Thursday 16th January 2025
Dear Prime Minister,
As organisations representing over 11,000 healthcare professionals in the United Kingdom, along with our allies; we call for sanctions to be imposed on Israel.
Decades of Israeli violations of International Humanitarian Law (IHL) and UN resolutions(1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18) in Gaza and the Occupied Palestinian Territories have led to what many scholars have described as a “prelude to genocide”(19). There are a number of well-regarded organisations that have concluded, in rigorous reporting, that what is happening now in Gaza amounts to genocide(20,21,22).
Of particular concern to us is that the Gazan healthcare system is on the “brink of collapse”(23) and is in some parts “obliterated”(24). We know from history that disease, the conditions created by and the consequences of conflict, in the absence of a functioning healthcare system, will kill(25) as many if not more Palestinians than have already died, directly or indirectly, at the hands of Israeli attacks since 7th October 2023. Therefore, a ceasefire alone will not stop the processes instigated that result in death and harm without urgent address of the root causes.
The normalisation of attacks on healthcare sets a dangerous precedent for future conflicts, particularly as attacks on healthcare and health workers are becoming more common in conflict situations(26), and may even be used as a weapon of war(27). The UK has very recently taken swift and commendable action in response to attacks on healthcare and other violations of IHL in Ukraine following Russia’s invasion, exerting pressure on Russia and holding it to account(28) for “clear patterns of serious violations of IHL attributable mostly to the Russian armed forces”. These included indiscriminate attacks on civilians and civilian objects, torture, unlawful detention, enforced disappearances, the killing of journalists and the targeting of hospitals and schools(29). These very same violations of IHL have been documented and verified by the UN High Commissioner for Human Rights (OHCHR) as having been previously and currently perpetrated by Israel against the Palestinian people(30,31,32).
A number of our members have worked in Gaza providing critical humanitarian and medical assistance since Israel’s offensive commenced 15 months ago, and have witnessed these violations as reported, first-hand. Some have submitted evidence to the South African case against Israel presently before the International Court of Justice (ICJ). Having considered that evidence, the ICJ imposed provisional measures requiring Israel to take steps to prevent the commission of any and all acts within the scope of Article II of the Genocide Convention, prevent and punish the incitement to commit genocide of the Palestinian people in Gaza, take immediate and effective measures to enable the provision of urgently needed basic services and humanitarian assistance to address the adverse conditions of life faced by Palestinians in the Gaza Strip, and to take effective measures to prevent the destruction and ensure the preservation of evidence in relation to alleged acts of genocide(33). The overwhelming evidence is of wilful non-compliance by the Israeli authorities since the ICJ’s ruling a year ago(34).
As healthcare workers, a core principle in our code of ethics is that we swear to uphold justice(35). It is therefore incumbent upon us to express our grave concerns as to the ongoing violations of IHL being perpetrated by Israel against the Palestinian people; particularly in the context of the destruction of healthcare provision, and the present and future medical emergency in Gaza.
A report published by the OHCHR on 31 December 2024 on the ‘Attacks on hospitals during the escalation of hostilities in Gaza (7 October 2023 – 30 June 2024)’, “graphically details the destruction of the healthcare system in Gaza, and the extent of killing of patients, staff, and other civilians in these attacks in blatant disregard for international humanitarian and human rights law.” (30) The catastrophic and systematic destruction of healthcare provision in Gaza included the burning of the Kamal Adwan Hospital and the enforced disappearance of its director, Dr Hussam Abu Safiyeh by Israeli forces on 27 December 2024 (36, 37). The position remains dire and unimproved. With over 595 healthcare workers confirmed killed(38), 436 detained and 643 attacks on healthcare facilities(39); to many in the medical world, Dr Abu Safiyeh’s story has become emblematic of the systematic targeting of the healthcare system in Gaza. Such attacks are plainly part of Israel’s violation of Article II of the Genocide Convention by “(a) killing members of the group; (b) causing serious bodily or mental harm to members of the group; (c) deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part; and (d) imposing measures intended to prevent births within the group”. They also breach the Provisional Measures Order made by the ICJ (40).
The position in northern Gaza is stark: there are no functioning healthcare facilities left as a result of “Repeated hostilities in and around hospitals”, putting civilians at an unacceptably grave risk of going without life-saving care”(24). This is the assessment of the International Committee of the Red Cross (ICRC), an institution recognised by the UK to play a critical role in upholding IHL “both at domestic level and at international level”(41), and providing humanitarian assistance and protection.
The OHCHR points out “Israel has openly defied international law time and again, inflicting maximum suffering on civilians in the occupied Palestinian territory and beyond…Israel continues to face no real consequences, largely due to protection offered by its allies, who have gone so far as to join Israel in delegitimising international institutions and besmirching Special Procedures mandate-holders.”(42)
This will be unsurprising to you: the Secretary of State for Business and Trade in his Open Position Statement (12 November 2024) before the High Court in the R (Al-Haq) v Secretary of State for Business & Ors (AC-2023-LON-003634) case set out that he made his decision on 2 September 2024 “to suspend licences authorising the export of items that might be used in carrying out or facilitating Israeli military operations in the current conflict in Gaza … follow[ing] the assessment by the Foreign Secretary that Israel is not committed to complying with international humanitarian law. That assessment was based, in summary, on the IHL Cell’s analysis that Israel had committed possible breaches of IHL in relation to humanitarian access and the treatment of detainees which undermined Israel’s statements of commitment to IHL overall, including in the conduct of hostilities.”(43).
However, the recent sanctions and embargoes imposed on Israel by the Foreign Secretary(44,45) have had no meaningful impact in either compelling the Israeli authorities to comply with IHL, or mitigating the consequences of Israel’s siege on Gaza: the entire population of Gaza is facing emergency levels of food insecurity; northern Gaza is in established famine(46). This comes as a result of Israel utilising starvation as a weapon of war, as well as other methods consistent with genocide(47). Combined with the continued attacks on healthcare(30) the fatal reverberations of Israel’s actions will continue to plague future generations of Gazans well beyond any ceasefire, particularly as it continues to wage “a war against children”(48). That is an unconscionable future to contemplate. The destruction of Gaza’s healthcare system is happening in plain sight. The UK Government is in a position to take a more robust position with Israel as it has done in recent memory against Russia, in Ukraine.
We echo and welcome recent calls in the House of Commons upon His Majesty’s Government to take stronger action through the imposition of stricter economic sanctions, suspending all arms exports to Israel, and more consequential diplomatic pressure(49). The UK has established precedent in taking action against Israel’s violations of IHL, including the suspension of arms licences(50), and has taken robust action to exert pressure in other conflicts as it has demonstrated with Russia in Ukraine.
Israel is one of the world’s longest standing and most frequent offenders of IHL(10,51,52) – that is the assessment of this Government and its Foreign Secretary, in express terms. Israel continues to preside over the Palestinians as an illegal occupier imposing practices of apartheid(53). It is in this light, and the grave consequences to inaction against decades of impunity that we call for stronger, wider and more sustained sanctions, whether a ceasefire is declared or not. The legacy of Israel’s “obliteration” of the healthcare system in Gaza will not only have consequences for the survival of the civil population in Gaza, long after any declared ceasefire, but it also undermines the international order’s most fundamental values.
We cannot allow this erosion to be normalised.