Meena Hasan
Every morning for over three weeks, since the attacks on Gaza started, I have been waking up with a deep sense of dread about what I will see on my phone screen. This past summer, I was a public health student in the occupied West Bank on a Harvard University-sponsored programme. My classmates, many of them Palestinians from Gaza, had set up a WhatsApp group for us to arrange transport to the university or make plans for after-class meet ups.
Now, that WhatsApp group serves a much different purpose. Every night my former classmates share updates about their situation. “They’re bombing our neighbourhood, our home was destroyed.” “We’re okay but the lack of food and water is a real problem.” “They flattened the bakery.” “The hospitals have no fuel to keep operating.” Their messages fill me with intense, at times contradictory feelings. Every morning, I feel relieved to see their names on my phone – to confirm that they are still alive. But I also despair at reading about the new calamities they suffered while I slept. Reading these messages describing Gaza’s desperate situation also deepen my disappointment in and frustration towards medical and public health institutions in the United States. The programme I attended in the West Bank this summer was aimed at exposing students to the social and structural factors that ultimately determine Palestinian health. During the course, we learned how the health of Palestinians is deeply intertwined and impacted by the illegal military occupation of their lands. Water, food security, access to green spaces, employment, education, violence, housing, healthcare quality – all of these and more are impacted by the Israeli occupation and contribute to significant disparities in health outcomes for the Palestinian people. The World Health Organization has also said social determinants of health like these account for up to 55 percent of the health outcomes for populations. Contributing factors from non-health sectors can exceed those from within the health sector in terms of their impact on health outcomes.
During my studies at the Harvard TH Chan School of Public Health, I came to realise how fundamental understanding – and addressing – these issues is to our discipline. As a physician, I know that when these external factors are not addressed, I am stifled in my capacity to care for my patients to help them get healthier, no matter how extensively trained I am in medicine.
This is why as I receive message after message from my friends in Gaza about the siege, about the lack of electricity, water, fuel, and medical supplies, about the many attacks on health facilities and medical personnel, I cannot help but be disheartened by the deafening silence of our public health institutions on the issue.
In Gaza today, every single socioeconomic and structural determinant of health including water, food, sanitation, access to medical care, and housing is being intentionally undermined by Israel. Yet most medical and public health institutions do not seem to have much to say about the unprecedented humanitarian catastrophe.
In Gaza, healthcare settings are being targeted in violation of international law. Healthcare staff, emergency medical responders, in fact, the entire healthcare system of the strip is under total siege. Doctors are performing surgeries by mobile phone light. Hospitals are running out of burn dressings. Medical providers don’t have what they need to provide even the most basic level of care. Doctors, nurses, other healthcare workers, and medical students, have been killed and maimed. As someone educated in public health and working as a physician, I know well that the death and destruction we are witnessing in Gaza today will cause further health challenges tomorrow. Lack of sanitation will lead to the rapid spread of many infectious diseases. Many will develop respiratory conditions from explosive pollution and white phosphorus fumes. Some of those who survive the war will suffer from severe psychological trauma, and countless other medical problems, for many years to come.
To be clear, the crisis within Palestinian healthcare did not start with this latest escalation. When I visited a community centre in a West Bank refugee camp this past summer, I saw many patients with chronic respiratory issues, linked to the frequent tear gas used by the Israeli military in their community. Palestinians, like many Indigenous people, also already face higher rates of chronic diseases including diabetes and respiratory conditions than non-indigenous populations. After Israel’s war on Gaza, management of these existing diseases will be much more difficult for many Palestinians. In Gaza and the occupied West Bank, a public health catastrophe of unprecedented proportions is happening right now. And yet, our medical and public health institutions are remaining silent.
If these institutions, including medical schools training the next generation of health professionals, continue to advocate for and teach the importance of social justice, appropriate crisis response, and addressing the social determinants of health, then they must speak up against the genocide unfolding before our eyes in Gaza. They must condemn the attacks on healthcare workers and infrastructure in Gaza and demand an end to the collective punishment of a besieged population. To be silent now when advocacy and public opinion can sway the course of this disaster is a dereliction of our duty to uphold public health and medical principles, particularly in a health crisis.
Those of us speaking out have been met with efforts to silence, suppress, bully and accusations of antisemitism. Students at Harvard and universities across the US are fearful for their jobs and personal safety merely for speaking out against the unfolding atrocities in Gaza. Rather than creating a hostile atmosphere where health practitioners feel afraid to call out Israel’s collective punishment of the people of Gaza, our institutions should support us in upholding our commitment to the common good. Medical professionals and public health leaders have a responsibility to advocate for the health of all and address the systems and structures that cause unjust health inequities between people. We cannot stay silent while a genocidal campaign and an illegal blockade of resources continue in Gaza, knowing that this will undermine the health of the Palestinian people for generations to come. We cannot stow away in the ivory towers of academia or hide behind the bureaucracy of our public health institutions. We need to collectively take a stand for the people of Palestine and demand their right to health. It is hypocritical of people with medical and public health training to ignore what is happening.
Now is the time for our medical and public health institutions to be firm and advocate to stop civilian casualties and end the blockade on Gaza. Support students and faculty who are doing the same. This is part of our duty, our ethos, and our jobs.
