5 March 2024

Over 40 global health groups, joining in the Health Justice Initiative, have just issued an open letter calling on members of the health and human rights communities to act in face of the destruction of the Gaza health system and ongoing genocide. Their open letter highlights the failures of states and health professions and institutions, above all in Israel, and contains “Eight Health-Related Demands”. The original can be found here.


Israel is using health care, food and water as weapons of war.

As organisations that have worked on issues of health justice and access to medicines for millions of
people around the world, some for decades, focusing on HIV, TB, sexual and reproductive health and rights,
cancer, and COVID, TODAY we bear witness to the deliberate military attacks on the right to health in Gaza.
The purposive and systematic destruction of the health system relied upon by 2.2 million people in Gaza
and the targeting of health workers, hospitals, laboratories, health facilities, ambulances, patients, and
blockades on lifesaving medical supplies by the Israeli Defence Forces (IDF) amount to war crimes and

Countries, governments, and political leaders should be prepared to be held accountable for their complicity
in these acts, and the ethnic cleansing associated with it. Because “once the health system is destroyed,
injuries cannot be treated, primary care cannot be delivered, and famine cannot be managed – in other
words, life cannot be sustained’’.1

In over four months of attacks and bombardment, Israel has destroyed healthcare facilities and undermined
the right to health in Gaza, on such a scale and with such evident awareness of the results of its actions,
that it has clearly contravened Article II of the Genocide Convention, namely, “Causing serious bodily or
mental harm to members of the group” and “Deliberately inflicting on the group conditions of life calculated
to bring about its physical destruction in whole or in part.”

As such, we believe, in line with the case brought against Israel by South Africa, that Israel’s actions
constitute genocide. Even the International Court of Justice (ICJ) has found that genocide is plausible,
and as such, that places the strongest duty of obligation both on Israel to desist in its actions and on
other signatories to the Genocide Convention to take measures within their power to prevent genocide,
failing which, they will be regarded as complicit in war crimes. This includes, very obviously, an immediate
embargo on arms sales and military cooperation.

As health professionals and activists, we are also under a moral obligation to speak out, and to take whatever steps are in our power to halt and prevent this genocide.

We call on all those who have dedicated their lives to anti-racism, decolonisation and the realisation of the human right to healthcare to join us.
Silence is complicity.

Health workers in Gaza are working under immense stress and hardship, having to carry out amputations,
caesareans and other procedures without anaesthesia, electricity, and most basic medical supplies.

A. The Lemkin Institute for Genocide Prevention warned that in respect of the most recent onslaught on
a Gazan hospital (Nasser) that it constitutes a war crime and is further evidence of Israel’s genocidal

B. The World Health Organization (WHO) has issued statement after statement urging Israel to protect
hospitals and the civilians and patients in them, and have reported facing obstructed, delayed or denied access to critically ill patients, most recently at the Nasser Medical Complex which has been under heavy bombardment and now, even occupation.

C. The UN Special Rapporteur on Health has repeatedly warned about the “unrelenting war on healthcare’’
and that the right of everyone to the highest attainable standard of physical and mental health is being
undermined while “the practise of medicine itself is being used as a political tool’’.
UN experts too, have said that the war on Gaza’s health system is one that has resulted in the complete obliteration of healthcare infrastructure.

D. OCHA has warned of a surge in acute malnutrition among children and women.

E. UNRWA has warned that it has reached breaking point4 as a result of a campaign by Israel to close UNRWA and 16 donor countries in the West that paused funding5 – thus placing UNRWA’s ability to
deliver on its UN General Assembly Resolution 302 mandate at risk. UNRWA has repeatedly warned
about a season of death: “…more children, more journalists, more medical personnel, and more UN
staff [have been] killed than anywhere in the world during a conflict. Over 150 UNRWA premises have
been hit by bombardment or shelling, killing over 390 people, and injuring over 1300.’’

F. UNICEF has warned of increasing child deaths due to malnutrition – 90% of young children under five
in Gaza now face severe hunger.

