UK Letter

The Rt Honourable Keir Starmer MP Prime Minister
Office of the Prime Minister
10 Downing Street

London SW1A 2AA

Dear Prime Minister,

We are 30 qualified doctors, surgeons, nurses and medical professionals, based in the UK, who have volunteered in Gaza since October 7, 2023. We worked with various non-governmental organisations and the World Health Organization in hospitals throughout Gaza. In addition to our medical and surgical expertise, many of us hold current roles within the NHS, as well as having worked in humanitarian crises and conflict zones across the world.

Many of us also have long standing experience working with British charities in Gaza and across the occupied Palestinian territory (oPt). We have seen the deliberate targeting of civilians on a mass scale, and a total lack of resources, due to the destruction of Gaza’s healthcare system and deliberate restriction of aid. The deleterious effects of Israeli occupation on the Palestinian healthcare system are something many of us have seen before – but never to this extent.

We are a multi-faith and multi-ethnic group, united not by any political motivation, but by the desire to care for those who are suffering. The Constitution of the World Health Organization states: ‘The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and States.’ It is in this spirit that we write to you, and it is in this spirit that we realise that we cannot remain silent about what we saw in Gaza.

We are among the only neutral observers who have been permitted to enter the Gaza Strip since 7 October. With international journalists being targeted and denied access to Gaza, our eyewitness experiences have had to serve in place of journalistic or investigatory accounts. Given our broad expertise and unique first-hand experience of working in Gaza in recent months, we are uniquely positioned to comment on several matters of importance to our new government, as it considers its methods of engagements with Israel, the oPt (and specifically Gaza), and international actors.

Specifically, we believe we are well positioned to comment on the massive human toll from Israel’s attack on Gaza, on Palestinian men, women and children, as well as the long term and systematic destruction of the healthcare system, which will impact the sick as well as the wounded for years to come.

This letter collects and summarises our own experiences and direct observations in Gaza. We are willing to speak to government officials in more detail about the specifics of our experiences in Parliamentary, evidentiary, or other forums as required.

It is impossible to know the true death toll in Gaza. The Ministry of Health figure of approximately 40,000 Palestinians killed refers only to the number of identified bodies, but while working in Gaza we bore witness to untold numbers of unidentified bodies, many of them truly unidentifiable due to the extent of damage caused. A correspondence piece in The Lancet, one of Britain’s leading medical journals, estimated that the true figure could be 186,0001, reflecting the scale of indirect and unrecorded deaths that have inevitably occurred due to the destruction of the healthcare system. Those suffering from malnutrition due to Israel’s use of starvation as a weapon of war, and those suffering from water-borne diseases from Israel’s restriction of water and aid has increased the Gaza population’s suffering further.

We demand that the UK government acts immediately to bring an end to the continued Israeli military escalation of catastrophe in Gaza. The United Kingdom must ensure that its policies are ones that result in a ceasefire by withholding military support to Israel and ending arms trade with Israel. We believe our government is obligated to do this, both under British law and International Humanitarian Law (IHL), and that it is the morally as well as legally right thing to do.

With only marginal exceptions, everyone in Gaza is sick, injured, or both. This includes every national aid worker, every international volunteer, and every man, woman, and child. While working in Gaza we saw widespread malnutrition in our patients and our Palestinian healthcare colleagues. Many of us lost weight rapidly in Gaza despite having privileged access to food and having taken our own supplementary nutrient-dense food with us. We have photographic evidence of life-threatening malnutrition in our patients, from babies to the elderly, that we are willing or have already shared with you.

