For Immediate Release

Contact: Nathaniel Raymond, Media and Public Affairs Coordinator
(tel) 617-695-0041, ext. 220; (mobile) 617 413 6407; (e-mail)
nraymond@phrusa.org
Leonard Rubenstein, Executive Director
(mobile) 011 972-56-417-936
 

Statement of Medical Delegation from Physicians for Human Rights (USA)
on Health Dimensions of Human Rights Violations in Israel, the West Bank
and Gaza

(March 22, 2002, Press Conference, Jerusalem)

We are a five-person medical delegation from US-based Physicians for
Human Rights (USA).  We are here today to call for an end to the
violence inflicted on civilians in Israel, the West Bank and Gaza, and
for the immediate cessation of assaults on ambulances and lethal attacks
on physicians and other health workers that constitute profound
violations of the most fundamental principles of medical neutrality.
These and other practices ? including the continuation of what should
properly be called homicide bombings, on the one hand, and military
assaults on Palestinian civilians and massive interference with
Palestinian access to medical care, on the other ? are bringing death,
fear, and probable long-term detrimental health consequences to Israelis
and Palestinians alike.

We are witnessing a race to the bottom in terms of respect for human
rights and international humanitarian law, with the danger that both
communities will come to support continual violence as normal and
acceptable.   Only a restoration of respect for human rights ? and human
life ? can end this slide toward an endless cycle of mutual
dehumanization. Yesterday's bombing in Jerusalem and the ongoing
destruction we have witnessed in the West Bank are terrible repetitions
of this cycle. We are urging concrete steps that can contribute to
ending this cycle.

1.  The protection of medical workers and those they serve

In the past four weeks, in the course of attacks by the Israeli Defense
Forces, five medical workers seeking to reach and provide transport to
civilians wounded in areas fighting were killed by IDF, incidents
documented in the recent reports by B’tselem and Physicians for Human
Rights-Israel. Assaults on clearly-marked ambulances attempting to reach
wounded civilians led to the deaths of Dr. Khalil Suliman, director of
the Red Crescent in Jenin; Ibrahim As’ad, a Red Crescent ambulance
driver in Tulkarm; Sa’id Shalayall, a medic, and Kamel Sallem, an UNWRA
ambulance worker in Tulkarm; and Dr. Ahmad ‘Otman, director of al-Yamama
Hospital, in el-Khader.  In addition, wounded individuals died because
they could not reach the hospital.

The number of deliberate assaults on medical personnel seeking to attend
to wounded civilians, and with such dire consequences, is unprecedented.

These deaths are the latest cases of IDF harm to ambulance and emergency
medical workers, as documented by our colleague organizations ? more
than 100 incidents in the last year.  They pattern suggests that the
Israeli Defense Force’s lacks a commitment to respect the principle of
medical neutrality and failure to develop and adhere to rules adequate
to assure that emergency medical transport is protected from attack.

The Israeli Defense Force does have procedures that are supposed to
permit emergency medical transport in areas of conflict or across
security zones, but they are implemented in ad hoc fashion.  Whenever an
ambulance service, such as the Palestinian Red Crescent Society
(representing about 70% of the services in Gaza and the West Bank),
seeks to enter a conflict area, it informs the International Committee
of the Red Cross and also supplies license plate numbers for the vehicle
and identification numbers for the medical personnel.  ICRC then
communicates with a Coordination and Liaison officer, and eventually to
IDF forces in the region.  The IDF then communicates back through this
chain, and giving a “green light” for the ambulance to proceed.
Ambulances are typically inspected before proceeding, without objection
from the ambulance services.

These procedures are cumbersome, and permission to reach wounded persons
is subject to sometimes long delays.  There have been many documented
cases where the long delays jeopardize the lives of individuals in dire
need. Moreover, there appear to be no fixed and widely accepted criteria
for issuing such permissions in conflict areas or at checkpoints or even
for assuring that the order to respect the medical function is
communicated and enforced through the chain of command. As a result, in
the recent incidents, the granting of permission ? the “green light” ?
did not protect the ambulance or medical worker from attack.  In three
of the cases in which the IDF shot and killed ambulance personnel, they
had been given the green light to proceed by the IDF.

For more than a year, the International Committee of the Red Cross,
whose mandate includes assuring the integrity of emergency medical
services in times of conflict, has sought a dialogue with the Israeli
Defense Force to put appropriate procedures into place.  But while
discussions continue, and some new rules have been put into place, the
ICRC has found the IDF’s response insufficient and inappropriate.  The
IDF has not taken the steps needed to comply with a fundamental
obligation.

Even after the killings drew attention to the attacks on ambulances,
another case of interference with emergency ambulance services took
place.  In Gaza earlier this week, a driver and emergency medical worker
in an ambulance of the Palestinian Red Crescent were detained at
gunpoint overnight in their vehicle after having been given permission
to enter an area where a civilian was reported to have been injured.
The ICRC repeatedly inquired of their whereabouts from the IDF and were
falsely told that no ambulance was on the scene.

