Statement of Solidarity with palliative care practitioners in Gaza
We, as palliative care professionals, who have worked in Gaza invite our palliative care practitioners from around the globe to join us in solidarity with our colleagues in Gaza. We are dedicated to easing suffering and upholding the dignity of those we serve, and we call on individuals, palliative care organisations, professional health bodies, and governments of the world, to urgently demand an end to the ever-escalating conflict and continuous human rights violations against Palestinians.
The human suffering experience for individuals, families and whole communities has been devastating. The previously accepted limits of international law have long been exceeded. We are particularly shocked and distressed with the direct targeting of fellow healthcare workers and healthcare institutions within Gaza, people and places that endeavour to bring healing and hope.
As palliative care practitioners, we recognise that:
‘Palliative care—the comprehensive support of seriously ill or dying people and their families—is rooted in the recognition of our common suffering in illness and dying, our compassionate response to suffering, and our shared humanity. Fundamentally, palliative care seeks to ease suffering and uphold dignity.’1
'Our moral, non-negotiable, duty must be to support and ensure the protection of health facilities, health professionals, and vulnerable people in conflict zones.'2
As palliative care practitioners, invited by Gazan colleagues, we have worked for the past decade to support the development of palliative care in the Gaza Strip. Many of us have collaborated in education, training and mentoring, research, clinical service delivery and health systems planning. We have witnessed the dedication, skill and kindness of healthcare colleagues as they have sought to care for patients through the challenging environment of the Gaza siege. The Israeli occupation and siege have exerted severe limitations on access to medication and restricted options for disease management and pain control.
The director of the Turkish-Palestinian Friendship Hospital — Gaza’s only hospital for cancer care — Dr Sobhi Skaik said, “Our people are in pain, we need to act.”3
Despite the challenges, palliative care has been integrated into the Islamic University of Gaza’s undergraduate medical curriculum. Healthcare colleagues in the Turkish-Palestine Friendship, Al-Ahli Arab, Dar Al-Shifa, Al-Rantisi-Nasr Paediatric, Hamad, and other hospitals across Gaza, have been working to progress the development of palliative care within inpatient settings. Colleagues at UNRWA have been exploring how to integrate palliative care into primary healthcare. The Ministry of Health has agreed to a palliative care situational analysis and strategic planning. Civil society groups have been mobilising to provide home-based care. Research programmes have been active and the huge challenge of accessing oral morphine has made significant progress.
We should have been in Gaza now supporting our colleagues to graduate the first multidisciplinary Professional Diploma in Pain and Palliative Care and Master’s cohort – the leaders for palliative care in Gaza.
The focus of all this work has been on the quality of life, dignity and relief of suffering for people living with serious chronic illness and heath related suffering in Gaza.
Present situation in Gaza
Instead of supporting the continued progress in palliative care in Gaza, we are now bearing witness to an unparalleled humanitarian catastrophe.
In addition to the wholescale destruction and withholding of the basics of life such as water, food, shelter and fuel, we see a trapped population moving within the tiny space and unable to find any safety. As of the 23rd November, we know that 14,854 have been killed with 60% children and women. We know the terrible statistic of a child killed every 10 minutes.4 In excess of 220 healthcare workers have been killed, 40 ambulances targeted, and 45 hospitals affected. This amounts to 181 health attacks in Gaza plus a concerning 183 health attacks in the West Bank. 5 6
The pictures of patients and families huddling for safety in hospitals or the injured left without healthcare is deeply disturbing and distressing and now include forcible displacement from healthcare settings.
Now the cancer hospital is closed with a small number of children being evacuated but for the majority there are no treatment options. Analgesia is almost absent for chronic illness but also for burns and crush injuries. Disease outbreaks, starvation and unclean water are causing outbreaks of disease and reveal the unfolding public health disaster.
The courage of our healthcare colleagues is humbling. Many have moved five or six times to try to stay safe and many have lost their homes. All have lost family members, and all are trying to balance caring for their family while continuing to offer support for patients.
Our colleague, Dr Hamman Alloh, a nephrologist, spoke in an interview of staying with his patients - ‘What would happen to my patients? We are not animals that do not deserve healthcare. Did I train for 14 years in medical school and speciality training to abandon my patients now?’7 This was Dr Hammam’s last interview before he was killed in his home by a missile strike. His head of internal medicine at Al Shifa Hospital, Gaza’s hub for healthcare, Dr Rafaat Lubbad, an inspirational colleague who was an advocate for palliative care, was killed shortly after along with his family.
We are losing the healthcare wisdom of the past, the leaders of the present and the promise of the future.
Dr Khamis Elessi, the lead for palliative care in Gaza, published a letter in the Lancet in the first week of this crisis, warning of the grave consequences we are now seeing - ‘If the massacre continues on its current path, we will be dangerously close to witnessing a large-scale genocide of civilians and patients. I am a doctor in Gaza, and I want to survive for my family and for my patients.’8
International perspectives
We state that all attacks on civilians are wrong including those against Israel which have caused such suffering. We support the statement by Antonio Gutteres, UN chief who outlined the long history of conflict and said ’The grievances of the Palestinian people cannot justify the appalling attacks by Hamas…those appalling attacks cannot justify the collective punishment of the Palestinian people.’ 9
We note that the leaders of 18 United Nations agencies and non-profit organisations (NGO) have called for an immediate ceasefire, expressing shock and horror at the mounting death toll from the conflict with Dr Tedros…stating ‘The extreme suffering of the people of Gaza demands that we respond immediately and concretely with humanity and compassion.’ 10
Quotes from our healthcare colleagues
Our palliative care colleagues continue to send messages from Gaza when they can:
‘'We are physically ok, but mentally and emotionally so far from being alive. We die hundreds of times every day. Each and every one of us has lost at least a relative, a friend, a colleague or more. God help us all.' Doctor.
‘The situation here in Gaza is worse and more difficult than what is reaching you. The occupation demolished homes, streets, schools, hospitals, churches, and healthcare centres. They cut off electricity, water, and all the necessities of life. My hope is to die with all my children and not leave them and them not leave me. I cannot live without them, and I do not want to die and leave them here in this unjust world.’ Cancer nurse.
‘Unfortunately, we are on our way to collapsing from the horror of the scenes we see, despite our strength, but they are beginning to fade and the world is watching as if we were in a movie theatre showing a horror movie and the viewers are silent.’ Paediatric doctor.
‘We need you and your colleagues to reach our scene of massacre to all the world. We trust you. Please be our voice outside. Gaza, the beautiful city which you knew and loved, it has become city of ghosts. All its building, streets, schools, trees completely destroyed. We are without any life support, and supplies. Many people are still under the collapsed building ask for help, many health workers are killed while they offer their duties. ‘The world became blind and deaf to our suffering. We don't ask more than life with peace and dignity like all people over the world and to be considered human beings.’ Pharmacist.
6 pPT Emergency Situation Update Issue 14
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