HEALTHCARE WORKERS AS HUMAN RIGHTS DEFENDERS: A MEDICAL PERSPECTIVE ON ISRAEL'S GENOCIDE ENABLEMENT APPARATUS IN GAZA AND ABROAD
The Full Report Now Published at the United Nations
As I was suspended and attacked by UCSF in the Fall of 2024, I shared with British Palestinian surgeon Dr. Ghassan Abu Sittah what was happening to my career. He was in Beirut at the time, working in the hospitals as Israel bombed Lebanese healthcare infrastructure, killed healthcare workers and attacked civilians and children with the exploding pagers. We understood early on that the silencing of healthcare workers in the West was a key part of Israel’s genocide of Palestinians. We worked with an international team of over a dozen healthcare workers and human rights advocates to produce this report submission to the Special Rapporteur for the Right to Health. Our report has been published on the UN website and I share it here for broad disemination. It documents the impact of Israel’s targeting of healthcare workers in Gaza and abroad as two prongs to their genocide. I am sharing it in its entirety here. I give thanks to all who contributed to this report, with special affection for Dr. Shourideh C. Molavi who poured countless hours of her valuable expertise into this report. May it serve to bring justice to all who have lost their lives to this terrible violence and may it shine a light for a future in medicine where all have the right to health. May it work for the release of all of our colleagues held in Israeli prisons and torture centers. For writers, please write about it. For teachers, please teach about it. For lawyers, please use it to build a world of health justice. The citations for this report can be found here.
Report
HEALTHCARE WORKERS AS HUMAN RIGHTS DEFENDERS:
A MEDICAL PERSPECTIVE ON ISRAEL'S GENOCIDE
ENABLEMENT APPARATUS IN GAZA AND ABROAD
October 2023 – December 2024
Submitted 10 January 2025 as part of the Call for Input to support a forthcoming report of the United Nations Special Rapporteur on the Right to Health
Dedicated to our beloved colleagues, the healthcare workers in Palestine
Contents
Executive Summary
Scope
Definitions
Brief Context on Israel’s Targeting of the Palestinian Medical Sector in Gaza
Brief Context on the Israeli Restrictions Imposed on Healthcare Workers Entering Gaza
Outline of Findings
6.1 Defining the Framework: Israel’s Genocide Enablement Apparatus
6.2 Israel’s Genocide Enablement Apparatus as it Functions in Gaza
6.2.1 Destruction of the Palestinian health sector since October 2023
6.2.2 Targeting Palestinian medical and healthcare workers
6.2.3 Effects of displacement on the Palestinian health sector
6.2.4 Trauma and psychological strain of Palestinian healthcare workers
6.2.5 The deleterious effects of Israel's seizure of the Rafah crossing
6.2.6 Israeli restrictions on the entry of healthcare workers, international
organizations, and medical supplies into Gaza
6.3. Israel’s Genocide Enablement Apparatus as it Functions in Western Medical Institutions
6.4 Medical Definition of Genocide
6.4.1 Genocide as a societal disease
6.4.2 Parameters of a medical definition
6.4.3 Healthcare workers as actors in the early prevention of genocide
About the Contributors
1. Executive Summary
This report, submitted to the UN Special Rapporteur on the Right to Health on 10 January 2025, outlines a two-pronged framework of Israel’s Genocide Enablement Apparatus, which has accelerated the annihilation of Palestinian people since October 2023 through the Israeli-led destruction of the healthcare sector in Gaza, and the simultaneous repression of healthcare workers implemented by American, British and Canadian (hereafter ‘Western’) medical and cultural institutions. Additionally, this report establishes a medical definition of genocide, as defined by Docgtors Against genocide and built from lessons from the ongoing genocide in Gaza, to enable and support the role of healthcare workers both as key frontline protectors of the right to health and life, and as meaningful actors in the early prevention of genocide.
The report highlights the urgent need for a medical definition of genocide to enable timely interventions by healthcare workers, particularly those who witness the systematic destruction of human lives in real time. Current legal frameworks, often slowed by political considerations and the prolonged process of establishing intent, delay critical action. A medical framework, rooted in observable impacts on health and life, empowers healthcare workers to act swiftly, preventing escalation and saving lives. Without a medical definition, healthcare workers are left without the tools to act decisively in the face of unfolding atrocities, hindering efforts to prevent further death and destruction.
Scope and Objectives
The report responds to the Special Rapporteur’s call to assess the rights of healthcare workers in conflict zones and their role in safeguarding the right to health and human rights. Specifically it:
Outlines a two-pronged framework of Israel’s Genocide Enablement Apparatus, which involves the Israeli-led systematic targeting of the Palestinian healthcare sector in Gaza and the suppression of healthcare workers by their Western medical and cultural institutions for advocating against these actions.
Describes the Apparatus as it functions in Gaza, including Israel’s destruction of the Palestinian health sector as central to its genocidal military violence in Gaza, and Israel’s restrictions on the entry of healthcare workers, international organizations, and medical supplies into Gaza;
Explores the apparatus as it functions in Western institutions, documenting the silencing, intimidation, and reprisals against healthcare workers advocating for Palestinian rights; and
Proposes a medical definition of genocide, built from the lessons of the ongoing genocide in Gaza, recognizing it as a societal disease and severe public health threat, to support healthcare workers as key actors in prevention and intervention.
Summary of Findings
Drawing upon hundreds of documented testimonials and the lived experiences of Palestinian and international healthcare workers and advocates who have lived and worked in Gaza or who have advocated for the rights of Palestinians in other countries, along with the evidence materials and documentation collected during their time in Gaza, this report makes five unique contributions:
Israel’s Genocide Enablement Apparatus:
The deliberate targeting of Palestinian healthcare infrastructure and personnel in Gaza since October 2023 has accelerated the annihilation of the Palestinian people.
Simultaneously, Western medical and cultural institutions have engaged in the widespread repression of healthcare workers advocating for Palestinian rights, suppressing a critical professional class that has a particular moral obligation to uphold life.
Cumulative Impact on Gaza’s Healthcare System:
The destruction of medical facilities, coupled with the closure of the Rafah crossing, has severely restricted medical supplies and humanitarian aid, exacerbating the health crisis.
Mass displacement, unsanitary conditions, and the collapse of healthcare infrastructure have led to widespread preventable morbidity and mortality.
Reprisals and Repression in Western Institutions:
Healthcare workers who document or speak out against Israel’s actions face employment termination, harassment, censorship, and professional blacklisting, disproportionately affecting marginalized groups.
This suppression normalizes the targeting of healthcare workers and facilities, setting a dangerous global precedent.
Medical Definition of Genocide:
Genocide is defined as a societal disease with identifiable symptoms, including mass killings, the systemic deprivation of essential resources, and the destruction of healthcare systems.
A medical definition is shaped by a public health perspective, emphasizing prevention and early detection, allowing for rapid response and reducing reliance on proving intent.
Healthcare Workers as Human Rights Defenders
Healthcare workers in Gaza and globally bear witness to atrocities, providing vital care and documenting war crimes. Their role as first responders to genocide underscores the need for a framework that empowers and protects them when giving testimony to war crimes at the local, national, regional, and international levels.
Recommendations
International adoption of a medical definition of genocide to prioritize prevention, risk reduction, and accountability.
Establishment of an independent international medical body with the authority to
Monitor and identify early signs of genocide using medical data;
Mobilize international resources for intervention and protection; and
Hold perpetrators accountable for targeting healthcare systems and workers.
Amending existing International Humanitarian Law to define the repression of healthcare workers speaking out against acts of genocide as a form of genocide incitement and abetment, in violation of the Genocide Convention (1948) and complicity in genocide, prohibited in Article 3(e).
Conclusion
The report underscores the urgent need to protect healthcare systems and workers during conflict and amid genocidal violence. By adopting the frameworks outlined in this report, and establishing an independent international medical body with executive powers, the global medical community can transform its response to atrocities against humanity. To prevent ongoing and possible future renditions of the types of genocidal violence that have been perpetrated against and continue to be unleashed upon Palestinians in Gaza the approach proposed in this report ensures that mass violence and systemic racialized oppression are addressed with the urgency, precision, and authority they demand—safeguarding human life and dignity above all else.
2. Scope
Within the framework of Human Rights Council Resolution 51/21, the Special Rapporteur on the Right to Health has identified health and care workers as a strategic priority, and intends in her forthcoming report “to explore the situation of health and care workers and their ability to enjoy and support the realization of the right to health and related human rights.”
Responding to the Special Rapporteur’s call for input issued in December 2024, a collective of healthcare and human rights workers (see section 7. About the Contributors) who have worked inside the occupied Gaza Strip (hereafter ‘Gaza’), and who have advocated outside Gaza for the prevention and end to genocide since October 2023, have produced this Report to:
Outline a two-pronged framework of Israel’s Genocide Enablement Apparatus, which has accelerated the annihilation of Palestinian people since October 2023 through: the Israeli-led destruction of the healthcare sector in Gaza, including the killing, detention and torture of Palestinian healthcare workers in the territory; and the simultaneous repression of healthcare workers implemented by American, British and Canadian (hereafter ‘Western’) medical and cultural institutions. In the case of the latter, all of the mentioned workers have suffered reprisals from Western institutions in their advocacy for the protection of Palestinian civilians and healthcare workers as an extension of their professional, legal, and moral obligation to prevent genocide, and many also have served as healthcare volunteers in Gaza;
Describe Israel’s Genocide Enablement Apparatus as it functions in Gaza: including Israel’s destruction of the Palestinian health sector as central to its genocidal military violence in Gaza and Israel’s restrictions on the entry of healthcare workers, international organizations, and medical supplies into Gaza;
Describe Israel’s Genocide Enablement Apparatus as it functions in Western medical institutions, including: the targeting and silencing of international healthcare workers who have returned from working in Gaza since October 2023, and the targeting and silencing of healthcare workers advocating to stop the genocide at medical institutions in the West; and
Establish a medical definition of genocide, built from lessons from the ongoing genocide in Gaza, to enable and support the role of healthcare workers both as key frontline protectors of the right to health and life, and as meaningful actors in the early prevention of genocide.
The report outlines a framework of Israel’s Genocide Enablement Apparatus to demonstrate the interconnectivity between the violent targeting of healthcare workers and healthcare systems in Palestine and the repression of healthcare workers in Western medical institutions, which together function to facilitate Israel’s ongoing genocide in Gaza. This framework was first articulated by Dr. Ghassan Abu Sittah who has provided multiple testimonies informed by his experience working as an experienced plastic surgeon in Gaza’s hospitals during the period October - November 2023.
This report is not exhaustive and includes a sample of cases of healthcare workers in American, British, and Canadian medical and cultural institutions to point to a broader pattern of repression—also replicated in other parts of the world—that has further enabled Israel’s genocide in Gaza.
The authors of this report write in various capacities: some as seasoned healthcare workers with direct experience in providing care in Gaza in various capacities since at least October 2023; some as human rights advocates who have witnessed and documented the catastrophic impact of the targeting of healthcare infrastructure and workers on Palestinian life; and others in their capacity as healthcare workers and advocates with experience being targeted by American, British, and Canadian medical institutions and governments for voicing their objection to Israel’s genocidal military actions in Gaza.
All of the contributors to this report advocate for the protection of civilians, healthcare workers and all protected groups as an extension of their professional, legal, and moral obligations to prevent genocide.
We write with extreme urgency, sounding alarm at the rising global normalization of the deliberate targeting of hospitals and medical facilities, and a broader pattern of assaults aimed at crippling medical infrastructure and personnel. This has resulted in the dehumanisation of Palestinians, Palestinian patients and Palestinian medical workers, painting Palestinians as undeserving of dignity or protection.
