We would like to thank Professor Holst for taking the time to read and respond to our article. Indeed, in developing the piece, we read with great interest Professor Holst’s 2020 article on emergence, hegemonic trends and biomedical reductionism in global health. We acknowledge that global health is a broad and complex field, and ongoing discourse around terminology is welcome and encouraged.
As Professor Holst himself states, “the predominant Global Health concept reflects the inherited hegemony of the Global North”.(1) With this is mind, we sought in our paper to articulate a practical interpretation of global health that emphasises the critical barriers to universal health coverage and optimal health outcomes. The challenges of access, resource and context limitation are global in nature, and do not relate exclusively to the provision of “humanitarian aid”. We agree with Professor Holst that addressing these issues requires trans-national solutions and multi-sectoral engagement.
In articulating the ARC-H principle, we acknowledge that we have applied a “clinical-biomedical” frame. This reflects our work as emergency physicians who have borne witness to the direct and indirect consequences of access-, resource- and context-limited healthcare. Our interpretation is pragmatic, and deliberately serves to emphasise the expertise and lived experience of ARC-H populations.
In no way do we seek to minimise the social, environmental, political and commer...
We would like to thank Professor Holst for taking the time to read and respond to our article. Indeed, in developing the piece, we read with great interest Professor Holst’s 2020 article on emergence, hegemonic trends and biomedical reductionism in global health. We acknowledge that global health is a broad and complex field, and ongoing discourse around terminology is welcome and encouraged.
As Professor Holst himself states, “the predominant Global Health concept reflects the inherited hegemony of the Global North”.(1) With this is mind, we sought in our paper to articulate a practical interpretation of global health that emphasises the critical barriers to universal health coverage and optimal health outcomes. The challenges of access, resource and context limitation are global in nature, and do not relate exclusively to the provision of “humanitarian aid”. We agree with Professor Holst that addressing these issues requires trans-national solutions and multi-sectoral engagement.
In articulating the ARC-H principle, we acknowledge that we have applied a “clinical-biomedical” frame. This reflects our work as emergency physicians who have borne witness to the direct and indirect consequences of access-, resource- and context-limited healthcare. Our interpretation is pragmatic, and deliberately serves to emphasise the expertise and lived experience of ARC-H populations.
In no way do we seek to minimise the social, environmental, political and commercial determinants of health, or the inequalities and power imbalances that contribute to sub-optimal health outcomes. Rather, we have endeavoured to highlight the practical, downstream consequences of these factors. Healthcare that is access- or resource-limited is invariably a manifestation of the broader social, environmental and political context.
As articulated in our article, our intent is not to replace established terminology and definitions, but rather emphasise the importance of clarity and precision when referring to global health activities and programmes. We hope to have encouraged those who use the term ‘global health’ to think critically about what they actually mean. In writing his response, Professor Holst has applied the exact type of reflexive approach that we were hoping to stimulate.
In a February correspondence to BMJ, Greenland et al opined that an end to violence in Palestine “can only occur when Hamas ends its war to destroy the state of Israel...”.[1] The Israeli offensive, the authors argued, is legitimised by the support of “the governments of the UK, the USA, Germany, France, Italy and other sovereign states”[1] and purported “evidence” contained within predominantly North American news outlets including the New York Times, CNN, and the Washington Post.
What the article glaringly omits are the evidence-based analyses and unified first-hand accounts of global health, humanitarian, and human rights organisations operating in Gaza – organisations borne in direct response to war atrocities and mandated to alleviate suffering, protect rights, uphold international law, and maintain neutrality, peace, security, and diplomacy. How far we have fallen if the experiences of such organisations are no longer considered valid and worthy of reference, but violence and oppression are legitimised through citing unreliable sources at best, and biased standpoints of political and vested interest at worst. Disappointingly, such citations undermine the high ethical standards of journals like the BMJ. In the interests of respecting evidence and facts, we highlight experiences from global bodies to refute Greenland et al’s baseless claims.
First, the authors dispute the occupation of Gaza itself, claiming – using a misquoted Wikipedia reference[2] – “t...
In a February correspondence to BMJ, Greenland et al opined that an end to violence in Palestine “can only occur when Hamas ends its war to destroy the state of Israel...”.[1] The Israeli offensive, the authors argued, is legitimised by the support of “the governments of the UK, the USA, Germany, France, Italy and other sovereign states”[1] and purported “evidence” contained within predominantly North American news outlets including the New York Times, CNN, and the Washington Post.