Virtually every child under the age of five whom we encountered, both inside and outside of the hospital, had both a cough and watery diarrhoea. Jaundice and hepatitis A infection were widespread in the hospitals in which we worked, while the surgical complication rate was near 100%. Surgical incisions were almost certain to become infected, due to the hospitals’ impossible operating conditions - including a lack of supplies, water, and medications including antibiotics - overcrowding, and due to patients’ malnutrition. We were forced to use household supplies including vinegar for antiseptic purposes, or went without. Due to the lack of painkillers, antibiotics, and hospital beds, patients exhibited a high rate of pressure necrosis.Pregnant women gave birth in unsanitary and overcrowded conditions, as there is simply nowhere left which is not unsanitary and overcrowded. These women face serious risk of complications, ill health, and death. Those of us who worked with pregnant women regularly saw still-births and maternal deaths that would be easily preventable in any functioning healthcare system. The rate of infection in C-section incisions was astonishing, and these were often delivered to women

going without anaesthesia or painkillers. Their infants were born underweight, while mothers are likely to be unable to breastfeed due to malnutrition. Potable water is unavailable across Gaza. Very few babies born under these conditions are likely to survive, and those who do will have their health permanently impaired.

We urge you to realise that epidemics are raging in Gaza. In addition to that, Israel has not stopped bombarding civilians in their tents or displacing the malnourished and sick population of Gaza, approximately half of whom are children, to areas with no running water or even toilets available. This is a horrifying reality. It is virtually guaranteed to result in widespread death from viral and bacterial diarrheal diseases and pneumonias, particularly in children under the age of five. According to the World Health Organization, since 19 July 2024, poliovirus has now been discovered in wastewater samples in Gaza.

We worry that unknown thousands have already died from the lethal combination of malnutrition and disease, and that tens of thousands more will die in the coming months. Most of them will be young children. Many of those who survive contracting polio will face lifelong consequences.

We condemn the use of infectious agents and the destruction of health care infrastructure as a means of warfare to be responsible for far more deaths of civilians compared to all combat arms combined.

All of us treated children who seemed to have been deliberately targeted by military violence. Bullet wounds to children’s heads and torsos and amputations of limbs and eyes of children were commonplace. Facilities serving Gaza’s children have been destroyed, including the Al-Rantisi Children’s hospital and the Gaza European Hospital’s Paediatric Intensive Care Unit. Much of the equipment for both facilities has been damaged during evacuation and both are currently inoperative.

The destruction of Gaza’s healthcare system capacity has meant that patients with chronic medical conditions, such as diabetes or renal failure, are forced to occupy increasingly-scarce hospital beds, while they are unable to access medicines and equipment, such as insulin, necessary for treating their conditions. It has been reported that these items, such as insulin needles, are being rejected at border crossings under ‘dual use’ prohibitions. Basic and specialist medication including immunotherapy and specialist blood products are wholly unavailable.

The sole cancer specialist hospital in Gaza, the Turkish–Palestinian Friendship Hospital, has been rendered inoperative, turned into a temporary Israeli military base, leaving cancer patients without basic facilities and unable to access treatment. Israel has destroyed more than half of Gaza’s healthcare resources and has killed one out of every 40 healthcare workers in Gaza. At the same time, healthcare needs have increased massively from the lethal combination of military violence, malnutrition, and disease.

The hospitals where we worked were starved of basic supplies from surgical material to soap. They were regularly cut off from electricity and internet access, denied clean water, and operated at four to seven times their bed capacity. Every hospital was overwhelmed beyond the breaking point by displaced persons seeking safety, by the constant stream of patients whose treatment of chronic conditions had been interrupted by the war, by the huge influx of seriously wounded patients who typically arrived in mass casualty events, and by the sick and malnourished seeking medical care.

Prime Minister Starmer, Foreign Secretary Lammy, it is difficult for many of us to recount the scenes we witnessed in Gaza, not least of all in the knowledge that many of the injuries we treated may have resulted from the use of weapons systems and components supplied from Britain. This includes the victims of the daily airstrikes conducted using F-16 and F-35 aircraft part-produced in the UK. Being some of the few UK citizens and residents able to travel to Gaza since October, we write to you in certainty that if you had seen, heard, and experienced the things we have, there would be no question of placing an arms embargo on Israel.

As noted, it is impossible to truly gauge a death toll, but these observations lead us to believe that it is far beyond the 40,000 confirmed and identified dead by Gaza’s Health Ministry. Tens of thousands face catastrophic injury of a type only inflicted by deliberate targeting of or wilful neglect for civilian life. What we have outlined to you amounts to probative evidence of widespread violations of British laws, International Humanitarian Law and the UK Government’s own rules on arms exports, namely the Strategic Export Licensing Criteria.