G. The Elders have called for an immediate ceasefire in Gaza and compliance by Israel and others including the US government – with the ICJ’s provisional ruling.6 https://health4palestine.com/ Health Activists in Solidarity with Palestine 3 By no means, law, moral, health or ethical code, is this carnage acceptable. It is genocide.

Genocide, ethnic cleansing, war crimes in health care
1. The United Nations (UN) has reported and the ICJ has accepted that at least 25 700 Palestinians have
been killed (this figure has, since the ICJ hearing, risen to 30 000), at least 63 000 injured, over 360 000
housing units destroyed or rendered unliveable. 1.7 million people are internally displaced as of 24
January 2024.

2. Of those killed, 70% are women or children, and the number of children killed is now, at present estimated to be 12 400. The UN figures are likely to be under-estimates given the difficulties of identifying bodies under the rubble.

3. At least 374 health workers have been killed, including in targeted assassinations. Health care workers
have also been arrested,10 some remain missing.

4. Amongst those detained, it has been reported that Israeli forces have used torture against them.

5. New reports indicate that the projected excess deaths driven by trauma injuries and infectious diseases
in the Gaza strip, could be in the region of 75 000 deaths.

6. On 12 January 2024, the UN Under-Secretary-General for Humanitarian Affairs reported that “134 UN
Relief facilities have been hit by the Israeli army and 148 UN personnel and NGO staff killed by Israeli
attacks’’.13 By January 24, 154 UN personnel were killed.

7. The Committee to Protect Journalists (CPJ) reports that by 25 February 2024, at least 88 journalists
have been killed by Israeli forces, at least 25 have been arrested, 16 are missing and many others have
been subjected to assaults, threats, cyberattacks, censorship and killing of family members.15

8. Israel has conducted more than 400 attacks on healthcare facilities including on every single one of its
hospitals. Of 36 hospitals in Gaza, the majority have been destroyed, and while 11 remain, they are only
partially functional (as at February 13). Among others:
a. Bed capacity across all of Gaza is negligible.
b. Gaza’s sole paediatric cancer ward was destroyed by Israeli attacks.
c. At least 122 ambulances have been seriously damaged.
d. 20 facilities needed for water provision, sanitation and hygiene were put out of action.
e. More than 80% of Primary Healthcare Centres are destroyed or unable to function.16
f. Medical convoys including clearly marked Medecins Sans Frontières (MSF) vehicles and staff17 have
been attacked, injuring, and killing humanitarian workers and their families.
g. Critical shortages of fuel, medicines, water, oxygen, anaesthetic, antibiotics, blood products, and
other lifesaving medical equipment are killing patients; intensive care patients in one hospital died
after oxygen supplies ran out on February 16, in Al Nasser Hospital; and
h. Gaza’s only two medical schools at the Islamic University of Gaza, and Al Azhar, together with the
targeted assassination of health experts, has left Gaza with no training capacity for healthcare
workers in the near future and ensures that even if hospitals are rebuilt, the healthcare system will
not recover.

Hunger and famine: Food is being used as a weapon of war

1. Famine looms in Gaza, with a chronic hunger, food and clean water crisis. Humanitarian aid is being deliberately blocked. This is ethnic cleansing.

2. The entire population of 2.2 million people face crisis levels of food insecurity and in the past two weeks,
the percentage of the population facing catastrophic food insecurity has risen to over half a million

3. The looming famine in Gaza – caused by the near complete siege imposed on the territory by Israel
since the beginning of the war – is also posing a threat to pregnant women.

4. Today, already half of all pregnant women in Gaza are suffering from anaemia and at least 50,000 pregnant women are facing extreme hunger while about 183 women give birth in Gaza every day. Access to care for a safe pregnancy is now impossible. There are reports of an increased number of miscarriages, too.

5. A real, verified and documented risk of famine exists in Gaza. On 16 January 2024 UN Human Rights
Experts stated: “It is unprecedented to make an entire civilian population go hungry this completely and
quickly. Israel is destroying Gaza’s food system and using food as a weapon against the Palestinian

6. UN experts have warned that Gazans now make up 80 per cent of all people facing famine or catastrophic
hunger worldwide, marking an unparalleled humanitarian crisis in the Gaza Strip amid Israel’s continued
bombardment and siege.

