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Wednesday, October 19, 2005


Open Letter on the Debate Over Dr. Derek Summerfield's British Medical Journal Article

by Ellen Cantarow

In a recent issue of The British Medical Journal, Dr. Derek Summerfield wrote an article detailing Israeli atrocities against Palestinians. He has been attacked for this. I wrote a letter to BMJ supporting his original article. Below is an opinion piece I wrote after reading an article in which Summerfield justifies his contentions and scores Dr. Yoram Blachar, President of Israel's Medical Association (IMA) and current Chairman of Council of the World Medical Association (WMA), the official body whose mandate is, in Summerfield's words, "to remit medical ethics (including the relevant parts of the Geneva Convention) worldwide.

Dr. Derek Summerfield is a good and courageous man who meticulously documents his assertions about Israeli brutalities against the Palestinians. What is truly discouraging is that in 2005, after decades of the Israeli policies he deplores, we are still going round and round rediscovering and documenting the same brutalities and having to prove our contentions against the "Our Israel Right or Wrong" crowd. There should come a time, one feels, when one could simply declare these deniers of evidence and historical fact abettors of crimes against humanity.

Of course Dr. Summerfield is right. Thirty-eight years of documentation, including that of Israeli "revisionist" historians, prove he's right (Of course you can never cite Palestinian historians: in today's world of US and Israeli Group-Think masquerading as "democracy" they're guilty of being terrorist sympathizers by mere fact of their ethnicity.). The revisionists include Benny Morris who thinks ethnic cleansing justified to establish a pure Jewish state but who does not deny the ethnic cleansing took place; Avi Schlaim, Benjamin Beit-Hallahmi, Baruch Kimmerling, Ilan Pappe, who do not condone ethnic cleansing but similarly document it - among the documents are extensive citations from Israeli army and government archives.

It shouldn't be Dr. Summerfield who needs to bolster his arguments and justify them; it's his detractors who should be tried. Theirs are the same old arguments that have been rehearsed and re-rehearsed for the past five-plus decades. The same Zionist hysteria leaps forth, never more than today when it has exploded into a McCarthyite crusade replete with efforts to try people for "falsification of history"; to fire faculty for criticizing Israel and voicing the Palestinian narrative, to ban books. There is the same shrill reaction to any criticism of Israel as"anti-Semitism" and "The Arabs Want to Throw the Jews into the Sea."

In fact it's Gaza's Palestinians who have been thrown out of their living as fishermen, into a desert created by the Israeli destruction of the old citrus and fruit groves, into the massive concentration camp that constitutes all of Gaza now, walled from one end and one side to the other, monitored as a prison camp by guard towers manned by soldiers armed with the most sophisticated weaponry known to the world; a Gaza bombed and shelled until vast swathes of towns and cities are left looking like Beirut and South Lebanon after Israel's bombardment. Not an apartment building is left intact, not a home without shell-holes pock-marking the walls; a generation of children who wet their beds, who are used as targets by taunting Israeli snipers (see Chris Hedges in Harper's for a good description of this loathsome practice); who cannot learn because of post-traumatic stress syndrome and malnutrition; a generation of youth without a shred of hope for a future beyond these prison walls. Israel under the expert, malevolent guidance of that past-master in provocation and destruction, Ariel Sharon, has reduced most of Gaza to a non-nation existing on the level of sub-Saharan Africa. Read Sara Roy on the subject in the current issue of Journal of Palestine Studies.

On the other hand it's useless to ask the screamers of "anti-Semitism!" and"You want the Arabs to throw the Jews into the sea!" to read Sara Roy. Their minds are as sealed to historical fact and evidence are those who believe the Bible is the World of God and that we are at the End of Days. Christian hysteria dismisses any critics as "Satanic"; Zionist hysteria dismisses all critics as "anti-Semitic." The threat approaches: the cross gets raised (or, in this case, I suppose, the Israeli flag.). If I raise Ilan Pappe's name he will automatically be dismissed as a self-hating Jew and an abettor of terrorism. Benny Beit-Hallahmi the same. Benny Morris has redeemed himself, of course, having prostrated himself before the altar of Israeli True Belief and said genocide is right and fitting for the creation of a purely Jewish state.