Global inaction over the past 15 years as healthcare systems were attacked in Syria, Yemen, Ukraine, and elsewhere have reached a crescendo in Gaza and the West Bank—deepening a pattern wherein patients, medical workers and hospitals are seemingly ‘legitimate’ and ‘acceptable’ targets in the conduct of war and armed conflict. Throughout occupied Palestine there is a clear and ongoing pattern of deliberate targeting, despite multiple first-hand accounts from Palestinian healthcare workers, non-governmental organisations, and UN agencies demonstrating that the current arguments used by the State of Israel to justify its attacks on Gaza’s healthcare system and healthcare workers are unsupported and without evidence. Relatedly, to date, no international healthcare worker has ever reported seeing any Palestinian military activity at any Palestinian hospital or other healthcare facility.
While Palestinians in Gaza are enduring the unimaginable, Israel’s yet unpunished and illegitimate attacks on medical personnel and facilities in Gaza has placed healthcare workers around the world who work in situations of conflict or other crises, including genocide, climate-related catastrophes, environmental disasters, pandemics, situations of civil unrest, and mass protests, at even greater risk.
Together, we submit this report to advance our collective understanding and to apply further pressure to stop Israel’s genocidal military violence in Gaza and its attacks on our profession, to hold all state and governmental entities accountable, and to prevent future atrocities of this nature.
3. Definitions
Healthcare workers: People who provide healthcare services (such as the diagnosis, treatment, and management of diseases and illnesses) to those who are seeking healthcare services in both clinical (such as the direct provision of care within a hospital, health, or primary care clinic) and non-clinical settings (such as the indirect work involved in the provision of care, such as those working in medical laboratories and medical imaging).
Human rights workers: People who provide logistical and organizational support to facilitate the provision of healthcare services as well as access to other life-improving amenities, such as housing, food, water, or sanitation. In the context of war and genocide, healthcare workers also take on the role of human rights defenders, by providing vital care and logistical support and bearing witness to war crimes at the local, national, regional, and international levels.
Medical infrastructure: The logistical systems and processes and material objects necessary to allow for a proper standard of healthcare services to be provided by healthcare workers, such as the equipment and resources to diagnose, treat, and manage diseases and illnesses typically housed in both clinical (such as the clinical exam room or surgical operating room in a hospital) and non-clinical environments (such as the janitorial rooms, fuel and generator rooms, or solar panels required to keep a healthcare facility operational).
Medical supplies: The materials and resources used by healthcare workers to provide a proper standard of healthcare services to people who are seeking care, such that they can effectively diagnose, treat, and manage diseases and illnesses, inclusive of medications and equipment. This also includes the logistical preparation and delivery of such services from outside of the region that requires services, including regional transport and storage, and ultimately their safe and timely delivery.
Civilian status: Status conferred on any individual who is not a member of an armed group or armed forces and does not actively participate in hostilities. Relatedly, attacks on civilians in this report involve any act of violence against the civilian population, their objects and infrastructure, regardless of whether the attack results in the death or injury of civilians.
Israel’s genocidal military violence: Referring to the nature, intent, and character of the Israeli military onslaught that accelerated in Gaza following 7 October 2023. To date, multiple international expert bodies and authorities have used the terms ‘genocide’ or ‘genocidal acts’ to describe this military violence, including the UN Special Committee on Israeli Practices, the International Federation for Human Rights, and the UN Special Rapporteur on the Occupied Territories, Francesca Albanese. On 5 December 2024, Amnesty International released a report based on a nine-month investigation, which included examination of visual and spatial evidence, interviews with healthcare leaders, and testimony from Palestinians in Gaza, which concluded that "Israel committed and is committing genocide against Palestinians in Gaza." It further stated that Israel's military actions in Gaza include three out of five acts prohibited under the 1948 UN Genocide Convention, namely: "killing", "causing serious bodily or mental harm", and "inflicting … conditions of life calculated to bring about … physical destruction of a national, ethnic, racial or religious group". On 19 December 2024, Human Rights Watch noted that "Israeli authorities have deliberately inflicted conditions of life calculated to bring about the destruction of part of the population in Gaza by intentionally depriving Palestinian civilians there of adequate access to water, most likely resulting in thousands of deaths. In doing so, [they] are responsible for the crime against humanity of extermination and for acts of genocide." There are multiple other reports and studies by civil society groups, forensic research organizations, and genocide experts that have reached the same conclusion—some as early as 13 October 2023, within a week of the launch of current Israel's military violence—including first-hand testimonies from Palestinian and international doctors who worked in Gaza.
Medical definition of genocide: According to the Convention on the Prevention and Punishment of the Crime of Genocide in 1948, the crime of genocide under international law refers to deliberate and intentional acts committed, in whole or in part, against a national, ethnical, racial or religious group. These acts include, among others, killing members of the group, causing serious bodily or mental harm to members of the group, deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part, and imposing measures intended to prevent births within the group.
Unlike the established legal framework, a medical definition of genocide moves beyond an emphasis on ‘intent’ in the determination of acts of genocide. From a medical and public health perspective, genocide is recognized as a societal disease and a severe public health threat, characterized by widespread physical and psychological harm. This includes mass killings, torture, the deprivation of essential resources (such as food, water, sanitation, or healthcare), forced sterilizations, and severe mental trauma inflicted on survivors and communities.
As a societal disease, genocidal acts propagate long-term health crises, and include generational trauma, mental health disorders, displacement-related diseases, physical disablement, and the collapse of healthcare systems. Genocidal acts also create fertile conditions for the spread of infectious diseases, malnutrition, and the decompensation of chronic conditions among targeted populations. Recognizing genocide as a disease underscores the urgent need for multidisciplinary preventive strategies, integrating healthcare, the enactment of existing policies and legal frameworks, and education to halt its progression and mitigate its devastating public health and wider societal impacts. Like an epidemic, genocide thrives in environments of oppression, systemic neglect, inequality, racism, and hatred. The prevention of genocide thus requires the development of approaches by which healthcare workers can identify genocide in its earliest stages and alert the international community based on agreed-upon criteria (see section 6.4 Medical Definition of Genocide).
4. Brief Context on Israel’s Targeting of the Palestinian Medical Sector in Gaza
Located along the eastern Mediterranean Sea, Gaza shares a border with Egypt and an armistice line with Israel. More than 2.1 million Palestinians, over half of whom are children, live in Gaza making it one of the most densely populated areas in the world. Approximately 70% of the population are also refugees—either survivors of the 1948 Nakba (‘catastrophe’ in Arabic, referring to the violent expulsion of more than 750,000 people from Palestine in 1947-1949, which culminated in the establishment of the State of Israel) or their direct descendants. These refugees were expelled to Gaza by Zionist paramilitary organisations and later the newly formed Israeli military from over 240 Palestinian towns, communities and farming villages throughout the country.
For over 30 years, and as a result of the Madrid and Oslo negotiation processes, Gaza has been slowly isolated from the rest of what are now the occupied Palestinian territories of the West Bank and East Jerusalem, and the outside world, and subjected to repeated Israeli military violence. The purpose of such violence was, in the conclusion of the 2009 UN Fact-Finding Mission, “to punish, humiliate and terrorize a civilian population, radically diminish its local economic capacity both to work and to provide for itself, and to force upon it an ever increasing sense of dependency and vulnerability.” The military blockade of Gaza was significantly intensified in 2007 by Israel with complete restrictions imposed on the movement of goods (including vital medication and medical equipment) and people in and out of Gaza to Israel—a closure that was replicated in the same year by Egypt on Gaza’s southern border.
The genocidal effects of the Israeli occupation and blockade on Palestinian life in Gaza have been repeatedly flagged by the United Nations for over a decade, long predating the period since October 2023. In August 2012, the United Nations Country Team in the occupied Palestinian territory initiated a study to model living conditions in Gaza by the year 2020. The study concluded that for Gaza to be “liveable” in 2020, “herculean efforts” needed to be undertaken in sectors such as health, education, energy, water and sanitation. By September 2015, the United Nations Conference on Trade and Development confirmed this catastrophic prediction for the future of Gaza, stating that “if the current blockade and insufficient levels of donor support persist” the likely result “will be more conflict, mass poverty, high unemployment, shortages of electricity and drinking water, inadequate health care and a collapsing infrastructure…. [i]n short, Gaza will be unliveable.”
In October 2018, the Special Rapporteur on the Situation of Human Rights in the Palestinian Territories Occupied Since 1967 noted that with “70 percent youth unemployment, widely contaminated drinking water and a collapsed health care system,” “the state of unliveability is upon us” already.
Key to the engineered ‘unliveability’ of Gaza for Palestinians has been the repeated targeting of its medical and health sector. In 2012 the World Health Organization (WHO) reported “more than 40% of the essential drug items in the essential drug list and more than 50% of medical consumables were out of stock” in Gaza at the time. This disastrous situation continued to deteriorate with steady shortages of drugs including life-saving antibiotics, anti-infectives, and essential treatments for cancer, cardiovascular disease, psychotherapeutics, and products for hemodialysis. A lack of consistent access to medical products and services, and resulting interruptions in treatment, placed vulnerable groups such as young children, pregnant women, the elderly, and people with cancer, diabetes, and chronic kidney disease at particular risk, with heightened short and long-term implications for entirely preventable morbidity and mortality.
The Israeli military began its direct attacks on Gaza’s healthcare sector and infrastructure during Operation Cast Lead in 2008-2009. Coupled with damage to medical equipment and infrastructure, with each recurring Israeli military onslaught—notably in 2008-2009, 2012, 2014, 2021, and other military operations and attacks—the manufactured shortage of replacement parts continued to pose a significant problem, resulting in diminished access to functional essential medical equipment.
A brief overview of the last five major Israeli military onslaughts in Gaza is revealing of the systematic targeting of Palestinian healthcare workers and medical infrastructure. A study published in April 2024, framed Israel’s widespread destruction of medical infrastructure in Gaza as ‘medical lawfare’—defined as “a specific political manifestation of lawfare in which legal accusations are made in the context of healthcare, normally by suggesting that combatants intentionally hide in hospitals, clinics, and ambulances, or among medical staff,” with Israel’s practice of medical lawfare used to accuse its enemy of using the healthcare facilities and staff that it subsequently targets as ‘medical shields’.
The study outlines that:
In December 2008-January 2009: 58 hospitals and clinics and 29 ambulances were destroyed, while 16 medical workers were killed and 25 injured.
In November 2012: 16 hospitals and clinics and 6 ambulances were damaged or destroyed, while 3 medical workers were injured.
In July-August 2014: 73 hospitals and clinics and 45 ambulances were damaged or destroyed, with 23 medical workers killed and 76 injured. The authors further explain that in its devastating 2014 military attack “the Israeli military also used ‘double-tap’ and ‘multiple consecutive strikes’ on a single location, which led to an increase in civilian casualties as well as the killing and injury of first responders.”
In March 2018-May 2019: During the weekly civilian-led Great March of Return protests along the eastern perimeter of Gaza, at least 3 medical workers were killed—including 21-year old paramedic Rouzan al-Najjar— and 845 injured.
In May 2021: 33 healthcare centres were destroyed or damaged, including Gaza’s main COVID-19 laboratory, with at least 2 medical workers killed. Notably, during this attack major road infrastructure leading to key hospitals, including Al-Shifa Hospital in Gaza City–were targeted, impeding civilian access to medical care.
However, since 7 October 2023, Israeli attacks on medical infrastructure and healthcare workers in Gaza have reached unprecedented levels, surpassing the total number of such attacks elsewhere in the world (see section 6.2.1 Destruction of the Palestinian health sector since October 2023).
5. Brief Context on the Israeli Restrictions Imposed on Healthcare Workers Entering Gaza
In October 2023, the Palestinian Ministry of Health in Gaza requested support from the WHO for international humanitarian healthcare support through Emergency Medical Teams (EMTs). The purpose of EMTs is to provide healthcare services in rapid response to support the existing capacity of the local healthcare system often in the immediate aftermath of a disaster, outbreak, or other emergency situation.
Non-governmental organizations that previously worked and operated in Gaza prior to October 2023 along with those that had not, sent applications for delegations to the WHO for initial approval. Further approval of the delegation was necessary from the Ministry of Health of Gaza, the Israeli Coordinator of Government Activities in the Territories (COGAT), and Egypt, as the delegations were entering through the Rafah crossing in southern Gaza that borders with Egypt.