As we met our healthcare colleagues in Gaza it was clear that they were malnourished, and both physically and mentally devastated. We quickly learned that our Palestinian healthcare colleagues were among the most traumatised people in Gaza, and perhaps in the entire world. Like virtually all people in Gaza they had lost family members and their homes. Most lived in and around their hospitals with their surviving families in unimaginable conditions. Although they continued working a gruelling schedule, they had not been paid since October 7. All were acutely aware that their work as healthcare providers had marked them as targets for Israel. This makes a mockery of the protected status hospitals and healthcare providers are granted under the oldest and most widely accepted provisions of International Humanitarian Law.

Amidst raids, bombings, and destruction of Gaza’s hospitals, many of our Palestinian healthcare colleagues were kidnapped by Israeli forces. During their detention, which lasted for weeks or months, almost all reported experience of physical and psychological abuse, mistreatment including torture and sexual abuse including being stripped naked, and other cruel and inhumane punishments - punishments given them solely for their being doctors. When returning to the United Kingdom, meanwhile, some of us have faced harassment, including threats of murder and violence, from which we have not been protected by the NHS nor Police.

Some of us have also been the direct victims of Israeli air strikes. Whilst sleeping in a deconflicted safe house some of us were targeted by Israeli artillery. A GBU-32 (Mk83) bomb landed 6 metres from the wall of our accommodation. This resulted in significant damage to the house as well as injuries to the medical team.

We urge you to see that Israel has directly targeted and deliberately devastated Gaza’s entire healthcare system, and that Israel has targeted our colleagues in Gaza for death, disappearance, and torture. These unconscionable acts are entirely at odds with British law, British values, and International Humanitarian Law.

Prime Minister Starmer and Foreign Secretary Lammy, with your respective extensive legal backgrounds, you must acknowledge the widespread breaches of British and International Law that continue to be committed in this conflict. Many of us have met and shared these stories with your colleagues in the Labour Party, but yet, we have seen no concrete action to prevent the senseless deaths occurring day-in and day-out. The UK government is impeding international procedures and has gone against its own standards that it has applied in other crises around the world. We sincerely hope to see these standards replicated in Gaza without hypocrisy to stop what is being done to innocent Palestinian men, women and children.

Any solution to this problem requires the withholding of military, economic, and diplomatic support from Israel, and participating in a full arms embargo of Israel, until a permanent ceasefire is established, and until good faith negotiations between Israel and the Palestinians lead to a permanent resolution of the conflict.

All land crossings between Gaza and Israel as well as the Rafah Crossing must be opened to unfettered aid delivery by recognised international humanitarian organisations, with a redeveloped ‘security screening’ regime conducted by an international co-ordination regime independent of Israeli military forces. These screenings must be based on a clear, unambiguous, and published list of forbidden items, and with a clear independent international mechanism for challenging forbidden items, as verified by the UN Office for the Coordination of Humanitarian Affairs in the oPt. This is vital in mitigating potential famine arising as a result of Israel’s use of starvation as a weapon of war.

Full and unrestricted access to the Gaza Strip must be created for medical and surgical professionals, including those of Palestinian descent who are currently barred by Israel

from entering or working in Gaza4. These healthcare professionals must have unimpeded ability to transport medical and surgical equipment in their personal luggage, so that they may safeguard their proper storage, sterility, and timely delivery, as verified by the World Health Organization.

The delivery of community care including immunisation programmes must be ensured, to help prevent communicable diseases including measles, polio, COVID-19, and skin disease. The United Kingdom must support the construction of field hospitals to service Gaza’s population in place of now destroyed health facilities, and must look to funding and supporting the reconstruction of Gaza’s hospitals in the future.

A bare minimum water allocation of 20L of potable water per person per day must be allocated to the population of Gaza, as verified by UN Water. This is vital in mitigating the spread of water-borne diseases.

