Israel’s new triage guidelines – purely for
international consumption
In my previous post on the extra-judicial execution
of a wounded Palestinian it was noticeable that 2 Israeli ambulances did
nothing to tend to someone who was clearly severely injured on the ground. Their only concern was a superficially wounded
soldier.
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| Palestinian Red Crescent |
It is clear that the new guidelines from the Israeli Medical Association, whilst
formally adhering to the triage rules, whereby you tend to the most severely
wounded first, is not in practice being adhered to.
formally adhering to the triage rules, whereby you tend to the most severely
wounded first, is not in practice being adhered to.
Israeli doctors are complicit in the shoot
to kill policies of Israel’s military.
The new guidelines are purely for international consumption.
to kill policies of Israel’s military.
The new guidelines are purely for international consumption.
Tony Greenstein
Israeli medics are leaving wounded Palestinians to bleed to death
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| Israeli soldiers invade hospital demanding records |
Dan
Cohen March 23, 2016
Cohen March 23, 2016
Last
December, an Israeli medic announced on
his Twitter account that he would not treat injured Palestinians he deemed
“terrorists.”
December, an Israeli medic announced on
his Twitter account that he would not treat injured Palestinians he deemed
“terrorists.”
“As
a ZAKA volunteer for close to twenty years. I am announcing publicly, I
will not offer aid to a terrorist/murderer that hurt innocents, whatever his
condition may be. Before I treat the victims,” he wrote.
a ZAKA volunteer for close to twenty years. I am announcing publicly, I
will not offer aid to a terrorist/murderer that hurt innocents, whatever his
condition may be. Before I treat the victims,” he wrote.
Soon
after, he claimed to have carried out his promise. On the scene at Jerusalem’s
Jaffa Gate where a Palestinian man who attacked an Israeli was shot, beaten
with a metal rod and kicked by civilians, the medic boasted on
Twitter that he did not treat the dying Palestinian man.
after, he claimed to have carried out his promise. On the scene at Jerusalem’s
Jaffa Gate where a Palestinian man who attacked an Israeli was shot, beaten
with a metal rod and kicked by civilians, the medic boasted on
Twitter that he did not treat the dying Palestinian man.
“For
all of those asking, when I arrived today to the scene of the terror attack at
Jaffa Gate in Jerusalem. I treated those wounded by stabbing and no! I did not
go to give aid to the terrorist may his name be erased! despite the fact that
his condition was mortal,” he wrote.
all of those asking, when I arrived today to the scene of the terror attack at
Jaffa Gate in Jerusalem. I treated those wounded by stabbing and no! I did not
go to give aid to the terrorist may his name be erased! despite the fact that
his condition was mortal,” he wrote.
This
is not an aberration, rather, it is an instance of increasing
turmoil in the Israeli medical community over the concept of triage,
the internationally recognized protocol for medical treatment based on severity
and likely benefit from immediate treatment.
is not an aberration, rather, it is an instance of increasing
turmoil in the Israeli medical community over the concept of triage,
the internationally recognized protocol for medical treatment based on severity
and likely benefit from immediate treatment.
Changing Israeli Protocol on Triage
In
2008, the website of the Israeli Medical Association listed a Talmudic
dictum in its section on ethics.
2008, the website of the Israeli Medical Association listed a Talmudic
dictum in its section on ethics.
“In
cases where human caused violence results in casualties for the perpetrators of
such violence (the enemy), the obligations towards these parties should be
clearly defined. Here, the principle to be implemented is “the poor of your
city come first,” it read.
cases where human caused violence results in casualties for the perpetrators of
such violence (the enemy), the obligations towards these parties should be
clearly defined. Here, the principle to be implemented is “the poor of your
city come first,” it read.