Healthcare workers who were entering Gaza by this route—effectively the only route available for civilians and humanitarian and healthcare workers—were limited by what they could physically carry and bring in on their person. This became the only reliable means to ensure the timely entry of medications and medical supplies that were a priority for healthcare workers during each delegation’s visit, as international aid trucks with varied resources and supplies were not reliably entering Gaza through the Rafah border crossing in a way that came close to meeting the needs of the besieged population in Gaza. As a result, healthcare workers brought multiple suitcases full of essential medications and medical supplies to ensure their time would be spent usefully in a clinic or hospital. However, this was far from a meaningful solution to the increased capacity demands of the decimated healthcare system in Gaza, and only provided piecemeal surge capacity, support, and a short respite for the Palestinian health workforce.
Despite widespread condemnation from civil society and the international community, the Israeli army invaded Rafah in southern Gaza on 7 May 2024, seizing, occupying, and later destroying the Rafah border crossing with Egypt. The entry and exit of EMT delegations briefly ceased for two weeks and later restarted via Amman, Jordan, whereby delegations entered through the Karem Abu Salem crossing in southern Gaza, which borders Israel. With full Israeli control of the only open border crossings, the restrictions were further tightened on humanitarian and healthcare workers entering Gaza as part of an EMT delegation, or as part of the wider humanitarian response.
Healthcare workers arrived in Amman on a tourist visa and travelled to the border with the occupied West Bank where they underwent Jordanian and Israeli security inspections, and officially entered Israel on a tourist visa in order to travel onwards to Gaza. With full Israeli control over their entry to and exit from Gaza, EMTs are restricted to one backpack-sized bag and one suitcase (23 kg limit), comprising only personal items, including at most two cell phones and one laptop. This means that any medicines must be for personal use, sometimes with the requirement of prescriptions in the name of the healthcare worker carrying them. Small equipment such as suturing supplies are permitted, but anything required for performing more complex healthcare-related tasks or surgery, requires permission from Israel/COGAT in advance—a cumbersome and usually unsuccessful administrative process. Meanwhile, portable devices that healthcare workers would use in low resource settings, such as handheld ultrasound devices, have been regularly confiscated and never released by Israeli border police. For a one month rotation, healthcare workers can carry a maximum of 3 kg of food, while liquids must be sized under 100ml using the security rules for carry-on baggage for civilian airplane flights. Importantly, a core principle of EMTs deployed under WHO guidelines is self-sufficiency: ensuring they do not place additional strain on already fragile national systems. However, by restricting access to essential medical supplies and food, Israel has severely undermined this principle, rendering the EMT response in Gaza woefully inadequate to meet the overwhelming demands of widespread injuries and casualties inflicted by the Israeli occupation forces. As it stands, briefings prior to entering Gaza now warn deploying teams of healthcare workers that they cannot be guaranteed that they will eat an adequate amount of food or have access to potable water during their service.
An added stipulation since May 2024 that has been enforced by Israel—consistent with its apartheid political and legal structure—is that healthcare workers cannot have Palestinian lineage or heritage. Someone who is Palestinian is defined by Israel as anyone who has a first or second degree relative who is Palestinian (for example, a parent or grandparent).
Since the shift to the Karem Abu Salem crossing, the rate of entry denials for individuals and entire humanitarian teams at the border after initial clearance skyrocketed in comparison to the Rafah crossing. Several EMTs report being turned away without explanation and some are detained—with at least one case of a doctor held in detention and interrogated for over two weeks by Israeli security services once arriving at the border, despite being previously cleared by COGAT and the WHO for entry. Others report being denied entry into Israel to cross into Gaza all together, and have been told that rejection was motivated by unidentified ‘security concerns’ by the Israeli security services (see section 6.2.6 Israeli restrictions on the entry of healthcare workers, international organizations, and medical supplies into Gaza).
6. Outline of Findings
Drawing from hundreds of documented testimonials, the lived experience of Palestinian and international healthcare workers and advocates who have lived and worked in Gaza, and the evidence materials and documentation collected during their time in Gaza, this report presents the following findings:
6.1 Defining the Framework: Israel’s Genocide Enablement Apparatus
Central to Israel’s genocidal military campaign in Gaza since October 2023 has been the well-documented systematic targeting of Palestinian healthcare infrastructure and healthcare workers. Simultaneously, American, British and Canadian medical and cultural institutions have also engaged in widespread repression, intimidation, silencing and censorship of healthcare workers and advocates who speak out against Israel’s attacks on Palestinian healthcare systems and workers.
This two-pronged framework of Israel’s Genocide Enablement Apparatus interlaces the targeting of healthcare workers and healthcare systems in Palestine with that of international healthcare workers in Western medical institutions, thereby facilitating the genocide in Gaza.
As a result, the suppression of healthcare workers in Western medical and cultural institutions who bear witness and accurately identify, meaningfully document, and effectively report on specific Israeli war crimes observed in Gaza has produced the following interrelated damaging results:
The obstruction and hindrance of international and professional condemnation and prevention of Israel’s assault on the Palestinian medical sector in Gaza;
The reprisal and punishment of healthcare workers in Western medical institutions for bearing witness to war crimes through the loss of employment, suspension, slanderous attacks, damaging of their reputation, harassment, intimidation, censorship, and in some cases, loss of livelihoods—with particularly damaging effects with limited recovery options for Black, Indigenous, minority and racialized healthcare workers;
The prevention of healthcare workers in Western medical institutions who returned from serving in Gaza from fulfilling their professional, legal and moral obligation to prevent genocide—thereby violating their ability to defend the right to health both in their daily work and in situations of conflict and genocide; and
The normalization of Israel’s deliberate targeting of Palestinian hospitals and medical centers and its broader pattern of assaults aimed at crippling medical infrastructure and personnel, resulting in the dehumanisation of Palestinian patients and medical workers, and setting a global precedent for impunity that renders hospitals, medical workers, and patients as ‘legitimate’ and ‘acceptable’ targets of war.
The first three points mentioned above are further explored in section 6.3 Israel’s Genocide Enablement Apparatus as it Functions in Western Medical Institutions.
6.2 Israel’s Genocide Enablement Apparatus as it Functions in Gaza
6.2.1 Destruction of the Palestinian health sector since October 2023
Israel’s deliberate ruination of the healthcare sector in Gaza has resulted in the acceleration of the mass killing of Palestinians.
Between 7 October and 14 November 2023 the WHO reported “181 attacks, resulting in 553 fatalities and 707 injuries, including 22 health workers killed and 59 injured” with Israeli attacks affecting “45 healthcare facilities, with 23 hospitals and 32 ambulances destroyed or damaged.”
These findings are reiterated in a report released on 15 October 2024 by the London-based research group, Forensic Architecture that examines the targeting of the Gazan medical sector. The report outlines that between 7 October 2023 and 1 August 2024, the Israeli military campaign has resulted in:
35 of 36 hospitals in Gaza going out of service at one or more points,
31 of 36 hospitals targeted by Israeli military attacks,
11 of 36 hospitals undergoing a siege,
10 of 36 hospitals invaded by the Israeli military,
5 hospitals being besieged twice,
4 hospitals being invaded twice,
1 hospital (Patients’ Friends Society Hospital) being attacked and forced out of service twice, later rebuilding and reestablishing operations,
27 hospitals being located within areas that received Israeli ‘evacuation orders’, and
4 field hospitals being forced out of service and to evacuate.
In each of the above attacks, Palestinian and/or international medical personnel and facilities were targeted along with the hospital infrastructure, with the report concluding that “healthcare workers have been direct targets of the Israeli military, as opposed to being indirect casualties of attacks on hospitals.”
A recent report released by the UN Human Rights Office (OHCHR) on 31 December 2024, covering a similar period of 7 October 2023 to 30 June 2024, also found that “Israel’s pattern of deadly attacks on and near hospitals in Gaza, and associated combat, pushed the healthcare system to the brink of total collapse, with catastrophic effect on Palestinians’ access to health and medical care.”
The report further noted that in this period, the Israeli military’s targeting of hospitals and their surroundings has followed a consistent and discernible pattern of consecutive phases “with often catastrophic impacts on the functionality of the hospitals and on the lives of those reliant on its services, as well as on those who have lost their homes and were sheltering inside.”
It explains that Israeli military operations against hospitals generally commenced with:
(a) “airstrikes or shelling on the hospitals and/or in the hospital’s vicinity, often resulting in serious damage to the hospitals’ premises and equipment;
(b) besieging the hospitals with ground troops, preventing Palestinians from accessing the hospital and blocking medical supplies;
(c) raiding the hospital with the assistance of heavy machinery, including tanks and bulldozers;
(d) detaining medical staff, patients and their companions, as well as internally displaced civilians sheltering inside the hospital—and here we would add also capturing and arresting medical staff and healthcare workers;
(e) forcing remaining patients, displaced civilians and others to leave the hospital; and finally; followed by
(f) withdrawing troops from the hospital, leaving in their wake severe damage to the structures, buildings and equipment inside, effectively rendering the hospital non-functional.”
As evident from the above pattern, the deliberate destruction of hospitals, and particularly of its critical medical infrastructure, appears only to have the purpose of rendering these services unavailable to the Palestinian population even after Israeli military withdrawal from those areas.
The OHCHR report further outlines, in great detail, the details of Israeli military raids and its impact on most major healthcare facilities across Gaza, including the Indonesian Hospital, Kamal Adwan Hospital, and Al-Awda Hospital in North Gaza; Al Shifa Medical Complex in Gaza City; as well as Al-Amal Hospital and Nasser Medical Complex located in Khan Younis. It also provides details of multiple cases of Israeli killings of civilians inside, nearby or heading towards a hospital: doctors killed inside hospitals during raids, pregnant women shot and killed on their way to deliver while only 20 meters away from a hospital, a medical staff member shot in the head while standing near a window in a hospital, a hospital worker shot in the head while moving between two buildings inside the hospital’s premises, and a hospital volunteer and security guards shot while standing adjacent to a hospital.
Significantly, the OHCHR report notes that "in all instances where the Israeli military has attacked hospitals, apart from Al-Awda Hospital in Northern Gaza and Al-Aqsa Martyrs Hospital in Deir al Balah in Middle Gaza, Israel has alleged that the hospitals were being used by Palestinian armed groups" but that "insufficient information has so far been made publicly available to substantiate these allegations, which have remained vague and broad, and in some cases appear contradicted by publicly available information"—nor has any evidence been provided by Israel to prove that "hostilities had been launched or directed from the hospital."
Importantly, the deliberate targeting of Primary Health Care (PHC) in Gaza deserves special attention. Historically, PHC has been a vital component of the health system in Gaza, serving as the first point of contact for individuals seeking medical care. Accessed by millions of Palestinians annually, with approximately five million visits to PHC centers every year, PHCs served as the backbone of Gaza’s medical infrastructure.
Since October 2023, less than 20 percent of PHC centres remain functional, and many of these are severely damaged. Some of the remaining centres are unable to provide essential healthcare services due to limited resources, a lack of medical staff, and a shortage of equipment. Despite these overwhelming challenges, the remaining healthcare centres continue to operate—“against all odds”— but they are increasingly overwhelmed by the sheer number of patients and the limited resources available. In an effort to cope with the massive destruction of healthcare infrastructure, makeshift medical points have been established in areas deemed ‘safe zones’ by the Israeli military. However, these medical points are small, temporary facilities that provide limited healthcare services, and are riddled with challenges such as lack of infrastructure, shortage of supplies, and limited diagnostic capabilities, among others.
6.2.2 Targeting Palestinian medical and healthcare workers
The targeting of medical facilities in Gaza has also involved the systematic targeting of Palestinian medical and healthcare workers. As key protestors of the right to health, Palestinian medical and healthcare workers are civilians serving a critical function and therefore enjoy special protections under international law. However, since October 2023, Palestinian healthcare workers across Gaza have been subjected to serious violations under international humanitarian and human rights law.
