Canadian Letter

August 7, 2024

Re: Canadian health care workers’ experiences in the Gaza Strip after November 2023

Dear Prime Minister Mr. Justin Trudeau,

Deputy Prime Minister Ms. Chrystia Freeland,

Minister of Foreign Affairs Ms. Melanie Joly,

We are Canadian health care workers who have volunteered in the Gaza Strip on medical relief missions since December 2023. We are a dedicated team of nurses, physicians, surgeons, and public health clinicians, from multiple religious and ethnic backgrounds. As humanitarians, all of us believe in International Humanitarian Law (IHL), including the authority of the International Criminal Court (ICC) and the International Court of Justice (ICJ).

As health care workers, we write you as part of our obligation to uphold the World Health Organization’s commitment to “promote well-being, prevent disease, (and to) give everyone an equal chance at a safe and healthy life.” As first-hand witnesses of the trauma that the ICJ has considered plausible for genocide, it is our obligation to comment on the horrendous suffering of all men, women, and children, in the face of ongoing Israeli attacks in Gaza.

Given the ten-month complete siege of Gaza and the blockade of foreign journalists, healthcare workers have become the eyes and ears for the outside world, bearing witness to the unfolding unprecedented catastrophe affecting 1.9 million internally displaced refugees.(1) This includes being witness to Israel’s repeated and ongoing violations of International Humanitarian Law, such as the deliberate targeting of the healthcare system.(2) with nearly 800 attacks against healthcare centers in Gaza.

Now over 300 days into the relentless Israeli military assaults on hospitals, 56% of hospitals are entirely non-operational, with the remaining functioning only partially.(3) A staggering 55% of primary healthcare facilities remain non-functional. Over 500 healthcare workers have been killed, including 63 physicians.(4) Hundreds of healthcare workers have been detained and subjected to torture.(4) The Israeli attacks have made this the deadliest place in history for aid workers.(5)

Indeed, Oxfam has reported that Israel’s actions have precipitated a death rate “in Gaza higher than any other conflict in the 21st century.”(6)

The ongoing tragedies in this conflict aren't solely the result of Israeli bombings; they stem from Israel’s targeting of public infrastructure, blockade of water and food and humanitarian aid,(7) and the inability to access healthcare facilities. The deliberate starvation of a civilian population, where it is estimated that half are children, constitutes a war crime [ICC Statute Article 8(2)(b)(xxv)]. It is projected that 96% of the population in Gaza is at the brink of a manmade famine.(1) According to The Lancet,(9) the reported death toll of 37,396 is likely a gross underestimation, with the actual number of deaths potentially reaching up to 186,000 or more.

The multiple public health crises in Gaza have included Hepatitis A, respiratory and skin infections, and diarrheal illnesses. Also very concerning is that on July 29 (2024), Gaza is now faced with being a polio epidemic zone. This is attributed to the complete collapse of the sanitation infrastructure and a severe lack of potable water. The situation represents yet another setback for an already vulnerable population. This also reflects a failure of the international community to intervene after 300 days of Israeli attacks that have violated IHL.

There are already encyclopedias of statistics that demonstrate how Israel’s deliberate destruction of healthcare infrastructure has led to massive death and suffering for people in Gaza. Of course, you should already be aware of these statistics; they’ve been widely publicized by major human rights and humanitarian organizations for months, and formed a significant part of South Africa’s case that Israel’s actions are plausible for genocide. Multiple signatories of this letter met with the Prime Minister’s Office on November 30 (2023) to communicate these concerns and to demand action.

Many of us have already shared our testimony with the ICC and ICJ. We now share our testimonies from Gaza with you, to reveal the horrors we witnessed and the nightmares that haunt us, in part due to the inaction of the Canadian government.

“As a paediatric intensive care doctor, I wasn’t expecting to be most relevant in a general ER and adult ICU, but children were overwhelming victims of the Israeli assault. What we received several times a day were massacres of entire multi-generational families, with an overwhelming number of children arriving into our arms already dead, gasping, or alive but suffering from the pain and terror of horrific traumatic injuries, often without any accompanying family alive to identify the child or hold their hand as they gasped and whimpered. I have never seen anything this horrific and like many, am utterly shocked and appalled that we have allowed this continue.”
Dr. Tanya Haj-Hassan, Paediatric intensive care physician, Gaza March 2024

“I saw multiple children who couldn’t walk due to severe malnutrition. I saw numerous cases of acute infections, burns and other severe injuries from Israel’s airstrikes. The majority of my patients had limited or no reliable access to nutritious food, clean water, or decent shelter. These patients were being deliberately starved. These are entirely preventable conditions. Infectious diseases are running rampant, including the most recent declaration of a polio epidemic zone in Gaza. There is no other conclusion than this being a genocide of the people in Gaza.”
Dr. Yipeng Ge, Primary care physician, Gaza February 2024