When Hadas
Ziv, Physicians for Human Rights Israel’s ethics committee coordinator, found
this in October 2015, the committee wrote a complaint to IMA’s ethics
committee that “statements from medical teams on the ground indicate that they
do not prioritize the injured according to their medical condition,”
and requested that the licenses of the offending medical staff be
revoked. The IMA does not have the authority to revoke medical licenses
themselves, but as a professional organization it is able to make
recommendations to the Ministry of Health. After PHRI’s letter, the IMA did
remove the directive from its website.
Ziv, Physicians for Human Rights Israel’s ethics committee coordinator, found
this in October 2015, the committee wrote a complaint to IMA’s ethics
committee that “statements from medical teams on the ground indicate that they
do not prioritize the injured according to their medical condition,”
and requested that the licenses of the offending medical staff be
revoked. The IMA does not have the authority to revoke medical licenses
themselves, but as a professional organization it is able to make
recommendations to the Ministry of Health. After PHRI’s letter, the IMA did
remove the directive from its website.
In
response to the removal of the instruction breaching triage, the aforementioned
ZAKA medic and a handful of others made online announcements that they
would continue to discriminate in defiance of the IMA.
response to the removal of the instruction breaching triage, the aforementioned
ZAKA medic and a handful of others made online announcements that they
would continue to discriminate in defiance of the IMA.
Rather
than expelling the medic who refused to treat a dying Palestinian, ZAKA, the
medical organization he works for, confirmed that this breach of triage is the
protocol they are training.
than expelling the medic who refused to treat a dying Palestinian, ZAKA, the
medical organization he works for, confirmed that this breach of triage is the
protocol they are training.
“Usually
already in the initial stage the attacker is identified, and our policy is to
give precedence to the attacked with medical treatment,” ZAKA wrote on Twitter.
already in the initial stage the attacker is identified, and our policy is to
give precedence to the attacked with medical treatment,” ZAKA wrote on Twitter.
A Twitter poll
started after the medic’s announcement indicates public support for attacking
triage, with 88% of the 59 polled in support.
started after the medic’s announcement indicates public support for attacking
triage, with 88% of the 59 polled in support.
On
October 18, Ziv filed a complaint over changes to the triage protocol with
the Ministry of Health, but more than five months later, she has not received a
response and the MOH has been silent on the issue.
October 18, Ziv filed a complaint over changes to the triage protocol with
the Ministry of Health, but more than five months later, she has not received a
response and the MOH has been silent on the issue.
A Pattern of Denying Medical Aid to Palestinians
In
November 2015, the NGO Euro-Mediterranean Human Rights Monitor released a report documenting five
separate incidents of denial of medical aid to Palestinians by Magen David
Adom, which is officially recognized by the International Committee of the Red
Cross, accusing it of violating the Geneva Conventions. “Such discrimination in
providing medical treatment, even when a crime has been attempted, is
prohibited and illegal under the International Convention on the Elimination of
All Forms of Racial Discrimination.”
November 2015, the NGO Euro-Mediterranean Human Rights Monitor released a report documenting five
separate incidents of denial of medical aid to Palestinians by Magen David
Adom, which is officially recognized by the International Committee of the Red
Cross, accusing it of violating the Geneva Conventions. “Such discrimination in
providing medical treatment, even when a crime has been attempted, is
prohibited and illegal under the International Convention on the Elimination of
All Forms of Racial Discrimination.”
A video taken
after a stabbing attack in the occupied West Bank last Thursday shows
Israeli medics treating an injured Israeli soldier while two Palestinians lie
on the ground, severely injured. Both Palestinians, Ali Jamal Muhammad Taqatqa,
19, and Ali Abd al-Rahman al-Kar Thawabta, 20, died of their wounds.
after a stabbing attack in the occupied West Bank last Thursday shows
Israeli medics treating an injured Israeli soldier while two Palestinians lie
on the ground, severely injured. Both Palestinians, Ali Jamal Muhammad Taqatqa,
19, and Ali Abd al-Rahman al-Kar Thawabta, 20, died of their wounds.