Israeli military raids on hospitals—including at Al-Awda and Kamal Adwan Hospitals in ‘north’ Gaza, at Al-Shifa Medical Complex in Gaza City, and at Al-Amal Hospital in Khan Younis— have often led to mass detention, enforced disappearances, and killing of Palestinian healthcare workers, including of health personnel, hospital directors, and medical staff.
The Palestinian Ministry of Health in Gaza reported in June 2024 that the number of healthcare workers detained by the Israeli army at that time stood at 310 persons—with many reporting abuse, torture and other ill-treatment in Israeli custody—and that over 500 Palestinian healthcare workers had been killed. Two prominent Palestinian doctors, Dr. Adnan Al-Bursh of the Al-Shifa Medical Complex and Dr. Iyad Al Rantisi of Kamal Adwan Hospital, reportedly died in Israeli detention a result of extreme torture—with Dr. Al-Bursh reportedly being likely raped to death.
On 12 December 2024, Israeli occupation forces assassinated Dr. Saeed Joda, the last remaining orthopedic surgeon in the north of Gaza, by shooting him in the head with a quadcopter drone as he was traveling to work at Al-Awda Hospital in Jabaliya. Two weeks later, on 27 December, Israeli forces raided Kamal Adwan Hospital in Beit Lahiya and detained Dr. Hussam Abu Safiya, a paediatrician and the hospital’s director. Several medical staff were reportedly “burned alive” from the fires ignited in the hospital by the Israeli army during the raid, and “and patients and medics stripped of their clothing by the army”. Before the latest raid in December, Israeli forces had fired on Kamal Adwan on a daily basis, and raided the hospital at least six times since 5 October. In one of these raids on 25 October, Israeli forces brutally stormed the hospital, destroyed its buildings, detained many patients and all hospital personnel and medical staff, and killed Dr. Abu Safiya’s son while he was sheltering at the hospital with his family—as a consequence of the director’s refusal to leave the hospital and abandon his patients.
The case of the Israeli raid on Kamal Adwan Hospital is an illuminating example of the interlacing of Israel’s systematic targeting of the medical sector in Gaza and its genocidal military campaign—a pattern that has repeated across Gaza since October 2023:
First, by reconfiguring Palestinians hospitals as main targets of its military operations, Palestinian health personnel working to protect the right to health of their patients and the safety of their medical staff are forced to serve the role of mediators, repeatedly called upon directly by the occupation forces and threatened, intimidated, harassed and badgered to initiate and succumb to a mass evacuation order of their hospital. This is a function that no healthcare worker should ever have to serve: choosing between providing life-saving care for injured and precarious patients or the possibility of their collective mass arrest or killing by the army.
In the months prior to the December raid, Dr. Abu Safiya was regularly threatened by the Israeli army and he issued near-daily updates to the international press about the impact of Israeli attacks on patients and medical workers at Kamal Adwan Hospital. Despite repeatedly calling for the protection of healthcare facilities in Gaza, Dr. Abu Safiya was one of numerous healthcare workers who were captured by the Israeli army when the hospital was forcefully emptied. Once detained, he was not seen publicly nor was his family provided any update on his whereabouts or condition. On 2 January 2025, in response to a petition filed by Physicians for Human Rights–Israel (PHRI) with the Israeli High Court, the Israeli military stated that it had “found no indication of the arrest or detention of the individual in question”—despite video footage showing the doctor walking towards an Israeli tank at the time of the raid, and the Israeli army admitting to his capture on social media. The next day, on 3 January, the Israeli army reversed this claim and stated that Dr. Abu Safiya “was apprehended for suspected involvement in terrorist activities, and for holding a rank in the Hamas terror organization, while hundreds of Hamas and Islamic Jihad terrorists were hiding inside the Kamal Adwan Hospital under his management.” Consistent with similar Israeli claims made about Palestinian hospital directors and healthcare workers in the past—and echoing the findings of the abovementioned OHCHR report—no evidence has been provided by Israel to support these outrageous allegations.
Second, as stated by Dr. Abu Safiya in his briefings to the local and international press before his capture and detention and reiterated by the WHO, the Israeli occupation forces ordered the evacuation of Kamal Adwan hospital staff and patients, instructing them to seek care in the Indonesian Hospital, also located in Beit Lahiya. However, at the time of this order, the Indonesian Hospital was itself “destroyed and non-functional” with no ability “to provide any care,” according to the WHO. Satellite footage further showed the Indonesian Hospital being used by the Israeli army as “a barracks or military base” on 21 December, only a week before the latest raid on Kamal Adwan. In effect, healthcare workers, medical staff, and patients, many of whom reportedly could not walk, were being forcefully evacuated by Israeli forces, in a catastrophic warzone without accessible roads or facilities, to a destroyed and non-functional hospital without water or fuel, and with “most of its medical equipment” destroyed by the army itself when using the hospital as a military outpost just days before.
In this manner, Israel’s systematic targeting of the Palestinian medical sector in Gaza—of its hospitals, medical equipment, and its healthcare workers—surfaces as a central operational arm of its genocidal military campaign.
6.2.3 Effects of displacement on the Palestinian health sector
At the time of writing, nearly two million Palestinians, almost the entire population of Gaza, have been displaced since 7 October 2023. The widespread, often multiple displacements of Palestinians has exacerbated the destructive effects of Israel’s systematic targeting of medical infrastructure and demands made of healthcare workers in Gaza. The promotion of mass displacement and deepening public health crises also results in an increase of excess mortality in the following ways:
A decimation of the local healthcare system has resulted in a collapse of reliable and high quality healthcare services for primary care, speciality adult and pediatric care, surgical and anesthesia services , post-operative care, and rehabilitation care.
Operational hospitals have become locations that shelter many thousands of internally displaced civilians seeking a safer location and close proximity to healthcare should they get sick or injured. Consequently, hospitals are severely overcrowded with internally displaced people, and cannot function effectively with maintenance of proper infection prevention and control measures for infectious or hospital-acquired diseases. It also makes proper medical follow-up with patients extremely difficult as patients become hard to locate in overcrowded environments. Operating theaters and intensive care units are required to maintain a degree of sterility. As such, displaced persons sheltering in the hospital setting often overflow into these very sensitive areas, increasing the risk of disseminating infection in vulnerable patient populations.
In primary care settings, manageable chronic diseases, like diabetes, escalate into severe complications—wound infections lead to amputations, and lack of timely care leaves countless individuals with permanent impairments. These preventable outcomes highlight the devastating human cost of such deliberate obstructions.
In specialty care settings, displaced patients have not been able to access routine treatment for conditions such as chronic or end-stage kidney disease with variable access to dialysis care, resulting in adverse outcomes or death.
In surgical care settings, displaced patients have received surgical limb amputations or given cesarean birth to a child with minimal to no anesthesia, due to lack of anesthesia medication. Surgical patients who have orthopedic fixation devices have had operative wound infections without proper sterile surgical care due to lack of surgical supplies and equipment, and some patients with orthopedic fixation devices have had to have these devices removed by the patient themselves because of a lack of follow-up with surgical specialists due to the ongoing attacks on hospitals and lack of access to specialists. Additionally, the targeting of hospitals with operating rooms have left hospitals with few rooms such that any surgery needed other than ‘trauma’ is forced to be deemed ‘elective’ even if it is medically necessary.
Without proper equipment entering in a meaningful way, surgeries for patients are delayed, cancelled, or been conducted below the desired standards prior to October 2023. Post-operative patients often have longer stays in the hospital contributing to the downstream congestion and overcrowding. In an effort to treat incoming trauma and critically ill patients, patients may be prematurely discharged without the possibility for proper follow up, wound care, or rehabilitative services. This contributes to a vicious cycle of discharged patients returning with complications and further straining the limited hospital capacity.
New diagnoses and management of certain medical conditions (such as cancer diagnoses) are extremely difficult due to a decimation of the healthcare personnel and infrastructure required for a tissue biopsy, imaging for staging, and pathology review. Without pathology there is also an inability to test for the potential kinds of chemical weapons that may have been used on the Palestinian population.
Continuous displacement has left many in Gaza to shelter in areas that lack access to sanitation facilities, clean water, or healthcare services. These makeshift camps become crowded quickly, and communicable diseases can spread rapidly directly linked to a rise in excess mortality. Skin infections, diarrheal illness, upper respiratory infections also become rampant. Furthermore, many tents for displaced persons have been set up using plastic bags and other ad hoc material that could be sourced locally. These tents are unable to withstand the elements and fail to protect those taking shelter in them from extreme temperatures—resulting in multiple deaths from hypothermia since December 2024 of vulnerable persons, particularly children.
6.2.4 Trauma and psychological strain of Palestinian healthcare workers
Adding to the generational trauma produced from previous Israeli wars in Gaza, the constant state of intense and unrelenting military attacks since October 2023 coupled with genocidal conditions on the ground, has shattered and traumatized the psychological state of many Palestinians. After over a year of a relentless genocidal military campaign, Palestinian healthcare workers have had to face unprecedented and historically incomparable challenges to provide medical care to hundreds of thousands of people—while simultaneously trying to survive and navigate the colossal emotional, psychological, physical, medical, and ethical toll the war has taken on them personally, and on their families, friends,and society.. Like all Palestinians in Gaza, healthcare workers including doctors, nurses, and emergency responders have also lost their homes—with many living in tents in displacement camps, having had their children, family members or friends killed without the time or space to mourn their immense loss.
The “profound psychological strain” and exhaustion of healthcare workers in Gaza was reported by Doctors Without Borders/Médecins Sans Frontières (MSF) in April 2024, where healthcare workers repeatedly described “receiving repeated large numbers of casualties with crushed limbs and burns from explosions, and having to perform amputations without sufficient pain medication or anaesthesia.” Faced with a famine, healthcare workers were often forced to made unthinkable decisions that “will leave scars for years to come,” due to a crippling shortage of medical supplies and equipment needed to properly treat their patients brought on by Israel’s total closure of Gaza in the first months following October 2023—preceded by three decades of closures that had already weakened the medical sector in Gaza—and a military campaign where the hospital itself had become a recurring target of Israeli attacks. As a result, healthcare workers and medical staff experience “anxiety, insomnia, depression, intrusive thoughts, emotional avoidance and nightmares, all of which can heighten the risk of mental health issues.” The long-term effects of the extreme trauma of many Palestinian healthcare workers will further affect their ability to restore systems in the medical sector and build resiliency.
6.2.5 The deleterious effects of Israel's seizure of the Rafah crossing
The cumulative effects of Israeli attacks on the healthcare system and medical personnel in Gaza that is described in the above UN, WHO, and civil society reports was further exacerbated with the complete closure of the Rafah crossing following Israel’s illegal seizure of the Philadelphi corridor along the Egyptian border on 7 May 2024.
The seizure has had deleterious effects on aid delivery, medical supplies and disposable restock, and imposed artificial restrictions on the amount and type of supplies incoming humanitarian and medical teams entering Gaza are permitted by Israel to bring. The forced closure of the Rafah crossing was part of a broader Israeli ground invasion that resulted in the forcible evacuation and closure of all hospitals in ‘southern’ Gaza, including Al-Najjar, Emirati Hospital, Indonesian Field Hospital, Kuwaiti Field Hospital, and all primary healthcare clinics.
Additionally, the already restricted movement of Palestinians in and out of Gaza has effectively halted, thereby removing the possibility of medical evacuations through that ‘crossing’ as a last option for most Palestinians. Since October 2023, a total of 5,383 patients have been evacuated, with only 436 able to leave after the Rafah crossing closed in May 2024—a process the WHO described as “excruciatingly slow.” At this pace, evacuating the over 12,000 critically ill and injured patients, including thousands of children in urgent need of life-saving treatment outside Gaza, could take 5 to 10 years. The futility of evacuating patients from the Gaza Strip adds an overwhelming layer of mental strain for healthcare workers, who grapple with the anguish of knowing they are unable to provide the help their patients urgently need.
