BMA position: Israel-Gaza conflict

The BMA is profoundly concerned by the humanitarian and healthcare implications of the Israel-Gaza conflict. Find out more about our concerns and asks.
Location: International
Audience: All doctors
Updated: Friday 19 January 2024
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Introduction

The BMA is deeply concerned about the unfolding Israel-Gaza conflict which has already led to thousands of civilian deaths (1). Our thoughts are with all those affected.

The BMA consistently and impartially defends humanitarian values and health rights throughout the world. Information about our previous human rights work and protocols for engagement on such issues can be found on our human rights webpage.

We are alarmed by the lack of respect for international humanitarian law currently being shown in the conflict and its impact on the provision of healthcare. This is contributing to more death and tragedy.

This page explains the BMA’s main concerns relating to the conflict and international humanitarian law and the impacts on healthcare provision resulting from the conflict. We also set out a series of asks that we strongly urge governments and medical organisations to act on.

The page then considers the knock-on impacts of the conflict on doctors and medical students in the UK, particularly those from certain minority communities, before pointing doctors and medical students to resources if they are at all affected by the crisis.

This page may be updated as the situation develops. The BMA’s focus on such matters is, as always, on the realisation of universal health and human rights.

 

International humanitarian law

Targeting of civilians

Non-combatants should never be targeted during times of conflict. As stated in the First Geneva Convention:

  • Article 3 — In the case of armed conflict not of an international character occurring in the territory of one of the High Contracting Parties, each Party to the conflict shall be bound to apply, as a minimum, the following provisions:
  1. Persons taking no active part in the hostilities, including members of armed forces who have laid down their arms and those placed hors de combat by sickness, wounds, detention, or any other cause, shall in all circumstances be treated humanely, without any adverse distinction founded on race, colour, religion or faith, sex, birth or wealth, or any other similar criteria. To this end, the following acts are and shall remain prohibited at any time and in any place whatsoever with respect to the above-mentioned persons: a) violence to life and person, in particular murder of all kinds, mutilation, cruel treatment and torture;

The Hamas attack on civilians in Israel represents a gross violation of international humanitarian law and has led to 1,400 deaths so far. We unreservedly denounce this action.

 

Hostages

The taking of hostages is clearly unacceptable under international humanitarian law. As stated in the Fourth Geneva Convention:

  • Article 34 – The taking of hostages is prohibited.

The BMA is therefore deeply concerned by Hamas’s abduction of approximately 200 civilians from Israel. Under article 147 of the Fourth Geneva Convention, the taking of hostages is recognised as a grave breach of the conventions.

 

Protection of medical facilities, personnel, and patients

International humanitarian law makes clear that hospitals, healthcare staff, and the sick are accorded specific protection during times of conflict. As stated in the Fourth Geneva Convention:

  • Article 16 - The wounded and sick, as well as the infirm, and expectant mothers, shall be the object of particular protection and respect.
  • Article 17 - The Parties to the conflict shall endeavour to conclude local agreements for the removal from besieged or encircled areas, of wounded, sick, infirm, and aged persons, children and maternity cases, and for the passage of ministers of all religions, medical personnel and medical equipment on their way to such areas.
  • Article 18 - Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack, but shall at all times be respected and protected by the Parties to the conflict.

In situations in which belligerents are concerned that civilian hospitals are being used for acts harmful to them, they may nevertheless only cease protection once due warning has been given to the occupants of the facility in question (see Article 19, GC IV).

The BMA is alarmed by reports of attacks on medical facilities and healthcare staff. The killing of healthcare staff and patients is utterly inexcusable.

 

Transportation and ensuring of sufficient medical supplies and food

International humanitarian law recognises that the transport of essential supplies for civilians should not be impeded during times of conflict. The Fourth Geneva Convention states:

  • Article 23 — Each High Contracting Party shall allow the free passage of all consignments of medical and hospital stores and objects necessary for religious worship intended only for civilians of another High Contracting Party, even if the latter is its adversary. It shall likewise permit the free passage of all consignments of essential foodstuffs, clothing and tonics intended for children under fifteen, expectant mothers and maternity cases.
  • Article 55 — To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring the food and medical supplies of the population; it should, in particular, bring in the necessary foodstuffs, medical stores and other articles if the resources of the occupied territory are inadequate.
  • Article 56 — To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring and maintaining, with the co-operation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory, with particular reference to the adoption and application of the prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics. Medical personnel of all categories shall be allowed to carry out their duties.
  • Article 59 — If the whole or part of the population of an occupied territory is inadequately supplied, the Occupying Power shall agree to relief schemes on behalf of the said population, and shall facilitate them by all the means at its disposal.

