Kevin M. Cahill, M.D., 2/22/09
My professional career in international health and humanitarian relief has, over the last 50 years, taken me to numerous conflict zones. I have often known the danger of being caught behind the lines in civil wars, and have shared in the pain and squalor that is the constant fate of those who survive. These experiences have provided a perspective on life - and on man’s inhumanity to man - that has been largely fashioned in the crucible of refugee camps.
Part of the obligation of those privileged to work in humanitarian assistance is to report on the sufferings of those we serve. We become the voice of the vulnerable, describing as clearly as we can the reali≠ties faced by the dispossessed and the helpless. But we do not focus merely on existing evils; we also search for rays of hope in situations where others see only utter despair. There are occasions where our unique experiences and insights can provide foundations for lasting peace. Certainly our suggestions are no less valid than political or diplomatic pronouncements made far from the fray. One way or the other, silence is simply not an option for us. I offer in this report from Gaza both an assessment of the current devastation, and a possible basis for progress.
Seeing Gaza in February 2009, shortly after the Israeli invasion, reminded me of Dore’s 19th century engravings of hell for Dante’s Inferno. The level of destruction conjured up images of Dresden or Hiroshima at the end of World War II. There were areas in the northern Gaza Strip where not a single structure was standing. An Amnesty International report has deemed this “wanton destruction” of civilian buildings on such a massive scale as constituting “war crimes.”
Gaza, a narrow strip of land, 25 miles long by 3 to 7 miles wide, with a population estimated at over 1.4 million, is one of the most densely crowded areas in the world. Its borders, completely surrounded by an Israeli barricade by land, and by its navy on the seacoast, prevent any escape. When war came, there was literally nowhere to flee, no safe haven as neighboring countries are required to provide under international refugee law. The population of Gaza has existed under a hostile occupation for over four decades, and in recent years there has been a steady reduction of all imports and exports, slowly stran≠gling the private economy, leading towards the highest unemployment rates, and among the poorest nutrition levels, in the developing world.
Military controls are imposed with a grinding force and overt disdain that is clearly intended to crush the human dignity of a still proud people. The daily humiliations - at border crossings, during constant incur≠sions by soldiers working under ever-changing rules and mandates, the herding of people, like cattle, into barbed wire waiting pens, are all a consistent and pervasive pattern of the occupation.
Israel’s “Operation Cast Lead,” begun by a bombing campaign on December 27, 2008 and lasting until January 19, 2009, damaged 16 of Gaza’s 27 hospitals and selectively attacked and burned ambulances and many clinics. Thirteen health workers were killed during the 3-week assault. The main United Nations warehouses, with all medical and humanitarian supplies, were totally destroyed, and 15 United Nations schools were severely damaged. A Board of Inquiry ordered by UN Secretary-General Ban Ki-moon into the circumstances of some of these incidents is ongoing.
The incursion, according to the World Health Organization, left 1,380 Palestinians dead and 5,380 injured; of the dead, 446 were children, 111 women and 108 elderly. Even higher proportions of women and children were among those seriously wounded. The vast majority of injured were in Gaza City and at the north end of the strip. During the same period, Israel listed 14 deaths; 3 were civilians, victims of the Hamas rocket attacks that continued throughout; most of the military that died had been accidentally shot by their own forces. These are not the data of a war, but of one-sided slaughter.
Statistics can offer a somewhat cold assessment of the damage inflicted by war. The number of dead can be measured with reasonable accuracy, though some innocent victims are never found, or are buried with understandable disregard for those who caused such grief. The number of wounded is a much more fluid figure. How does one measure pain, or the permanent deformity caused by white phosphorus, or the life-long impact of lost limbs? Do we have any way to calculate the terror from bombings, or from the eerie white phosphorous glow that cannot be extinguished, from the resultant burns, or from the scars of panic, and of families broken apart by useless death?
The semantics of war usually disguise obvious truths. Consider phrases such as “friendly fire,” “disproportionate response,” “collateral damage;” or what does it mean to be the “victor” in a unilateral massacre; or what happens to the soul of a nation when the majority of its 18 and 19 year olds, both male and female, fulfilling their army obligation, casually carry M16 machine guns in the public malls and streets, learning early in life how to intimidate their neighbors?
The entire commercial zone of Gaza and other industrial plants, including ice cream and biscuit factories, along with the territory’s only asphalt plant and 22 of the 29 cement factories, were systematically demolished as the Israeli army withdrew, clearly demonstrating the intent of crushing a community by collective punishment. Even the withdrawal was timed with a cynical disregard for world opinion. Israel, who had begun the assault with the tacit approval of the United States in the dying days of the cooperative Bush administration, brought back their troops the day before President Obama’s inauguration in order not to tarnish his image with a sordid conflict in a volatile region. But there was no escaping the fact that this was a war using American weapons of incredible power and precision guided missiles against the home made rockets, gasoline bombs, and rocks that are the major weapons of long oppressed peoples.
All the schools were closed the day I arrived because heavy rains had left a majority of the children without any dry clothes. Emergency tents had either leaked so badly or completely collapsed into the flowing mud quagmire that was now home for over 200,000 people displaced when their houses were destroyed. The water system was also severely damaged and sewage flowed down open streets and gutters into the sea.
The United Nations Relief Works Agency (UNRWA) and the Palestinian Authority had made funds available for emergency rentals, but there were few apartments available. Reconstruction cannot begin because Israel does not permit the importation of steel, cement or glass, among other building materials. They had also restricted the importation of lentils, pasta, tomato paste and juice by some incomprehensible logic that these items may pose a security threat. In a particularly cruel twist, even batteries for hearing aids used by deaf children cannot be imported, condemning these unfortunates to a world of silence. Despite these Draconian regulations, UNRWA has been able to provide a basic food supply to over a million refugees in the Gaza Strip. I visited a food station where hundreds of displaced persons waited to collect their meager staples of rice, sugar, lentils and cooking oil. While this program may save people from starvation, it is a diet that does not prevent the highest level of anemia in the region, with alarming rates of childhood stunting due to inadequate nutrition.
