January 25, 2015
In July 2014, Israel initiated a military offensive in the Gaza Strip. Questions arose regarding violations of international human rights and humanitarian law in the course of the conflict. Thus IFHHRO member Physicians for Human Rights-Israel (PHR-Israel) commissioned a fact-finding mission to Gaza, the report of which has just become available.
The aim of the mission was to gather evidence and draw preliminary conclusions regarding types, causes and patterns of injuries and attacks; attacks on medical teams and facilities; evacuation; impact of the conflict on the healthcare system; and longer-term issues including rehabilitation of the wounded, mental health, public health and displacement.
Although accounts vary, most estimates put the number of residents of Gaza killed in the 50-day armed conflict at over 2,100, of whom at least 70% were civilians, including over 500 children. Over 11,000 were wounded and over 100,000 made homeless. According to Israeli official accounts, 73 Israelis were killed (67 soldiers and 6 civilians, including one child and one migrant worker) and 469 soldiers and 255 civilians were wounded.
A team of 8 independent international medical experts, unaffiliated with Israeli or Palestinian parties involved in the conflict, made three visits to the Gaza Strip between 19 August and 12 November 2014. The team consisted of four people with special expertise in the fields of forensic medicine and pathology; and four experts in emergency medicine, public health, paediatrics and paediatric intensive care, and health and human rights.
Meetings and site visits were held in medical facilities and in the community, and included interviews with victims, witnesses, healthcare professionals and human rights workers, officials from the Gaza Ministries of Health and Justice, and representatives of international health organisations in Gaza and the West Bank. Wherever possible, forensic, medical and other material evidence was collected to support oral testimonies.
The team found that:
- The overwhelming majority of injuries causing death or requiring hospitalisation were the result of explosion or crush injuries, often multiple complex injuries
- A majority of hospitalised patients interviewed reported people being injured or killed while in, or very close to, their homes or those of relatives and neighbours
- Numerous cases in which significant numbers of casualties including members of the same family and rescuers were killed or injured in a single incident
- ‘Double tap’ or multiple consecutive strikes on a single location led to multiple civilian casualties and to injuries and deaths among rescuers
- Heavy explosives were used in residential neighbourhoods, resulting in multiple civilian casualties
- Emergency medical evacuation was not enabled and/or in which medical teams were killed or injured in the course of evacuation of the injured (notably in Shuja’iya, Gaza City
- At least one case in which a mine-breaching explosive device (‘tsefa shirion’) was used in a residential street in Khuza’a, Khan Younis, causing massive destruction
- At least one case, of Shuhada’ Al Aqsa Hospital in Deir Al Balah, where several people were killed and injured in what was apparently a deliberate attack on the hospital on 21 July 2014
Attacks on health care
An in-depth study of the town of Khuza’a suggests that a medical clinic in which civilians and injured people were sheltering after the attack was hit by missiles, causing deaths and injuries. There were also problems with referral and evacuation of patients from Gaza hospitals to hospitals outside. Coordination of medical evacuation was often denied and many attacks on medical teams and facilities were reported. It is not clear whether such contravention of medical neutrality was the result of a policy established by senior decision-makers, a general permissive atmosphere leading to the flouting of norms, or the result of individual choices made on the ground during armed clashes. The team also identified long-term psychosocial and mental health damage caused by this and previous wars, and an increased need for rehabilitation services while there are insufficient current resources in Gaza to meet them.
The experts also report about the double attacks on medical evacuation teams. “…(they) attempted to respond to the air attacks by distributing ambulances to strategic places, hoping to decrease response time and to respond even when injured people were unable to call for help in the event of electricity and communication failures. In practice, the result was that in many cases the ambulances travelled to a location after a first explosion, without knowing its nature, and shortly after they arrived there was a second, larger explosion, causing damage, injuries and sometimes casualties among the medical teams.”