7. Despite the warning of famine, in what has been described by global health activist groups as an act of
‘’depravity’’, barely 48 hours after the first ICJ ruling, several western countries decided that instead of
taking measures to give effect to the ICJ rulings, that it would rather institute a funding pause for UNRWA.
Health activist groups; the Lemkin Institute for Genocide Prevention and others, have all warned that
this creates genocidal complicity (in violating ICJ’s provisional ruling dealing with measures to enable
humanitarian assistance).

8. Targeting Gazans with mass starvation is an act of genocide that makes people further dependent on
the health infrastructure that Israel is systematically erasing, a further act of genocide.

9. The health situation in Gaza and the OPT was not perfect before the war either, as the Israeli blockade
of Gaza also extended to the provision and in turn denial of certain specialist health services including
for cancer, requiring patients to get apartheid type ‘’permits’’ to travel to and access medical treatment,
outside of Gaza, in other words, a practice of medical apartheid.

Destruction of Gaza’s health system

The entire hospital and health system in Gaza is being obliterated by Israel. This is intended.

1. By 12 January 2024, MSF confirmed the almost total lack of “options for people to find medical care. The
amount of safe space for organisations to provide healthcare to people is now virtually non-existent…’’.

2. At least 374 health workers have been killed including two of only four pathologists in Gaza.

3. “By late December, the number of health workers killed in Gaza had already exceeded the total number
of all health worker deaths recorded across all other conflicts globally last year, and in any single year
since 2016.’’
a. Dr. Hammam Alloh, a Palestinian nephrologist at Al-Shifa Hospital, refused evacuation when the
facility was captured by the Israeli military. In an October 2023 interview with Democracy Now he
said, “And if I go, who treats my patients? We are not animals. We have the right to receive proper
health care.” He died two weeks later, killed in an Israeli airstrike, along with three family members.
https://health4palestine.com/ Health Activists in Solidarity with Palestine.
b. As extensively shared at the ICJ hearing on Israel’s genocide, by MSF and on social media, Dr.
Mahmoud Abu Nujaila, a doctor working in Gaza for MSF wrote on a hospital whiteboard normally
used for planning elective surgery the words: “Whoever stays until the end will tell the story. We
did what we could. Remember us.” On 21 November 2023, he was killed by a strike on Al Awda
Hospital along with another MSF doctor, Dr. Ahmad Al Sahar.

4. The NGO Insecurity Insights reports that 212 health workers have been arrested since 7 October 2023.

5. The torture of arrested healthcare workers has also been reported.

6. The consequences of the targeting of health facilities are clear to all. Palestinians of all ages have died
from lack of care, lack of equipment or treatment options because of the blockade, inability to operate
because of damage to generators, lack of electricity to run critical equipment in ICUs and for neonatal

7. Testimonies of surviving surgeons, doctors and health workers have also unpacked what transpired
when they were forced to evacuate patients at several hospitals, including evacuating premature babies,
as well as critically ill patients. In at least one instance, babies in ICU also died because they could not
be safely evacuated – video footage shows their decomposing bodies (Al Nasr Hospital).

8. Doctors volunteering in Gaza have also recounted what they saw in Gaza, including ‘’on one occasion,
a handful of children, all about ages 5 to 8, were carried to the emergency room by their parents. All
had single sniper shots to the head. These families were returning to their homes in Khan Yunis, about
2.5 miles away from the hospital, after Israeli tanks had withdrawn. But the snipers apparently stayed
behind. None of these children survived.”

9. Surgeons in Gaza have reported conducting caesarean sections and amputating children’s limbs without
anaesthetic, electricity, and essential medical supplies; having to use vinegar to dress wounds in the
absence of antiseptics; carrying out surgery, without anaesthesia on a kitchen table because there is
nowhere else to do so.

10. The Palestinian Medical Relief agency has also reported an outbreak of Hepatitis A in the Gaza Strip
due to poor sanitary conditions and lack of clean water.

11. Infectious diseases are soaring, but clinicians are being denied access to the tools to diagnose, prevent
and treat these conditions for a population coping with profoundly weakened immune systems due to
anaemia, dehydration, and malnutrition.

