Below is a letter from Professor Dr Derek Summerfield
to Sir Mark Pepys, a Zionist academic at University College, London.  Pepys has spearheaded an attack on The Lancet
medical magazine and its editor, Dr. Richard Horton, for it printing a letter
criticising Israel for its genocidal bombing of Gaza last year.

I also enclose a letter that I sent to Pepys.

Tony Greenstein

Dear Sir Mark Pepys and signatories

I am aware that Professor Graham Watt and colleagues
have already sent  you a response to your
attack on The Lancet editor Dr Richard Horton and  the signatories to the Manduca et al letter
published in The Lancet  during Operation
Protective Edge in Gaza last summer. As one of the  signatories of that letter I wish to reply on
my own account.

An early indication that yours is simply an
indiscriminate smear letter  is the
inclusion of entirely irrelevant material- the Lancet publication  of the Wakefield MMR paper 17 years ago, your
highlighting of what one  signatory might
have said in a talk somewhere, what Internet material  another signatory might have looked at etc.

Our case rests on the substantive evidence base from
a range of  international and regional
human rights and documentation centres  generated
by Operation Protective Edge and precedent events like the  long-running seige of Gaza. The indiscriminate
bombardment and mass  killing of a
helpless, trapped civilian population (including the  killing of hospital patients in their beds,
and of health professionals  on duty) is
at the centre of all these accounts. Look at the photo I  attach. You cannot be unaware of this evidence
base but your letter  ignores it
entirely. I attach just one example, an independent medical  fact-finding report organised by Physicians
for Human Rights-Israel and  other
reputable documentation centres. (1)

Your detachment from the human costs of Operation
Protective Edge, and  the medical ethical
issues thrown up, was there from the start. I note  that you, Sir Mark, were quoted in the
Telegraph of 22 September 2014 as  saying
on 29 August, at the height of the bombardment, that the Manduca  et al authors were displaying “most
serious, unprofessional and  unethical
errors”. Not a word about events on the ground in Gaza, yet  these were the events which even then the UN,
Amnesty International and  Human Rights
Watch were all recording as prima facie evidence of war  crimes!  Since then The International
Criminal Court has opened a  preliminary
examination of war crimes violations during Operation  Protective Edge.

I would suggest that if a letter of protest with
exactly the same  contents had appeared
in The Lancet, but where the State concerned was,  say, Sudan or Syria, you would have no reason
to see as it as  objectionable or as
inappropriate material for a medical journal, and  might well have applauded such coverage- after
all, the medical  profession has a duty
to individual patients, but also a generally  recognised wider ethical duty to address the
social origins of distress  and disease.
So how are we to understand the apparent exceptionalism you  display? In his classic work
“Phenomenology of Sociopolitical Actions: A  Methodological Approach to Conflict”, the
sociologist Max Weber  distinguished
between an “ethic of responsibility” and an “ethic of  conviction”. By “ethic of
responsibility”, Weber meant conformity to  professional standards and accountability. In
our profession this means  the ethical
standards by which doctors should practice, including a  commitment to factual evidence- standards
determined by their peers,  employers,
the General Medical Council and, on the international scene,  by the World Medical Association. By
“ethic of conviction”, Weber was  identifying actions that were inspired by
personally valued ideals,  political or
other philosophies, or identities. In my 29 years of  conflict-related human rights work (23 on
Israel-Palestine), I have  witnessed how
regularly an ethic of conviction trumps an ethic of  responsibility, not least amongst doctors, and
this is sadly true of you  too. The
signatories of your letter seem united around a felt connection  with Israel and a wish to defend it, and this
is what counts. In the  service of this
you can dismiss war crimes, seek to bludgeon a medical  journal into silence, and demand that a letter
grounded on so multiply  documented an
evidence base be retracted. This is a flagrant abuse of  medical ethics. You write as if you had the
ethical clarity that would  attach, say,
to your discovery of research fraud in a published paper,  and your further discovery that the editor of
the journal concerned had  been in
knowing collusion with this fraud!

Those signatories who are Israeli are in support of
the state of which  they are citizens;
the majority of signatories who reside elsewhere are  serving the propaganda interests of a foreign
power.

Your allegations are defamatory and libellous: that
we published  “deliberately
inflammatory falsehoods….abusive  dishonesty…..unverifiable
dishonest ‘facts’…..malignant wilful  disregard
of honest and ethical medical authorship and  editorship…..under the direction of Horton,
The Lancet has become a  vehicle for
publication of deliberately false material…” So we – both  authors and editor- are publishing lies which
we know to be lies in a  famous
international medical journal? Few allegations made against a  doctor could be much graver than this.

