Why are global health organisations not speaking up on genocide in Gaza?

It has been more than six months since the International Court of Justice ruled in South Africa v Israel that the latter was plausibly in violation of the Genocide Convention for its treatment of Palestinians. Israel’s ongoing systematic attacks on Gaza’s health workers and infrastructure have played a central role in the court’s deliberations, putting the unfolding violence squarely within the domain of health scholars and institutions.

It is striking then that nearly all influential United States-based global health organisations have ignored what may be the most acute and most preventable global health catastrophe in the world today. From the gargantuan Bill and Melinda Gates Foundation to the many smaller NGOs and academic centres that shape this field, these organisations have abstained from taking any meaningful stand against the systematic destruction of health infrastructure in Gaza actively enabled by the Biden administration’s provision of arms, funds and diplomatic cover for Israel.

Given such organisations’ extensive lobbying and collaborations with the US government, receipt of funding from it, and close relationships and substantial influence among many of its top officials, this silence is especially disappointing.

It also testifies to the enduring relevance of what Frantz Fanon observed in his 1959 essay Medicine and Colonialism while working as a psychiatrist in French-colonised Algeria during its struggle for liberation. Doctors, when economically or otherwise professionally incentivised, are an “integral part of colonization, of domination, of exploitation”, he wrote, and “we must not be surprised to find that doctors and professors of medicine are leaders of colonialist movements.”

This is also true of global health today – a field previously known as colonial medicine, tropical medicine and then international health – which has always been mired in complicity with colonial domination and white supremacist ideologies.

But while Fanon testified firsthand to organised medicine’s tendency to align with state violence, he also believed and showed through his own life that individual doctors and collectives can choose to do otherwise and instead become vital contributors to movements for freedom, care and justice.

Today, Palestinian health workers and organisations like Doctors Without Borders (known by its French acronym MSF), which was founded in France nine years after Algeria won its independence, most poignantly illustrate the truth of Fanon’s observations. When doctors are themselves “sleeping on the ground”, Fanon wrote, and “living the drama of the people” alongside the oppressed, they can become genuine allies against oppression rather than collaborators with it.

Working side by side with Palestinians, MSF staff members are doing just that and using their organisation’s international influence not only to provide care for those maimed by Israeli attacks on civilians but also to publicly document and condemn the crimes that Israel continues to perpetrate with US-supplied weapons.

This decision has come at a profound cost: Six MSF staff members and several members of staff families have been killed by Israeli attacks – as have about 500 other health workers, almost all of whom were Palestinian.

MSF has not always taken such a strong stand against the political actors and decisions behind the infliction of disability and death on civilian populations. Since its founding, the organisation has debated the use of expressly depoliticising paradigms like “neutrality”, “témoignage” (a French term for testimony or bearing witness), and “humanitarianism”. It has seen them as tools for securing access to conflict zones and occupied territories without falling into disfavour with political groups that could either target MSF staff or prohibit the organisation from reaching affected populations.These frameworks help avoid offending philanthrocapitalists and formerly colonising governments in the Global North wary of political criticism about their ongoing neocolonial policies and practices sustaining the economic inequalities from which they benefit while the global poor die.

But over the past several decades in response to both internal and external criticism as well as the Rwandan genocide that underlined in bold the untenability of neutrality, many within MSF have increasingly confronted the fact that there is no possibility of effectively caring for people or of stopping atrocities except through political engagement, even when it displeases donors and politicians.

By contrast, other medical organisations in the Global North are refusing to follow suit. Although the Euro-American global health and humanitarian industry – much like the US medical profession with which it is intimately entwined – is built on evasion and denial of this reality, the simple fact is that human life and health is, from birth to death, determined by political decisions.

By selectively appealing to political neutrality and depoliticising ideologies like “humanitarianism” and “crisis” as a way of sidestepping the political-economic determinants of health amid an unfolding genocide, most institutional leaders and rank-and-file doctors in the US are once again retreating from their ethical responsibility to do all they can to protect life.

The history of humanitarian organisations is riddled with impossible choices and genuine ethical dilemmas. This truth has, in turn, been used to create abundant opportunities for organisations to hide behind the terms that “humanitarianism” has created to navigate access under challenging circumstances.

But the well-established facts of Israel’s deliberate targeting of health workers and infrastructure, killing of civilians in hospitals and refugee camps, and use of famine as a weapon of war alongside open declaration of genocidal intent do not present an ethically ambiguous choice for any organisation truly concerned about either global health or the medical humanitarian act.

The medical profession, global health practitioners and our institutions have betrayed our most basic ethical responsibilities time and time again, and yet we continue to refuse to learn from our sordid past.

By staying silent in the face of a politically determined atrocity, we may evade professional risks and loss of funding that could result from taking a principled stand against the violence of US imperialism and Israeli occupation. But the decision by global health organisations today to remain “neutral” – or worse – in the face of a genocide is sacrificing something far more valuable and difficult to recover: any plausible claim to ethical credibility.