In
video footage of the killing of 18-year-old Hadeel al-Hashlamoun in Hebron, an
Israeli settler named Ofer – who local activists claim has no medical
training and operates a fake ambulance – can be seen discouraging Israeli
medics from treating her. Other videos show Israeli medical personnel standing
idly as she bleeds to death, meanwhile medics from the Palestine Red Crescent
Society were refused access to treat her. Amnesty International called
her death an “extrajudicial execution.”
video footage of the killing of 18-year-old Hadeel al-Hashlamoun in Hebron, an
Israeli settler named Ofer – who local activists claim has no medical
training and operates a fake ambulance – can be seen discouraging Israeli
medics from treating her. Other videos show Israeli medical personnel standing
idly as she bleeds to death, meanwhile medics from the Palestine Red Crescent
Society were refused access to treat her. Amnesty International called
her death an “extrajudicial execution.”
In
another incident, 21-year old Yasmin al-Zarou was gunned down by Israeli
soldiers, who then interrogated
her as she bled on the ground. Israeli medics stood over her and even
pushed her outstretched hands away as she asked for help.
another incident, 21-year old Yasmin al-Zarou was gunned down by Israeli
soldiers, who then interrogated
her as she bled on the ground. Israeli medics stood over her and even
pushed her outstretched hands away as she asked for help.
Widespread Support
Last
October, Deputy Minister of the Interior Yaron Mazuz publicly backed the change
to triage. “The first priority should be give in to the residents of Israel,
mostly to those who were injured from the attacks. Is it unacceptable that we
would treat terrorists before residents of the state,” he said on Israel’s
Channel Two.
October, Deputy Minister of the Interior Yaron Mazuz publicly backed the change
to triage. “The first priority should be give in to the residents of Israel,
mostly to those who were injured from the attacks. Is it unacceptable that we
would treat terrorists before residents of the state,” he said on Israel’s
Channel Two.
But
for Ziv, the MOH’s silence is unusual and deeply troubling.
for Ziv, the MOH’s silence is unusual and deeply troubling.
“Even
worse than the right-wing populist politicians who are just looking for
headlines – fine, they understand nothing in medical ethics,” Ziv told me in a
telephone call. “What worries me is that the Minister of Health [Ya’aldoesn’t
see it as its role to say something very clear cut, and I wonder why is that
so.”
worse than the right-wing populist politicians who are just looking for
headlines – fine, they understand nothing in medical ethics,” Ziv told me in a
telephone call. “What worries me is that the Minister of Health [Ya’aldoesn’t
see it as its role to say something very clear cut, and I wonder why is that
so.”
Attacks
on triage are also gaining support in Shaare Zedek, one of Israel’s top
hospitals. Speaking at at a conference on the ethics of terror attacks, Dr.
Ofer Merin, Executive Director of the Trauma Unit & Deputy Director of Medicine
at Shaare Zedek hospital in Jerusalem, told the audience that adoption of this
practice was inevitable – however in euphemistic terms.
on triage are also gaining support in Shaare Zedek, one of Israel’s top
hospitals. Speaking at at a conference on the ethics of terror attacks, Dr.
Ofer Merin, Executive Director of the Trauma Unit & Deputy Director of Medicine
at Shaare Zedek hospital in Jerusalem, told the audience that adoption of this
practice was inevitable – however in euphemistic terms.
“When
we reach the ‘day of judgement’ in which we won’t be able to treat everyone, I
think – and I say this with complete caution – that if it is impossible to
treat everyone, I think there is no avoiding the moral statement that we need
to give the innocents different rights than the person who harmed them
intentionally,” he said.
we reach the ‘day of judgement’ in which we won’t be able to treat everyone, I
think – and I say this with complete caution – that if it is impossible to
treat everyone, I think there is no avoiding the moral statement that we need
to give the innocents different rights than the person who harmed them
intentionally,” he said.