12. In November 2023, about 100 Israeli doctors publicly called for the ‘bombing of hospitals’ in Gaza by
the IDF, as a strategy to destroy ‘terrorists’. To date, no action has been taken against these doctors
for statements that are of genocidal intent by either the Israeli Medical Association or the Israeli

13. Worryingly, and most shamefully, it will not be long before the genocidal call of retired Israeli General
Giora Eiland is realised. Eiland, openly supported by far-right Finance Minister Bezalel Smotrich, has
said that Israel should permit the outbreak of severe epidemics amongst Palestinians in southern Gaza
as it will bring Israel ‘closer to victory.’
Israel is deliberately creating conditions under which preventable sickness and death will accelerate even further, particularly among the most vulnerable: people with disabilities, the elderly, the young, and pregnant women, in furtherance of its genocide.

Double standards and disregard by the global health community

1. Hardly any discussion has graced the pages of the 17 global health journals that currently fill the public

2. Of the 12 articles since October 2023 that were generated by a PubMed search on “Global Health”
AND “Gaza” AND “health”, only two global health journals (Lancet and BMJ) featured any contemporary
discussion about the ethical, human rights or professional challenges that arose.

3. Why have our universities, medical schools, professional associations and academic bodies remained
silent? Save for isolated public statements, the public response from those whom we expect to maintain
the highest medical and scientific professional and ethical standards around the world, has been missing
in action.

4. While the American Medical Association (AMA), issued, in 2022, a very strong condemnation of
the Russian invasion of Ukraine, an effort to do the same for Gaza in 2023 was shut down – while
mounting evidence exists of the obliteration of the health force and health system in Gaza. We believe
this demonstrates a level of unacceptable double standards which can only be explained by racist
dehumanisation of the Palestinian people.

5. A climate of virulent censorship, especially in the global north (countries that supposedly value free
speech), has also led to open victimisation of health workers and academics for speaking out in defence
of the rights of Palestinians and against racism.

Complicity of the pharmaceutical industry

1. Israeli pharmaceutical company, Teva – is one of the world’s biggest generic drug firms, and benefits
from apartheid occupation.

2. Teva is one of the most lucrative companies in Israel and its proceeds are reported to enrich Israel’s
military machine.

Israel is a colonial settler occupier, now committing genocide and crimes against humanity. As an occupier, it is in clear violation of international law.


1. Without delay, health workers, health activists and advocacy and patient groups should call out Israel’s war crimes and unequivocally condemn the genocide that is underway in Gaza, including exposing and condemning Israel’s long standing medical apartheid in the OPT.

2. All professional health associations must end their perceived complicity in a genocide and condemn the weaponisation of health care.

a. Here, we specifically call on the World Medical Association (WMA); American Medical Association; and respective British, German, Australian, French and Canadian medical associations, to unequivocally and without delay, publicly condemn the targeting of health workers and health infrastructure by Israel. They and other professional bodies (where
applicable) should also rescind any harrassment actions against members speaking out against the genocide in Gaza as part of their professional obligations to defend the right to health and to protect freedom of speech.

b. We call on the World Medical Association (WMA) to suspend the Israeli Medical Association (IMA) until such time as (i) the IMA condemns the destruction of the Gazan health system and the targeting of Gazan health professionals and (ii) takes appropriate disciplinary action against doctors who called for the bombing of hospitals in Gaza. In the same way that apartheid South Africa’s participation and membership of the WMA was actively opposed during apartheid, it is time for Israel’s suspension from the WMA – because the Israeli state has committed war crimes, using health care as a weapon of war.

c. At the very least, professional medical associations that have remained silent, should publicly share why it has chosen to do so, in the face of war crimes that have harmed the principle of health neutrality.

3. All health activist groups and HIV patient groups, must target the company TEVA for boycott, divestment and sanctions. Specifically, we call on all PrEP users to switch from TEVA generic PrEP to other generic manufacturers.

