The ongoing conflict between Israel and Hamas echoes an alarming trend in modern warfare: attacks on health workers, aid workers and care centers, as well as increased vulnerability of civilians, two people said on Tuesday. experts from Johns Hopkins University during a roundtable: November 14.
Paul Spiegeldirector of Johns Hopkins Humanitarian Health Centernoted that “attacks on health workers, aid workers and health centers did not occur decades ago, but they are becoming increasingly common.”
They are central to the war between Israel and Hamas, he said, where much of the recent fighting has taken place just outside Al-Shifa Hospital in Gaza City. Civilians account for the largest number of victims and the region is experiencing an untenable public health crisis, Spiegel added.
Spiegel joined Leonard Rubenstein for a virtual question-and-answer session Johns Hopkins Briefing Series. The conversation, moderated by Lainie RutkowJHU vice provost for interdisciplinary initiatives, examined how humanitarian health in the Middle East has been decimated by the ongoing fighting.
Spiegel is professor emeritus of practice in the Department of International Health at Johns Hopkins Bloomberg School of Public Health. He was previously deputy director and head of public health at the United Nations High Commissioner for Refugees.
Rubenstein is Professor Emeritus of Practice in the Department of Epidemiology at the Bloomberg School and Acting Director of the Johns Hopkins Center for Public Health and Human Rights. He previously served as executive director and president of Physicians for Human Rights.
Notable topics covered included:
Humanitarian law
“The law itself could be a casualty of this war,” Rubenstein warned, stressing that Israel and Hamas have likely flouted international law dictated by the Geneva Convention.
Rubenstein defined humanitarian law as “imposing specific obligations on combatants with one overarching objective: to protect civilians, civilian objects and structures, and the health of civilians.” In accordance with humanitarian law, military attacks must distinguish between civilians and military personnel, he said.
Rubenstein said he saw no evidence of respect for humanitarian law on either side. Hamas murdered civilians, took them hostage and launched rockets into random neighborhoods, he said. Israel has taken few steps to minimize harm to civilians, Rubenstein said, cutting off fuel to Gaza and failing to provide refugees with shelter, food and protected spaces where they can receive care.
Violating international law carries few penalties, he added. With no governing body responsible for enforcing the rules, violations are simply reported and condemned by organizations such as the United Nations, various NGOs, and the International Committee of the Red Cross.
Ultimately, enforcement of the Geneva Convention relies on the unlikely scenario of the military becoming self-politicizing: “Basic protections are the responsibility of the combatants,” Rubenstein said.
The public health report
While fighters who break international law may face few consequences, civilians and aid workers do, Spiegel said. The mental and physical strain on Gazans, Israelis and aid workers is “incredibly severe,” he said.
In what Spiegel called a “clear humanitarian emergency,” Gaza’s health system has essentially collapsed. On November 7, the United Nations Office for the Coordination of Humanitarian Affairs declared 40% of hospitals in Gaza have stopped functioning, meaning death rates are expected to increase in the coming weeks from normally treatable illnesses and injuries. With refugees crammed into overcrowded camps and hospitals, respiratory infections are inevitable, Spiegel said. The lack of drinking water could cause cholera epidemics and is already causing diarrhea. Disrupted continuity of care means people with non-communicable diseases, such as diabetes, cannot receive their medications. Furthermore, he added, pregnant women were unable to access healthcare and, among the thousands of victims in Gaza, women and children were killed in disproportionate numbers.
“Gaza lacks a humanitarian space where workers can be protected and do their jobs,” Spiegel said. “This makes it extremely difficult for workers to perform the necessary functions, if they have enough supplies, which they do not.”
Naturally, much of the public health discourse has focused on Gaza, but Israel has also experienced destabilization, Rubenstein said. An estimated 150,000 Israelis living near the Gaza border have been displaced, a number that includes entire towns; 50,000 Israelis living near Lebanon were also forced to evacuate. And then, of course, there are the events of October 7, when Hamas massacred more than 1,200 people and took more than 240 hostage.
“There was a tremendous amount of psychological trauma because it’s a small country,” Rubenstein said. “The horror of what happened on October 7 reverberates throughout the country because everyone knows someone who knows someone (who was affected).”
Spiegel added: “We have to take into account what is happening in Israel, as well as the echoes of World War II and the Holocaust that this has created. »
The decline in security and mental health concerns extends beyond the Middle East, they said, as rising anti-Semitism and Islamophobia emanating from the crisis are felt everywhere in the world.
The importance of accurate information
This conflict also opened a new front in the war against information. “Both sides are putting out information and videos and claims, and we have no way of verifying them,” Rubenstein said.
In the search for reliable information, both experts strongly warn against resorting to social media. Instead, they recommend turning to official sources, such as United Nations agencies, other governments and reputable news outlets. “It’s important to look at information and triangulate it from different angles, recognizing the biases on each side,” Spiegel said. “In some cases, you have groups that want to downplay or inflate the deaths or other things that they’re reporting.”
Amid conflicting reports from the Middle East, it may be somewhat reassuring to know that precise statistics matter less in assessing humanitarian crises than broader statistical trends, Spiegel said: “In terms of response, it doesn’t matter whether 10,000 or 12,000 people have been killed at this point – the numbers are so large and so serious that it should make no difference to the acuity of the response needed. »
Despite a flood of misinformation online, a clear picture of the suffering of Gaza residents has emerged. Rubenstein made clear that “there is sufficient information from independent reporting and news media that very serious damage is occurring and thousands of civilians are being killed, although we do not know the exact number.
