Medical neutrality and structural competency in conflict zones: Israeli healthcare professionals’ reaction to political violence

ABSTRACT

This article explores the meaning, manifestations, and ramifications of medical neutrality in conflict zones. We analyse how Israeli healthcare institutions and leaders responded to the escalation of the Israeli-Palestinian conflict in May 2021 and how they represented the role of the healthcare system in society and during conflict. Based on content analysis of documents, we found that healthcare institutions and leaders called for cessation of violence between Jewish and Palestinian citizens of Israel, describing the Israeli healthcare system as a neutral space of coexistence. However, they largely overlooked the military campaign that was simultaneously taking place between Israel and Gaza, which was considered a controversial and ‘political’ issue. This depoliticised standpoint and boundary work enabled a limited acknowledgement of violence, while disregarding the larger causes of conflict. We suggest that a structurally competent medicine must explicitly recognise political conflict as a determinant of health. Healthcare professionals should be trained in structural competency to challenge the depoliticising effects of medical neutrality, with the aim of enhancing peace, health equity, and social justice. Concomitantly, the conceptual framework of structural competency should be broadened to include conflict-related issues and address the needs of the victims of severe structural violence in conflict areas.

KEYWORDS:

• Structural competency
• conflict
• medical neutrality
• depoliticisation
• Israel/Palestine

Disclosure statement

No potential conflict of interest was reported by the authors.

Figure 1. Map of the Occupied Palestinian Territory. Source: United Nations Office for the Coordination of Humanitarian Affairs – Occupied Palestinian Territory. The original figure, which includes additional text boxes, is available at https://www.ochaopt.org/content/west-bank-including-east-jerusalem-and-gaza-strip-january-2019

Notes

1 The International Code of Medical Ethics of the World Medical Association states that ‘Medical ethics in times of armed conflict is identical to medical ethics in times of peace’ (World Medical Association, 2022, and see the opposing position of Gross, 2006).

2 Between March 16, 2012 and March 15, 2022.

3 These figures do not include indirect reasons such as access delays.

4 Between November 22, 2011 and November 21, 2021.

5 These figures do not include people who were killed or injured in conflict-related incidents that took place in Israel and did not involve residents of the occupied Palestinian territories.

6 Death tolls in the Gaza Strip and Israel Include those who died due to indirect consequences of hostilities, such as cardiac arrest.

7 The Green Line served as the de facto borders of Israel from 1949 until the 1967 war, in which Israel occupied the West Bank, East Jerusalem, and the Gaza Strip (as well as Sinai, which was later returned to Egypt, and the Golan Heights). Hence, Israel “within the Green Line” does not include the occupied West Bank, East Jerusalem, and the Gaza Strip (Figure 1).

8 The hospitals that comprise the Forum and signed this statement are Hadassah Medical Center (Jerusalem), Shaare Zedek Medical Center (Jerusalem), Mayanei HaYeshua Medical Center (Bnei Brak), The Holy Family Hospital (Nazareth), Nazareth Hospital EMMS (Nazareth), St. Vincent de Paul Hospital (Nazareth), and Laniado Hospital (Netanya).

9 Galilee Medical Center in Nahariya and Ziv Medical Center in Safed.

10 Among healthcare workers, several casualties and about 42 injured staff were recorded (World Bank Group et al., 2021).