It is highly likely that the Israeli siege of Gaza constitutes a breach of the Geneva Conventions. The denial of access to food, medical supplies, electricity, and fuel is having a profoundly harmful impact on civilians in Gaza and contributing to their unacceptable deaths.

 

Collective punishment

Collective punishment is strictly prohibited under the Fourth Geneva Convention:

  • Article 33 — No protected person may be punished for an offence he or she has not personally committed. Collective penalties and likewise all measures of intimidation or of terrorism are prohibited. Pillage is prohibited. Reprisals against protected persons and their property are prohibited.

Like many organisations, the BMA is concerned the Israeli state’s action in Gaza is likely to constitute collective punishment, noting the denial of access to basic supplies. We strongly condemn any form of collective punishment.

 

Healthcare for detainees

It is expected under international humanitarian law that belligerents in conflict should provide healthcare for those they detain. For example, the Third Geneva Convention states:

  • Article 15 – The Power detaining prisoners of war shall be bound to provide free of charge for their maintenance and for the medical attention required by their state of health.

The BMA therefore condemns the Israeli Ministry of Health’s instruction to Israeli public hospitals to refuse to give medical care to injured Palestinians detained by the Israeli authorities (2). Medical care must be provided equally as per the principle of medical impartiality. This places an unacceptable conflict of conscience to doctors in Israel whose professional duty is to treat all patients equally and impartially. Furthermore, if Hamas persist in holding hostages (though this is clearly prohibited under international humanitarian law) then they must ensure the healthcare of those it keeps captive.

 

Human shields

The term ‘human shield’ as used in international humanitarian law means a civilian placed in front of a military objective so that their civilian status will deter the enemy from attacking that objective. It is forbidden, as stated the in Fourth Geneva Convention:

  • Article 28 – The presence of a protected person may not be used to render certain points or areas immune from military operations.

The BMA is concerned by reports that human shields are being used in this conflict and strongly condemns this.

 

Conflict and siege - implications for healthcare provision

Israel’s military action in Gaza has placed unprecedented pressure on an already fragile and under-resourced healthcare system that has been grappling with a 15 year-long blockade. The denial of essentials such as water, electricity, and medical supplies, coupled with damage from airstrikes and high numbers of casualties and fatalities threaten to shut down the remaining operational hospitals. The World Health Organization (WHO) has described hospitals as standing on the ‘brink of collapse’.

Healthcare professionals are facing exceptionally challenging working circumstances. The provision of timely and quality care to the injured is seriously constrained by the lack of access to essential commodities, ongoing insecurity, and increased demand for health services. At the same time, attacks on healthcare and the displacement of healthcare professionals have exacerbated shortages of staff and specialised personnel.

Routine healthcare delivery has been brought to a standstill. Not accounting for casualties and fatalities in the context of violence, morbidity and mortality rates in Gaza are expected to rise due to restricted access to essential healthcare. Continuity of care will be disrupted for many, including the elderly, who suffer from chronic illnesses. Up to 9,000 cancer patients in Gaza are facing delays in their chemotherapy treatment or missing out on appointments altogether. Approximately 50,000 pregnant women lack access to essential health services, with 5,500 expected to give birth in the coming month. Deaths will increase due to shortages of critical life-saving medications, including insulin.

The impact of conflict on the spread of communicable disease is well-established. Organisations, including the UN, have warned of an imminent infectious disease outbreak, such as cholera, due to the disruption of water and inadequate sanitation infrastructure. Overcrowding of clinics and hospitals, and the inability to safely store bodies in morgues, are also associated with an increased risk of transmission of infectious diseases.

The WHO has condemned the recurrent orders to evacuate hospitals treating thousands of patients in northern Gaza, on grounds that it will significantly worsen the ongoing humanitarian and public health crisis. There are serious risks for critically ill patients, including those on respiratory support machines, haemodialysis, and newborns including premature babies in incubators, if they are relocated and denied care during evacuations. There are also significant concerns around transferring thousands of patients to health facilities in southern Gaza which are operating at full capacity and unable to admit an influx of patients.