What the article glaringly omits are the evidence-based analyses and unified first-hand accounts of global health, humanitarian, and human rights organisations operating in Gaza – organisations borne in direct response to war atrocities and mandated to alleviate suffering, protect rights, uphold international law, and maintain neutrality, peace, security, and diplomacy. How far we have fallen if the experiences of such organisations are no longer considered valid and worthy of reference, but violence and oppression are legitimised through citing unreliable sources at best, and biased standpoints of political and vested interest at worst. Disappointingly, such citations undermine the high ethical standards of journals like the BMJ. In the interests of respecting evidence and facts, we highlight experiences from global bodies to refute Greenland et al’s baseless claims.
First, the authors dispute the occupation of Gaza itself, claiming – using a misquoted Wikipedia reference[2] – “there are no ‘occupying Jews’”.[1] Not only is this confused and irrelevant, but the “belligerent”[3] military occupation of the Palestinian territories, including Gaza, is an irrefutable fact under international law, recognised by United Nations (UN) bodies and international organisations since 1967 and enduring today.[3–5]
Second, the authors blame Hamas for the current conflict – again, with historical reference drawn from Wikipedia – without acknowledging Israel’s culpability in the decades prior to October 7, and their attacks on civilians since. As António Guterres, UN Secretary-General, stated: “the attacks by Hamas did not happen in a vacuum, with the Palestinian people being subjected to 56 years of suffocating occupation… and those appalling attacks cannot justify the collective punishment of the Palestinian people.”[6]
Furthermore, the authors’ claim that Israel declared war against Hamas, not civilians, is farcical given the astronomical civilian death toll exceeding 31,700 people.[7] At least 12,300 Gazan children have been killed over four months.[8] UN human rights experts have issued multiple warnings of the risk of genocide.[9] 2.3 million Gazans face impending famine due to Israel’s “total siege”[9,10] despite Israel’s obligation to provide basic supplies to the Gazan population under international law.[11] All these facts have been confirmed by credible global organisations with presence in Gaza.
Third, the authors draw focus to the undetermined origin of attack on Al-Ahli Hospital on October 17,[12] yet omit reference to Israel’s well documented and verified attacks on the Indonesian hospital and near Al-Shifa and Al-Quds hospitals[13] days prior to article submission. Christopher Lockyear, Secretary-General of Médecins Sans Frontières (MSF), reported: “Israeli forces have attacked our convoys, detained our staff, and bulldozed our vehicles, and hospitals have been bombed and raided.”[14] In January, the World Health Organisation (WHO) reported almost 600 attacks on health infrastructure since October 7.[15]
The authors then use the unfounded claim, a so-called “fact known for years”, that Hamas has used hospitals for military purposes to justify attacks on health infrastructure, citing CNN and the Washington Post.(1) “[W]e have seen zero independently verified evidence of this,” declared Lockyear.[14] The ICRC emphasises that in cases of doubt, health establishments should be presumed not to be used as accessories to war.[16] On March 18, Israeli attacks on Al-Shifa resumed, with MSF reporting mass arrests and loss of contact with staff.[17]
Gazans are facing an “unparalleled humanitarian crisis”.[9] We reiterate the calls of WHO Director-General Dr Tedros Adhanom Ghebreyesus, Guterres, Lockyear, and every global organisation witnessing the atrocities in Gaza, for an immediate ceasefire.[14,18–20] These are the voices that must be taken seriously, unified in their outrage and disbelief at a politics and propaganda taking unjustifiable and unconscionable positions in denial of reality, and in denial of humanity.
The authors are to be commended on an important article which makes a compelling point.
Out of interest, where authors are appropriately credited as joint first and joint last, should their names then be listed alphabetically? In the example of this paper, this would place authors based in more resource-poor countries as the first and last listed authors, and would also seem the more rational ordering if authorship is jointly shared. There is some evidence that the ordering of 'joint first' authors does involve some implicit biasing in terms of gender balance - might this not also be an issue in work published as part of an global partnership? Attributing authorship can be genuinely difficult, but where equivalence is recognised it then seems concerning that the chosen (but not explained) order still places the high-income authors in the traditional positions of distinction.
Recently, in BMJ Global Health, Nasir Jafar and colleagues made another attempt to redefine 'global health'. They aim for 'greater clarity and precision' in a pragmatic and more inclusive sense, with the noble objective '‘to offload colonial vestiges present within the field and terminology of ‘global health’.‘ While this goal is undoubtedly right, important and overdue, the argument is alarmingly unconvincing and narrow. In their attempt to redefine, or rather reinterpret, global health, the authors make two important restrictions. Their proposal is based on an understanding of global health that is limited not only to a single country, but also to the field of humanitarian aid. Health emergencies and relief are only part of global health, so reducing the latter to humanitarian aid is absolutely unacceptable. It blatantly neglects both the meaning of "global" as "universal" and the complexity of global health as an explicitly political concept.