Prior to the seizure of the Rafah crossing, most international non-governmental organizations (INGOs) had based operations and logistics out of Egypt—arrangements that Israeli authorities have since replaced with a more cumbersome, arbitrary, restrictive, unpredictable, and bureaucratic process that has profoundly damaged the public health and humanitarian conditions in Gaza (see section 6.2.6 Israeli restrictions on the entry of healthcare workers, international organizations, and medical supplies into Gaza).
6.2.6 Israeli restrictions on the entry of healthcare workers, international organizations, and medical supplies into Gaza
Since October 2023, Israel’s systematic dismantling of the health sector in Gaza has created a human rights catastrophe. As a result of Palestinian healthcare workers being targeted— harassed, badgered, tortured, killed, injured, imprisoned, and disappeared—international healthcare workers have been invited by the Palestinian Ministry of Health in Gaza through the WHO to assist in the provision of medical care for the high number of critically injured, ill, traumatized, and vulnerable Palestinian patients.
After over a year of relentless military campaigns most Palestinian healthcare workers are also navigating severe emotional, psychological, physical, and medical distress on them personally, including also their families, friends, society, and people (see section 6.2.4 Trauma and psychological strain of Palestinian healthcare workers). In such a context, the presence and support of international healthcare workers is even more imperative, to support an exhausted and targeted local health sector facing genocidal conditions on the ground.
Prior to Rafah Closure (Egypt Corridor)
Post Rafah Closure (Jordan Corridor)
Entry Days
Monday and Wednesday
Tuesday and Thursday
Number of EMT personnel entering
Between 25 to 30 each
entry day on average
Maximum 7 on each entry day
Permission to enter Gaza
48 to 72 hrs in advance
Less than 24 hours in advance
Rotation Duration inside Gaza
Personal choice
(a week on average)
Mandatory 4 weeks
EMTs of Palestinian heritage
Allowed
Not allowed
Baggage allowed
No cap on the number of bags of medical supplies
No medical supplies—1 suitcase and 1 backpack of personal supplies
Average number of EMT personnel entering Gaza Jan-April 2024*
129 per month
(Minimum in Jan = 69)
(Maximum in April = 217)
Average number of EMT personnel entering Gaza June-Dec 2024*
48 per month
(Maximum in Dec = 31)
(Maximum in Oct = 60)
Figure 1. Comparison of EMT response pre- and post-Rafah closure.
*Data sourced from Emergency Medical Teams-Gaza Response 2024 by the World Health Organization.
Since May 2024, Israel has placed unnecessary and deliberately difficult restrictions and impediments on international workers entering Gaza:
The process for entry is extremely tolling, as passing through multiple arbitrary and changing Israeli checkpoints is made strenuous by design. Long waiting times, multiple cumbersome checks, delays, harassment and intimidation, and changing requirements for entry, make the entry of international healthcare workers into Gaza increasingly frustrating and precarious. Some of the personal examples of harassment and intimidation by the IDF experienced or witnessed by authors of this report include extensive searching of bags and the removal and confiscation without cause of their medical equipment.
Unreasonable restrictions are placed by Israel on medical equipment brought in, often impeding the medical care the international healthcare worker is able to provide; and
Harassment and the possibility of rejection and detention at the border create hesitance on the international healthcare worker to enter Gaza.
The period of stay in Gaza was extended by WHO to 4-weeks minimum to mitigate the burdensome rotation procedures imposed by COGAT. This is a long period of time that is difficult to manage for most international healthcare workers who have regular employment at hospitals or in their private practice abroad. When finally exiting Gaza, there is immense fear on the international healthcare worker that they may be rejected, that their exit may be delayed or they may be harassed or intimidated by the Israeli security services at the border. The delay in exit, faced by many international healthcare workers since the start of Israel’s military campaign, also leads to tensions in their home hospital or medical clinics, and can also jeopardize their jobs and family situation.
Together, these and other restrictions significantly impede and limit the number of international workers who are able to enter Gaza and provide meaningful medical care.
Additionally, since the forced closure of the Rafah crossing, Israel has also taken directly punitive, racially discriminatory, and retaliatory measures to target and sabotage the work of international healthcare providers and EMTs in Gaza:
Since assuming full control over all crossings into Gaza in May 2024, Israel has rejected any international healthcare workers of Palestinian heritage. If the grandparents of the healthcare worker have Palestinian ancestry, they will not be granted permission to enter Gaza. Specifically denying healthcare workers of Palestinian descent significantly limits and denies entry to highly competent, culturally sensitive, and language proficient healthcare workers into Gaza. Often, the Israeli border police and security services will ask where parents and grandparents were born as a method of identifying Palestinian heritage and denying entry to international healthcare workers.
In October 2024, Israel placed an arbitrary ban on at least 7 international medical organizations operating as EMTs in Gaza—among them being Fajr Scientific, Glia, and the Palestinian American Medical Association—without providing any reason or justification. The sudden ban of these organizations, most of which still had delegates working inside Gaza at the time as well as other EMTs previously scheduled for entry, created great unease and instability for the healthcare workers entering with these organizations, as well as logistical issues on the ground in Gaza for medical projects underway. The ban has since been overturned for all but one organization, again with no reason or justification given.
The Israeli government has repeatedly shrunk the ‘humanitarian’ or ‘green zone’ where international workers could theoretically move freely without fear of military activity, such as air strikes or ground operations. Documented extensively by UN, WHO and civil society groups, Israeli designated ‘humanitarian zones’ for displaced people are often ‘unlivable’ and lack almost any infrastructure to support the number and needs of displaced civilians there. Even after Israel designated many areas as ‘humanitarian zones’ they are often regularly targeted from the air and invaded by the Israeli military on the ground. That said, in addition to having an immediate, deleterious effect on the local Palestinian population, who are constantly forced to pack up all their belongings and move to an increasingly smaller and smaller ‘safe zone’ the shrinking ‘humanitarian corridor’ has also meant increased coordination of movement between INGOs and COGAT. As the ‘humanitarian zone’ shrank and coordination requests increased, there was a significant backlog on approvals from the Israeli side, which meant that in some cases, travel—such as essential and sometimes time-sensitive travel between the EMT’s local home office, safe house, and hospitals—could not be approved (or be provided the ‘green light’ from COGAT) in time, and thus meetings, field visits, and hospital visits would be cancelled or postponed.
Israel has refused to allow for new applications from interested medical organizations around the world to the EMT initiative, restricting the ability to support the medical sector in Gaza to only those groups who were already permitted to operate under the WHO in May 2024. Compared to Spring 2024, where multiple organizations were given permission to participate in the EMT initiative, the possibility for international healthcare workers to support the vital work of Palestinian healthcare workers in Gaza has since significantly been reduced.
On 9 December 2024, Israel unilaterally introduced new restrictions on the registration and operation of INGOs in the occupied Palestinian territory. A new committee was created to ‘oversee’ the registration applications of INGOs as well as making decisions on extensions or cancellations of their activities. This committee will also be responsible for issuing visas where necessary, and can approve or reject an application or extension of visa applications based on political and ideological parameters defined by Israel, such as whether the organization:
“denies the existence of Israel as a Jewish and democratic state”;
has in the previous seven years taken “any actions or made any public statements in support of a boycott on Israel“; and whether it
“actively promotes delegitimization activities against Israel.”
The sample of above restrictions imposed by Israel on INGOs, including those participating in the EMT initiative in Gaza, creates numerous problems and targets their work in the following ways:
INGO registrations were previously issued permanently, and the new procedures requires renewal every three years, which can create considerable uncertainty in the operational capacity of an INGO, particularly during an ongoing genocidal military campaign;
No clarity has been provided by Israel on when these new rules will be practically implemented. The announcement made indicates that the rules go into effect in early February 2025, but will organizations be immediately reviewed? What type of correspondence will be given? And will there be due process or an appeals mechanism?;
Nearly all INGOs operating in the occupied Palestinian territory have engaged in some form of humanitarian and human rights advocacy as an extension of their professional and moral duty, which could be interpreted as fulfilling one or more of the criteria that would deem that INGO invalid, and have their registration either cancelled or rejected; and relatedly,
The vague, totalizing and discriminatory phrasing of the new rules invites situations where INGO activity is unjustifiably dismissed or rejected. For example, INGOs that are viewed negatively by the Israeli government may be unfairly targeted.
On 19 December 2024, respected Jordanian surgeon Dr. Abdullah Al-Balawi was detained while traveling to Gaza on a sanctioned medical relief mission orchestrated in partnership with the WHO and the UN. Dr. Al-Balawi received all required approvals from COGAT but was detained at the King Hussein Bridge (Allenby Crossing) and held at the Petah Tikva detention center without clear justification. Dr. Al-Balawi was not reachable by his family during the entirety of his abduction and was later released by Israel on January 5, 2025. For over two weeks of detention, he was denied access to legal counsel, interrogated, and no explanation has yet been provided by Israel for his arrest. Such violent and arbitrary actions by Israel against international healthcare workers, even after providing them with an approval to enter the country, creates a chilling-effect and serves to intimidate potential delegates while also putting the entire EMT initiative at risk.
Once in Gaza, INGOs and EMTs have immense pressure on them to comply with occupational impositions. Resulting from the shrinking Israeli ‘humanitarian zone’ in Gaza described above, at least one international field hospital in the Rafah Mawasi area was forced to repeatedly close in May 2024, due to nearby Israeli airstrikes. Despite having its location established in coordination with COGAT, the entire field hospital was eventually permanently closed as the Israeli government included its location in the ‘red zone’ when again redrawing the borders for the ‘humanitarian zone.’. One of many instances where sudden Israeli ‘evacuation orders’ impede and fundamentally disrupt the vital work of EMTs in Gaza, this case also shows the fragility of the coordination process. One of the limitations of these semi-permanent field clinics is that, because they are not permanent structures and are not being run by state actors, they will simply shut down services in the face of hostility and/or military aggression. With the permanent closure of this INGO field hospital after the Rafah invasion, the thousands of Palestinians who relied on the hospital for everything from primary care to surgical intervention, to mental health support are left bereft—in a context where no international presence can provide a modicum of safety exist, nor do any other healthcare options. In addition to an occupational imposition, this case reveals the devastating perils of INGO presence as a substitute for Ministry of Health hospitals—almost all of which have been rendered ‘non-functional’ due to Israeli attacks (see section 6.2.1 Destruction of the Palestinian health sector since October 2023).
With international journalists, multiple UN commissions, and independent observers barred by Israel from entering Gaza, international EMTs serve not only as providers of medical relief but have also surfaced as vital witnesses to an unfolding genocide on the ground. In fact, they are probably one of the only demographic of workers who have had near-regular access to Gaza since the start of the present war. Israel's destruction of spaces of medical care and deliberate attempt to collapse the health sector in Gaza has, as the WHO has noted, transformed hospitals into “battlefields.”
In this context, international healthcare workers based in, working from, and in many cases also sleeping in hospital complexes, during their service in Gaza find themselves in the central nervous system of Israel's military campaign. Here the hospital becomes a kind of node that registers multiple genocidal practices on the ground: revealing the ways in which policies like deliberate restriction of aid, famine, the disproportionate use of munitions, targeting of civilians—particularly children and women, forced evacuations and displacement, lack of clean water, sanitation, and fuel, among others things, all intersect and aggravate one another to systematically delete the Palestinian people. As such, the humanitarian data collected—whether field notes, observations of patient injuries, conversations with local healthcare workers, sound files, video recordings, photos taken for training and education, and diary entries—collected, documented and reported on by international health workers all work to serve a second and integral function of documenting atrocities and war crimes committed against civilians.
Fearing being delisted or banned by Israeli authorities from having their medical teams entering Gaza, some international non-governmental and medical organizations place restrictions to prevent the documentation and collection of evidence. These groups then force their delegations to stay within strict confines of patient care and dissuade the sharing of their testimonies with international press once they exit Gaza.