Writing
in the UK
medical journal The Lancet, Merin subtly proposed the idea of
abandoning triage in April 2015. “The moral issue of concurrently treating a
terrorist and his victim is even more complex. Is it actually realistic to
expect the staff to disregard the fact that the terrorist intended to kill the
innocent person lying wounded in the same trauma unit?”
in the UK
medical journal The Lancet, Merin subtly proposed the idea of
abandoning triage in April 2015. “The moral issue of concurrently treating a
terrorist and his victim is even more complex. Is it actually realistic to
expect the staff to disregard the fact that the terrorist intended to kill the
innocent person lying wounded in the same trauma unit?”
Ultimately,
he concluded that “Punishment is not the role of the medical staff; rather,
their duty and obligation is to preserve life and restore health. Judgment
should be the exclusive provenance of the legal system and physicians should
practice their art without discrimination and with a clear conscience.”
he concluded that “Punishment is not the role of the medical staff; rather,
their duty and obligation is to preserve life and restore health. Judgment
should be the exclusive provenance of the legal system and physicians should
practice their art without discrimination and with a clear conscience.”
But
the recent violence appears to have created the pretext for Merin to warn
that the hospital would soon have no choice but to embrace racist medical
practices.
the recent violence appears to have created the pretext for Merin to warn
that the hospital would soon have no choice but to embrace racist medical
practices.
Top
state-funded rabbis have also endorsed this practice, abandoning the
euphemistic terminology of a moral dilemma, and have even encouraged
Israeli police and soldiers to execute wounded Palestinians deemed “terrorists”
on the spot.
state-funded rabbis have also endorsed this practice, abandoning the
euphemistic terminology of a moral dilemma, and have even encouraged
Israeli police and soldiers to execute wounded Palestinians deemed “terrorists”
on the spot.
Rabbi
Chaim Kanievsky, a top haredi authority, instructed
paramedics from United Hatzalah to “not treat injured terrorists,” and that
“If the terrorist was in a life threatening condition, they should leave him or
her to die.”
Chaim Kanievsky, a top haredi authority, instructed
paramedics from United Hatzalah to “not treat injured terrorists,” and that
“If the terrorist was in a life threatening condition, they should leave him or
her to die.”
“It
is forbidden to leave a murderer alive,” Chief Rabbi of Safed Shmuel Eliyahu told
the Galei Yisrael radio station.
is forbidden to leave a murderer alive,” Chief Rabbi of Safed Shmuel Eliyahu told
the Galei Yisrael radio station.
In
another instance, Eliyahu said,
“Only in a case where you really have no other choice…keep him alive, interrogate
him and then send him to hell as soon as possible.”
another instance, Eliyahu said,
“Only in a case where you really have no other choice…keep him alive, interrogate
him and then send him to hell as soon as possible.”
Rabbi
Ben-Tzion Mutzafi, another top haredi rabbi, ordered his students to bludgeon
wounded Palestinians to death. “It is commanded to take hold of his head and
hit it against the ground until there is no longer any life in it,” he said.
Ben-Tzion Mutzafi, another top haredi rabbi, ordered his students to bludgeon
wounded Palestinians to death. “It is commanded to take hold of his head and
hit it against the ground until there is no longer any life in it,” he said.
Rabbis
Eliyahu and Mutzafi
even called for soldiers and police who let Palestinians live to be prosecuted.
Eliyahu and Mutzafi
even called for soldiers and police who let Palestinians live to be prosecuted.
“The
political situation in Israel is horrific,” Ziv lamented. “The atmosphere,
environment and political leadership all influenced other systems in our
[Israeli] society. Education has changed, courts have changed – the medical
system is not immune to that.”
political situation in Israel is horrific,” Ziv lamented. “The atmosphere,
environment and political leadership all influenced other systems in our
[Israeli] society. Education has changed, courts have changed – the medical
system is not immune to that.”
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