I made clinical rounds in the partially destroyed Palestinian Red Crescent Society Hospital (the Palestin≠ian Red Crescent is a full partner in the International Federation of Red Cross and Red Crescent Societ≠ies, to which the American Red Cross and Israel’s Magen David Adom also belong.). One night, during the height of the campaign, doctors were forced to evacuate hundreds of patients after an incendiary bomb caused a fire that consumed the top four floors of the institution. Imagine trying to move a full intensive care unit (ICU), and neonatal patients on respirators and in incubators, wheeling critically ill patients down debris laden streets, manually pumping breathing machines, until they could deposit their terrified charges in another hospital.
Another surgeon told me of operating on a wounded man while bombs dropped on the hospital, and I later examined that patient with massive soft tissue damage and a fractured femur treated by external fixation. The doctor also described injured patients with grossly infected, putrid wounds because they had not been able to be evacuated from their homes for up to 5 to 7 days after being injured. Besides these obvious war injuries, other medical crises loom. Forty percent of those with chronic diseases, such as hypertension or diabetes, were denied routine drugs for the full duration of the invasion. Deafness due to sonic booms, and bombs, mental health problems due to trauma, loss of loved ones or being forced to live in utterly changed circumstances (in tents or amid the rubble), are other major medical problems.
The gross disparity in the number of victims suffered by the two sides, along with the graphic media images of senseless destruction, may, it seems to me, actually offer an opportunity. The fundamental evils of continued forced isolation and economic strangulation have finally come to the fore. American congressmen visiting Gaza in the past week have been unable to hide their shock at the levels of destruction. They are fully aware of the central role that the Palestine crisis plays in the broader Arab unrest in the region.
Unless border crossings are promptly, and fully, opened, and supplies for humanitarian aid and recon≠struction, as well as commercial goods for the private sector, are allowed to flow in an uninterrupted stream, the suffering will inevitably accelerate. Unless the destroyed water and sewer systems are quickly repaired, predictable epidemic diseases will occur, claiming more innocent lives. Unless the private sector can rebuild, and get the material resources it needs, the staggering levels of unemploy≠ment will continue. Empty rhetoric is a cheap substitute for obviously needed relief and assistance. It is time for the United States of America to demand a halt to Israeli polices and actions that are damaging American interests throughout the Middle East, as well as in Islamic countries around the world.
After leaving Gaza, I traveled to the Israeli town of Sderot, which has been one of the places that has recorded indiscriminate Hamas rocket attacks. There was no evidence of serious structural damage in the town, though concern is evident in the bomb shelters built next to most bus stops and malls. An elaborate alarm system warns the public of incoming rockets. There are, not incidentally, no preventive alarm systems, or bunkers in Gaza. Palestinians must take refuge in public buildings, and when UNRWA schools were hit during the Gaza invasion, many people were killed and wounded.
In 1982, I was in Beirut on a Vatican mission during a prolonged Israel-Palestine conflict. I wrote an op-ed article for the New York Times that dealt with the clinical horrors of war, the death of innocents - and innocence. The article suggested that unbridled assaults on civilians are very likely to be counter-productive, prompting a radical response from those who had lost loved ones, and whose only recourse was to embrace the traditional weapons of rebels. The article, detailing offenses against helpless women and children, questioned, “What ends could ever justify these means.” The op-ed was published just before the very predictable massacres that took place at the Sabra and Shatila camps where over 900 women and children were sacrificed on an altar of folly. Now, over a quarter century later, one could insert the word Gaza for Beirut, and tragically, republish the article as current news.
We cannot afford to repeat the past, pursuing a path that offers no hope of peace. Sometimes history suggests that a new administration, with fresh insight, and the necessary political will can make a coura≠geous change. When General Charles de Gaulle was elected President in France in 1958, it was with the vigorous support of the military. Shortly after taking office he reviewed the Algerian quagmire, where torture and repression were staining the essence of his beloved France. He concluded that his nation should offer Algerians full independence. De Gaulle survived an assassination attempt, and a military coup, but France emerged free from a sordid colonial oppression.
A more recent historical example is the realization of peace in Northern Ireland. There, neighbors, divided by religion and culture, had endured decades of killings and maimings. Peace came through dialogue, not by dictating a resolution, but by finding common ground among all parties. Two years ago, the then Irish Prime Minister, Bertie Ahern, told a Council on Foreign Relations audience in New York that the mediators communicated with “the bad guys” as well as with “the establishment.” During the question period, a member of the audience, discussing the Middle East, noted “we cannot talk with Hezbollah or Hamas for they have been labeled ‘terrorist organizations’ for fighting with Israel.” The Prime Minister responded – simply but bluntly – “then you will never find peace.” That lesson is obvious today in Gaza. It seems impossible that peace will ever be found there without involving the democratically elected Hamas gov≠ernment. As in Northern Ireland, an inclusive process is the only way forward.
If President Obama, in reviewing the long-standing Arab-Israel conflict, were to withdraw support for the failed policies of the past against the Palestinian people, and truly foster a peace process, then, when a new Israeli government is formed, it might well, willingly, search for a new path toward peace, one that is consistent with the nobility of a people this nation has long admired and assisted.
Kevin M. Cahill, M.D. is Chief Advisor on Humanitarian Affairs to the President of the United Nations General Assembly, H.E. Miguel D’Escoto Brockmann. He is also President of the Center for International Humanitarian Cooperation (CIHC).