Palestinian health issueDr.Elihu D Richter MD MPH
Ms.Tamar Pileggi

Hebrew University-Hadassah School of Public Health and Community Medicine

And Jerusalem Center for Genocide Prevention

Table of Contents:

  • Executive Summary
  • Perspective
  • The Regional Context of Operation Protective Edge
  • The Conduct of the War
  • Prior trends
  • Public Health Situation in Gaza since 1967
  • “Root Causes” of “the conflict”
  • Lessons from a thought experiment: Gaza and Hong Kong:
  • A Public Health Imperative: Implement a policy of Zero Tolerance for Incitement and Hate Language
  • Stop Hamas’ Incitement to Genocide
  • Conclusion

Executive Summary: Comments on Faculty of Public Health Interim Statement on the recent conflict in Gaza

The core values of Respect for Life and Human Dignity require Hamas to abandon its genocidal charter and explicit commitment to the destruction of Israel. Reconstruction without commitment to these values will not advance peace or public health initiatives and will lead to the more war. Our context is the widespread spread of jihadist genocidal totalitarianism in Iraq and Syria and its global reach.

In Operation Protective Edge, Israel sought to end rocket attacks directed against its civilian population. Col Richard Kemp has stated that the IDF’s conduct of the war set a new norm for ethical conduct in asymmetric warfare exceeding that of all other militaries. Anthony Reuben, the BBC’s chief statistician, wrote In Gaza, young males were overrepresented in the age sex tolls for deaths relative to the age sex distributions for the general population, a finding that disputes the claim of Israel’s indiscriminate targeting of the population at large.

Since 1967, there has been substantial improvement in all indicators of public health, medical care and professional training in Gaza, Judea and Samaria. In the past decade, as Israel increased the number of permits for entry for medical care, Hamas increased its rocket attacks. In 2013 alone, Israel treated 200,000 Gazans in its hospitals and clinics.

Lifelong exposure to incitement is the most hazardous exposure in the Mideast, and children are the most vulnerable to its effects. It produces the hate that leads to war. Without an end to public and state sponsored incitement to violence, providing more aid will not bring about regional stability. Gaza remains poor as compared to places such as Hong Kong because its energies are largely invested in the destruction of Israel and not in bettering its own well being. As public health professionals, we all must promote a policy of zero tolerance for incitement and support all measures to stop incitement, especially directed at children.

Comments on Faculty of Public Health Interim Statement on the summer war in Gaza

We are writing to comment on the draft statement of the British Public Health concerning the context, circumstances and consequences of Operation Protective Edge in Gaza.

We commend the Faculty of Public Health for recognizing that public health workers should address the causes and consequences of war, conflict, genocidal terror and genocide from the perspective of public health.


Our perspective is that there can be no moral equivalence when we examine an ongoing war between a society that reveres life over death and one that reveres death over life. In 2006-7 Israel withdrew from territory in Gaza and received more terror than before. Since then Israel has had to fight a war-for the third time since 2008, to protect itself against rocket, missile and terror attacks which are crimes against humanity.

Our commitment is to the values of life and respect for life and dignity for all remains. But without abandonment by Hamas of its genocidal charter and its terror there will be no advance towards achieving these values, and public health itself for that matter. The Interim Statement needs to make some basic revisions reflecting the regional context of the war, what happened during the war, and what needs to be done now.

The Regional Context of Operation Protective Edge

Israel’s third war to defend itself from Hamas terror must be examined within the larger context of the horrific violence, terror and genocidal massacres taking place in Syria and Iraq at the hands of jihadist and genocidal groups such as ISIS. The statement ignores the significant threats posed by ISIS’s bestiality, brutality and violence against non-Sunni Muslims, namely Christians, Yezidis, Kurds, Turkmens, and Baha’is.

The Conduct of the War

Hamas: The Interim Statement needs to call attention to the similarities between Hamas and ISIS. Hamas has been classified a terror organization by the UK and US. Both ISIS and Hamas are guided by explicitly genocidal platforms. Hamas’ explicit calls to eliminate Israel and Jews are in violation of the UN Convention on the Prevention and Punishment of Genocide. Hamas’ military campaign against Israel in direct violation the Oslo Accords. Its use of rockets and tunnels to attack civilian populations are crimes against humanity, as is its use of civilians to shield rocket launchers

Israel: Israel was forced to go to war to put a stop to thousands of rockets fired indiscriminately into Israel, targeting its civilian populations. Hamas’ terror attacks on Israeli busses and markets go back to the post Oslo period in the 1990’s The war led to the discovery of many underground tunnels dug from Gaza into Israel, that were intended to be used for terror attacks directed against civilians. Col Richard Kemp, retired commander of the British Forces in Afghanistan, stated that the IDF’s conduct of the war set a new norm for ethical conduct in the complex conditions of asymmetric warfare, exceeding that of all other militaries.[1] The evidence of Israel’s concern for safety of civilians included: the IDF’s advanced warnings of upcoming attacks to Gaza’s civilians by text messages and leaflets together with its careful use of precision bombing.