I quote from the GMC publication Good Medical
Practice (2006).  In the  section on
Working with colleagues, doctors must “respect the skills and  contributions of your colleagues” (para
41); “you must treat your  colleagues
fairly and with respect.  You must not bully or harass them  or unfairly discriminate against them by
allowing your personal views to  affect
adversely your professional relationship with them.  You should  challenge colleagues if their behaviour does
not comply with this  guidance”
(para 46); “you must not make malicious and unfounded  criticisms of colleagues that may undermine
patients’ trust in the care  or treatment
they receive, or in the judgement of those treating them”  (para 47).  In the section on Probity,
the GMC says that “probity means  being
honest and trustworthy, and acting with integrity: this is at the  heart of medical professionalism” (para
56); “you must make sure that  your
conduct at all times justifies your patients’ trust in you and the  public’s trust in the profession” (para
57).  In the section on Writing  reports,
giving evidence etc, the GMC says that “you must do your best  to make sure that any documents you write or
sign are not false or  misleading. This
means that you must take reasonable steps to verify the  information in the documents, and that you
must not deliberately leave  out relevant
information” (para 65); …you must be honest in all your  spoken and written statements. You must make
clear the limits of your  knowledge or
competence” (para 67).

As one of the signatories whose academic reputation
your letter seeks to  blacken, I am an
involved party and I challenge you retract your  allegations promptly or justify them
evidentially. If you fail to do so  I
will look to appropriate action, starting with a formal complaint to  the General Medical Council naming yourself as
lead signatory for a  start.

  Yours  Derek
Summerfield  

Honorary Senior Lecturer,
Institute of Psychiatry, King’s College,  London Consultant Psychiatrist, South London
& Maudsley NHS Trust  Formerly
Research Associate, Refugee Studies Centre, University of  Oxford; Consultant to Oxfam and other
humanitarian organisations;  Principal
Psychiatrist, Medical Foundation for Care of Victims of Torture.

Yours sincerely,

Gaza 2014 

Physicians for Human Rights-Israel, Al Mezan Center
for Human  Rights-Gaza, Gaza Community
Mental Health Programme,  Palestinian Centre  for Human Rights

״There was a call
for help in a house which had been randomly shelled at Mujama’a St, East Gaza
City. It was nearly 01:00 on the last day of Ramadan. The house was in complete
chaos when the team arrived. There was dense smoke everywhere and a very bad
smell which hardly allowed them to breathe. I got the stretcher and the
flashlight and entered the building, where I immediately saw a badly injured woman
under the staircase. I took her to the ambulance and went back to the house. We
managed to fit 3-6 people into the second ambulance…. What shocked me most
about this incident was that I forgot the flashlight in the house and my
colleague asked me to go back and get it, since we would need it later for
other evacuations. When I went back, I heard the feeble cry of a small baby
which I hadn’t noticed before. I looked around but couldn’t see anyone. Then I
felt that the voice was coming from under a heap of rubble in flames. I
searched in the rubble, though I felt my hands getting burnt, and finally I
found a baby around one month old. I took her and ran back to the ambulance,
but before I arrived she stopped breathing. I performed cardio-pulmonary
resuscitation (CPR) on her, and she came back to life. I was shocked by the
incident, because she could have been one of my children, and I had almost left
her behind in the fire to a certain death. I still thank God that I forgot the
flashlight, so I was forced to go back to the house and could find her! I found
a picture of her in the hospital on the internet, and I saved it, because it is
a great encouragement for me. Now I want to look for her and see her grow, to
tell her how proud I am that she is alive. ״

(Yousef Al Kahlout, a PRCS
paramedic)

• The overwhelming majority of injuries causing death or
requiring hospitalisation seen by the FFM 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;

• Numerous cases in which  significant numbers of casualties including
members of the same family and rescuers were killed or injured in a single
incident; – ‘double tap’ or multiple consecutive strikes on a single location
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 and/or in
which medical teams were killed or injured in the course of evacuation of the
injured (notably in Shuja’iya, Gaza City);

• At least one case in which a mine-breaching explosive
device (tsefa shirion) was used in a residential street in Khuza’a, Khan
Younis, causing massive destruction.

• At least one case, of Shuhada’ Al Aqsa Hospital in
Deir Al Balah, where several people were killed and injured in what was
apparently a deliberate attack on the hospital on 21 July 2014.  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 the town on 23 July 2014;

• 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
on 24 July. 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 at close range.

In addition, the FFM examined:

• The strains placed on hospitals in Gaza during the
attacks;

• Problems with referral and evacuation of patients from
Gaza hospitals to hospitals outside;

• Long-term internal displacement in Gaza as a result of
the partial or total destruction of about 18,000 homes;

• Long-term psychosocial and mental health damage caused
by this and previous wars;

• An increased need for rehabilitation services and
insufficient current resources in Gaza to meet them.

Conclusions

• 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;
they 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 enable the safe evacuation of the civilian population,
including 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.

• In numerous cases double or multiple consecutive
strikes on a single location led to multiple civilian casualties and to
injuries and deaths among rescuers.

• Coordination of medical evacuation was often denied
and many attacks on medical teams and facilities were reported. It is not clear
whether such contravention of medical neutrality was the result of a policy
established by senior decision-makers, a general permissive atmosphere leading
to the flouting of norms, or the result of individual choices made on the
ground during armed clashes.

• In Khuza’a, the reported conduct of specific troops in
the area is indicative of additional serious violations of international human
rights and humanitarian law.