For example, Dr. Mimi Syed, a physician who has Gaza multiple times since October 2023, testifies that:
“Once in Gaza, the medical NGO that had granted me written permission to collect evidence and testimonies, subsequently retracted their authorization. They forbade me from doing any media while I was in Gaza. They said that they would face extreme pressure from the Israeli security services and jeopardize their future missions if they allowed their healthcare workers to do live media from the ground. This again created tension between my professional and moral duties as international healthcare worker and the medical NGO hosting and facilitating my presence in a genocidal war zone. I was alienated, anxious, put under immense pressure, and left to advocate for myself.”
Once they return home, healthcare workers are most often either forbidden or warned about speaking up about their experiences in Gaza, with some having been terminated, reprimanded, suspended from their jobs, or been denied promotions (see section 6.3. Israel’s Genocide Enablement Apparatus as it Functions in Western Medical Institutions). However, since the start of the genocidal campaign in Gaza, and largely resulting from the abovementioned restrictions on UN observers and international journalists, international healthcare workers have increasingly been professionally, legally and morally compelled to also served the role of human rights defenders by providing vital care and logistical support and also bearing witness to war crimes at the local, national, regional, and international levels.
6.3. Israel’s Genocide Enablement Apparatus as it Functions in Western Medical Institutions
Since October 2023, hundreds of international healthcare workers in Western medical and cultural institutions have borne witness to, documented, and reported on specific Israeli war crimes observed in Gaza. Many healthcare workers who have spoken up about the dire health conditions in Gaza and Israel’s attacks on the healthcare system have experienced backlash from their medical institutions. Those targeted include both healthcare workers who have returned after working in Gaza as well as healthcare workers who have observed the systematic targeting of the Palestinian medical sector and expressed disagreement with Israel’s genocidal military campaign in Gaza.
Healthcare workers who denounce Israel’s well-documented attacks on Palestinian healthcare infrastructure and medical workers, as well as those who have called for an end to its military campaign in Gaza as part of their professional, legal and moral obligation to prevent genocide, have faced numerous acts of reprisals from their home institutions. These acts include the loss of employment, suspension, slanderous attacks, damaging of their reputation, harassment, intimidation, censorship, and in some cases, loss of livelihood. Together, these actions by Western medical and cultural institutions to silence healthcare workers speaking up to stop genocide serve as genocide abetment and enablement. Because the moral and professional responsibilities of healthcare workers include advocacy to stop violence that harms human health, the active repression of healthcare workers violates their ability to defend the right to health both for their patients at home and in situations of military conflict and war crimes, and genocide.
A selection of these attacks are described in this section, each of which have also affected the families of these workers, carrying particularly damaging effects with limited recovery options for Black, Indigenous, minority, female and racialized healthcare workers. The impacts of reprisals on healthcare workers are disproportionately experienced based on class, gender, immigration and socio-economic status, and this may also affect how and if people step forward to share their cases of reprisals publicly. The details outlined in the cases included in this report are limited to details that are publicly available at the time of writing and do not include current, ongoing acts of reprisals by Western medical and cultural institutions against healthcare workers who oppose Israel’s genocidal military campaign.
Numerous Western medical and cultural institutions have silenced and punished healthcare workers who are speaking to their moral and professional obligation to defend life in the face of violent atrocity. Many of these healthcare workers have also been framed by these institutions as a ‘danger’ or ‘threat to patient safety’ for speaking out against genocide in Gaza.
In the United States university donors at medical schools have reportedly funded entities, such as the Canary Mission, that work to destroy the future employability of professors of medicine and students who speak out about Israel’s targeted destruction of Palestinian healthcare systems.
Similarly, reported collaboration across Western medical and cultural institutions and governmental actors to silence voices advocating for the end of Israel’s genocidal military campaign have also created toxic and repressive working and teaching environments. Together, these reprisals have been tantamount to abeting the genocide in Gaza, by removing the potential obstruction posed by a critical, experienced, and professional class—the medical community.
For example:
On 17 October 2023, Dr. Abeer AbouYabis, a Palestinian hematologist/oncologist and transfusion medicine specialist was terminated from her positions at Emory University School of Medicine and Emory Healthcare, in Atlanta, Georgia. Due to a private social media post comparing the previous Israeli Defense Minister’s reference of Palestinians as ‘human animals’ with the dehumanizing language used about Jewish communities in World War II, she was falsely accused of anti-semitism. As a result, Emory immediately suspended Dr. AbouYabis while she was seeing patients in the clinic, and asked her to go home. Ten minutes after receiving an email about her suspension on the same day, Emory leaked details of her case to media outlets who proceeded to write biased and racially charged articles about Dr. AbouYabis. After a week-long investigation, which included interrogating Dr. AabouYabis’s old Facebook posts in which she refers to Israel as a ‘settler-colonial state,’ she was terminated from her position. Since Emory’s targeted campaign against Dr. AbouYabis, she has been unable to find a new position practicing medicine in the U.S. or abroad.
Since October 2023, Dr. Rupa Marya, professor of medicine at the University of California, San Francisco (UCSF) and international expert on the health impacts of colonialism has been repeatedly censored, silenced, harassed, defamed and threatened, suspended due to her scholarship and writing on, critique and disagreement with Israel’s targeted military campaign on the health sector in Gaza. As result of these reprisals, some of which are mentioned below, she has has been suspended from her university position, lost vital income from lost speaking opportunities at other universities, received harassment by university officials, barrages of death and rape threats, and suffered waves of defamatory posts online:
In October 2023, Dr. Marya posted her insights as a scholar of colonialism on Israel’s settler colonial history on her personal social media and received a cold call on a weekend from UCSF Vice Chancellor Catherine Lucey, who inquired into the content of the post. Dr. Marya felt intimidated knowing that the UCSF Vice Chancellor was reading her social media posts and felt the urge to call her to discuss them. Relatedly in November 2023, Dr. Marya received death and rape threats online after making public social media posts about Israel’s bombing of hospitals in Gaza. When sharing her concerns about these threats with UCSF leadership and requesting assistance in removing her public profile from their website which had her email publicly listed for her protection, she received no response. One week after notifying UCSF leadership about the threats to her safety, the administration’s first communication with Dr. Marya, informed her that she was under investigation for her behavior on social media.
In January 2024, UCSF appeared to collaborate with California State Senator Scott Wiener in publishing a defamatory social media post framing Dr. Marya as ‘anti-semitic’. This defamatory post resulted in Dr. Marya being listed on the Canary Mission, an online doxxing site that frames critics of Israel as anti-semitic, resulting in the loss of income and speaking opportunities, as well as months of death and rape threats to Dr. Marya’s work email and social media sites. The online interactions between UCSF and Senator Scott Wiener sparked the interest of the Center for Protest Law and Litigation, who requested public records access to determine the degree of collusion between Senator and the University of California and their shared donor, the Diller Foundation. UCSF failed to meet the deadline to produce the requested communications and was sued in California Superior Court for access to those emails in September 2024—the lawsuit is ongoing.
By June 2024, Dr. Marya was placed under disciplinary proceedings by UCSF, on the grounds that she had violated the Faculty Code of Conduct, citing 77 social media posts, some of which did not belong to her. Later in July, Dr Marya was named along with others in a Congressional letter to UCSF Chancellor Hawgood, threatening to withhold federal funds if “anti-semitism” on campus was not addressed. In September 2024, Dr. Marya was placed on paid leave pending an investigation for her sharing of medical student concerns that UCSF did not have procedures in place to ensure that people coming to be a part of the university directly from Israel during an active genocide had not participated in war crimes—once again she was targeted online by California Senator Scott Wiener leading to waves of death and rape threats. These reprisals were committed against Dr. Marya despite similar concerns being echoed by Jewish physicians and many in the broader medical and academic community. One hour after Dr. Marya was officially notified of her leave, news of her suspension was reported by the local media, in violation of California Labor Codes.
On 1 October, 2024, the Executive Medical Board at UCSF suspended Dr. Marya’s clinical privileges, stating that she was a ‘danger’ to patients—their letter further stated that if clinical privileges were to be suspended for 14 days, the Board would be required to notify the California Medical Board, which would also put Dr. Marya’s medical license at risk. In over two decades of employment at UCSF, Dr. Marya has received no documented instances of patient safety concerns. On October 15, her clinical privileges were reinstated but UCSF failed to inform her in writing of the same until a month later. At the time of writing, Dr Marya remains on paid leave pending investigation.
This behavior has been consistent with UCSF’s reported broad pattern of repression against healthcare workers and health students supportive of Palestinian life or critical of Israel. Also at UCSF:
A UCSF violence prevention advocate who supported Dr. Marya against the university’s online attack—Ms. Denise Caramagno—was framed as ‘anti-semitic’ and has been subsequently terminated.
Surgery chief resident Dr. Keith Hansen revealed his Palestinian identity to his colleagues during a Grand Rounds in which he described his work in organ transplantation as well as the impact of medical apartheid in Palestine. His talk was removed from its usual online space and several complaints were lodged against him for creating an “unsafe work environment.” Dr. Hansen was harassed by senior faculty who tried to get him expelled from his 7 year residency program just weeks before its completion.
Nurses, midwives, staff, students and trainees have been disciplined and even suspended for showing symbols of support for Palestinian people, with supervisors declaring that watermelons and cultural items such as the keffiyeh scarf create an environment of hostility.
On 12 November 2023, several hundred delegates at the American Medical Association (AMA) put forth a motion to discuss a Ceasefire Resolution in Gaza and were silenced at the House of Delegates, with AMA leadership abandoning the organization’s standard democratic process to stop the motion from going forward by silencing the microphones of speakers providing their timed remarks. Importantly, the AMA has existing policies, notably H-515.950 in which it pledges to “act to reduce the incidence of antagonistic actions against physicians”. Further, in policy D-65.993 the AMA explicitly states that it will “condemn the military targeting of health care facilities and personnel and using denial of medical services as a weapon of war, by any party, wherever and whenever it occurs.” Despite this, the AMA moderator citied the silencing as a call to ‘avoid political discussions,’ this move was in stark contrast to the AMA’s statement denouncing Russia’s attack on civilians and healthcare infrastructure in Ukraine. Meanwhile the AMA has allowed space for positions taken by healthcare workers in support of Israeli policies in Gaza. For example, on 8 November 2023, the week before this AMA session, the Journal of the American Medical Association published an article by another physician, Dr. Matthew K. Wynia, that provided moral cover for the wartime practice of bombing hospitals. At the end of November 2023, professor of medicine Dr. Rupa Marya met with the AMA’s then Chief Health Equity Officer, Dr. Aletha Maybank, to request her to use her office to advocate at the AMA and to publicly call for an end to the targeted Israel attacks on Gaza’s healthcare system—Dr. Maybank refused to do so.
Targeting of healthcare workers has also extended to reprisals against students who express disagreement with Israel's targeting of the health sector in Gaza. On 19 November 2024, Ms. Umaymah Mohammad, a Palestinian MD/PhD candidate at Emory University School of Medicine and Department of Sociology was suspended over comments made in an interview with the press about the Emory encampments in April of 2024. Speaking to Democracy Now! Ms. Mohammad was asked about a letter she authored and shared with her medical school about their complicity in genocide. In her response, Ms. Mohammad juxtaposed two cases at Emory University School of Medicine, anonymously referencing Dr. AbouYabis’s case (see above), with that of Dr. Joshua Winer, a professor at Emory who served in the Israeli army and wrote publicly about his service in Gaza. She stated: “In October, Emory fired a Palestinian physician for posting a private social media post on her Facebook in support of the Palestinians. And yet one of the professors of medicine we have at Emory recently went to serve as a volunteer medic in the Israeli Offense Force and recently came back. This man participated in aiding and abetting a genocide, in aiding and abetting the destruction of the healthcare system in Gaza and the murder of over 400 healthcare workers, and is now back at Emory so-called teaching medical students and residents how to take care of patients.” Ms. Mohammad was suspended by the Emory medical school for one year and put on probation for the rest of her medical training. Ms. Mohammad is the only Palestinian medical student at Emory, and her suspension follows a pattern of repression in Emory’s healthcare spaces of silencing critique of Israel, its genocidal campaign in Gaza, and the complicity of U.S. healthcare institutions.
