Readers respond to articles about health care in Gaza

CMAJ has every right to publish on matters medical from around the world. In fact, it is one of the Journal’s duties. However, when the Journal covers a controversial issue, especially one with strong political overtones, it is clear that various views should be solicited. In this vein, I have many concerns about the 2 recently published articles on Gaza. 1^,2 I mention only a few.

These pieces are replete with unsubstantiated claims. For example, the statement that “Gaza has the highest prevalence of traumatized children in the world” 1 is not supported with a reference, and the denominator is not given. From my experience working in southern Israel bordering Gaza, I can tell you of thousands of traumatized Israeli children who have had to endure rocket attacks from their neighbours in Gaza over the past 8 years. Do these children not count?

Christopher Mason states that “the Gaza health care system was already crippled by underfunding and a border blockade that prevented needed medical supplies and personnel from entering the region.” 1 The critical question must be Why? He should have pointed out that this blockade was not only enforced by Israel (in an attempt, only partly successful, to prevent the smuggling of heavy arms) but is also supported to this day by the United States, the European Union and an Arab state (Egypt). As in clinical presentations, context is everything.

Who is responsible for the under-funding of Gaza’s health care system? The Hamas government decided to use its abundant resources (including foreign aid) to prepare for war rather than building a health care system. CMAJ readers should be reminded that Israel withdrew from Gaza several years ago at great internal political cost. I can attest to the fact that this step was taken in the fervent, and as it turns out naive, hope that Palestinians would begin to build themselves a state. Unfortunately, they chose war, not peace; mortars, not medicine. Even Palestinian commentators confirm this tragic state of affairs. 3

As a Canadian physician who just went through this war, I tried mightily to keep my patients up and my head down. 4 I have been involved with CMAJ for years, and I might have expected the editors to have asked me or someone else here for our perspective. To their credit, BMJ ’s editors commissioned a blog, 5 transmitted a podcast and published a “Personal View” article on the conflict. 4 Although they posted articles critical of Israel, they did not completely ignore the “other side.” The Medical Post likewise solicited material from the front. 6 Why could CMAJ not have taken such an approach?

Even if I do not agree with every word published, I have always considered CMAJ to be my voice in Canadian and world medicine. With respect to the extremely complex and fraught issue of health services in the Middle East, I would have expected a more professional approach from the Journal. I was most disappointed with CMAJ ’s strange editorial decision in this most sensitive matter. The articles by Mason and Dumont have contributed mostly heat, shedding very little light. Such pieces will help neither Israelis nor Palestinians to find a solution to this tragic conflict.