Letter to President Biden and Vice President Harris

Dear President Joseph R. Biden, Vice President Kamala Harris, and Dr. Jill Biden,

We are forty-five American physicians, surgeons, and nurses who have volunteered in the Gaza Strip since October 7, 2023. We worked with various nongovernmental organizations and the World Health Organization in hospitals throughout the Strip. In addition to our medical and surgical expertise, many of us have a public health background, as well as experience working in humanitarian and conflict zones, including Ukraine during the brutal Russian invasion. Some of us are veterans of the United States Armed Forces. We are a multifaith and multiethnic group. None of us support the horrors committed on October 7 by Palestinian armed groups and individuals in Israel.

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.

We are among the only neutral observers who have been permitted to enter the Gaza Strip since October 7. Given our broad expertise and direct experience of working throughout Gaza we are uniquely positioned to comment on several matters of importance to our government as it decides whether to continue supporting Israel’s attack on, and siege of, the Gaza Strip. Specifically, we believe we are well positioned to comment on the massive human toll from Israel’s attack on Gaza, especially the toll it has taken on women and children.

This letter collects and summarizes our own experiences and direct observations in Gaza. We have also provided links to a much longer and heavily cited appendix summarizing the publicly available information from media, humanitarian, and academic sources on key aspects of Israel’s invasion of Gaza. The appendix is available as a PDF file at https://tinyurl.com/gazadoctorsletterappendix. This letter can be accessed electronically as a PDF file at https://tinyurl.com/gazadoctorsletter.

This letter and the appendix show probative evidence that the human toll in Gaza is far higher than is understood in the United States. It is likely that the death toll from this conflict is already greater than 92,000, an astonishing 4.2% of Gaza’s population. Our government must act immediately to prevent an even worse catastrophe than what has already befallen the people of Gaza and Israel. A ceasefire must be imposed on both Israel and Palestinian armed groups by withholding military support for Israel and supporting an international arms embargo on both Israel and all Palestinian armed groups. We believe our government is obligated to do this, both under American law and International Humanitarian Law, and that it is the right thing to do.

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With only marginal exceptions, everyone in Gaza is sick, injured, or both. This includes every national aid worker, every international volunteer, and probably every Israeli hostage: every man, woman, and child. While working in Gaza we saw widespread malnutrition in our patients and our Palestinian healthcare colleagues. Every one 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, especially children, that we are eager to share 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 diarrhea. We found cases of jaundice (indicating hepatitis A infection under such conditions) in virtually every room of the hospitals in which we served, and in many of our healthcare colleagues in Gaza. An astonishingly high percentage of our surgical incisions became infected from the combination of malnutrition, impossible operating conditions, and lack of supplies and medications, including antibiotics. The pregnant women we treated often gave birth to underweight infants, and they were unable to breastfeed due to malnutrition. This left their newborns at high risk of death given the lack of access to potable water anywhere in Gaza. Many of those infants died. In Gaza we watched malnourished new mothers feed their underweight newborns infant formula made with poisonous water. We can never forget that the world abandoned these innocent women and babies.

We urge you to realize that epidemics are raging in Gaza. Israel’s continued, repeated displacement of the malnourished and sick population of Gaza, half of whom are children, to areas with no running water or even toilets available is absolutely shocking. 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. 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.

Children are universally considered innocents in armed conflict. However, every single signatory to this letter treated children in Gaza who suffered violence that must have been deliberately directed at them. Specifically, every one of us on a daily basis treated pre-teen children who were shot in the head and chest.

President and Dr. Biden, we wish you could see the nightmares that plague so many of us since we have returned: dreams of children maimed and mutilated by our weapons, and their inconsolable mothers begging us to save them. We wish you could hear the cries and screams our consciences will not let us forget. We cannot believe that anyone would continue arming the country that is deliberately killing these children after seeing what we have seen.

The pregnant women we treated were particularly malnourished. Those of us who worked with pregnant women regularly saw stillbirths and maternal deaths that were easily preventable in any third-world healthcare system. The rate of infection in C-section incisions was astonishing. Women underwent C-sections without anesthesia, and were given nothing but Tylenol afterwards because no other pain medications were available.

All of us observed emergency departments overwhelmed by patients seeking treatment for chronic medical conditions such as renal failure, hypertension, and diabetes. Aside from trauma patients, most ICU beds were taken up by type 1 diabetics who no longer had access to injected insulin, due to the lack of medication and the widespread loss of electricity and refrigeration. 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.

These observations and the publicly available material detailed in the appendix lead us to believe that the death toll from this conflict is many times higher than what is reported by the Gaza Ministry of Health. We also believe this is probative evidence of widespread violations of American laws governing the use of American weapons abroad, and of International Humanitarian Law. We cannot forget the scenes of unbearable cruelty directed at women and children that we witnessed ourselves.

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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 traumatized 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 grueling 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.

We met healthcare personnel in Gaza who worked at hospitals that had been raided and destroyed by Israel. Many of these colleagues of ours were taken by Israel during the attacks. They all told us a slightly different version of the same story: in captivity they were barely fed, continuously physically and psychologically abused, and finally dumped naked on the side of a road. Many told us they were subjected to mock executions and other forms of mistreatment and torture. Far too many of our healthcare colleagues told us they were simply waiting to die.

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 American law, American values, and International Humanitarian Law.

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Dr. Biden, you worked with young people throughout your life. We hope and pray that you will not look away from the unspeakable horrors the youth of Gaza face today, horrors only we as Americans can end. We sincerely hope you will do everything in your power to stop what is being done to them.

President Biden and Vice President Harris, any solution to this problem must begin with an immediate and permanent ceasefire. We urge you to withhold military, economic, and diplomatic support from the State of Israel and to participate in an international arms embargo of both Israel and all Palestinian armed groups until a permanent ceasefire is established, and until good faith negotiations between Israel and the Palestinians lead to a permanent resolution of the conflict.

In the meantime:

1. All land crossings between Gaza and Israel as well as the Rafah Crossing must be opened to unfettered aid delivery by recognized international humanitarian organizations. Security screening of aid deliveries must be conducted by an independent international inspection regime instead of Israeli 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 occupied Palestinian territory.

2. 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.

3. Full and unrestricted access of medical and surgical professionals and medical and surgical equipment to the Gaza Strip must be allowed. This must include items taken in healthcare professionals’ personal luggage to safeguard their proper storage, sterility, and timely delivery, as verified by the World Health Organization. Incredibly, Israel is currently blocking any physician of Palestinian descent from working in Gaza, even American citizens. This makes a mockery of the American ideal that “all men are created equal” and degrades our nation and our profession. Our work is lifesaving. Our Palestinian healthcare colleagues in Gaza are desperate for relief and protection, and they deserve both.

We are not politicians. We do not claim to have all the answers. We are simply physicians and nurses who cannot remain silent about what we saw in Gaza. Every day that we continue supplying weapons and munitions to Israel is another day that women are shredded by our bombs and children are murdered with our bullets. President Biden and Vice President Harris, we urge you: end this madness now!

Sincerely and urgently,