It is said that critics like me or Dr. Summerfield need to be measured; we need to be polite; we need to document our arguments. We need to keep a nervous, respectful eye on "the Jewish community." But the Palestinians are on the point of being annihilated as a social and political entity. After the nth talk has been delivered, the nth letter or essay written in measured tones; the nth petition sent to bullies and war criminals like George Bush and Ariel Sharon, the nth explanation issued with patient documentation, footnote after footnote after footnote, the nth citation of "impeccable JEWISH sources"- - how could they find any fault with Israeli JEWISH sources?-- have met with the same cries of anti-Semitism and the rest, the constant writer-- to echo Dorothy Parker writing in a much lighter moment--throws up [ read Rapid Responses to Dr Summerfield and his replies here].

The late Dr. Israel Shahak used to score people like those who attack Dr.Summerfield as state idolators. The truth is thrown to the flames and the big lie is championed in the name of "supporting Israel." As such, these supposed Israel-supporters betray the very ideals of Judaism which forbids worshiping idols. They lead the state they say they support toward its inevitable doom. Absolute power corrupts absolutely. The licensing of an army to commit any crime against a subject population spells moral, spiritual, and social degradation of the whole society.

Reply to Dr. Yoram Blachar: Moral Corruption at the IMA and WMA

by Dr. Derek Summerfield

Dr. Yoram Blachar's response to my letter in this week's BMJ is morally and strageically of a piece with his responses over many years in the pages of the Lancet and BMJ, including his response to my BMJ review of 16 October 2004 (1)(2).

He declines to regret the killing by Israeli soldiers of a single Palestinian child, much less 600 in five years. He has consistently declined to regret the use of torture as an instrument of state policy inIsrael (indeed, under its Israeli euphemism of "moderate physical pressure," he has defended it), nor regretted the shooting of Palestinian doctors and other health professionals on duty during the 2002 invasions, nor the otherviolations of the Fourth Geneva Convention which continue to plague Palestinian society on an entirely systematised basis. As well as guaranteeing health professionals and facilities the right to immunity from military action, the Convention safeguards the right of a civilian population to unimpeded access to medical care and other essentials for life like food aid. We should note that Dr Blachar is not speaking as an individual doctor, but as the long time president of the Israeli Medical Association (IMA) and - surely extraordinary - the current Chairman of Council of the World Medical Association (WMA), the official body whose remit is to patrol medical ethics (including the relevant parts of the Geneva Convention) worldwide.

Behind this stance is a dehumanised contempt for the Palestinian population, whose suffering weighs nothing on the scales by which Israel measures its interests. We are to understand from Blachar that they are not a people in the same moral universe.

Many of the hostile responses at bmj.com remind me that there are no natural limits to the human capacity to deny, even what is in front of one's nose. Holocaust denial is perhaps an extreme example of this. The mass of documentation from reputable international and local sources I have drawn from is dismissed out of hand, if it is attended to at all (for example Amnesty International has issued no fewer than 301 reports since October 2000, whose thrust is wholly consistent with the findings of Israeli organisations like B'Tslem and Physicians for Human Rights, and with Palestinian health and human rights organisations like the Health, Development, Information and Policy Institute). This week Professor Alan Meyers and others from the US-based Jewish American Medical Project confirmed again at bmj.com that what I document is in accord with their own fact-finding missions.

Dr. Blachar calls what I document "uncorroborated" when of course he must be perfectly aware of all this material from so many sources in the public domain. This is denial as conscious choice and political strategy (similar to the way that Western nations collude with Turkey's denial of the Armenian holocaust of 1915, because Turkey is a loyal NATO member). Dr Blachar and the IMA have made their choices with their eyes open over many years, inline with a tacit version of Israeli citizenship that has it that unpleasant things need to be done to Palestinians in the name of national security. A representative of Physicians for Human Rights (PHR) Israel (whose exemplary practice shames the IMA neglect of their duty to provide ethical leadership) wrote in the pages of the Lancet 2 years ago that the IMA was "merely an executive arm of the Israeli establishment - one that works very hard to present the face of the 'enlightened occupier' rather than striving for universal medical ethics" (3) .