“The hallways of hospitals were overflowing with patients and internally displaced people - injured were lying on the floor. Widespread malnutrition was apparent. I treated numerous children bearing the scars of bullets and shrapnel- amputated limbs being a grim necessity. These amputations were often done without anesthesia. All patients were struck with psychological trauma. I remember a three-year old boy struck with extensive shrapnel wounds and facial fractures, paralyzed and unable to communicate. He was too young to comprehend the agony he endured. The overwhelming majority of the victims were children - the victims of an ongoing multi-faceted killing spree.”
Dr. Fozia Alvi, Primary care physician, Gaza February 2024

“I treated one young woman who died from pneumonia because we didn’t have access to oxygen or the right antibiotics. I treated a teenager who died from continuous seizures because there were critical shortages of basic medications including his seizure medication. I treated a young girl, about 18 months old, with likely new diagnosis of cancer who couldn’t receive treatment because of attacks on the healthcare system. I treated multiple patients, including physicians, who were victims of Israeli torture. All of this would have been preventable had the healthcare system not been targeted in Israeli attacks.”
Dr. Ben Thomson, Internal medicine/Nephrologist, Gaza Sept 2023 and March 2024

“I personally treated over 10 children within 4 days who needed amputations of the eyeball, some as young as age 2. They were all obviously noncombatants, clearly innocent victims. 90% of the injuries I saw were in children under 16. In over 20 years of practice in over 40 different countries these are the most horrific injuries I’ve ever seen. This is unprecedented and it’s mostly children.”
Dr. Yasser Khan, Ophthalmologist and oculoplastic surgeon, Gaza December 2023 and March 2024

"During my recent July medical mission to Gaza, I encountered a woman in her 40s who was begging me in the ICU to save her remaining 5-year-old child, for whom I performed a laparotomy due to multiple bowel injuries. She was the sole survivor of a family of six because she was outside the tent trying to bake some bread to her family after three days without food. The tent was struck by an Israeli drone, and her three other children died instantly. Husband lost both legs. All three children died hungry." Dr. Anas Al-Kassem, Trauma surgeon, Gaza December 2023 and July 2024

We direct you to recent decisions of the world’s highest court, the International Court of Justice:

1. On July 19 (2024), the ICJ issued its opinion that Israel’s occupation and annexation of Palestinian territories are unlawful, and its policies against Palestinians violate the prohibition on racial segregation and Apartheid.(10) The Occupied Territories include West Bank, Gaza and East Jerusalem.

2. Israel has consistently failed to comply with the provisional measures ordered by the ICJ to prevent genocide in Gaza, and has continued to violate IHL after the January 26 (2024) ruling.(11) This has included violation of the May 24 (2024) ICJ ruling(12) which advised “Israel must immediately halt its military offensive, and any other action in the Rafah Governate.”

As a member of the United Nations, Canada is under obligation to respect the ruling of the ICJ. There are solutions that have not been implemented to protect the civilian population in Gaza.

There are several urgent measures that must be implemented to address the immediate needs of Palestinians in Gaza:

1. Lift the blockade of Gaza strip so humanitarian aid from all border crossings can be delivered under the surveillance of the UN Office for the Coordination of Humanitarian Affairs in the occupied Palestinian territory.

2. The World Health Organization and other neutral agencies should be the sole authorities responsible for conducting background checks on EMTs and humanitarian aid workers entering the Gaza Strip, rather than the Coordination of Government Activities in the Territories (COGAT) and Shabak.

3. To ensure self-sufficiency of all emergency medical teams entering the Gaza Strip, complete unrestricted access of medical and surgical equipment must be allowed.

4. End the blockade of healthcare professionals of Palestinian descent (including Canadian citizens) to enter the Gaza Strip for humanitarian efforts.

5. Canada must respect and comply with the ICJ decisions, including that Canada will not support Israel in maintaining apartheid in the Occupied Territories of Palestine. Canada must withhold all military and economic aid to the State of Israel until a ceasefire is reached and a permanent end to the sixteen-year-old blockade of the Gaza Strip is reached.

6. Canada must enact a two-way arms embargo immediately, to prevent supporting the Israeli military that has played a critical role in the apartheid, racial segregation, genocide and ongoing violations of IHL.

Canada must publicly and unequivocally state the need for each of the above 6 items.

As healthcare workers who have witnessed the ongoing genocide in Gaza, we cannot and will not remain silent. Women, men, and children in Gaza continue to be torn apart by bombs dropped by Israel on tents, schools, mosques, and hospitals.

It is time that Canada moves to the right side of history, and plays an important role in ending this genocide.

