The US Medical Establishment Is Making One of Its Worst Mistakes—Again

by Eric Reinhard and Mary T. Bassett
May 21, 2024
The world’s most influential medical journal has finally confronted its failure to address an unfolding genocide—over 80 years after the fact. Last month, the historians Joelle Abi-Rached and Allan Brandt were invited to reflect on The New England Journal of Medicine’s choice to remain silent from 1935 to 1944 about the escalating horrors of the Holocaust—particularly the crimes committed by the Nazis in the name of medical science.
In their conclusion to the piece, Abi-Rached and Brandt wrote, “As we explore historical injustices in the Journal and beyond, we must consider not only expressions of explicit and implicit bias, discrimination, racism, and oppression, but also how rationalization and denial may lead to silence, omission, and acquiescence—considerations that are critical to understanding systematic historical injustices and their powerful, tragic legacies.”
The article is part of a series, “Recognizing Historical Injustices in Medicine and the Journal.” Its stated purpose is to “enable us to learn from our mistakes and prevent new ones.” But, in a bitter twist of irony, it has been published at a time when the NEJM is repeating the very mistakes it now claims to be rectifying.
For the last seven months, the world has witnessed Israel’s relentless attacks on Gaza—and, more specifically, its war on Gaza’s medical system. We have seen the indiscriminate murder of health workers and patients in their hospital beds; the bombing of hospitals and clinics; the targeted destruction of health and sanitation infrastructure; the blockade of humanitarian aid and essential medications as famine is used as a weapon of war; and the infliction of conditions that are designed to be incompatible with human life.
These actions represent precisely the kind of systemic racism and sustained state violence that the The New England Journal of Medicine’s historical reflections are intended to push the medical profession to help prevent. Yet, just as it did so many decades ago, the NEJM has declined to use its pages to even acknowledge, let alone condemn, the slaughter and starvation Israel is inflicting on civilians with US military aid.
The journal’s failure to acknowledge the existence of Palestinians is nothing new. In fact, it has not published any mention of the health effects of Israeli medical apartheid, occupation, military incursions, or blockades on Palestinians since 1986. By contrast, since 2015 alone, it has published articles on war-related health outcomes in Ukraine, Syria, and Yemen.
De facto censorship of scholarship on Palestine and criticism of Israeli state violence against Palestinians is well-known as part of “the Palestine exception.” Many of our colleagues have submitted articles about health conditions in Gaza and the West Bank both before and after October 2023, only to receive prompt rejections without outside review.
These editorial choices are emblematic of a much broader disregard for Palestinian life that pervades US medical organizations and their powerful lobbies. Not a single major US medical society nor journal has opposed the US government’s ongoing material support for the destruction of Gaza. The profession’s largest lobby, the American Medical Association (AMA), rejected calls even to endorse a cease-fire and protections for Palestinian health workers. And nearly all major US-based global health actors—from academic research centers to nongovernmental organizations like The Bill & Melinda Gates Foundation (and the many influential health organizations, researchers, and journalism outlets it funds) to public agencies like the CDC and USAID—have abstained from taking any meaningful stand against the obliteration of healthcare in Gaza. This collective refusal by US health institutions, which represent the largest sector of the nation’s economy and wield considerable political power, to address the rights of Palestinians carries substantial material consequences.
Israel is currently inflicting the deadliest violence against civilians since the Rwandan genocide in 1994. No conflict since has led to more rapid loss of life than the ongoing attacks on the Gaza Strip, which have been 10 times more deadly for children than any other recent conflict––and not by accident. A recent peer-reviewed analysis of satellite images from the first 42 days of the ongoing Israeli campaign against Gaza shows extreme levels of destruction of health, water, and education infrastructure. According to the study, by November 22 of last year, half of all critical civilian infrastructure in Gaza had already been damaged, a third destroyed, and even the Israel-designated evacuation corridor bombed. The data show clustering of Israeli attacks on these essential civilian sites, including Gaza’s medical facilities, suggesting that Israel has been, in the words of the 1948 Genocide Convention, “deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part.”
On January 26, 2024, the International Court of Justice ruled in South Africa v. Israel that Israel was plausibly in violation of the Genocide Convention for its treatment of Palestinians. The court ordered emergency provisional measures to halt all activities in violation of the convention and “to take immediate effective measures to enable the provision of urgently needed basic services and humanitarian assistance” to Palestinians in Gaza, who face the worst famine since World War II. A key component of the court’s deliberations falls squarely within the purview of health scholars and journals: a review of Israeli attacks on Gaza’s health and sanitation infrastructure.
In “The War on Hospitals” published by Boston Review last December, Abi-Rached—one of the authors of the article on The New England Journal of Medicine’s failure to condemn Nazi Germany—characterized Israel’s attacks as “the intentional undermining of the entire health care system.” Abi-Rached piece foreshadowed the ICJ’s ruling on charges of genocide against Israel, writing, “The attacks have made clear that the repression of Palestinian rights now has a new feature: the systematic destruction of the very institutions that sustain life.”
On March 28, 2024, by ruling in favor of additional emergency measures to try to stop Israel’s use of famine as a weapon of war, the court officially recognized what disappointingly few in the US medical field have been willing to publicly acknowledge: a preventable, large-scale deliberate decimation and starvation of human beings is underway.
The US medical profession’s silence has also persisted in relation to the participation in genocidal violence by…