Blachar's response at bmj.com to my 2004 paper concluded that "the lies and hatred he spews in his piece is reminiscent of some of the worst forms of anti-semitism ever espoused." The point that needs to be noted here is that this slur is strategic, seeking to substitute for any engagement with the material itself, which is dismissed by association. So too Blachar's response, published after mine, in the BMJ of 24 September 2005. He saysthat the contents are "nothing new." At one level this is sadly true, since the patterns of abuse I and others have documented have been a consistent feature of Israeli policy for many years. But what is new, and news, is the"Breaking the Silence" testimony. When before has so much explicit and verbatim testimony come from so many Israeli ex-soldiers, more than 300 to date, and because, in their words, they have felt "corrupted" by what they saw and were asked to do on active service in the Occupied Territories. They write that it is "a patriotic duty" for them to inform the Israeli people of the grim reality of what is being done in their name, and to expose the cynical mantras of the IDF that so many correspondents at bmj.com have taken at face value. Here is the president of a national medical association, and chairman of council of the world watchdog on medical ethics, utterly repudiating these young men and their principled accounts.

Similarly, when Blachar writes that "the Israeli Medical Association looks into any claim brought to our attention" this again is strategic rhetoric. Independent humar rights evidence is ignored, as we have seen for years, and the testimony of Palestinian victims does not count by definition.

Blachar concedes that some abuses do take place- at this point it would scarcely be possible to claim otherwise- but calls them "occasional." As he well knows, this is utterly at odds with the public record and now with the"Breaking the Silence" testimony. Does the killing of 3500 civilians in 5 years suggest "occasional" abuse? The testimony makes it clear that these abuses were not occasional but systemic, with the-shoot-to kill orders coming from superior officers to ordinary soldiers, and as standing orders in certain parts of the Occupied Territories during certain time periods. Consider a recent episode that depressingly bears out what the ex-soldiers of "Breaking the Silence" are saying. On the night of 24 August 2005 the IDF shot dead 3 teenage boys and 2 adults in a West Bank refugee camp. An IDF communique claimed the 5 were terrorists, killed after opening fire on the soldiers. However, an investigation by the Israeli human rights organisation B'Tselem and the newspaper Haaretz found that none of them had been armed, nor had any connection with any terrorist organisation. They were ordinary citizens. The reality as opposed to the rhetoric of IDF policy is to lie and obfuscate where necessary. Blachar is not out of touch with IDF realities (indeed WMA Secretary General Delon told me 3 years ago that Blachar had brought 'highly sensitive' documents (ie. from military sources) to the WMA to make a point) and is I infer seeking to deceive the BMJ readership.

In his first paragraph Blachar, as he has done repeatedly, uses the issue of suicide bombers as a barndoor defence for the mass shooting of civilians, whose names he thus blackens by association. If this is not grotesque than I too have lost my moral compass. I would add that disproportionate and indiscriminate fire upon civilians long predates the onset of suicide bombers, being similarly evident during the first intifada (1988-93), when more than 25% of all civilian dead were children. Suicide bombers only began later. Blachar also adds a justifying anecdote about a Palestinian woman who he says took advantage of a humanitarian medical clearance granted by Israel to attempt a suicide bombing at a hospital. I would want this confirmed by an unimpeachable source like B'Tselem. If true I would of course deplore it, but it is gross to attempt to use this as a justificationfor the indiscriminate killing of civilians.

I would add some personal experience that refutes Blachar's claim that the IMA looks into any claim brought to their attention. At a human rights conference in Gaza in 1997, an Israeli physician told me that an Israeli medical colleague had confessed to her that he had removed the intravenous drip from the arm of a seriously ill Palestinian detainee, and told the man that if he wanted to live he should co-operate with his interrogators. I sent this information to the then IMA Head of Ethics, Professor E. Dolev, and asked for an investigation. I received no reply, even after reminders.

