13 Jul, 09 | by BMJ Group
The corridors of the hospital were packed with worried expressions. Individuals were hysterically clarifying the status of their relatives following a vicious violent eruption between Arabs and Jews at the outskirts of an Israeli settlement. As we were moving through the hospital’s wings at the time, each provided us with a glimpse of families uniting their spirits, sharing their energies. On the third floor, a religious Jewish couple was being notified of their daughter’s fracture severity, while across the stairs a Palestinian father approached his bandaged and weeping child. One level lower, wounded husband and wife – both settlers – were separated, guided by an Arab surgeon, each to the specific medical intervention needed. On walking through the hospital’s entrance, head lifted just enough to catch the tower’s symbol, a shivering sensation spread through our bodies.
“Shaare Tzedek,” the sign humbly read. Conveyed by this logo was not merely the name of a medical institution, but a humanitarian attitude devotedly adopted by local medical practitioners. Meaning ‘the gates of justice’ in Hebrew, Shaare Tzedek is a medical facility in Jerusalem that is an example of how the extension of health care services to patients in a border-crossing manner produces desirable results. The hospital is located close to where most terrorist attacks have taken place. Therefore, it has regrettably become experienced in dealing with victims of these types of attacks. The hospital also recognizes its broader mandate to treat victims of distant humanitarian crises, whether it is victims of the Beslan Massacre or the recent Georgian-Russian war. Most striking, though, is the optimal medical treatment that the hospital’s staff regularly provides to terrorists, dissociating political arguments from the process of medical care. It is the example of the valuable ethical imperative justly brushing politics aside, which should reverberate through the medical community and be introduced wherever military conflicts take a toll on innocent civilians.
What if a similar hospital was to be built just at the border line of Gaza with Israel? The hospital may be incorporated into the fabric of the security wall, thus becoming a Cordon Sanitaire with both meanings of the word (Figure 1). Any Palestinian whose initial “field” evaluation reveals an unequivocal and significant medical need would immediately be transferred by an ambulance to that hospital. There, undergoing a triage, patients will have urgent access to care, with fast track out to appropriate tertiary care centers in Israel. This medical facility would be surrounded by a non-military geographical gap, manned by an internationally-based health-keeping force. A complex of roads would connect the hospital to the “outside world”, so that specialized doctors, medications, analgesics, and blood transfusions would be able to arrive at the scene without hindering the process of intensively caring for patients. Thus, a safe and optimally efficient path for the routine delivery of medical instruments will be preserved. A humanitarian delegation would constantly regulate the proper functioning of the unit, monitoring the adequate staffing of the facility by medical personnel, and assuring sufficient amounts of supply. They would also scrutinize the multinational cooperation that is vital to the timely and high-quality care that is to be given.
Military ambulances would collect any wounded individual, regardless of nationality, deeds, or beliefs, and effectively transport him or her to the hospital. Ambulances would not have to cross the border and enter Israel, a fact that has historically created moral challenges, such as when a vehicle was suspected to contain explosives hidden under the passengers’ cloths.
This medical facility would maintain a constituent interaction with Israeli hospitals. Complicated medical emergencies would be dispatched to the closest medical centers that perform specific sophisticated medical procedures. Moreover, this mechanism might aim to serve as a solution for a global problem where there is constant re-ignition of hostilities. Through a broader reciprocal relationship with other war-ravaged zones, the institution would spread its humanitarian fruits while gaining insight from similar international trials worldwide. It would share its database of wounded patients, distribution of various primary wounds, the effectiveness of improvised medical treatments as well as other medical parameters relevant to the care of conflict-induced injuries. Doing so, the immediate care outcomes may be improved, benefiting doctors’ command of more fertile ways to save as many wounded as they can.
An illusory tranquility pervades the districts of Gaza these days. Nevertheless, Palestinians living there may await the next chaotic chapter, knowing that nobody was there last time to protect their basic rights, prime amongst them the right to health. They crave a messiah, but the only one that promises to serve their needs is a terror organization named Hamas. They wish to purchase medications, see a doctor, or just pray at the mosque, but commonly their essential mobility is restricted. In our dream a philanthropic enterprise will be situated at the Israeli-Gazan border, exercising the same goodwill as the Shaare Tzedek hospital, while being sincerely dedicated to providing equal and efficient access to medical care. We must not forget that we are bound by a moral obligation to ensure that adequate medical care is available to Gazans and that their already fragile environment does not go on to amputate their most essential human right.
Ohad Oren, fourth year medical student, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
Michal Oren, fourth year medical student, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel