A Palestinian boy rides between the ruins of houses that witnesses said were destroyed during the seven-week Israeli offensive in Gaza in August and September last year. The writer says many children were killed and injured during the war. Photo: Mohammed Salem

Wits is to host the local launch of a major medical fact-finding mission into the 2014 onslaught. Professor Laurel Baldwin-Ragaven was on the team.

In mid-July last year, an urgent call was issued by Physicians for Human Rights-Israel (PHR-I) for experts to visit Gaza and document the health effects of the war that Israel dubbed Operation Protective Edge.

At that stage, there were media reports of attacks on civilians, particularly children, as well as mass casualties. There had been bombing of schools, markets and homes. We knew it would be important to fact-find as soon as possible, to interview survivors about their experiences of the bombings and the ground invasion, while these were still fresh in their minds, as well as to collect evidence for corroboration.

PHR-I had conducted a similar mission during the 2008 to 2009 Operation Cast Lead. I had been invited to participate but could not go. Instead, I worked with the organisers to connect them with colleagues who could. That mission included two South African specialists, Professor Shabbir Ahmed Wadee, a forensic pathologist at Stellenbosch, and Professor Sebastian Van As, a paediatric surgeon at UCT.

I felt ambivalent about having put these colleagues in harm’s way, although their report was critical in corroborating the Israeli Defence Force use of white phosphorous and other unconventional weapons.

So when the call came this time around, I could not ignore it. The decision involved family members, my husband and children and close friends. All were worried but understood that I needed to go.

My interest in the association between people’s social conditions and their health dates back to before I began medical school in 1979. My background is in the social sciences. This has deepened over time to become both a clinical and academic passion to uncover the inextricable links between human rights, both their violations and promotion, and health.

In terms of imagining what I could encounter in Gaza, with social media and graphic press coverage, this was fairly evident. I realised that we would all need debriefing after our mission.

Medically, it was very hard to separate the instinctual family physician, the “healer” who wanted to get involved in the care of patients, the need being so great, and the “fact-finder”, whose role it was to carefully and meticulously document what was happening to people on the ground.

To conduct an assessment comprehensively, and not intervene, was difficult. I’m not sure I anticipated how tough it would be to hold back on intervening clinically.

This is no comment on the care being provided by the health-care workers in Gaza, either the local Palestinians or the volunteers who had come from the region and all over the world. They did everything they could with the resources available.

Still, there was a certain helplessness in the face of such overwhelming suffering. Was producing a report “enough”?

As soon as all eight members of the fact-finding mission were identified, we began a robust exchange via e-mail and Skype about the scope of our research, methodology and technical issues.

There were two teams constituted depending on availability and the skills mix required. We knew we were going to be inseparable for the week we were together and there was a great spirit of camaraderie, respect and collaborative effort.

Objectivity posed interesting and important questions – ones that don’t have easy answers. After all, we are all products of particular world views that affect our interpretation of what we experience.

Our team comprised a Catholic nun, a Muslim, a Jew and an atheist – each bringing to bear some subjectivity to what we witnessed, although we had all been trained “clinically”. However, we also understood that we had a huge responsibility to be as “scientific” as possible, to question the evidence, to “see” for ourselves, to interrogate what was being presented to us, to cultivate scepticism.

This is why the report has a large section on “limitations”. We could not access everything we wanted to see. Our movements were limited. Within hours of our arrival, the ceasefire fell apart and there was a curfew and restrictions on travel within Gaza. The second team had visa and transport challenges.

However, even with these limitations, we were able to conclude from our interviews and observations that what people went through during this latest conflict constituted violations of international human rights and humanitarian law. We only published what we could corroborate through definitive sources in the report.

The 3km crossing on foot into Gaza through Erez was surreal. A stripping away of one’s sense of security could not have been more clear, both physically and emotionally. Luckily, three of the team members had already been through this process several times before, so attempted to “normalise” it for Onder and myself.

In addition, we were taken for lunch to a restaurant, which we soon recognised as overlooking the beach where the three boys had been killed by gunboat fire about a month earlier. It was hard to enjoy the sumptuous food and great hospitality.

At the restaurant, within two hours of our arrival in Gaza, we learnt that the ceasefire had fallen apart with the attempted attack on a man called Mohamed Deeb. His wife and child were killed. We found ourselves in the middle of a war zone, which was not the intention of the mission. However, the border crossing had already closed. It was unsafe to be on the roads and we had not even begun.