It was Professor Dolev, whilst still Head of Ethics no less, who in 1999 stated flatly to a visiting delegation from the Medical Foundation for the Care of Victims of Torture, London, that "a couple of broken fingers" duringthe interrogation of Palestinians was worthwhile for the information it might garner. When this was published in the Journal of the Royal Society of Medicine by those present, Blachar defended Dolev (4).

Contrast these interpretations of medical ethics with that of, say, the director of the Al-Basra hospital in Iraq, executed in the mid 1990s for refusing to carry out punitive amputations. Unlike the plight of ethically minded doctors in many countries, the IMA has not had to fear loss of life or liberty for speaking out. It has chosen not to, and should be judged by these decisions.

Last year I challenged Dr Blachar at bmj.com to state whether he had any concerns whatever about violations of the Fourth Geneva convention by the IDF. I did so again in this week's letter, but again he simply will not engage with the data, does not attempt fact-based rebuttals of specific charges. Let me ask him once more, in relation to his leadership positions both at the IMA and WMA: Dr Blachar please, in your professional judgement have there been and do there continue to be any reason for medical ethical concerns arising out of the conduct of the Israeli army towards thePalestinian general population? Do you accept any of the human rights documentation to this effect, not least from Amnesty International? As I summarised in my BMJ 2004 review, the public record attests to the death of seriously ill Palestinians, and of new born infants, at army checkpoints because they were denied access to hospital. Palestinian health professionals have been shot dead or wounded on duty. Ambulances drivers are interrogated, searched, threatened, humiliated and assaulted. Wounded men have been taken from ambulances at checkpoints and sent directly to prison. There have been cases where ambulance drivers have been forced to act as a human shield against stone throwers, and on other occasions Israeli soldiers have commandeered ambulances as transport. On hundreds of occasions ambulances of the Palestinian Red Crescent society have been hit by IDF gunfire. On the 1st April 2004 the IDF fired missiles at Bethlehem psychiatric hospital, which had 250 patients and 75 staff present at the time. There was extensive damage and staff were arrested. Clearly identified medical clinics, including those run by the aid agency Medecins Sans Frontieres, have been hit by gunfire. The International Committee of the Red Cross and other aid agencies have at times been forced to limit their work in the West Bank because of threats to staff and attacks on vehicles by theIDF. There has been willful hampering of the distribution of food aid. TheIDF has also wilfully destroyed water supplies, electric power and other elements of the public health infrastructure. The continued building of the apartheid wall and fence has hugely damaged the coherence of the Palestinian health system.

The Israeli doctors of PHR have documented what they called "the appalling deterioration in the attitude of Israeli military forces towards Palestinian health and rescue services. Yet despite severe injury to medical personne l and to the ability of physicians to act in safety to advance their patients' interests, despite Israeli shells that are falling on Palestinians' hospitals, despite the killing of medical personnel on duty - the IMA has chosen to remain silent." Would Dr Blachar please comment on all this?

Lastly, I must reiterate the international dimension. Over the years the IMA has made much of their association with the WMA, presenting their membership per se as guarantee of their probity. For the past 3 years I have been regularly bringing this material to the attention of theI nternational Committee of the British Medical Association (BMA), which as an influential member of the WMA is surely in a position to challenge the ethical stance of the IMA- as they did the Medical Association of South Africa during the apartheid era. In response to an open letter of appeal tothe BMA published in the BMJ in September 2003, Dr V Nathanson of the BMA talked about "facilitating change through education," as if the IMA hadn't known what it was doing over many years. Dr Nathanson also wrote that theBMA International Committee sought to "engage constructively with ourIsraeli colleagues"(5). These colleagues are, I take it, from the IMA rather than from, say, PHR, and in particular, its president Blachar who is right there at the WMA. What has this constructive engagement amounted to, and how can any personal assurances offered by Blachar to be set against the mass of documentation in the public realm pointing the other way? There is an unfortunate echo to Blachar's contemptuous dismissal of human rights evidence in Dr Nathanson's comment in the BMJ that whilst there was a case for "thorough investigations of all allegations of malpractice or culpable inaction concerning doctors by an appropriately resourced and independent expert body, the problem is to identify by whom" (5). This is extraordinary: has not Amnesty long since been such a body, or B'Tselem, or PHR Israel and their Palestinian equivalents! What is Dr Nathanson really saying?