IDF spokespersons continue to impugn, as they did to our delegation,
that ambulances have been or may be used to transport weapons or
terrorists, that they have refused to cooperate with inspections of
their vehicles, and that they charged IDF forces at checkpoints.  These
are serious charges because misuse of an ambulance deprives it of
protected status. For more than a year our colleague organizations have
repeatedly asked that the IDF make public its evidence, and the IDF has
produced none.  Moreover, the IDF has asserted this position even in
cases where its forces have fired at medical workers after they have
given the “green light” for passage.

In our view, this pattern of conduct as well as the IDF’s reluctance
even to engage vigorously to establish clear rules and procedures that
are communicated and enforced through the chain of command suggests a
dangerous lack of commitment ? even indifference ? at the highest levels
of military command, to the principle of medical neutrality and the
mandates of the Geneva Conventions.   It is a pattern that must be
brought to an end.

2.  Medical consequences of the conflict.

Casualties that have resulted directly from this conflict have
justifiably attracted the most attention ? the cumulative totals of
Israeli and Palestinian dead and injured in the past few weeks alone
number in the hundreds and of people, including children..  The Israeli
incursions in the Balata, Jenin, Tulkarem camps, in Gaza and elsewhere,
were marked by extraordinary force, including use of Apache helicopters
and heavy machine guns mounted on tanks.

There is also a cohort of other victims that is far larger. This is the
silent majority of the chronically ill, pregnant women and others in
need of care, who are cut off from care by roadblocks, drastic
limitations on travel, or curfews in the West Bank and Gaza.  We spoke
to a woman who suffered a hemorrhage while under military lockdown in a
refugee camp but was not permitted to leave. She miscarried.  When the
soldiers left, her husband, a diabetic with congestive heart failure,
found his medicines scattered on the ground and his Glucometer missing.
We received reliable reports of cancer patients whose chemotherapy has
been interrupted, dialysis patients who died because they were unable to
travel to their treatment centers, and elderly and disabled patients who
were forced to walk long distances through checkpoints to get to a
source of medical care.

In other instances, physicians have been prevented not only from
reaching wounded civilians, but on many other occasions have been
prevented from reaching patients in rural villages. And Palestinian
hospitals and clinics have suffered from interruptions in the delivery
of oxygen, medical supplies and food. Physicians reported that severe
travel restrictions have brought the medical and public health care
system in the West Bank, quite apart from responses to trauma, to near
paralysis in every respect, from the performance of routine
immunizations to the inspection of water supplies to the care of the
seriously ill.  Certain services have become absolutely unavailable to
individuals because they are restricted from traveling to areas where
the services are located.   In Gaza, the de facto division in three
parts has prevented health workers from getting to their jobs and
patients to facilities that offer the care then need.

Of particular concern are the medical consequences of the intense
conflicts of the past month.  A physician told us that six civilians
living in the Tulkaram refugee camp, wounded during the assault, died
because they could not reach a hospital.   Trauma is widespread. Intense
panic and terror have been caused by the use of Apache helicopters and
F-16 fighters to shell civilian residences, often accompanied by the
invasion of refugee camps and the systematic occupation or destruction
of homes and apartments. The humiliation of residents by soldiers, the
disruption of roads and the interruption of water, electricity or
telephone lines ? sometimes those serving hospitals ? and the wholesale
destruction of automobiles and other personal property all add to this
damage and trauma We visited a civilian apartment made uninhabitable and
a children’s recreation center that has been reduced to rubble. The
consequences to health are psychological as well as physical. The
intense exacerbations of fear and panic are not limited to adults. From
Palestinian physicians ? and parents ? we have heard repeated reports of
extreme anxiety, depression, sleeplessness and other regressive
behaviors in Palestinian children, including many who have themselves
witnessed shootings and fatalities.

Israeli civilians, too, are experiencing trauma from the bombings that
strike without warning.   At Shaare Zedek hospital in Jerusalem, we were
told that approximately 50 per cent of the victims who appear in the
emergency room after a homicide bombing are not physically injured but
are in states of profound anxiety and emotional shock as a result of
what they have witnessed or experienced. One predictable consequence of
the tactics on both sides in this conflict is the likelihood of a
long-lasting epidemic of post-traumatic stress disorder, again among
both adults and children.

3.  Professional collaboration: A basis for hope

Despite the intensity of the conflict, PHR-USA heard repeated reports of
physicians, nurses and medical staff providing unbiased care to patients
and respecting colleagues regardless of religion or ethnicity.  In the
aftermath of the March 21st terrorist bombing on King George Street,
where two civilians were killed and roughly 60 injured outside a
Jerusalem cafe just four blocks from the PHR hotel, PHR witnessed Jewish
and Palestinian medical staff laboring together to treat the victims in
the Shaare Zedek Medical Center’s emergency department.  A Palestinian
intensive care physician rushed to the hospital after receiving the
emergency call.  Whatever the situation outside the hospital, both he
and another independently interviewed Arab physician reported being
treated with uniform nondiscrimination by Jewish colleagues over the
past 18 months.  Touring the hospital, PHR-USA witnessed Arab and Jewish
patients being treated side by side.