Respect and support for international and domestic accountability mechanisms from the UK government must be ensured. This includes supporting the International Criminal Court Prosecutor’s investigation in the Palestine Situation, South Africa’s case before the International Court of Justice, domestic universal jurisdiction prosecutions, and any other means of judicial, political and diplomatic accountability.

We repeat: we are not politicians driven by political agendas. We are simply medical professionals who feel duty bound to speak out about what we saw in Gaza. Our duty is to our patients, to our fellow healthcare workers still in Gaza and to humanity. It is the same principle of duty many of us apply to our day-to-day work in the NHS as we did in Gaza as well. Every day that the United Kingdom continues supplying weapons and munitions to Israel is another day that the Palestinian men, women and children of Gaza are killed and maimed by weapons, including those manufactured in the UK.

Prime Minister Starmer and Foreign Secretary Lammy, we urge and implore you to end our role in this unimaginable cruelty now.

Yours sincerely:

Dr. Muhammad Junaid Sultan
Consultant Vascular Surgeon
National Health Service, UK
European Gaza Hospital (3 April 2024 - 15 April 2024)

James Smith MBBS MA MSc MSc
Emergency Medicine
Lecturer in Humanitarian Policy & Practice, UCL
Shuhada Al-Aqsa Hospital (26 December 2023 - 8 January 2024)
Al Mawasi, Rafah, Al Awda Nuseirat, Al Aqsa, patient evacuations from North Gaza and Gaza City, (16 April 2024 - 6 June 2024)

Victoria Rose MBBS FRCS plast LLM
Plastic Surgeon
Ideals Charity since 2019, Chair of RCSE Special Advisory Committee for Plastic Surgery
European Gaza Hospital (March 2024)
Nasser Hospital (August 2024)

Alan Frederick Graeme Groom MA MB FRCS
Trauma and Orthopaedic Surgeon
Co-Chair of IDEALS charity
European Gaza Hospital (25 December 2023 - 9 January 2024, 24 March 2024 - 9 April 2024)
Nasser Hospital (5 August 2024 to Present)

Dr. Andrew Ferguson MBCHB MPH MFPHM MRCGP
Family Medicine
Co-Chair of IDEALS charity and veteran of over 50 previous missions to Gaza since 2009
European Gaza Hospital (26 December 2023 - 8 January 2024)

Dr. Omar El Taji
Urological Surgeon
European Gaza Hospital (29 April 2024 - 17 May 2024)

Mahim I Qureshi MA MBBS PhD FRCS
Vascular Surgeon
Shuhada Al-Aqsa Hospital (3 April 2024 - 15 April 2024)

Basil Budair MBBS FRCS
Trauma and Limb Reconstruction Surgeon
Visited Gaza multiple times before the war as part of work with IDEALS charity limb reconstruction
European Gaza Hospital (25 December 2023 - 8 January 2024, 26 February 2024 - 11 March 2024)

Miss Ana Jeelani MBChB FRCS (Tr&Orth)
Consultant Paediatric Orthopaedic Surgeon
Shuhada Al-Aqsa Hospital (11 March 2024 - 25 March 2024)

Miss Kaji Sritharan MBBS FRCS (Eng) MD (Res) DIC FEBVS
Consultant Vascular Surgeon
Nasser Hospital (25 July 2024 - 14 August 2024)

Konstantina Ilia Karydi MD, MSc, DMCC
Consultant Anaesthetist, Oxford University Hospitals
European Gaza Hospital (21 February 2024 - 6 March 2024)

Mohammed Abdus-Samee BSc Hons MBBS MRCSEd PGDip FRCSEd (Tr & Orth)
Trauma & Orthopaedic Surgeon
European Gaza Hospital (25 February 2024 - 12 March 2024)

Miss Sarah Phillips TD FRCS (Orth)
Trauma & Orthopaedic Consultant Surgeon
Trustee of IDEALS, involved with setting up The Limb Reconstruction Project
European Gaza Hospital (24 January 2024 - 5 February 2024)

