In response to:

Palestinians: The Crisis in Medical Care from the March 15, 2007 issue

To the Editors:

I was extremely amazed and disappointed to read such a hostile anti-Israeli article published in The New York Review of March 15, on the item “Palestinians: The Crisis in Medical Care,” which presents a distorted picture without trying to describe the objective situation.

Since the transfer of authorities and responsibilities to the Palestinians in December 1994, the Palestinian Authority has been independently ruling the civilian life of the Palestinian population including the health and medical services. Along all the years Israel has been continuing and still continues to provide the needed complementary medical care and hospitalizations for Palestinian patients in Israeli hospitals. Physicians, nurses, and paramedical workers have been continuously trained in Israel until this very moment. Medicines and medical equipment donated to the Palestinians by countries and organizations are sent to Israel and the Israeli authorities are directing the transports to the Palestinian authorities in the areas of Gaza and the West Bank (the Palestinians persistently reject Israeli offers to assist with medicine supplies).

The bilateral cooperation on the above-mentioned items has been continuing despite the hostile attitude of the Palestinians who opened the second intifada in September 2000 and in spite of the arbitrary decision of the Palestinian Health Authority to freeze official relations with the Israel Ministry of Health and to stop the function of the Palestinian-Israeli joint committees in various fields of health and medicine.

The Palestinians, regrettably, have chosen the way of terrorism against the civilian Israeli population, killing innocent citizens. Palestinian suicide bombers have penetrated Israeli cities and assassinated children, women, and old people. Palestinian terrorism leaders proved to be evil without borders by using even children, girls, and women as carriers of explosives.

Understandably, checkpoints are essential for protection of Israeli lives. Military interventions are needed on specific occasions for disaster prevention. The separation fence is expected to provide more security to the Israeli citizens and proper measures are being taken for avoiding obstacles to normal life of Palestinian inhabitants.

After the disengagement from Gaza in 2005 the Palestinians have been continuing with their terror activities and have begun firing Qassam rockets over Israeli territory. Israeli military forces were obliged to enter the Gaza area for reaction against terror units located in towns and villages, in houses of Palestinian inhabitants, near schools, and near hospitals. The Israeli forces tried their best not to harm innocent people, but despite all efforts, errors sometimes occurred that regrettably caused loss of lives. Such cases are inevitable during fights against terror troops.

If there is deterioration in the quality of the Palestinian health and medical system, the Palestinian Authority is to be accused because instead of investing the needed budgets for maintaining and keeping satisfactory health services, their financial resources are channeled for purchase of ammunition, training of terrorists, and scaling up the terrorism performance. Israel persistently behaves in a humanitarian manner by encouraging and enabling NGOs and various international organizations to provide assistance to the Palestinians.

As mentioned above, Israel continues to provide medical care to Palestinians and during the last year about 20,000 patients have been hospitalized in Israeli hospitals and about 40,000 patients have used ambulatory services in Israel, for clinical consultation and treatment as well as for laboratory tests. During the last year, around fifty Palestinian physicians and some nurses and laboratory technicians underwent training programs in Israel.

In view of the avian influenza outbreak, cooperation between Palestinian and Israeli public health experts could be performed under the umbrella of an international organization. The conclusion is that whatever is the political situation, and irrespective of the Palestinian terrorism against Israel, the humanitarian attitude of Israel dominates in all fields and aspects of health and medicine.

Yair Amikam
Deputy Director-General
Information and International Relations
Ministry of Health
State of Israel

Richard Horton replies:

I am grateful to Mr. Amikam for giving me an opportunity to sharpen the case for urgent international attention toward Palestinian health.

Perhaps I can begin by updating readers with the results of recent surveys of the region. The United Nations World Food Program, for example, reported earlier this year that “the humanitarian situation in the occupied Palestinian territory is grave.” Access to affordable and nutritious food remains “a daily challenge” for many living in the West Bank and Gaza. World Food Program research estimates that over half of Palestinians lack reliable provisions of food.

On May 9, 2007, a World Bank technical team issued a report on the impact of Israeli restrictions on movement and access in the West Bank and between the West Bank and the Gaza Strip. It concluded that

the practical effect of this shattered economic space is that on any given day the ability to reach work, school, shopping, healthcare facilities and agricultural land is highly uncertain and subject to arbitrary restriction and delay.

The bank reaffirmed the link between Palestinian economic growth and Israeli security. Without the former, the latter will never be assured. The bank also pointed out the inconsistency of effectively closing over half of the West Bank to free Palestinian access, while allowing Israeli settlements to grow unhindered on that same land. The logic of the bank’s analysis is that without sustainable economic recovery, the Palestinian Authority will never be able to develop the kind of health system it so desperately needs to protect its citizens.


The UN’s special rapporteur on human rights in the Palestinian Territory, John Dugard, has followed the human predicament of the region closely. Last year he concluded that “Israel is in violation of important norms of human rights and international humanitarian law.” In January 2007, he went on to report that Israel’s disproportionate response to Palestinian Qassam rocket attacks “has resulted in serious war crimes.”

Since the capture of Corporal Gilad Shalit by Palestinian militants on June 25, 2006, Israel Defense Forces have destroyed or damaged hospitals, water pipelines, electricity supplies, schools, and civilian homes. Between June 25 and the truce that came into effect in November 2006, ninety children were killed and over three hundred children were injured by Israeli military action (in the same period, two Israeli civilians were killed and thirty civilians were injured by Qassam rockets).

