In response to:
The Shame of Israeli Medicine, May 31, 2025
To the Editors:
We were deeply dismayed by many of the claims in your article entitled “The Shame of Israeli Medicine,” published recently. Its glaring omissions, selective interpretations, and misrepresentation of facts call for an urgent and clear response.
To begin with, oddly, the piece makes no mention whatsoever of the unprovoked October 7th Hamas massacre—the horrific attack that precipitated the current war. Simply put, Hamas declared war on Israeli civilians, not the other way around. The article also fails to acknowledge the 251 hostages, many of whom were denied food, water, and medical care, and who endured unimaginable cruelty. More than fifty (both dead and alive) remain in captivity today. It is not only possible—but essential—to grieve the devastation in Gaza’s health care system while also recognizing the calculated violence inflicted on Israeli civilians.
Secondly, the article adopts an overtly biased tone, presenting unverified allegations as fact while ignoring any perspectives or evidence that might challenge its narrative. In stark contrast, the Israel Medical Association (IMA) has consistently acted to uphold medical ethics and international humanitarian law.
For example in January 2024, the IMA issued a public statement affirming that Israeli physicians must provide care to all individuals—regardless of identity, affiliation, or actions—based solely on their shared humanity. We reached out to hospital directors facing pressure to cease treating terrorists and reaffirmed their ethical responsibilities, offering the IMA’s full support.
When reports emerged that certain Israeli doctors had endorsed the bombing of Palestinian hospitals, the IMA immediately condemned such statements, reaffirmed that medical facilities must never be deliberately targeted, and personally contacted each signatory to reinforce the ethical obligations of the profession.
Ironically, the article references the Geneva Convention’s call for the protection of hospitals but omits the critical clause stating that such protection may cease if hospitals are used to commit harmful acts against the enemy. This caveat is central to the debate. Claims that Hamas utilized hospitals for military purposes have been substantiated by reputable outlets, including The New York Times. Testimonies from both Israeli intelligence and video footage from Hamas members confirm that hospitals were used as command centers and to hold hostages.
On the matter of prisoner restraint, the IMA’s ethical stance long predates the current conflict. Our first statement was issued in 1997, the issue was revisited in 2008 and an updated edition was released in September 2023, prior to the war. Most recently, we reiterated this position in a February 2025 letter to the Ministry of Health.
The authors also criticize Israeli doctors for joining the IDF and taking pride in defending their country. No one longs more to return to the sanctity and relative comfort of clinical practice than these physicians—treating patients of all ethnicity and religions. But in the face of existential threats to the country, they are called to serve. To imply that such service is incompatible with medical ethics is both unjust and profoundly naive.
The claim that the IMA has “failed grievously in its obligations to defend medical ethics” is not only unfounded—it is clearly both false and offensive. We have long and consistently condemned any unethical behavior by Israeli physicians, investigated individual complaints, and reasserted our unwavering commitment to medical neutrality and humanitarian principles (latest statement).
In times of war, nuance matters. The New York Review of Books owes its readers a more honest and comprehensive portrayal of the complexities at hand.
Zion Hagay, M.D.
President, Israeli Medical Association (IMA)
Malke Borow, J.D.
Director, Division of Law and Policy, IMA
Neve Gordon, Guy Shalev, and Osama Tanous reply:
We do not contest the assertions by Zion Hagay and Malke Borow that facts are important and that omissions, selective interpretations, and misrepresentations “call for an urgent and clear response.” Indeed, it was precisely the bias by omission and disregard for facts that the IMA has demonstrated since October 7, 2023, that compelled us to criticize its response to the destruction of Gaza and the deprivation of Palestinians’ right to health. The IMA’s letter simply offers further evidence that Israel’s premier health association is unwilling to look at the evidence and draw the necessary conclusions.
The facts are clear. Israel has killed over 55,000 Palestinians in Gaza, including more than 15,000 children, and has wounded close to 120,000 Palestinians, many of whom have suffered life-altering injuries. There are now between 3,105 and 4,050 child amputees in Gaza—the largest such cohort in modern history. For eighteen months the IMA chose to remain silent as the Israeli air force and infantry systematically decimated the medical system in Gaza, killing 1,400 health care workers, with all of the multiplication of harm that such attacks produce. As Hagay and Borow correctly note, the laws of war include exceptions to the protections bestowed on medical units, but considering that the Israeli military has bombed thirty-three of the Strip’s thirty-six hospitals, these exceptions have simply become the rule. Parroting claims made for decades by the Israeli military’s spokespeople—and often left unsubstantiated—Hagay and Borow invoke international law not to bolster the norm obliging warring parties to protect hospitals but as a legal shield for Israel’s genocidal violence. The day after our article appeared, Israel destroyed the only dialysis center in northern Gaza, but Hagay and Borow decided that it was more important to respond to our article than to protest the egregious harm to Palestinian patients with kidney disease.