A term like "constructive engagement" can be little more than a rhetorical device: when nothing changes it may amount to little more than a form of collusion and (I measure my words) conspiracy. There may be a tacit but distinct BMA position that Israel is a 'special' case, and a sense of collegiate solidarity with the IMA. My successive letters to the International Committee, drawing responses from Dr V Nathanson and from Dr E Borman, have been a case study in evasion and distancing. The consistent line is to fend me off. The World Medical Association too is surely in breach of its own mandate in continuing to shut its eyes in this way.

All this must be a source of quiet satisfaction to the IMA and indeed in Israel, which is sensitive to Western public and professional opinion. The BMA have chosen to offer nothing to endangered health professionals and general public in the Occupied Territories, save possibly increased risk as a group for whom demonstrably no authority abroad- not even the medical ethicists- would speak in solidarity. This is a disgrace.

What comes through very strongly in the responses to this material at bmj.com is that people cannot imagine that Israeli government and IDF representatives, or significant other leaders, could lie to them. When theIDF repeatedly states that it goes to great lengths to avoid excessive civilian casualties, and that the overwhelming majority of those killed are"terrorists and suicide bombers," people want to believe this. Similarly, when an authority like the President of the Israeli Medical Association speaks out, people want to have their doubts set to rest and feel reassured. Dr Blachar is perfectly aware of this, that he has the power to influence many in the Jewish Diaspora who seldom visit Israel (and when they do so do not venture near Palestinian areas), and who might have begun to worry because of some of the things they have seen in the media. Surely Dr Blachar, not just an Israeli medical leader but also an office bearer in the international body concerned with medical ethics, must be speaking the truth, so the reasoning goes. Thus those who publish otherwise, from Amnesty International downwards, can only be motivated by crude anti-Israeli motives and anti-semitism. So good people continue to defend Israeli actions and a sense of impunity within Israel continues, with war crimes that mean terrible costs for a hapless, imprisoned Palestinian populace. I don't believe it is possible for a doctor to reveal a state of moral corruption much more nakedly than this, and in an international medical journal to boot. Thus Blachar is indeed sticking fast to the task which, as I noted above, PHR Israel described: justifying state policies whatever the cost to thePalestinian population. PHR Israel noted in the Lancet that on its return from the 2002 WMA convention, the IMA presented its performance as a propaganda coup, though its position paper had failed even to condemn theIDF shooting at ambulances. As I wrote at the outset, a conscious strategy is at work, a world away from the principles of medical humanitarianism and ethical practice.

Lastly, bmj.com has so far heard little from those who registered their outrage in such numbers last year. I do hope they are reading the "Breakingthe Silence" testimony (6). Perhaps those representatives who threatened theBMJ will write in with further reflection. For instance, the news channel of Totallyjewish quoted Dr Daniel Ellis, a representative of the London Jewish Medical Society to the Board of Deputies, as saying that a group of prominent doctors were working to petition the BMJ, and Prof Eric Moonman, chair of the Academic Response to Racism and Anti-Semitism was said to have written to the head of the BMA urging action to be taken against the editor(7).

Apologies are due from these parties to the BMJ.

1. Blachar Y. Palestine: the assault on health and other war crimes.Response from the IMA. BMJ 2005; 330:254-5.
2. Blachar Y. Israeli army's shoot-to-kill policy. Reply from thepresident of IMA. BMJ 2005; 331:699.
3. Ziv H. The role of the Israel and World Medical Associations. Lancet2003;361:1827-8
4. Bamber H, Gordon E, Heilbronn R, Forrest D. Attitudes to torture.JRSM 2002; 95:271.
5. Nathanson V. Medical Ethics, the Israeli Medical Association, andthe state of the World Medical Association. Reply from the BMA. BMJ2003;327:561-2.
6. http://www.breakingthesilence.org.il/files_eng/rulesofengagementbooklet.doc
7. http://www.totallyjewish.com/news/stories/?disp_type

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