One physician told us, “Politics stop at the front door.” said a staff
member.  This outlook was not unique. At the Gaza Community Mental
Health Program, Palestinian psychiatrists told of continued contact with
Israeli colleagues at Tel Aviv University, in spite of a travel ban that
kept them from visiting one another and co-teaching the Program’s
post-graduate certificate course.

We applaud the unbiased attitude that individual medical professionals,
medical centers and NGOs display in their professional work.  Their
tolerance, cooperation and peaceful coexistence survive in spite of the
divide.   PHR strongly encourages professional medical organizations and
ministries of health to follow the example of their members by
facilitating coordinated medical efforts and condemning attacks on
civilians, violations of medical neutrality and other human rights
abuses.

Recommendations

As a medical and human rights organization, we do not address the
political resolution essential to ending the conflict.  We believe that
steps can be taken to protect human rights immediately.

1.  A commitment to ending violence against civilians is essential.  The
problems we document all involve violence that brings about loss of
life, restrictions on liberty, and the denial of so many other human
rights, including the human right to security.  Israel must end its use
of excessive and often lethal force in civilian areas. It must respect
all the provisions of the Geneva Conventions regarding civilian
protection.  The Palestinian Authority should not merely condemn the
bombings in Israel but also take definitive action to stop them.  The
Palestinian Authority must establish a regime of human rights for its
own citizens as well.

2.  International observers should be placed in conflict areas to
promote respect for human rights and report on violations.

3.  The Israeli Minister of Defense and Chief of Staff of the Israeli
Defense Forces should immediately take all steps necessary to assure
that the IDF complies with the requirements of the Geneva Conventions
that protect the ability of emergency medical personnel to fulfill their
medical mission, including gaining expeditious access to the sick and
wounded, transporting them, and providing emergency care to them.
Explicit protocols establishing procedures that can be executed quickly
should be established and applied in conflict zones and at existing
roadblocks and checkpoints.  Military obligations under the Geneva
Conventions and the procedures to implement them should be clearly
communicated and strictly enforced through the chain of command.  The
Israeli Defense Forces should investigate each alleged violation and
hold perpetrators accountable, through prosecution if necessary.

4.  The Israeli government must end the violations of the right to
health in Gaza and the West Bank by ending its obstructions of critical
health services.  It should work in cooperation with the International
Committee of the Red Cross, Palestinian health officials and Israeli and
Palestinian health professionals, to assure such access. We believe that
health professionals particularly can play a constructive role in
meeting health needs of the population

5. Israeli and Palestinian physicians and other health professionals
should build on the trust and collegiality they have frequently created
on the individual professional level and serve as models for the
possibility of constructive alternatives to violence. They should
advocate strongly for the protection of professional independence and
medical neutrality.
 

The PHR-USA delegation in Israel, Gaza and the West Bank includes
Leonard S. Rubenstein, JD, Executive Director of Physicians for Human
Rights (USA); H. Jack Geiger, M.D., Arthur C. Logan Professor of
Community Medicine, Emeritus, at CUNY Medical School, a founding member
and past president of PHR-USA and a founding member and past president
of Physicians for Social Responsibility; Burton J. Lee III, former
Senior Attending Physician on the Lymphoma Service of Memorial
Sloan-Kettering Cancer Center and formerly in charge of the White House
Medical Unit under President George H.W. Bush; Sheri Fink, M.D. Ph.D.,
physician who has served with International Medical Corps in the
Balkans, Russia, Central Asia and Africa; and Alan Shapiro, M.D.,
Assistant Professor of Pediatrics, Albert Einstein Medical College,
Assistant Attending Physician, Montefiore Medical Center and the
Children’s Health Fund.

The delegation has visited health facilities, physicians and health
workers in Israel, Gaza and the West Bank. We also had the benefit of
the extraordinary reporting performed by the independent colleague
organization Physicians for Human Rights-Israel,  as well as by
B’tselem, and the work of organizations working on the ground, sometimes
literally under fire, to preserve the principles of non-interference
with medical services. These include the International Committee of the
Red Cross, the Palestinian Red Crescent Society and the Union of
Palestinian Medical Relief Committees.

Physicians for Human Rights, with offices in Boston, Massachusetts and
Washington, D.C., is an organization that promotes health by protecting
human rights. PHR has investigated torture, extrajudicial executions and
disappearances, the epidemiology of landmine casualties, war crimes, and
the health aspects of other human rights abuses in more than 70 nations
around the world, including the United States. It has presented
testimony on these violations to governments and tribunals throughout
the world including the International Criminal Tribunals for Rwanda and
former Yugoslavia.  It has been investigated and reported on violations
of human rights in the Middle East since the late 1980’s, including
evaluations of allegations of excessive use of force as the second
intifada began.   In 1997, Physicians for Human Rights shared the Nobel
Peace Prize as a member of the steering committee of the International
Campaign to Ban Landmines.

For more information, visit www.phrusa.org.