Morality of convenience: the ongoing failure to protect hospitals and health workers in conflict zones

Dear Editor

Your recent Editor’s choice (BMJ 383 2681 2023) reflected on our collective failure – internationally, as medical professionals and personally – to recognise awful consequences of violence and war. However, mulling over your comments, I was concerned. There is an added noxious dimension to current events going beyond the warzone itself.

Last Sunday evening (19th November), cold and wet in London, I found thoughts and words to respond. I ventured out to a central medical school campus. I had promised the student Jewish Medical Association UK (JMA) group (drawn from many medical schools) to call in to their event. Much of the campus was in darkness, so it was easy to track rooms they were using by lights.

Inside I found tables arranged for Jewish medical students to run mock multiple mini-interviews timed stations for A level students applying for medical school intake 2024. For me, as a medical academic, the atmosphere was nothing short of inspirational. If you like, the message of the light outside was amplified inside. The engagement and enthusiasm of candidates was matched by the mature way the students questioned them and then provided feedback. The organisers were troubleshooting, helping to convey a positive environment. They had prepared questions sheets which could easily be used by medical school panels. I found myself reflecting that here I really saw the refreshing buzz of excitement, of wanting to become a doctor, and hoping only that they can retain this sense of commitment to learning and caring at medical school and in future careers.

But there was a dark side to my observations this year. I recognised some of the medical students. Some had contacted me: they had been told not to attend classes during the past month because there were likely to be antisemitic incidents. Others had been confronted with marchers carrying banners and shouting slogans that were overtly threatening to Jews. Many had been subjected to Jew hatred – including comparison between Jews and Nazis, true Holocaust weaponizing – on social media. Among the more observant several were struggling to have their rights to religious observance recognised. Several prospective and present medical students had relatives and friends – their own age – in the Israeli Defence Forces. One or two mentioned they had heard that there were UK doctors, participants in antisemitic abuse, being reported to the General Medical Council. And even the A level students were not immune, talking about amplified security at Jewish school.

Of course, none of this was new to me: unfortunately, the JMA receives all too much of this information. But what was new, and in some ways inspirational, was how - despite all this – these young people were resilient enough to contribute in the way they were doing. Not to be put off by the threatening environments that they encounter. And for already students, not to try to put their peers off from pursuing a medical career.

Dear Editor

Paraphrasing Obama's words on Gaza - "There's blood on everyone's hands."
António Guterres made a statesmanlike speech in the UN and was viciously attacked for his thoughtful skilled equipoise.

I experience sympathy for both communities, in direct proportion to the aggregate per capita death toll. The dead, the maimed, the dispossessed, the bereaved and the psychologically devastated are all equal in their plight - regardless of which side they are on.

None has the moral high ground. Neither will ever surrender. Both take absolutist positions and give no quarter. The scene is set for millennia of conflict - elements of Islam still resent the Crusades and much of the basis for positions adopted derives from oral and written traditions from the dawn of history.

A substantial proportion of Israeli and Palestinian people would, I strongly suspect, be capable of living together in harmony but the witches cauldron of nationalism, ethnocentricity and entitlement is kept roiling by the bitter, damaged and murderously obdurate zealots in both communities.

There are parallels to be drawn with actual or incipient or frozen conflicts all across the planet. Nor should we forget the other existential threats that confront us all.

Calling for leadership is an obvious first step but there is a more profound need.

In the absence of evidence to the contrary, the one dominant species on the surface of this tiny wet rock at the unfashionable end of the universe, us - Homo sapiens, is the most advanced life form in existence. The sheer improbability of our existence defies our combined numeracy skills. The terrifyingly precarious hold that we have on that existence cannot be overstated. And yet we have the rank idiocy to behave as we do - widespread combat, rampant inequality, heedless consumerism, the pursuit of assets far beyond any rational need, the squandering of irreplaceable resources, the amoral, asocial seedy barbarianism that we call politics, the destruction of the ecosphere upon which we depend absolutely...

Either we all learn to live and love, work and play together, in intelligent harmony with each other and our planet or we encounter The Great Filter.

One planet, one dominant species, one common fate - no exceptions.

It is everyone's heart and mind that must change.

Yours sincerely

Steve Ford