The term ‘healthocide’ should be adopted to describe the deliberate destruction of health services and systems – something which amounts to carrying out an ‘act of war’.
And medical practitioners should ‘call out’ the weaponisation of healthcare and stand firm against it, according to a commentary published today (6 August) in the open access journal BMJ Global Health.
Silence implies complicity and approval: t undermines international humanitarian law as well as medical and professional ethics, say the four authors, all of whom work in the Beirut capital of Lebanon.
The first author is Joelle Abi-Rached, from the American University of Beirut’s Department of Internal Medicine and Department of History and Archaeology.
While the authors mainly focus on the impact of armed conflict on healthcare in Lebanon and Gaza, they also refer to conflicts in El Salvador, Ukraine, Sudan and Syria.
‘Attacks [in Gaza and Lebanon] have been met with astounding silence or, at best, terse and often belated statements from American, European, or Israeli medical associations, professional groups, and journals’ [Joelle Abi-Rached]
Data from Lebanon’s Ministry of Public Health show that from 8 October 2023 to 27 January 2025, 217 healthcare workers were killed by the Israel Defense Forces; 177 ambulances were damaged; 68 attacks on hospitals were recorded; and 237 attacks on emergency medical services took place, they say.
Chilling death toll
Israel’s military operations in Gaza since 7 October 2023 have resulted in at least 986 medical workers’ deaths: 165 doctors; 260 nurses; 184 health associates; 76 pharmacists; 300 management and support staff; and 85 civil defence workers, they add.
‘Both in Gaza and Lebanon, healthcare facilities have not only been directly targeted, but access to care has also been obstructed, including incidents where ambulances have been prevented from reaching the injured, or deliberately attacked,’ Dr Abi-Rached and colleagues note.
‘What is becoming clear is that healthcare workers and facilities are no longer afforded the protection guaranteed by international humanitarian law,’ they state. Yet, faced with such wanton destruction, doctors have done little, the authors suggest.
Medical neutrality is not ‘apolitical’
‘These attacks have been met with astounding silence or, at best, terse and often belated statements from American, European, or Israeli medical associations, professional groups, and journals,’ Dr Abi-Rached and his co-authors point out.
‘Are medical doctors ready to forsake the principle of medical neutrality, first forged amidst the carnage of 19th century wars and profoundly reshaped following the liberation of Nazi death camps in 1945? And if so, at what cost?’ they ask.
‘As difficult as this question is, it is one that physicians must address as they grapple with the normalisation of healthcare’s weaponisation in a world where warfare has changed dramatically, marked by the use of Artificial Intelligence for mass killing, the reliance on drones and killing robots, the deployment of internationally banned weapons, which carry devastating public health and ecological consequences, and, of course, the looming threat of nuclear weapons,’ they write.
The ‘normalisation’ of healthcare attacks has increased alarmingly over the past few years, say the authors. ‘But what we are witnessing today is more pernicious than mere normalisation of such attacks, something that could be described as “healthocide”: the deliberate killing and/or destruction of health services and systems for ideological purposes.’
Normalising or excusing healthocide sets a dangerous precedent, the authors argue, as it emboldens future violators and erodes the principle of medical neutrality, which is essential for ensuring impartial and humane care during conflict.
‘Medical neutrality is not “apolitical”; for us it means standing with humanity, social justice, and health-enabling policies’, the authors insist.
Medical practitioners must start advocating for the enforcement of justice and international humanitarian law; and documenting and exposing abuses to medical neutrality by both state and non-state actors, they state.
‘Rather than passively observe the erosion and normalisation of the weaponisation of health and healthcare, [we call] for critical reflection and decisive action, underscoring that silence implies complicity, approval, or the toleration of double-standards – all of which stand in clear opposition to international humanitarian law and medical deontology [ethics],’ Dr Abi-Rached and colleagues conclude.
To access the full version of the article – titled Healthocide and medical neutrality: a call for action and reflection Doi: 10.1136/ bmjgh-2024-018656 – see: https://gh.bmj.com/lookup/doi/10.1136/bmjgh-2024-018656
Image: Shutterstock
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Physiotherapists‘ deaths highlighted in article in March
In a blog published in BMJ Leader in March, three physiotherapists – Uzo Ehiogu, Basman Aldirawi and Osman Ahmed – said that 45 or more physiotherapists had died during the recent military operations in Gaza.
They wrote: ‘Many courageous Physiotherapists in Gaza have demonstrated leadership and volunteered in emergency departments to assist the triage of trauma causalities. Tragically it is estimated that at least 45 physiotherapists, including Fadi Al-Wadiya from Médecins Sans Frontières, have been killed to date due to military operations.
‘This is a figure which is greater than the number of qualified staff in the average physiotherapy department in the United Kingdom. It is a chilling statistic.’
To access the blog – titled How will history view Physiotherapy Professional Bodies’ “neutrality” during the Israel-Gaza Conflict? – see: https://bit.ly/3J3P2sq