In July 2024, Dr. Thaer Ahmad, an emergency medicine physician, was informed by hospital leadership that his fellow colleagues had recommended that the hospital report him to the Department of Homeland Security for his volunteering in Gaza and his advocacy work upon returning.
Acts of reprisals are also complemented with the broader silencing, censorship, and cancellation of space for condemning Israel’s deliberate targeting of the health sector in Gaza. Cultural institutions have canceled talks, round-tables and teach-ins organized by faculty and students. For example, on 14 October 2024, a public talk at Columbia University in New York City that was pre-approved by the administration by Dr. Mark Pearlmutter, Dr. Adam Hamawy and Dr. Feroze Sidwha who worked in Gaza in March-May 2024 was cancelled and forced to be moved elsewhere in the city. A similar presentation was scheduled on 31 October at the College of Medicine at Mount Sinai for the doctors to address the unique challenges surgical and medical practices experience within austere medical environments challenged by military conflict. This talk was later also cancelled within 24 hours of the previously administratively approved event. Since leaving Gaza and speaking to what they witnessed in open meetings and both mainstream and social media presentations, multiple personal death threats have been delivered to Dr. Perlmutter and more recently to Dr. Sidhwa.
Reprisals have also been pursued by Canadian medical and cultural institutions against healthcare workers who openly disagree with Israel’s targeting of the health sector in Gaza and its military campaign more broadly:
On 13 October 2023, Dr. Ben Thomson, a nephrologist and internal medicine specialist physician was suspended from his clinical work due to social media posts critical of Israel and warning the dangers of dehumanizing Palestinians. Medical colleagues and other members of the public were highly critical of his social media posts and framed them as ‘anti-semitic,’ calling for his employment to be terminated. Dr. Thomson’s information was doxed online and he received death threats and was required to temporarily relocate from his home due to these threats to his life and family. He was later reinstated, and is now pursuing legal action against the hospital and medical colleagues who have attacked his livelihood and personal safety.
On 5 November 2023, Dr. Yipeng Ge, a family doctor and public health and preventive medicine resident physician at the University of Ottawa, was suspended due to complaints sent to the university by a faculty member. The complaints alleged that the social media posts about Palestinian human rights made by Dr. Ge were ‘inflammatory’ and ‘anti-semitic’. Subsequently, the university’s own professionalism subcommittee heard and investigated the case and recommended immediate reinstatement citing no wrongdoing by Dr. Ge—going so far as to state that the university should issue an apology. An apology was never provided by the university. Dr. Ge was also on the Board of Directors for the Canadian Medical Association (CMA) at the time and, similarly, the senior leadership of the CMA accused Dr. Ge of making ‘inflammatory’ and ‘anti-semitic’ statements based on social media posts in support of Palestinian human rights. Dr. Ge resigned from the Board of the CMA in December 2023, and also resigned from the University of Ottawa in June 2024. He has shared parts of this experience with the Canadian House of Commons Standing Committee on Canadian Heritage on a study on protection of freedom of expression and with the Standing Committee on Justice on a study on Islamophobia and additional measures that could be taken to address the valid fears that are being expressed by Canada’s Muslim community.
On 21 November 2023, Ms. Arij Al Khafagi, a nursing student at the University of Manitoba was suspended due to social media posts criticizing Israel’s actions against the Palestinian people in Gaza. She was also given a five year reprimand on her academic record. Her suspension was overturned in January 2024 with a removal of her academic reprimand.
In May 2024, Dr. Gem Newman, the valedictorian of his graduating medical school class at the University of Manitoba was targeted for the content of his valedictory speech which addressed Israel’s genocide in Gaza. Dr. Newman critiqued the silence of medical institutions, and called for a ceasefire in Gaza. His statement was publicly condemned by the university administration and university donors, and labelled as ‘divisive’ and ‘inflammatory’.
During the 2023-2024 cycle of the Canadian Medical Residency matching process, there were documented coordinated efforts to screen medical students applying for residency positions for those having signed an open letter calling for a ceasefire and an end to attacks on healthcare infrastructure in Gaza. A clear example is of Dr. Carly Kirshen, program director of the dermatology residency program at the University of Ottawa, who requested the compiled list of medical students with the intention of using the list as a program director to influence the process of selection of prospective resident physicians. This led to a statement made by the Association of Faculties of Medicine of Canada which, while it did not call out the issue directly, explicitly stated that “no external lists, data, or letters may be shared, disseminated, or utilized at any stage in the resident selection process”.
The targeting of healthcare workers in Canada has also affected workers in adjacent fields, such as public health, who voice disagreement with Israel’s deliberate destruction of the medical sector in Gaza and its military campaign. For example:
In October 2024, Amy Blanding, the former director of inclusion, diversity, and equity with Northern Health Authority, a public health organization in northern British Columbia, filed a claim with the British Columbia supreme court for wrongful dismissal. She shared social media posts in April 2024 of a community concert event including one where she wore a sweater with a watermelon on it, and this was later criticized by colleagues as ‘anti-semitic’. A communications firm was consulted by the workplace and a pre-drafted statement was prepared for her to share on her social media, and when she refused she was demoted and put on leave.
In October 2024, Dr. Sean Tucker, a graduate school professor in occupational health at the University of British Columbia’s School of Population and Public Health was fired for advocacy and organizing efforts related to Palestine. He co-hosted a film screening of Israelism with students within the School of Population and Public Health in February 2024 at the request of the students. In April 2024, he also helped plan an event on the impact of war on Gaza’s children with a representative of Save the Children, which the school declined to sponsor as an event. In September 2024, attended a student orientation event to introduce himself as an instructor for the course he teaches in January, however he would learn a few weeks later that he was subsequently removed from his teaching responsibilities in October 2024 without any clear explanation.
In Britain dozens of healthcare workers advocating for the rights of Palestinians have been targeted by groups and individuals who have made complaints against doctors to the General Medical Council, framing them as “antisemitic” in an attempt to have their medical licenses suspended—effectively preventing them from practicing medicine and therefore losing their livelihoods.
British-Palestinian surgeon, Dr. Ghassan Abu Sittah was the first to be targeted in this manner, after volunteering his medical services in Gaza during the genocide for forty-three days from the 9 October 2023. Of note, Dr. Abu Sittah provided detailed testimony to the International Criminal Court (ICC) and Scotland Yard about the targeted destruction of healthcare infrastructure and attacks on healthcare workers in Gaza.
In October 2023, Dr. Abu Sittah was in almost daily contact with Dr. Rupa Marya and was relaying the experience of the genocide unfolding as he moved between various hospitals in Gaza. Dr. Marya had been solicited by the British Medical Journal (BMJ) to write an article on decolonization, and she had obtained approval from the editors to focus the subject of the article on the situation in Gaza. Dr. Marya worked with Dr. Abu Sittah to submit and rework several drafts of reporting on Israel’s targeted destruction of healthcare systems from the early days of the genocide. Each draft was declined by the editors at the BMJ, in spite of the authors addressing the editors' requests with each revision.
Upon his return to London, Dr. Abu Sittah spoke at a press conference organised by the International Centre of Justice for Palestinians (ICJP), where he told his story of the horrors he had witnessed first-hand during the genocide—including “amputating six different children in one night and being forced to use vinegar as antiseptic, and intravenous paracetamol as pain relief for surgeries.” The initial complaint was made by the pro-Israeli lobbying organisation UK Lawyers For Israel (UKLFI), regarding posts Dr. Abu Sittah had allegedly made on social media which the complaining claimed ‘impaired his fitness to practice medicine,’ and sought for Dr. Abu Sittah’s medical license to be suspended. In response to the complaint, Dr. Abu Sittah pointed to the political nature of the complaints and clarified that he was not the author of a number of the posts in question, and that others had been translated inaccurately. After a long investigation by the Interim Orders Tribunal, the complaints by UKLFI were resoundingly rejected. The Tribunal also rejected UKLFI’s arguments that there was a risk to patients or members of the public due to the social media posts, as there was no evidence that patient safety would be compromised. A second attempt to revoke Dr. Abu Sittah’s medical license was also made following this ordeal.
On 12 April 2024, after providing testimony to the ICC, Dr. Abu Sittah was denied entry to Berlin where he was traveling to attend a conference. German authorities stated they could not ensure the ‘safety’ of attendees in the conference.
On 4 May 2024, he was barred from entry to France because Germany had enforced a Schengen-wide ban on his entry to Europe. At the Charles de Gaulle airport, he was taken into a holding cell by armed guards and had his personal items removed, before he was deported back to the United Kingdom.
On 9 May 2024, Dutch officials informed the Palestinian Ambassador to the Netherlands, a ban that would also prevent him from future access to potentially testifying in-person at the International Court of Justice at the Hague. This restriction of his movement prevented him from presenting his testimony of international significance in person at academic and public conferences.
On 14 May 2024, after a successful legal challenge to overturn his Schengen-area travel ban was filed, Dr. Abu Sittah had the German-imposed ban reversed.
Other examples of healthcare workers in Britain who were targeted include:
In October 2023, British emergency physician and academic Dr. James Smith was targeted following the publication of a co-authored commentary in the BMJ Global Health, titled ‘Violence in Palestine requires immediate resolution of its settler colonial root causes’. Subsequent complaints were registered against Dr. Smith and another co-author, and included targeted harassment in articles published in The Times, and later in The Telegraph. A journalist involved in The Telegraph article launched an enquiry directly with the NHS Trust with which Dr. Smith works, which prompted the Trust to suspend Dr. Smith from further work pending an unspecified investigation. The investigation was ultimately closed with no wrongdoing identified, and Dr. Smith was able to return to clinical practice.
Ms. Fatima Mohameid is a midwife with a clinical role in addition to her role as Cultural Safety Lead, at a leading London maternity unit:
On 11 October 2023, Ms. Mohameid was called in for an emergency meeting with management, where she was advised her social media posts from the 7 October had triggered a complaint from ‘a Jewish midwife’ for anti-semitism. She was advised to either not post regarding Palestine on her social media or to open an anonymous account.
On 13 October, Ms. Mohameid was advised by management that a tabloid paper had contacted the trust and was going to run a story about her tweets.
In December 2023, Ms. Mohameid was advised that her manager had received 3 emails in one day from the public stating that she was ‘unsafe’ for Jewish women and they called for her employment to be terminated. Two weeks after this incident, UKLFI had contacted the CEO of her Trust, asking for her immediate dismissal. Ms. Mohameid was advised if more complaints were received. Due to the ongoing harassment and lack of support she decided to find an alternative workplace.
In September 2024, she received an email titled ‘Decision about your case’ from the Nursing and Midwifery Council as, unbeknownst to her, someone had reported her 11 months prior to having her registration in the council revoked. The final decision arrived 11 months after the complaint, concluding that there was no evidence of anti-semitism in Ms. Mohameid’s social media posts and that she had the right to express her opinion. Ms. Mohameid had since moved from a clinical role to an academic one due to the harassment and targeting that she has endured.
Dr Nadeem Crowe, an emergency physician who worked in London, was suspended from his work while on shift on August 14 2024. No explanation was provided in the initial email correspondence. During a subsequent meeting, Dr Crowe was informed that social media posts related to the ongoing genocide in Gaza could be considered upsetting. On this basis his suspension was upheld, and he was asked to delete the social media posts. Following removal of the social media posts, Dr Crowe was permitted to return to work. However, he has since opted to leave the NHS, feeling unable to continue working in such an environment. Despite lodging a formal grievance and the submission of a solicitor’s letter detailing the breach of NHS Trust policy and the basis for a discrimination claim, no further information was provided by the Trust. When these concerns were escalated to NHS England and the GMC Dr Crowe was told that neither body perceived any wrongdoing.