4. All health activist groups, and HIV patient groups must demand that the organisers of the 25th AIDS conference in Munich, Germany in July this year devote a plenary to Gaza, including a moment of silence for the health workers killed in Gaza during the opening ceremony.

a. If the IAS permits speeches, exhibitions or pavilion stalls from/of genocidal governments/state officials as well as from/of pharmaceutical and health companies supporting genocide, we call on all activists and researchers attending the AIDS conference to engage in civil disobedience.

5. The World Health Assembly (WHA) to be held in May 2024, must, in addition to its annual report on health care access in the OPT, devote a dedicated session to the current health crisis in Gaza, and the war crimes that have resulted in its “obliteration’’.

6. Scientists, researchers, clinicians and patient advocacy groups must actively pause health research, scientific and data collaboration and research projects with Israeli health institutions, universities, research councils, pharmaceutical companies and any organisations affiliated with the Israeli Defence Forces (IDF) in any form – it is time to reject such partnerships and funding.

7. Health workers, health activists, advocacy and patient groups must support colleagues who are being censored and targeted for speaking up about anti-Palestinian racism in medical institutions, universities and professional bodies across the globe.

8. Health workers including unions, and health activist groups must call for and pressure all governments to immediately resume and increase funding for the critical work of UNRWA, and other agencies/groups – to scale up humanitarian, health care, food and water assistance.

Given the January 2024 findings of the ICJ [of ‘’plausible genocide’’] health workers and health activist groups should now fully lend their support to the global call for a sports, arts, cultural and academic boycott of Israel. To prevent more death and suffering, we ALSO call on all health professionals, health
workers, health unions and health activist groups to continue to call for, among others:

A.An immediate and sustained ceasefire;

B.The protection of all civilians and respect for international law;

C.The immediate scaling up of humanitarian aid and assistance in Gaza;

D.Appropriate action from all health professional bodies (and governments) to not just condemn, but actively prevent further war crimes in Gaza or face being complicit in a genocide; and

E. An immediate arms embargo, as well as trade and other sanctions against Israel.

It is time to ACT UP, SPEAK UP, STAND UP.

Issued by:

1. Health Justice Initiative (HJI) -South Africa
2. Just Treatment -UK
3. Health GAP -USA
4. Initiative for Medicines, Access & Knowledge (I-MAK) -USA
5. Access to Medicines -Ireland
6. Global Justice Now (GJN) -UK
7. Jewish Voice for Peace Health Advisory Council -Global
8. World Social Forum on Health and Social Security -Global
9. Health Workers 4 Palestine -Global
10. Equalhealth Campaign Against Racism -Global
11. People’s Health Movement -Global
12. HealthCareWorkers4Palestine SA -South Africa
13. Healthcare Workers for Palestine NYC -USA
14. Healthcare Workers for Palestine North of Ireland
15. Brazilian Interdisciplinary AIDS Association (ABIA) -Brazil
16. Southern African HIV Clinicians Society (SAHCS) -South Africa
17. Legal Resources Centre (LRC) -South Africa
18. British Arab Nursing and Midwifery Association (BANMA) -UK
19. Harm Reduction International -Global
20. Policies for Equitable Access to Health (PEAH) -Italy
21. Socio-Economic Rights Institute (SERI) -South Africa
22. Public Service Accountability Monitor (PSAM) -South Africa
23. Development Alternatives with Women for a New Era (DAWN) -Global South
24. Palestine Solidarity Campaign SA (PSC) -South Africa
25. #UniteBehind -South Africa
26. Debt for Climate SA -South Africa
27. Treatment Action Campaign (TAC) -South Africa
28. Equal Education (EE) -South Africa
29. Corporate Accountability -USA
30. Ndifuna Ukwazi -South Africa
31. Rural Health Advocacy Project -South Africa
32. TB Accountability Consortium -South Africa
33. Release UK -UK
34. People’s Health Movement -South Africa
35. PreHospital Aid -UK
36. Muslim Youth Movement SA -South Africa
37. USA Palestine Mental Health Network -USA
38. Third World Network (TWN) -Global
39. Southern Africa Litigation Centre (SALC) -Southern Africa
40. Women’s Legal Centre -South Africa
41. Section 27 -South Africa
42. African Alliance -Africa
43. Blouses Blanches Gaza (Health Care Workers Collective) -France
44. EveryDoctor -UK