The government of Israel does not recognize the mandate of the UN’s special rapporteur. However, I would be happy to take Mr. Amikam to the hospital in Beit Hanoun on the Gaza Strip, which struggles, because of Israel’s strict border controls, with severely limited access to medicines, hospital supplies, and medical equipment; to the clinics in Gaza City and Rafah, whose funding and functions are ebbing away due to neglect by the Quartet, fueled by Israel’s fierce but effective lobbying; to the villages, such as Seer, Deir Ghazala, Arabuna, and Jalama in the northern reaches of the West Bank, where dozens of Israeli military checkpoints, far from protecting civilian lives, put in effect policies that prevent Palestinian patients from reaching essential medical services in large urban centers; to families which do not have ready access to the kind of basic health facilities—including, for example, specialist physicians—that any Israeli citizen would take for granted; and to the children of the West Bank and Gaza, many of whom are chronically undernourished, anemic, and vulnerable to entirely preventable disease. This is the “objective situation” in the Palestinian territory today, a situation that Israel bears a great responsibility for creating and sustaining.

Mr. Amikam’s letter displays the now notorious propagandizing tactics used by other spokesmen for the Israeli government. He relies on the hope that most readers of The New York Review will not have visited Gaza and the West Bank. He trusts that non-Israeli and non-Palestinian readers will be skeptical of the deprivation and hardship that visitors repeatedly and consistently report. Israel is, after all, a prosperous and successful democracy. Surely Israel could not possibly allow such endemic poverty to persist within its neighbor, a neighbor whose land it largely occupies and controls? This systematic effort to mislead is part of Israel’s campaign to manufacture a state of disbelief over the reality of life in Gaza and the West Bank. Only when one sees the tight networks of heavily armed Israeli checkpoints can one begin to understand how the Israeli occupation is choking life out of Palestinian communities; only when one walks through Gazan streets can one feel the tension brought about by Israel’s military lockdown of this scarred ribbon of land; and only when one speaks with ordinary Palestinians in their homes can one sense the fear and hopelessness that occupation has rooted in Palestinian lives.

Any visitor will quickly discover the claim that Palestinians as a group have “chosen the way of terrorism” to be a lie of the most outrageous proportions. According to all the sources I was able to consult, the overwhelming majority of Palestinians abhor violence and condemn the actions of Palestinian militants. To argue that the predicament of the Palestinian people rests squarely with the Palestinian Authority alone is also a deliberate attempt to misinform. The Palestinian Authority has been denied access to critical funds that it needs to maintain the most basic of public services. The Authority does not have the right to determine the future of the Palestinian people and its lands. In sum, its powers are severely circumscribed.

That Israel provides needed care for thousands of Palestinians in its hospitals and clinics is important and should be acknowledged. But in pointing to that care, Amikam ignores the fact that it also creates a dependency—one that can be a drain on the Palestinian Ministry of Health and works against what fragile success the Palestinian Authority is having at creating its own health system. The rejection by many other Palestinians of Israeli services stems from the understandable conviction that to accept help would be an act of collaboration with an illegal occupying force. To accept direct assistance when Israel continues to colonize Palestinian land, divide Palestinian communities, and kill Palestinian civilians by the score (Mr. Amikam trivializes these deaths as “errors”) would be seen by such Palestinians as an act of betrayal—a betrayal that Israelis will be only too well aware of from their own tragic history.


Israel’s response to descriptions of Palestinian life appearing in the Western press is well known and well orchestrated. A network of correspondents is activated to discredit the offending writer and publication. For example, when my article appeared in The New York Review, the Committee for Accuracy in Middle East Reporting in America (CAMERA) sent a summary of the essay, together with tendentious rebuttals, to its “e-mail team,” asking them to write to the editors and publishers of the Review to “repudiate the erroneous and biased account of Palestinian medical care.” This call to action was sent out as a “CAMERA Alert.” Steven Stotsky, a research analyst for CAMERA, asked correspondents to blind-copy their replies to the committee. A flurry of similarly worded e-mails then arrived at the New York offices of the Review.

I am not “anti-Israeli.” I wrote my article as a physician, not as a politician. As an outsider to Palestinian politics, I sympathize with those who criticize the Palestinian leadership’s failure to protect its own people and to crack down on militant groups that seek to use violent attacks against Israeli citizens to pursue their political aims. It seems self-evident that the Palestinian Authority’s refusal to renounce violence once and for all, its weak measures to stem corruption, and its self-destructive tribal politics all damage the Authority’s ability to govern. Any use of an ambulance to convey a bomb must obviously be condemned, although it should be noted that the circumstances of the one confirmed incident of an explosive belt being found in a Palestinian Red Crescent Society (PRCS) ambulance are disputed. Medical representatives of the PRCS insist that this discovery was staged by Israelis. But it also seems important to remember—and this fact presses itself onto every conversation one has with Palestinians—that the root cause of this terrible situation is Israel’s continued violent occupation of lands that are internationally recognized as Palestinian.

One final and, to me, disturbing anecdote. At the end of my conversation with officials from the Israeli Medical Association, we talked freely about the intractable nature of the Israeli–Palestinian impasse. Dr. Blachar, the IMA’s president, had left by this point. I was in the company of other senior IMA officers. “We are aware of how people see us,” I was told. “No matter what we say, people will hate us. We have given up trying to persuade others. We must simply look after ourselves.” And then one man, a physician, said: “Britain will be like Israel in a few years’ time. It’s happening already. Your country is being invaded by Muslim extremists. These people are different from us. If you are caught stealing, they will cut off your hand. They strap bombs to themselves. They are not like us.” The usual frame of understanding for the Israeli–Palestinian conflict is land. But here was one instance where a deep-seated attitude of religious and racial difference was being expressed. Palestinians are not equal human beings, I was being told. They do not deserve our equal consideration. Mr. Amikam’s letter, I’m sorry to say, suggests the same attitude.

This Issue

June 14, 2007