Professor Nick Maynard MS FRCS FRCSEd
Consultant Upper GI Surgeon
Working and teaching in Gaza since 2010
Shuhada Al-Aqsa Hospital (26 December 2023 - 8 January 2024, 22 April 2024 - 6 May 2024)

Dr. Deborah Harrington FRCOG
Obstetrics
Teaching medical students and doctors in Gaza annually since 2016 as part of a medical education group from Oxford
Shuhada Al-Aqsa Hospital (25 December 2023 - 9 January 2024)

Tim Goodacre MB BS FRCS
Reconstructive Plastic Surgery
Worked in Gaza since 2014 with IDEALS and MAP associates
European Gaza Hospital (23 January 2024 - 5 February 2024)

Dr. Mhoira Leng FRCP FRSE
Palliative Care and Internal Medicine
Visiting academic faculty at IUG and MOH hospitals including Al Shifa, Al Rantisi, and Turkish Hospitals for 10 years
Medical Director, Cairdeas International Palliative Care Trust
Non-Communicable Disease Clinics (18 March 2024 - 1 April 2024)

Dr. Aalisha Mariam Karimi MBBChir MRCP FRCA DipTMH
Anaesthetics
Nasser Hospital (25 July 2024 - 14 August 2024)

Dr. Riyadh Masharqa
Consultant Plastic Surgeon
European Gaza Hospital (18 March 2024 - 1 April 2024)

Muhammad Farooq BSc MSc PhD MBChB FRCS
General and Colorectal Surgeon
Nasser Hospital (11 January 2024 - 18 January 2024)
Evacuated after a missile attack on 18 January 2024

Dr. Ahmed Habib
Thoracic Surgeon
European Gaza Hospital (24 January 2024 - 5 February 2024)

Dr. Ibrahim Barouni
Orthopaedic Surgeon
European Gaza Hospital (April 2024)

Dr. Khaled Dawas
Director of GI Surgery at University College Hospital
Shuhada Al-Aqsa Hospital (26 December 2023 - 9 January 2024, 3 April 2024 - 15 April 2024)

Dr. Abdullah Hanoun
Orthopaedic Surgeon
European Gaza Hospital (24 January 2024 - 5 February 2024)

Dr. Shah M. Rahman BSc (Hons) MBBS DCH DMCC DipMedTox DipRTM FIMC RCSEd FRCEM
Pre-Hospital & Emergency Medicine, Critical Care Doctor NHS
European Gaza Hospital (May 2024 - June 2024)

Professor Ghassan Abu-Sittah
Plastic and Reconstructive Surgeon
Worked in Gaza during wars in 2009, 2012, 2014, Second Intifada, and the March of Return in 2018
Al Ahli Hospital and Nasser Hospital (9 October 2023 - 21 November 2023)

Amer Shoaib BSc (Hons) LMSSA FRCS (Orth)
Orthopaedic Surgeon
Veteran of previous medical missions to Syria, Gaza, Yemen, Iraq, Bosnia, and Libya
Nasser Hospital (10 January 2024 - 20 January 2024)

Dr. Asma Lina Fazlanie MBChB MSc BMedSci FRCA MRCP
Anaesthesiologist
Shuhada Al-Aqsa Hospital (March 2024)
Attempted to enter Gaza in July 2024 but was prevented, stranded in Jordan for two weeks

Dr. Shaik Yousufuddin
Trauma and Orthopaedics
European Gaza Hospital (25 March 2024 - 10 April 2024)

Professor Suheal A Khan MBChB FRCS Ed FRCS Tr & Orth
Senior Consultant Orthopaedic Surgeon
European Gaza Hospital (5 January 2024 - 18 January 2024)
Nasser Hospital (5 July 2024 - 18 July 2024)

This letter has been supported by the International Centre of Justice for Palestinians.
The International Centre of Justice for Palestinians (ICJP) is an independent organization of lawyers, politicians, and academics who support the rights of Palestinians and aim to protect their rights through the law. ICJP is a not-for-profit company registered at Companies House under number: 13054048.