News  Emergency in Gaza

War doctor Mads Gilbert discusses the politics of health in the Occupied Territories

Mads Gilbert and Erik Fosse became the eyes of the world in Gaza during Operation Cast Lead, the Israeli invasion of December 2008. As the only two foreign doctors in Gaza when the fighting broke out, Gilbert and Fosse reported to CNN, Al-Jazeera, ABC, BBC, and CBS from outside al-Shifa hospital where they worked, allowing the world to see the conflict through the eyes of those affected.

Gilbert spoke to students Friday night at an event hosted by the McGill chapter of Solidarity for Palestinian Human Rights. Gilbert described the interwoven nature of politics and medicine, and his belief that health is the most important foreign policy issue of our time. Gilbert’s political opinions stand out in a profession where neutrality is often the expected norm. But in his view, to be neutral would be tantamount to complicity – putting his patients in further danger. He has argued that the wall separating Gaza from Israel is a dividing line between those who have the right to health care and those who do not, and that pushing for an end to violence and the blockade of Gaza is just “good preventative medicine.”

McGill Daily: Can you describe the scene at al-Shifa hospital once the first casualties started to arrive when the bombing began last year?
Mads Gilbert: We were coming at New Years Eve, and at that time the damage from the bombing had been going on for days already, and we knew the first day, December 27, had been a complete nightmare with many injured going to the hospital…. The bombing of the al-Shifa mosque nearby had shattered all the windows in the surgical block. They were lacking everything and the patients kept pouring in, in waves, up to three, four, five hundred per day.

It was a huge trauma, very painful trauma for us. I really can’t fully understand what kind of trauma it was for our colleagues. They had all their own people coming in, so devastated, so torn apart. But they had their own family members too, friends, neighbours, working colleagues killed, paramedics. I had the deepest respect for their courage and persistence….I don’t think many Western hospitals – my hospital – would have prevailed [through] three weeks of this enormous flow of victims coming in, and lacking so much equipment and capacity.

MD: How were people getting to the hospital? Were ambulances and emergency vehicles able to move freely?
MG: No, ambulances were being shot at. They were not able to move freely. People were carrying children in arms, in private cars, any transport that was available. Often the injured could not [be brought in] because Israel was attacking the ambulances. It was complete chaos. It was mayhem, I would say, outside the entrance to al-Shifa. There were stretches of quiet…but we never knew if they would bomb or attack the hospital. They did bomb hospitals, the al-Quds hospital.

MD: Did you treat individuals who were victims of the use of unconventional weapons? What are their noticeable effects?
MG: We were treating people who we think were victims of new weapons. The first time they were used was in Lebanon in 2006 – DIME weapons – dense inert metal explosives. They are a new generation of bombs that are highly explosive, very short range of action. But if you are in the range of action you are torn apart. A fair amount of children sustained these injuries, and it completely ripped off their arms and legs. Some of the adults could survive it with amputations.

MD: There have been claims about Israel using white phosphorous gas, which results in severe chemical burns. Did you deal with any of these casualties?
MG: I didn’t see any myself, but there were casualties. But phosphorous grenades are not illegal and can be used as smokescreens under international law, although they should not be used against civilian targets. I think all the focus on phosphorous bombs is a little bit ill-informed, and not the main issue.

The most important weapon that Israel is using, and has used against the Palestinians, is the siege of Gaza – that is illegal, against international law, and needs to be lifted immediately. As we are speaking, Israelis are still sieging Gaza, and it is a huge blockade. No building material is coming in, no food, cement, schoolbooks, pencils – security for the people.

MD: What effect has the siege had on the medical infrastructure in Gaza, before and after the war?
MG: First of all, it has caused a very severe and worrisome decline in the health condition of Gaza, stunting amongst children, malnutrition, anemia, and a general exhaustion. People are exhausted, the lack of freedom to move around…. The fundamental condition of health has been weakened by the years of siege…. The hospital health care is deficient of important supplies, maintenance, spare parts, which makes it difficult to work as a doctor and nurse.

MD: Do you believe that medicine and politics can be separated?
MG: As a medical doctor it is my duty to see the world from the angle of my patients and to try to safeguard their fundamental needs for health…. If the first provisions are not in place, then as a doctor I have to talk about their living conditions so that they can change. It goes without saying that if you have unsafe water in Montreal, the general surgeon has to talk to the government, and that is a political process.

All the patients who came in came in because of Israeli bombings. That was the main medical problem. It was not lack of materials, a lack of doctors. It was the ongoing destruction of human life, at the hands of the Israeli government and army…. Bear in mind that 13 Israelis were killed, whereas 1,400 Palestinians were killed. That is 13, and 1,400 too many.

[The] power distribution in society, the distribution of access to health care, human security, all these aspects of life are political aspects. I think the medical community has a responsibility to take part in the decisions that affect the power distribution, and the distribution of wealth, access to fundamental provisions needed for a good life.

So I think politics and medicine are interwoven and that health is currently the most important foreign policy issue of our time.

MD: Why did you feel it was important to report what you were witnessing as a medical professional?
MG: We had to tell the world what was going on in order to stop that, so as to safeguard the safety and living conditions of our patients, and we did what any doctor has the obligation to do: to be a spokesperson for the voiceless, to be a defender of the patients’ interests, and that is an outstanding tradition, and we did our best to inform the leaders of the world, so that they could see what was going on. Unfortunately they didn’t act, but we are convinced to this day that it was right of us to talk about this.

MD: You have been criticized by the Israeli government, among others, for providing one-sided criticism while concealing your political stance. Should people see you as an objective, third party observer?
MG: Yes, we are being criticized by the Israeli government and by the Zionist lobby for being liars and what not, and that is an interesting illustration that medicine is indeed political.

The doctor and the medical community should be concerned with prevention, with changing fundamentally the conditions for health that will only treat the patient. If we were to only stand there and patch up people and stop the bleeding, and not say anything about the causative factors, we would betray our patients. So it was our duty to speak, our duty to tell the world, why all these patients, why all these children were coming in and were dying, were so injured. It was not an earthquake, not a natural disaster; it was a deliberate man-made disaster, planned meticulously, and executed by the state of Israel.

Nobody is neutral, really. While we have chosen sides with the Palestinian people, that does not mean that we won’t treat an Israeli soldier coming to al-Shifa. At the individual level we will always be neutral. But at the system level we went to Gaza…because we think the Palestinian people have a just cause, that they are being occupied and that that is unjust, simple as that.

What is the difference between me and Erik, and the Israeli doctors working in the army? They have chosen sides in their government, and for the oppressor, and for the occupant, and well, that is their decision. But it is a political decision too. Why should only we be criticized of being one-sided? Where are the discussions about the duties and the responsibility of the Israeli medical associations, Israeli medical community, of all the Israeli doctors who joined the army? Where is that discussion; where is the discussion about their medical ethics?
All that happened in Gaza could have been prevented if the world had not kept silent, if the American administration did not keep silence, if the world had not keep silent, but told Israel to stop it, stop it, stop it. You have to come to the negotiation table, we have to find a solution, you can not kill all these civilians – period.