Sincerely and urgently,

Dr. Ben Thomson, Nephrology and internal medicine, public health
September 2023, March 2024

Dr. Fozia Alvi, Primary care medicine
February 2024

Dr. Yipeng Ge, Primary care medicine, public health
February 2024

Dr. Yasser Khan, Ophthalmology and oculoplastic surgery
December 2023 and March 2024

Dr. AbdulGhani Basith, Emergency medicine
March 2024

Dr. Mohammad Rizwan Minhas, Primary care and chronic pain medicine
April 2024

Dr. Noor Amin, Emergency medicine and sports medicine
March 2024

Dr. Abdel-Rahman Lawendy, Orthopedic surgery
March 2024

Dr. Adel Elsharkawy, Pediatric medicine
April 2024

Dr. Amgad Elsherif, Thoracic surgery
December 2023, February 2024, April 2024, July 2024

Dr. Anas Al-Kassem, Trauma surgery
December 2023, July 2024

Dr. Kamran Karatela, Internal medicine
March-April 2024

RN Anna Tratnyek, Nurse practitioner primary health care, emergency medicine
February 2024

Dr. Mohamed Mahmoud, Primary care medicine
March 2023

Dr. Tanya Haj-Hassan, Paediatric intensive care medicine
March 2024

Dr. Muntasir Saffie, Internal medicine and respirology
April 2024

Dr. Dorotea Gucciardo, Team lead of medical delegation
May to June 2024

Dr. Saif Ullah, Internal Medicine and Respirology
April 2024

Ms. Heba Al-Nashef, Midwife
June-July 2024

Cc:
NDP Leader Jagmeet Singh
PC Leader Pierre Poilievre
Green Party Leader Elizabeth May
Speaker of the House of Commons Greg Fergus
Minister of International Development Ahmed Hussen
Minister of Immigration, Refugees and Citizenship Marc Miller
Minister of Health Mark Holland
Minister of Justice and Attorney General of Canada Arif Virani

REFERENCES:

1.United Nations Office for the Coordination of Humanitarian Affairs. Reported impact snapshot – Gaza strip (July 31, 2024). Available at: https://www.ochaopt.org/content/reported-impact-snapshot-gaza-strip- 31-july-2024

2. Human Rights Watch. Gaza: Unlawful Israeli Hospital Strikes Worsen Health Crisis: Israel’s Blockade, Bombardment Decimate Healthcare System; Investigate as War Crimes. November 14 (2023). Available at: https://www.hrw.org/news/2023/11/14/gaza-unlawful-israeli-hospital-strikes-worsen-health-crisis

3. Health Cluster. Occupied Palestinian territory. Available at: https://healthcluster.who.int/countries-and- regions/occupied-palestinian-territory

4. United Nations Human Rights Office of the High Commissioner- Occupied Palestinian Territory. June 25 (2024): Available at: https://reliefweb.int/attachments/c0cee80e-234c-453b-8cfd- 3b093d065ed0/Statement%20on%20the%20killing%20and%20arbitrary%20detention%20of%20health% 20workers%20in%20Gaza%2025%20June.pdf

5. International Crisis Group. Israel has made Gaza the deadliest place for aid workers. May 7 (2024). Available at: https://reliefweb.int/report/occupied-palestinian-territory/israel-has-made-gaza-deadliest- place-aid-workers#:~:text=Download%20Report,PDF%20%7C%20135.35%20KB)

6. Oxfam International. Daily death rate in Gaza higher than any other major 21st century conflict- Oxfam. January 11 (2024). Available at: https://www.oxfam.org/en/press-releases/daily-death-rate-gaza- higher-any-other-major-21st-century-conflict-oxfam

7.Human Rights Watch. Israel: Starvation Used as Weapon of War in Gaza. Evidence Indicates Civilians Deliberately Denies Access to Food, Water. December 18 (2023). Available at: https://www.hrw.org/news/2023/12/18/israel-starvation-used-weapon-war-gaza

8.Just Security. Gaza Arrest Warrants: Assessing Starvation as a Method of Warfare and Associated Starvation Crimes. May 31 (2024). Available at: https://www.justsecurity.org/96257/assessing-gaza- starvation/#:~:text=Based%20on%20the%20determination%20of,impeding%20relief%20supplies%2C% 20acts%20which

9. Khatib R, McKee M, Yusuf S. Counting the dead in Gaza: difficult but essential. The Lancet 2024; Volume 404, Issue 10449, P237-238

10. International Court of Justice. Summary of the Advisory Opinion of July 19 (2024). Available: https://www.icj-cij.org/node/204176

11. International Court of Justice. Summary of the Advisory Opinion of January 26 (2024). Available: https://www.icj-cij.org/index.php/node/203454

12. International Court of Justice. Summary of the Advisory Opinion of May 24 (2024). Available: https://www.icj-cij.org/node/204091