The establishment of a humanitarian corridor will help mitigate some of the challenges linked to shortages of medicines and supplies, particularly for those requiring urgent medical attention, continuity of care, and for infectious disease management. The restoration of supplies will improve doctors’ ability to do their job safely and effectively. Like other organisations, such as the UN and Amnesty International, we also consider Israel’s forced evacuation order impossible to implement in such a short period of time, and strongly oppose these demands on medical humanitarian grounds.

In both Israel and Gaza, the horrific events unfolding are likely to create psychological trauma in survivors. This is likely to have short and long-term serious consequences for those affected.

 

BMA asks

1. An immediate ceasefire

A ceasefire is essential to ensure humanitarian needs are met, medical supplies can be delivered, and non-combatants can leave the areas under threat if they so wish.

2. Respect for international humanitarian law

There has been a terrible disregard for international humanitarian law during this recent conflict. We strongly urge all sides to recognise and abide by these principles.

3. The immediate release of all hostages

It is unacceptable for hostages to be taken during a conflict. Hamas must return the 200 hostages without delay.

4. Resumption of supplies and resources entering Gaza

Food, water, electricity, fuel, and medical supplies are not bargaining chips but essentials. Israel must allow Gazans to access these basic needs.

5. Respect for medical impartiality and neutrality

Doctors, other healthcare professionals, patients, and medical facilities are protected under international humanitarian law. All parties must respect this, not target such individuals and facilities, and make all reasonable efforts to ensure that there is no accidental damage to them. Furthermore, doctors must not be placed in a position where there are unable to care for patients equally and impartially.

6. The establishment of a humanitarian corridor

It is vital a humanitarian corridor is established to ensure necessary supplies reach Gaza. We welcome the news that the aid convoys are now reaching Gaza. However, what has arrived so far is insufficient. It is highly concerning the UN's agency for Palestinian refugees described Gaza a ‘hellhole’ for civilians; time is running out to get aid into the territory.

7. Governments of the world to work together to ensure humanitarian needs are met

We ask governments of the world to recognise these asks, which have been reinforced globally, and work with all parties concerned to ensure this is achieved.

 

Impact on doctors and medical students in the UK

The UK medical workforce is incredibly diverse, and many doctors and medical student working and studying in the UK have close ties to people directly impacted by the conflict, including those who have been killed.

Global conflict has the capacity to impact us all, and we urge everyone to be considerate of this and act thoughtfully when engaging with others. We advocate for equality for doctors, and we know a workplace culture that is caring, supportive and collaborative is paramount to ensuring fair outcomes for everyone in the health sector. It is important to recognise that for our members, identity and professionalism extends beyond the workplace and into wider society, and we have seen the impact of this conflict in all parts of a doctor’s life, including personal interactions and the presence on social media.

In times of conflict, issues of discrimination or harassment of individuals or groups based on race, religion, ancestry, place of origin, ethnic origin, nationality, or any other identity can be exacerbated. We know that there has been a recent increase in antisemitism and islamophobia. There is no place for antisemitism and islamophobia in our NHS and society. Islamophobia, antisemitism and racial discrimination harms people and harms communities. We empathise with the negative impact these events are having on our members. There is a genuine fear of attack within Jewish and Muslim communities in the UK. This is an awful position to be in and we ask everyone to be cognisant and culturally aware at this especially difficult time. Hate in all forms is intolerable and has no place in our society. If you face discrimination or harassment at work, the BMA can provide support in the workplace.

 

Resources for doctors and medical students in the UK

The BMA has a free 24-hour wellbeing service, available to all doctors and medical students and their dependants in the UK.

If members would like to donate towards aid in the region, they can do so via the British Red Cross.

We urge any doctor and medical student wishing to travel to Gaza or Israel to offer assistance to do so having arranged it through the appropriate established channels, such as Médecins Sans Frontières. There is an extremely high risk to their own safety and any unarranged arrivals of medics could be doing more harm than good.

 

Factual note

Hamas is a proscribed terrorist organisation by the British Government.

Addenda

(1) The BMA acknowledges the conflict has now spread to the West Bank. We are equally concerned by the loss of life here and the damage to medical facilities.

(2) The BMA acknowledges these patients were later transferred to secure Israeli medical facilities to receive treatment.