Since 28 October 2023, concerns have been raised regarding referrals to the General Medical Council for healthcare professionals who have spoken out about the situation in Gaza. The fear of retaliation for speaking out about violence against Palestinians and the ongoing genocide in Gaza has led some healthcare professionals to ‘hide their grief’, while the British Islamic Medical Association surveyed 651 healthcare professionals and students and identified evidence of ‘censoring, self-censoring, targeting, uptick in Islamophobic incidents and harassment of our members with disciplinary action being taken against colleagues of all HCP backgrounds.’
Since December 2024, the President of the British Medical Association (BMA), Dr. Mary McCarthy, has been targeted by pro-Israeli lobbyists and is now under investigation by the BMA for social media posts related to the situation in Gaza, including retweeting a post by Palestinian-American writer Ms.Susan Abulhawa, which stated ‘'We need teams of lawyers now to go after complicit world leaders and...corporations and 'nonprofits' profiting from this Holocaust.'
6.4 Medical Definition of Genocide
The deliberate and systematic targeting of hospitals, medical workers, and patients by state and non-state actors is not unique to the current military campaign in Gaza. However, the case of Palestine stands apart due to the pervasive and unprecedented scale, as well as the intensity of the destruction inflicted upon Gaza’s health sector.
Taking lesson from the catastrophic realities that continue to unfold against Palestinians in Gaza, this report proposes a medical definition of genocide to enable and support the role of healthcare workers both as key frontline protectors of the right to health and life, and as meaningful actors in the early prevention of genocide.
This definition reinforces the role of healthcare workers as human rights defenders, by providing vital care and logistical support in moments of military conflict and bearing witness to war crimes at the local, national, regional, and international levels.
6.4.1 Genocide as a societal disease
From a medical and public health perspective, genocide is recognized as a societal disease and a severe public health hazard. Genocide is characterized by widespread physical and psychological harm, including the following: mass killings, torture, deprivation of essential resources (such as food, water, housing, or healthcare),the destruction of civil infrastructure for the delivery and maintenance of such essential resources, forced sterilizations, and severe mental trauma inflicted on survivors and communities.
As a societal disease, genocide propagates long-term health crises, including generational trauma, mental health disorders, displacement-related illnesses, and the collapse of healthcare infrastructure. It also creates fertile conditions for the spread of infectious diseases, malnutrition, and chronic conditions among people who are forcibly displaced and marginalized. Recognizing genocide as a disease underscores the urgency for multifaceted preventive strategies, integrating healthcare, policy-making, and education to halt its progression and mitigate its devastating public health impacts.
6.4.2 Parameters of a medical definition
Genocide, like an epidemic, thrives in environments of systemic neglect, inequality, and racial discrimination and supremacy. It requires a medical approach to focus not only on treatment but also on early detection, intervention, and prevention. Early detection of the major risk factors of genocide, including dehumanization, discrimination, and polarization, ensures that action is taken at the earliest credible signs of mass violence or systemic oppression. Delays in recognition—often driven by political hesitation or rigid legal requirements—result in catastrophic loss of life, an outcome that inevitably puts colossal pressure on local healthcare systems and which the global medical community has a professional, moral and legal obligation to prevent.
The parameters of a medical definition of genocide proposed in this Report involve:
Unequivocal defense of human life, dignity and value: Any mass loss of lives and livelihoods should be viewed as intolerable and unjustifiable, regardless of political, social, or economic contexts or war aims. This definition reasserts the sanctity of human life and reinforces the moral duty to act.
Lower diagnostic threshold: Like any disease, genocide has identifiable signs and symptoms that allow for early recognition and intervention. Unlike the legal framework, a medical definition of genocide moves beyond an emphasis on ‘intent’ with a lower diagnostic threshold for the determination of acts of genocide. Focusing on observable health impacts, such as mass deaths, serious bodily harm, displacement, and infliction of conditions calculated to bring about the destruction of life in whole or in part, a medical definition of genocide identified these undeniable markers of a crisis to demand an immediate response;
Prevention as a medical imperative: A health-oriented approach to defining genocide focuses on the duty to prevent and protect life regardless of whether intent is conclusively proven. In so doing, a medical definition of genocide prioritizes prevention over retroactive adjudication; and
Commitment to the protection of the health sector: Healthcare workers, medical infrastructure and supplies must never become the object of military attack. Respect and special protection of the health sector must be adhered to by all parties and at all times during military conflict. In circumstances where a deliberate and widespread pattern of military attacks against the health sector is identified, immediate response and intervention is demanded. In exceptional circumstances when medical personnel, ambulances, and hospitals lose their special protection because they fulfil the strict criteria in international humanitarian law to be considered military objectives, any military attack on them must fully comply with the fundamental principles of distinction, proportionality and civilian precautions.
6.4.3 Healthcare workers as actors in the early prevention of genocide
The medical definition of genocide prevention must take its rightful place within the international community and lead efforts in genocide prevention. Current international legal parameters must evolve to reflect a medical definition by aligning with public health principles, prioritizing rapid response, risk reduction, and proactive accountability.
To this end, an independent international medical body with legal and executive authority is needed to enable healthcare workers to serve as actors in the early prevention of genocide.
The mandate of such a medical body would involve the following:
A commitment to remain free from political interference, operating solely on humanitarian and medical principles to uphold the sanctity of life and to prevent mass atrocities.
Using data-driven methods and medical expertise to monitor and identify early signs of genocide or mass atrocities;
Developing and implementing interventions to prevent escalation, as well as to provide life-saving care;
The power to declare an impending or ongoing genocide based on medical and humanitarian evidence;
The ability to mobilize international resources and interventions, including medical, logistical, and protective measures;
The authority to hold governments and entities meaningfully accountable for acts that contribute to genocide or hinder prevention efforts; and
A commitment to the training and democratizing of knowledge, particularly among healthcare workers worldwide, for the early detection of mass atrocities or indiscriminate violence. Standardizing education to democratize knowledge, including training on early warning signs, and disentangling trauma care from militaristic frameworks, would empower healthcare workers to independently and ethically raise credible alerts.
By adopting this framework and establishing an independent international medical body with executive powers, the global medical community can transform its response to atrocities against humanity. To prevent ongoing and possible future renditions of the types of genocidal policies that have occurred and continue to be unleashed on Palestinians in Gaza—particularly since October 2023—the approach proposed above ensures that mass violence and systemic racialized oppression are addressed with the urgency, precision, and authority they demand, safeguarding human life and dignity above all else.
7. About the Contributors
Dr. Tamathor Abughnaim is a board certified Emergency Medicine physician in the United States. She has contributed to the development of grassroots partnerships between universities and NGOs in South America, and has experience advancing social justice curricula in emergency residency training. She is a core member of the Chicago chapter of Healthcare Workers for Palestine, a collective formed in October 2023 to amplify the specific needs of the healthcare sector.
Dr. Ghassan Abu Sittah is a renowned and award-winning British-Palestinian plastic and war surgeon who has worked in numerous conflict zones including Syria, Yemen, Iraq, South Lebanon and the Gaza Strip. He is Clinical Lead for the Operational Trauma Initiative at the World Health Organization’s EMRO Office and serves on the board of directors of INARA, a charity dedicated to providing reconstructive surgery to war injured children in the Middle East, and Board of Trustees of the UK based Medical Aid for Palestinians.
Dr. Thaer Ahmad, MD is a board certified Emergency Medicine physician. He is also an Assistant Clinical Professor at the University of Illinois. Thaer has been working in humanitarian relief since 2009. His work focuses on local healthcare capacity building. Dr. Ahmad has worked on global health projects in Gaza, Syria, Lebanon, Jordan, Greece, Turkey, and Kenya.
Dr. Fozia Alvi is an American and Canadian board certified family physician, founder and president of Humanity Auxilium, a global medical relief organization. She has been actively involved in numerous medical relief missions over the years.
Dr. Yipeng Ge is a family doctor and public health practitioner based on the traditional unceded unsurrendered Algonquin Anishinaabeg territory, also known as Ottawa, Canada. He has worked on and studied the structural and colonial determinants of health in both the settler colonial contexts of so-called Canada and occupied Palestine.
Dr. Dorotea Gucciardo has a PhD in History and is the Research Coordinator for the Starling Centre for Just Societies and Just Technologies at Western University, where she studies technologies of apartheid, including breakdown and repair in Gaza’s healthcare sector.
Ms. Maysa Hawwash is the founder and CEO at ScaleX, HR Management and Director of Strategy and Global Partnerships, Doctors Against Genocide.
Dr. Faiza Hussain has a PhD in Biophysics and is the Director of Operations and Development at Humanity Auxilium, one of the 24 iNGOs with WHO clearance to deploy EMTs to Gaza.
Dr. Nidal Jboor is board certified in Internal Medicine and Geriatrics in Dearborn, Michigan. He is a co-founder of Doctors Against Genocide.
Dr. Ayesha Khan is a board certified Emergency Medicine physician, public health practitioner and Associate Professor of Emergency Medicine at Stanford University. Her academic work focuses on global health systems building, disaster and refugee care, as well as international and domestic health equity. In addition to working clinically in Gaza, she is currently involved in creating sustainable virtual platforms to train and provide clinical care in the face of ongoing destruction of the local health system.
Dr. Karameh Hawash Kuemmerle is an Assistant Professor of Neurology at Harvard Medical School and co-founder of Doctors Against Genocide.
Dr. Rupa Marya is a board certified Internal Medicine physician and Professor of Medicine at the University of California, San Francisco, in unceded and occupied Ohlone territory and a co-founder of the Do No Harm Coalition, an organization of healthcare workers who address racism and state violence as health crises. She is a scholar on the health impacts of colonialism and co-authored the internationally best-selling book with Raj Patel, Inflamed: Deep Medicine & the Anatomy of Injustice.
Ms. Umaymah Mohammad is an MD/PhD candidate at Emory University School of Medicine and Department of Sociology. She has been a community organizer for over a decade with experience building national campaigns around the colonization of Palestine, anti-Muslim state violence, and unlawful surveillance of communities of color.
Dr. Shourideh C. Molavi is the dedicated Palestine researcher at Forensic Architecture and has worked in Palestine/Israel for over 20 years, and in Gaza for a decade. She is also a Senior Lecturer at the Institute for the Study of Human Rights at Columbia University in New York City and has a background in political science and international humanitarian law.
Ms. Amira Nimerawi has a background in nursing, global health and holds a Masters in Business Administration with a Social Impact specialisation. Currently working as Program and Impact Specialist for the Palestinian Medical Relief Society (PMRS) specialized in emergency response and SRHR programs across Palestine and holds the position of CEO of Health Workers 4 Palestine (HW4P) a UK founded advocacy group of health workers, committed to the protection of the Palestinian healthcare system and Palestinian right to health.
Dr. Mark N. Perlmutter is an orthopedic hand surgeon practicing in rural North Carolina. He is the global Vice President for the International College of Surgeons and current President of the World Surgical Foundation. He has participated in more than 40 surgical and disaster relief missions on four continents.
Dr James Smith is an emergency physician practicing in central London, and a lecturer in Humanitarian Policy and Practice at University College London. He worked in Gaza December 2023 to January 2024, and April to June 2024.
Dr. Mimi Syed is a board-certified emergency medicine physician with a Masters in Business Administration and a Fellow of the American College of Emergency Physicians. She is also an assistant clinical professor at University of Washington and Washington state university. She has been on two medical missions to Gaza. Currently works clinically and administratively in western Washington state.
Brilliant, timely, vitally necessary report. Thank you for this work, Dr. Marya, and thanks to all who put this together, and to those health care and other workers who put themselves and their careers at risk in order to get this information and proposal out.
Each Sunday, I watch the livestream Doctors Against Genocide report for the week. I almost can't take watching this horror unfold, but the presenters are among the finest people in the world, and their stories are too compelling to ignore.
This report took a while to read, well worth it... Now for another report I would recommend to all, by Francesca Albanese on the profiteers cashing in on this genocide.
So important. Thank you for sharing it here 🙏