What does it mean to be a doctor…?
We, a group of Australian medical professionals, have been asking ourselves this question over the last few weeks with increasing urgency. And we implore you, our colleagues, to ask yourselves this, as we watch events unfold and escalate in Gaza.
Our fellow Palestinian healthcare workers are working, living and dying in nightmarish conditions. Firsthand accounts detail doctors in Gaza pushed beyond the brink, attempting to stem the haemorrhage of critical injuries and deaths in non-functioning hospitals.
Caesarean sections and amputations are being performed without anaesthetic and morgues overflow with the dead—all while a siege and Israeli military raids are imposed on Al-Shifa and Indonesian Hospitals.
We know, better than anyone, that their efforts are near futile in a system under constant bombardment. Without electricity, fuel, clean water or telecommunications we would barely recognise our own hospitals.
As indiscriminate airstrikes by Israeli forces continue, the choices forced on our colleagues are impossible. Which premature babies, dying as the electricity powering incubators fails, can be saved? Which patient can receive treatment for severe burns, or undergo surgery for life-threatening injuries?
And how do you protect yourself from the threat of injury and death whilst fighting for the inalienable right of your patients to life? It appears you cannot. More than 200 healthcare workers have been killed in Gaza since 7 October, with over 130 attacks on healthcare centres reported.
Palestinian doctors working on the frontlines of the conflict sleep, eat and work in hospitals around the clock. Many are unable to return home, and some are sheltering with their families in the very hospitals where they work, often under threat of constant attack. As they are forced to witness the deaths of their colleagues, friends and families, they continue to work—an act both unimaginable and extraordinary.
So where does our duty of care as Australian doctors begin and end? Does it terminate at colleagues and patients we can see and touch in front of us? At our local community, or our national borders?
It is unequivocally our role to advocate for equitable healthcare delivery. The question of where and for whom doesn’t diminish this.
Health infrastructure, its workers and patients are inextricably linked to the geopolitical forces surrounding them. The impact of conflict on healthcare is not a secret. The direct casualties of violence and mass displacement are compounded by food insecurity and lack of clean water.
Infectious diseases outbreaks then ensue, as is being documented in Gaza. Fractured healthcare systems significantly affect those living with chronic diseases; treatments such as dialysis, chemotherapy and insulin that tether them to life are severely restricted or denied.
Death, poverty, malnutrition, housing destruction and significant trauma intertwine to form a catastrophe like the one we see unfolding in Gaza.
Essential health infrastructure cannot amount to collateral damage. The safety of patients and healthcare staff is not an exchangeable commodity. Their protection is enshrined in international law.
Every patient in Al-Shifa Hospital’s Intensive Care Unit has died, and Gaza’s only centre for cancer treatment has been bombed and ceased operations. These are no longer theoretical possibilities, but a horrifying reality for Palestinian healthcare workers and their patients.
We cannot ignore that healthcare facilities in the occupied Palestinian territory were being attacked long before 7 October. And we cannot pretend to be unaware that Palestinians living in the Occupied Territories already faced a disproportionately high burden of chronic disease prior to the escalation of the current conflict. Increased child and maternal mortality and reduced life expectancy are the inevitable outcomes for a colonised people living under militarised occupation.
If we know all of this, as professionals who understand the intrinsic relationship between public health and advocacy, why do we remain silent?
Many of us, in Australia and abroad, are raising our voices to ask this of our healthcare institutions, associations and professional colleges. However, we face retribution for speaking out. We have received threats and incidents of being reported to our healthcare regulator (AHPRA) merely for posting on social media about the dire humanitarian crisis unfolding in Gaza.
We have been termed ‘liars’, ‘unfit doctors’ and ‘anti-Semitic’ for expressions of sympathy for our colleagues on the frontline or of horror at the catastrophic death toll (more than 13,000) in Gaza. In medical discussion forums, we have seen the promotion of secular, medical organisations such as Médecins sans Frontières gagged, an unprecedented action and one discordant with the response to the ongoing conflict in Ukraine.
Disturbingly, even amongst our fellow doctors, we note incidents of racism and hate speech directed at our advocacy efforts. We are warned by our medical indemnity providers not to express opinions about the situation in Gaza, and reminded to behave in a ‘manner befitting our profession’.
At what point is it that we are permitted to speak—to advocate in the manner that truly is befitting this profession? Australian doctors and healthcare professionals have a long history of calling for the protection of human rights, particularly among vulnerable groups.
Our actions advocating for refugee and asylum-seeker welfare, against youth incarceration and recently for the Indigenous Voice to Parliament stand as testaments to this—and in stark contrast to the silence of many of those advocates at present. Palestinian doctors in Gaza despair that the international community has abandoned them as their healthcare system crumbles, and as they face death carrying out the same job we perform daily.
We, their colleagues and counterparts, cannot fail them now.
Our voices are rising, and our movement is gathering momentum. As we petition and rally our government to support an immediate ceasefire in Gaza, we address you, our fellow doctors. To remain silent in the face of the mounting man-made catastrophe in Gaza is to ignore the foundational tenets of medicine and healthcare.