Physicians in Wartime

“Here is a hand-to-hand struggle in all its horror and frightfulness,” wrote Henri Dunant, a nineteenth-century international activist,
in his book A Memory of Solferino. The book concerns the Battle of Solferino in June of 1859 between the Austrians and the French. Dunant describes
the combatants “trampling each other under foot, killing one another on piles of bleeding corpses, felling their enemies with their rifle butts, crushing
skulls, ripping bellies open with sabre and bayonet.”

An 1897 illustration depicting ambulance corps from
Russia (left) and England (right).
Image via Shutterstock

But amidst these horrors, Dunant gives us at least some hope in the form of the field hospitals. As a volunteer there, he points out that French surgeons
did not rest for more than twenty-four hours, amputating legs and taking care of soldiers, eventually fainting from exhaustion. And this was not just done
for French soldiers. Dunant observes that many wounded Austrians and Hungarians were “given the same food as the French officers, and their wounded were
treated by the same doctors.” In the hospitals only the soldiers’ uniforms on the shelves above their beds, not the quality of the care they received, indicated which side they fought for.

After witnessing this, Dunant proposed that the international community establish relief societies composed of volunteers and sanctioned by a convention
that would govern the treatment of the wounded during wartime. His proposal drew huge international support and on August 22, 1864, 16 countries signed
onto the first treaty of the Geneva Conventions which,

in its first article, reads that

“Ambulances and military hospitals shall be recognized as neutral, and as such, protected and respected by the belligerents as long as they accommodate
wounded and sick. Neutrality shall end if the said ambulances or hospitals should be held by a military force.”

Implied in this law is a principle far more ancient, one embodied in the physician’s Hippocratic Oath. In it, the doctor swears, “in every house where I come I will enter only for
the good of my patients, keeping myself from all intentional ill-doing….” The physician, therefore, is responsible only for the good of the patient no
matter what uniform that patient may wear. The Oath makes no exception for wartime or for the treatment of an enemy. Even if physicians disagree about who
bears the blame for a conflict, they must abide by this ancient promise and its nineteenth-century ideological successor.

But what if one side in the conflict obstructs or prevents physicians from following this code? On July 23, during the latest war between
Hamas and Israel in Gaza, more than twenty leading physicians and scientists from the U.K. and Italy sent a letter to the distinguished British medical
journal The Lancet, claiming that Israel does exactly that. This letter is filled with accusations leveled
against Israel regarding the political origins and conduct of this conflict, but I’ll let others in the medical field and outside the medical field cover that ground. There is one aspect of the letter I would like to
address — specifically, the role of medicine in this conflict. On the basis of their “ethics and practice,” the physicians go on to claim:

As we write, the BBC reports of the bombing of another hospital, hitting the intensive care unit and operating theatres, with deaths of patients and
staff. There are now fears for the main hospital Al Shifa. Moreover, most people are psychologically traumatised in Gaza. Anyone older than 6 years has
already lived through their third military assault by Israel.
The massacre in Gaza spares no one, and includes the disabled and sick in hospitals, children playing on the beach or on the roof top, with a large
majority of non-combatants. Hospitals, clinics, ambulances…. As we write, other massacres and threats to the medical personnel in emergency services and
denial of entry for international humanitarian convoys are reported. We as scientists and doctors cannot keep silent while this crime against humanity
continues….

Though there is death and destruction in every war, the physicians want to point out that Israel, and not Hamas, is particularly bad in trampling on the
inviolability of the medical profession and its principled goal to care for all, Israeli or Palestinian.

And yet, this accusation glosses over some very important information. Financial Times reporter John Reed

tweeted that rockets are being fired by Hamas from Gaza’s main hospital, Al Shifa
. William Booth at the Washington Post

reported that

Hamas has been using Shifa Hospital as “de facto headquarters for Hamas leaders, who can be seen in the hallways and offices.” In

another article
 in the Washington Post, Adam Taylor reports that the Israeli military targeted Gaza City’s el-Wafa Rehabilitation Center (after
calling the hospital and telling them to evacuate), because they believed that rockets “were being fired from the vicinity of the hospital” and that there
were “militants firing from the building.” In an
al Jazeera article describing an Israeli attack on al-Aqsa hospital in Gaza, Israeli officials claim that there was a weapons cache near the hospital which the military was
targeting.

