The essays in this series were written during the summer of 2024, and may not fully address rapidly escalating violence in the region.

The provision of medical care to people under attack is a central part of the humanitarian response to war. Equally important to many of the providers of this care, and to their patients, is providing testimony about what they have witnessed. When doctors’ ability to provide adequate medical care is constrained, the importance of their witness role looms even larger.

The many healthcare workers who have gone to Gaza during the current war, many of whom have gone repeatedly, feel this double imperative. With international access severely limited, and Palestinian testimony regularly discounted, the presence of foreign medical personnel has been an important conduit for reporting. Even as doctors go back, and even as they continue to speak about what they have seen, international attention and international institutions have failed to bring an end to the massive destruction—of lives, of homes, of cultural and educational institutions. When neither care nor testimony are able to accomplish their aims, medical personnel, and indeed all of us, are forced to confront the question of whether humanitarianism is possible in genocidal times.

These questions are not new, nor limited to Gaza. They have recurred across the geography of Palestinian dispersal and throughout the decades of what Palestinians describe as an ongoing nakba (catastrophe). As in Gaza now, in Lebanon in 1982 foreign doctors and nurses saw medical care as an expression of solidarity. Then, as now, they faced extreme limits in their ability to provide either. For medical personnel gaining access to treat people is and was difficult, getting access to medical supplies even more so. Whatever limited treatment can be offered to wounded people is and was often undone by a next attack. And hospitals, meant to be protected spaces, are and were regularly threatened and attacked.

Doctors and nurses who had gone to Lebanon to work in the hospitals and clinics of the Palestine Red Crescent Society (PRCS) were witnesses to Israel’s June 1982 invasion of Lebanon, and to the Israeli-permitted massacre of Palestinians in the Sabra and Shatila refugee camps in Beirut in September of that same year. After their eventual evacuation from Lebanon, medical personnel gave chilling testimony about what they witnessed, including targeting of hospitals, devastating injuries caused by cluster bombs, and wounded people buried under rubble. Chris Giannou, a Canadian surgeon who worked for the PRCS in Lebanon, described his mission to “inform people of what has occurred and the lack of respect for the Geneva Conventions.” What do such testimonies—then and now—reveal about humanitarian possibility and impossibility?

Medical workers who have gone to Gaza, and returned to Gaza, during the current conflagration, have also tried to use their testimony to call attention to Israeli violations of international law. At a panel convened in June 2024, Tanya Haj Hassan, a pediatrician who has been providing care and training in Gaza for more than a decade, emphasized that in Gaza the humanitarian space is not simply shrinking (as has been observed in many conflicts around the world) it has been completely eviscerated. She pointed out that medical providers are not only being denied the protections that are due to them under the Geneva Conventions, but they are also being directly targeted. According to testimony by Gazan doctors, their medical garb—one of the “distinctive signs” that the Conventions envision to aid in protection—is exposing them to attack and detention. In these conditions, Dr. Haj Hassan said, “anything that you try and achieve as a physician or humanitarian worker is nullified, seconds later, when you have a genocidal campaign against a population.”

Can there be effective care, or effective solidarity, in such circumstances? Ellen Siegel, an American nurse working in the Gaza Hospital (the largest PRCS facility) in Sabra camp during the 1982 massacre, described how, as the killing unfolded, the thousands of refugees who had been sheltering at the hospital, hoping that its status would offer some protection, fled in a seeming instant. Gaza Hospital was not safe, as Gaza’s hospitals are not safe. Ang Swee Chai, an orthopedic surgeon who also worked in Gaza Hospital (and later in the Gaza Strip), recounted emerging from the hospital to encounter the destruction of the camp—“the bodies, the smashed homes, the rubble, the terror in everyone’s faces.” And, she realized, while they had been trying to “save a handful of people in the operating theaters of Gaza Hospital, the camp folks had been dying by the thousands outside.”

What is the meaning of medical treatment amidst a massacre? Even as they grapple with the implications of this question, medical workers feel an imperative to continue to attempt to provide care. This care is inextricably entangled with the crimes that make it necessary.

As significant as international medical presence was and is, in Lebanon and in Gaza, Palestinian doctors and nurses have remained the backbone of the healthcare sector under assault. Testimonies of international personnel, practicing in Beirut and Gaza, describe working alongside Palestinian colleagues, who have suffered enormously and worked heroically. Feroze Sidhwa called attention to the desperate conditions under which Gaza’s medical providers work. Like most people in Gaza, many have been displaced and have lost family members. And many repeatedly receive threatening texts from the Israeli military, warning them that what has happened to their colleagues in places like Shifa Hospital could happen to them.

The crumbling of the architecture of international humanitarian law and international humanitarian aid in Gaza today poses enormous questions about the future of this arena. Yipeng Ge, a primary care physician who has traveled to Gaza during this war, detailed the enormous, and increasing, barriers to access for medical personnel and, even more, supplies.

If doctors can enter, albeit with considerable difficulty, but they cannot bring or access what they need to treat people, what does their presence do? If their harrowing reports of the violence being inflicted on people in Gaza do not seem able to effect change, what does their testimony mean? These questions have no ethically comfortable answers.

Postscript

In October 2024, Israel barred six international medical NGOs whose personnel have been providing vital care to Palestinians from entering Gaza.