Hagay and Borow accuse our essay of “ignoring any perspectives or evidence that might challenge its narrative.” In fact, we cite each of the IMA’s three statements that Hagay and Borow mention from after October 2023: its November 2023 letter criticizing a group of Israeli doctors who called for the bombing of Palestinian hospitals; its January 2024 statement about the treatment of wounded Gazans; and its February 2025 notice on prisoner restraints in civilian, prison, and military facilities.1 At no point did we suggest that the IMA’s February letter on prisoner restraint was the association’s first-ever statement on the matter—simply that it took the IMA until fifteen months into the current war to take note of the surge in such cases since October 2023. Far from ignoring the IMA’s perspective, in other words, we considered it closely—and found the statements in question vague, belated, often misguided, and ultimately inadequate. Indeed, the statements that Hagay and Borow cite—by referring to Palestinian detainees, often held without charges, in dehumanizing terms that implicitly justify the denial of care, or by ignoring the mounting evidence of violations committed by Israeli doctors—strongly support our claim that the IMA has failed grievously in its obligations to defend medical ethics against the backdrop of continuous crimes and violations of the right to health in Gaza, in Israeli prisons, and in Israeli hospitals.
Meanwhile, Hagay and Borow themselves neglect to respond to the grave violations of medical ethics we documented in our article. We cited numerous reports demonstrating that Israeli prisons were transformed into torture camps after October 7, including documents by B’Tselem, Human Rights Watch, and Physicians for Human Rights Israel (PHRI), with which two of us are actively affiliated. PHRI’s research has, as we showed, found ample evidence that over the past twenty months doctors and other health professionals have repeatedly disregarded their ethical obligations as they are spelled out in the UN’s Istanbul Protocol: Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. As we mention in our article, during this period ninety Palestinian prisoners have died in detention; postmortem reports detail abuses ranging from broken ribs to starvation and untreated pneumonia. These prisoners were likely examined at some point by a medical professional, either in prison or in a civilian hospital, who returned them to detention despite signs of abuse—a phenomenon of which PHRI has documented numerous concrete cases.
And yet, to the best of our knowledge, the IMA has failed to investigate and discipline a single doctor. It has likewise made no public statement to suggest that it has investigated the allegations raised in PHRI’s report, which is based on twenty-four affidavits gathered from Palestinian doctors and health professionals who were detained and suffered torture and medical neglect. If the organization has in fact investigated the misconduct these medical professionals describe, it ought to say as much, and release the findings as soon as possible.
Hamas’s attack on October 7, 2023, was indeed horrific, but Hagay and Borow’s suggestion that the violence began on that day is shocking. After all, about 75 percent of the Gaza Strip’s population are refugees who were expelled from their villages and towns during the 1948 Nakba and who, in breach of international laws and UN resolutions, have been forbidden from returning to their homes. In 1967 Gaza was occupied by Israel, which for years has ruthlessly controlled the population while denying Palestinians self-determination. In 2007 Israel imposed a hermetic siege, caging the Palestinians in what human rights organizations have called the world’s largest open-air prison. In the process it exerted extensive control over Gaza’s health infrastructure, restricting access to treatment outside the Strip, limiting the entry of medical supplies, and hindering the training of medical professionals. These policies, and the multiple wars Israel has launched on the besieged enclave, have persistently undermined the quality and capacity of Palestinian health services in Gaza.
The IMA has the authority and responsibility to uphold medical ethics among its members. This duty goes beyond issuing broad statements that invoke universal values. It requires concrete policies, rigorous implementation, staff training, and accountability measures. Of what use are lofty statements—such as those on patient restraint—if practitioners routinely ignore them, or if the IMA itself continues to support the policies of the Israeli government, by both omission and commission? One such deadly policy is Israel’s obstruction of medical evacuations, which has adversely affected more than 12,000 sick and wounded Gazans in need of urgent care unavailable in the Strip. Had the IMA insisted on treating patients just kilometers away, how many lives might have been saved?
Instead of reprimanding us, we suggest that Hagay and Borow engage with our conclusion that Israel’s largest medical association has disrespected the profession’s most basic ethical principles. The IMA talks about medical ethics, universalism, and international humanitarian law even as, in practice, it embraces the logic of the Israeli government, according to which the lives, suffering, and deaths of some groups are more valuable than those of others. But as Arundhati Roy has put it, “not all the power and money, not all the weapons and propaganda on Earth can any longer hide the wound that is Palestine—the wound through which the whole world, including Israel, bleeds.” It is high time that the IMA stops trying to hide this wound.
English (US) · 