Israel: Intent, Distinction and Proportionality: The Epidemiologic Evidence

Anthony Reuben, the BBC’s chief statistician, wrote that in Gaza, young males were overrepresented in the age/sex categories for deaths relative to the age/sex distributions for the general population.[2] Reuben notes that this finding would appear to argue against the accusations that the IDF military strikes in Gaza indiscriminately targeted the population at large. But Reuben’s work requires follow-up to verify the accuracy and reliability of the Hamas database of those killed and injured with respect to numbers, classification by age and sex, combatant status, and injury circumstances. During Operation Protective Edge (as was the case with Operation Cast Lead), Hamas misclassified many combatants as civilians, and other groups classified many young adults as children or youths. Reports coming out of Gaza included more than 100 persons it reportedly executed as victims of Israeli attacks and still more victims of Hamas rockets misfiring and landing in settled areas or hospitals. We note that the credibility of the reports of human rights groups listed in the Document has been undermined by the lack of rigor in their past investigations of the most recent war with Hamas and during the 2008 Operation Cast Lead.[3] The burden of proof is on these organizations to verify their accuracy, reliability and lack of bias.

Prior trends: Public Health Situation in Gaza since 1967

There has been a substantial improvement in public health as well medical care and training in Gaza, Judea and Samaria since 1967 until 1994 when the Palestine Liberation Organization took over. Public health and per capita income improved under Israeli occupation, as Gaza’s work forces and earnings were tied to the Israeli economy. Israel made investments in water infrastructure, provided immunizations and developed hospital infrastructure.

It is worth noting that in 2013 the American Public Association Executive Council (N=300 members) rejected, by a 74 to 25 percent margin, a resolution attributing the problems in Gaza, Judea and Samaria to Israeli occupation and recommending disinvestment, after reviewing the evidence.[4]

In a 2013 letter to the American Public Health Association Joint Policy Committee Cherly and Richard Berensen wrote “We have carried out an in-depth analysis of the health and economic conditions among Palestinian refugees including those living not only in Gaza, Jerusalem, Judea and Samaria but those in the other countries housing Palestinian refugees: including Lebanon, Jordan, and Syria. What is clear from the data is that poverty, poor health, and lack of healthcare services are common to Palestinian refugees in all of these countries. There are more similarities than differences in the status of Palestinian refugees in these countries/regions, and those differences that do exist show no consistent trend between Palestinian refugees in Gaza, Jerusalem, Judea and Samaria, compared to refugees in other countries.”

More Medical Care from Israel, More Terror Rocket Attacks from Hamas:

In the years prior to Operation Cast Lead, Israel increased the number permits for entry for medical care Hamas was increasing its rocket attacks. In 2013 Israel treated 200,000 Gazans in its hospitals and clinics. Throughout the war, Israel was sending large convoys of trucks to Gaza carrying basic necessities, and admitting Gazans to a hospital set up at the border. But Hamas blocked access to these hospitals.


“Root causes” of “the conflict”

The term “root causes”, as used in the Document implies that more economic aid is essential to alleviating the “conflict”.

Empirical evidence suggests that that the opposite may be closer to the truth. [5] Gazans are healthier than ever before, with lower infant mortality rates. Better nutrition on growth and development, and lower blood lead Levels, but Gaza is more violent than ever under the Hamas leadership, which has squandered aid in the pursuit of war, terror and violence.

Lessons from a thought experiment: Gaza and Hong Kong:

Why does Gaza continue to be Gaza, and not become another Hong Kong? And why does


[1] Somfalvi, A. (2014, July 24). ‘IDF does more than any other army to prevent civilian deaths’Ynet. Retrieved September 15, 2014, from,7340,L-4548821,00.html

[2] Reuben, A. (2014, August 11). Caution needed with Gaza casualty figures. BBC News. Retrieved September 15, 2014, from

[3] Richter, E., & Stein, Y. (2009, January 1). Comments on B’tselem’s Civilian Casualty Estimates in Operation Cast Lead. Retrieved September 15, 2014, from

[4] Siegel-Itzkovich, J. (2013, November 10). Pro-Israeli activists defeat anti-Israel resolution on Palestinian health issues. Jerusalem Post. Retrieved September 15, 2014, from

[5] Stotsky, S. (2008). Does Foreign Aid Fuel Palestinian Violence? Middle East Quarterly,XV Number: 3(Summer 2008), 23-30.


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