There are those who doubt these reports. But Hamas has a history of doing this. The United Nations Relief and Works Agency (UNRWA) recently released a statement
saying that its inspectors had found rockets, for a second time, in a UNRWA school for Palestinian children. As Adam Taylor

points out
 in the Washington Post, “If Hamas is hiding missiles in schools, why not in hospitals?” And Hamas has a long track record of exploiting civilians and civilian infrastructure in this way. In an article for the New York Times in 2009, Steven Erlanger wrote that “Weapons are hidden in mosques, schoolyards and civilian houses, and the leadership’s war
room is a bunker beneath Gaza’s largest hospital, Israeli intelligence officials say. Unwilling to take Israel’s bait and come into the open, Hamas
militants are fighting in civilian clothes.”

And what of the Israeli hospitals? Israeli physicians recently treated
the mother-in-law of Ismail Haniyeh, the leader of Hamas, for cancer in a Jerusalem hospital.
Israeli physicians also treated, though unsuccessfully, the granddaughter of Haniyeh
in a children’s hospital in Israel. Even as the fighting started, Israeli physicians were operating on Palestinian children with heart defects. As Dr.
Akiva Tamir, head of pediatric cardiology at Wolfson Medical Center in Holon, stated, “It does not matter what side of the political map you are on. The
parents of these children want them to live — just like parents [in Israel].” Indeed. And, as ABC News has reported, Israel opened up a
field hospital at the Gaza border to treat Palestinians wounded in the conflict. CNN reports that Barzilai Hospital in Israel, which treats soldiers, civilians, and
injured Palestinians, is “frequently hit by rocket attacks from Gaza.”

These facts make the letter from the international physicians and scientists incomprehensible: the signatories support an organization that defies the
very principles integral to the job of the physician. While Israeli physicians hold to the oath of Hippocrates and to the principles of Henri
Dunant, Hamas uses the very place where lives are supposed to be saved as a place to plan the end of human life. This renders their hospitals in clear
violation of the original Geneva text: “Neutrality shall end if the said ambulances or hospitals should be held by a military force.” And the consequences have been devastating for
Palestinians in need of medical care. Physicians, in the spirit of Dunant, must seek to treat enemies and friends, combatants and noncombatants. Hamas and its defenders are obfuscating this principle.

The “Gamepocalypse” and Why We Don’t Heed “1984”

CNN has a rather silly (what else?) piece up called “Why games will take over our lives,” interviewing Carnegie Mellon professor Jesse Schell. Among other things, it speculates that within the next five years, “toothbrushes will be hooked-up with Wi-Fi Internet connections,” so that when others know how often we brush, we will have an incentive to brush more often. From this, the piece moves in short order to the central thesis:

Schell says dental hygiene — and, really, just about everything else — will become a game. He thinks the “gamepocalypse,” the moment when everything in our lives becomes a game, is coming soon — if it’s not already here.
The article usefully illustrates what seem to be two recurrent features of futurism. The first is one of the most basic moves of futurists celebratory and alarmist alike: take some techno-social trend, blur its boundaries to near-dilution, and thereby extrapolate to everything, so that in just a few short years all of society will be defined by it. (Speaking of which, remind me to write about the looming portmantocalypse.)
This move is particularly evident in fictional futurism of the self-consciously “cautionary what-if” variety: think Repo Men and Surrogates, just to name two recent cinematic examples. And all transhumanists seem to have some rapturous vision of the future as defined by their favorite technology. But this move is also evident in much futurism of less extreme varieties, both contemporary and historical.
All this is obvious enough, but there is something of an equal but opposite problem that is much more subtle: it seems that the combined popularity, fervency, and specificity of futuristic speculation winds up blinding us to how basically correct much of it turns out to be. When we (legitimately) dismiss the “gamepocalypse” scenario, it becomes that much easier to shrug off the extent to which gaming, virtuality, and digital immersion really are altering our lives. The extreme predictions end up functioning like a disinformation campaign.
The problem of futuristic specificity is particularly acute in fiction (which all speculation is to some extent). This is because much of the power of fiction is aesthetic: For example, we aren’t just repelled by Orwell’s 1984 as a philosophical response to its narrative, but also because we are drawn into its world, imagining ourselves in it and experiencing the dread of what it feels like to live in its dystopia. But the moral repulsion that 1984 teaches us to recognize then becomes linked to our aesthetic sense of it. Rather counterintuitively, because our own world still feels like our plain old everyday world and not like what we read, 1984 remains emotionally hypothetical, numbing us to how our society has come to resemble that of the novel in some ways (e.g., especially, surveillance). Even if we might recognize it on an intellectual level, it’s hard to find the resemblance nearly as worrisome with reference to the book — not because we’re unfamiliar with the book, but rather, in a way, because we’re too familiar with it.
(hat tip: Ann Kilzer)