We decided unanimously that we would stay as long as we could, although PHR-I was keen to abort the mission and bring us back. Yet, that would not have been easy either, since the funerals were in Jabaliyah, close to Erez (the way out), and our transporter was afraid.

We were fortunate to have been able to move around in Gaza and to reach the border crossing two days later without being harmed, as our exit was not guaranteed.

Ironically, when we were at the Erez crossing, we came under Hamas mortar fire, which further delayed our entry into Israel.

Yet, another angle is that the Palestinians were grateful that we were there to witness what they had been experiencing continuously. The arrival of ambulances carrying the dead and wounded to Shifa Hospital and seeing how patients were received and triaged made the interviews with patients more real.

Also, trying to personally decipher the “warning” shots and respond to the constantly hovering drones made me feel on high alert most of the time; it was hard to sleep. This made things like having no electricity, showering in salt water and non-potable water from taps pale in comparison.

We met many children who had been burnt, maimed and psychologically scarred. Yet, even severely wounded children of all ages seemed incredibly resilient, interacting with our team.

The grief among those who had often lost their spouse or children, and were homeless, was palpable. We also reviewed hundreds of photographs of dead children, which was sickening. There is no excuse for this type of carnage. However, history indicates that at least 50 percent of all casualties in wars waged in the past 70 years were children. Gaza’s population is predominantly children.

There were so many challenging moments. Every encounter was a challenge – sharing in the human act of bearing witness; the futility in not being able to respond adequately to the trauma; suffering and disability; the burden of representation; the need to portray the situation accurately.

Some doctors, health-care workers and paramedics were injured or killed during the onslaught. Our team conducted at least eight interviews with health-care workers: doctors, ambulance crew, nurses, surgeons, ICU staff, the burn team. What was striking was many of them had worked overseas (and could have stayed there), yet decided to come back to serve the population.

There was no political interference in our work from Israel, the Palestinian Authority, or Hamas. There has, however, been a backlash from some quarters to discredit the report by claiming the non-neutrality of some of the authors, including me. This type of mud-slinging is to be expected.

On the positive side, the Israeli military has requested details in order to conduct an internal investigation into some of the incidents documented in the report.

As a Jewish health professional, it was meaningful for me to participate in this mission. Having collected the evidence myself, I can say with absolute certainty that what Israel is doing in Palestine does not merit exceptionalism to international human rights norms and standards.

Being able to witness and document this unacceptable tragedy in Gaza, as well as provide support to Israeli human rights advocates who are being marginalised for their opposition to the occupation, was both humbling and affirming.

Summary of the report

On July 8, 2014, Israel initiated a military offensive in the Gaza Strip. Although accounts vary, most estimates put the number of residents of Gaza killed in the 50-day armed conflict at over 2 100, of whom at least 70 percent were civilians, including over 500 children.

Over 11 000 were wounded and over 100 000 made homeless.

According to Israeli official accounts, 73 Israelis were killed: 67 soldiers and six civilians, including one child and one migrant worker. A total of 469 soldiers and 255 civilians were wounded.

Questions arose regarding violations of international human rights and humanitarian law in the course of the conflict. In July 2014, following discussions with Al-Mezan, Physicians for Human Rights-Israel (PHR-Israel) commissioned a fact-finding mission to Gaza, whose aim was to gather evidence and draw preliminary conclusions regarding types, causes and patterns of injuries and attacks; attacks on medical teams and facilities; evacuation; impact of the conflict on the health-care system; and longer-term issues including rehabilitation of the wounded, mental health, public health and displacement.

PHR-Israel recruited eight independent international medical experts, unaffiliated with Israeli or Palestinian parties involved in the conflict: four with special expertise in the fields of forensic medicine and pathology; and four experts in emergency medicine, public health, paediatrics and paediatric intensive care, and health and human rights.

The fact-finding mission made three visits to the Gaza Strip between August 19 and November 12 last year. Access and meetings were facilitated by PHR-Israel in partnership with local Palestinian non-governmental organisations: the Al Mezan Centre for Human Rights, the Gaza Community Mental Health Programme (GCMHP) and the Palestinian Centre for Human Rights in Gaza (PCHR).

Meetings and site visits were held in medical facilities and in the community, and included interviews with victims, witnesses, health-care professionals and human rights workers, officials from the Gaza Ministries of Health and Justice, and representatives of international health organisations in Gaza and the West Bank.

Wherever possible, forensic, medical and other material evidence was collected to support oral testimonies.

The mission interviewed 68 hospitalised patients who had been injured in the course of the attacks, in different hospitals, most of them outside Gaza.

Their findings were dramatic.

The overwhelming majority of injuries causing death or requiring hospitalisation were the result of explosion or crush injuries, often multiple complex injuries.

A majority of hospitalised patients interviewed reported people being injured or killed while in, or very close to, their homes or those of relatives and neighbours.

There were numerous cases in which significant numbers of casualties including members of the same family and rescuers were killed or injured in a single incident. There were also many cases of “double tap” or multiple consecutive strikes on a single location, which led to multiple civilian casualties and to injuries and deaths among rescuers.

Heavy explosives were used in residential neighbourhoods, resulting in multiple civilian casualties. Emergency medical evacuation was not enabled, even in which medical teams were killed or injured.

There was at least one case in which a mine-breaching explosive device was used in a residential street, causing massive destruction.

In the case of Shuhada’ Al Aqsa Hospital in Deir Al Balah, several people were killed and injured in what was apparently a deliberate attack.

An in-depth study of the town of Khuza’a suggests that: a convoy of hundreds of civilians came under fire while attempting to flee; a medical clinic in which civilians and injured people were sheltering after this attack was hit by missiles, causing deaths and injuries; a seriously injured 6-year-old child was not assisted and his evacuation was obstructed, despite eye contact with troops on the ground. He later died. Civilians in a house occupied by Israeli soldiers suffered abuse and ill-treatment including beatings, denial of food and water, and use as human shields. One was shot dead.

In addition, the fact-finding mission examined the strains placed on hospitals in Gaza during the attacks. There were problems with referral and evacuation of patients from Gaza hospitals to hospitals outside. There was long-term internal displacement in Gaza as a result of the partial or total destruction of about 18 000 homes, and long-term psycho-social and mental health damage caused by this and previous wars. This means there has been an increased need for rehabilitation services, and there is insufficient current resources in Gaza to meet them.

Conclusions were made.

The attacks were characterised by heavy and unpredictable bombardments of civilian neighbourhoods in a manner that failed to discriminate between legitimate targets and protected populations and caused widespread destruction of homes and civilian property.

Such indiscriminate attacks, by aircraft, drones, artillery, tanks and gunships, were unlikely to have been the result of decisions made by individual soldiers or commanders. These must have entailed approval from top-level decision-makers in the Israeli military and/or government.

The initiators of the attacks, despite giving some prior warnings of these attacks, failed to take the requisite precautions that would effectively have enabled the safe evacuation of the civilian population. This includes the provision of safe spaces and routes. As a result, there was no guaranteed safe space in the Gaza Strip, nor were there any safe escape routes from it. The fact-finding mission also made recommendations, calling on the UN, the EU, the US and other international actors to take steps to ensure that the governments of Israel and Egypt permit and facilitate the entry of investigative teams into Gaza, including experts in international human rights law and arms experts.

This has not yet been done, months after the offensive.

The report also draws attention to the independence and credibility of the local Palestinian civil society groups, and encourages the international community to support and recognise their efforts to collate evidence in Gaza, in order to proceed with legal and other remedies as well as to seek justice and reparations.

The mission believes that the prima facie evidence collected and presented in this report should be used for the purposes of legal determination of violations of international human rights and humanitarian law, whether through local or international justice mechanisms.

It is willing to assist and provide evidence to any credible investigation established for this purpose, and recommends further urgent and rigorous investigation into the impact of this war, as well as the previous armed conflicts, on public health, mental health and the broader social determinants of health in Gaza.

In this assessment, the implacable effects of the ongoing occupation itself must be taken into account.

* The local launch of the report is at Wits on Monday at 5pm at the School of Public Health on the Parktown Education Campus. Vice-chancellor and principal Professor Adam Habib will engage in a roundtable discussion on the report with head of the Wits School of Public Health, Professor Laetitia Rispel, health and human rights experts and health professional students about what it means for South Africans.

** The views expressed here are not necessarily those of Independent Media.

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