obvious fact: the United States can impose a ceasefire on the warring parties by simply stopping arms shipments to Israel, and announcing that we will participate in an international arms embargo on both Israel and all Palestinian armed groups. We stress what many others have repeatedly told you over the past year: American law is perfectly clear on this matter, continuing to arm Israel is illegal.
President Biden and Vice President Harris, we urge you to immediately withhold military, economic, and diplomatic support from the State of Israel and to participate in an international arms embargo of Israel and all Palestinian armed groups until a permanent ceasefire is established in Gaza, including the release of all Israeli and Palestinian hostages, and until a permanent resolution of the Israeli-Palestinian conflict is negotiated between the two parties. Vice President Harris, as the likely next president of the United States, we urge you to publicly announce your support for such a policy, and to state publicly that you are duty-bound to uphold the laws of the United States even when doing so is politically inconvenient.
President Biden and Vice President Harris, we are 99 American physicians and nurses who have witnessed crimes beyond comprehension. Crimes that we cannot believe you wish to continue supporting. Please meet with us to discuss what we saw, and why we feel American policy in the Middle East must change immediately.
In the meantime, we reiterate what we wrote in our letter of July 25, 2024:
1. The Rafah Crossing between Gaza and Egypt must be immediately reopened, and must allow unfettered aid delivery by recognized international humanitarian organizations. Security screening of aid deliveries must be conducted by an independent international inspection regime instead of by Israeli forces. These screenings must be based on a clear, unambiguous, and published list of forbidden items, and with a clear independent international mechanism for challenging forbidden items, as verified by the UN Office for the Coordination of Humanitarian Affairs in the occupied Palestinian territory.
2. A bare minimum water allocation of 15L of potable water per person per day, the Sphere Handbook minimum in a humanitarian emergency, must be allocated to the population of Gaza, as verified by UN Water.
3. Full and unrestricted access of medical and surgical professionals and medical and surgical equipment to the Gaza Strip must be resumed. This must include items taken in healthcare professionals’ personal luggage to safeguard their proper storage, sterility, and timely delivery, as verified by the World Health Organization. Incredibly, Israel continues to block healthcare workers of Palestinian descent from working in Gaza, even American citizens. This makes a mockery of the American ideal that “all men are created equal” and degrades both our national ideals and our profession. Our work is lifesaving. Our Palestinian healthcare colleagues in Gaza are desperate for relief and protection, and they deserve both.
We are not politicians. We do not claim to have all the answers. We are simply healing professionals who cannot remain silent about what we saw in Gaza. Every day that we continue supplying weapons and munitions to Israel is another day that women are shredded by our bombs and children are murdered with our bullets.
President Biden and Vice President Harris, we urge you: end this madness now!
Sincerely,
(signed by 99 American physicians and nurses)
Note: urge the Biden-Harris administration to meet with American healthcare professionals who've seen the carnage in Gaza:
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