The second, unacceptable limitation is the authors' narrowing of global health to healthcare and healthcare systems. It may be that a clinical-biomedical understanding dominates the theory and practice of global health, but the call for an a posteriori recognition of pragmatic development should not distract from the fact that global health is much more complex, encompassing the social, environmental, political and commercial determination of health, as well as inequalities...
Recently, in BMJ Global Health, Nasir Jafar and colleagues made another attempt to redefine 'global health'. They aim for 'greater clarity and precision' in a pragmatic and more inclusive sense, with the noble objective '‘to offload colonial vestiges present within the field and terminology of ‘global health’.‘ While this goal is undoubtedly right, important and overdue, the argument is alarmingly unconvincing and narrow. In their attempt to redefine, or rather reinterpret, global health, the authors make two important restrictions. Their proposal is based on an understanding of global health that is limited not only to a single country, but also to the field of humanitarian aid. Health emergencies and relief are only part of global health, so reducing the latter to humanitarian aid is absolutely unacceptable. It blatantly neglects both the meaning of "global" as "universal" and the complexity of global health as an explicitly political concept.
The second, unacceptable limitation is the authors' narrowing of global health to healthcare and healthcare systems. It may be that a clinical-biomedical understanding dominates the theory and practice of global health, but the call for an a posteriori recognition of pragmatic development should not distract from the fact that global health is much more complex, encompassing the social, environmental, political and commercial determination of health, as well as inequalities and power imbalances between and within countries. Against this backdrop, the attempt by Nasir Jafar et al. to redefine global health proves to be inadequate and misleading. Due to the fundamental reductionism reflected in their commentary, the approach is unlikely to make a relevant contribution to decolonising global health, as it diverts the attention from the far more relevant upstream determinants of global health and health inequalities.
A recently published article addresses the worrysome connections existing between the progressively increasing Arctic Sea ice melting and the chronic starvation experienced by polar bears (Ursus maritimus) (1). Indeed, the progressively declining Arctic Sea ice thickness represents a leading cause of the profound ecological, behavioural, feeding and dietary pattern modifications reported with an increased frequency in this highly threatened apex predator (1).
Within such an alarming context, the animals' chronic stress deriving from prolonged starvation is an additional matter of concern. Indeed, besides being a powerful and efficient machinery allowing us and all the other living organisms to cope with a huge number of environmental stressors, chronic stress responses are invariably characterized by immunosuppression, originating from enhanced cortisol production (2). Therefore, while increased cortisol levels should be reasonably expected to occur in the blood of polar bears experiencing chronic starvation (1), it should be emphasized they may also become, at the same time, much more susceptible to microbial pathogens impacting their health and conservation status.
This could be especially true for Toxoplasma gondii, a cosmopolitan and zoonotic protozoan parasite infecting humans and a large number of terrestrial and aquatic mammal species, including polar bears. In this respect, anti-T. gondii antibodies were previously reported in almost half of the p...
A recently published article addresses the worrysome connections existing between the progressively increasing Arctic Sea ice melting and the chronic starvation experienced by polar bears (Ursus maritimus) (1). Indeed, the progressively declining Arctic Sea ice thickness represents a leading cause of the profound ecological, behavioural, feeding and dietary pattern modifications reported with an increased frequency in this highly threatened apex predator (1).
Within such an alarming context, the animals' chronic stress deriving from prolonged starvation is an additional matter of concern. Indeed, besides being a powerful and efficient machinery allowing us and all the other living organisms to cope with a huge number of environmental stressors, chronic stress responses are invariably characterized by immunosuppression, originating from enhanced cortisol production (2). Therefore, while increased cortisol levels should be reasonably expected to occur in the blood of polar bears experiencing chronic starvation (1), it should be emphasized they may also become, at the same time, much more susceptible to microbial pathogens impacting their health and conservation status.
This could be especially true for Toxoplasma gondii, a cosmopolitan and zoonotic protozoan parasite infecting humans and a large number of terrestrial and aquatic mammal species, including polar bears. In this respect, anti-T. gondii antibodies were previously reported in almost half of the polar bears from Svalbard, Norway, with males showing higher seroprevalence values than females and with the infection's frequency turning out to have doubled in comparison to an earlier investigation carried out in the same area (3).
Furthermore, the well-known top predator position occupied by polar bears within the marine food chain makes these animals prone to bioaccumulate and biomagnify a huge number of persistent environmental pollutants within their body tissues, including immunotoxic heavy metals like methyl mercury (methyl Hg) (4).
Summarizing, the immunosuppression synergistically induced by the chronic stress response deriving from prolonged starvation as well as by the high tissue concentrations of immunotoxic environmental xenobiotics, may render polar bears much more susceptible toward the acquirement and subsequent development of various infectious disease processes, of both viral and non-viral nature, impacting their already threatened health and conservation status, including SARS-CoV-2 infection, which has shown a progressively expanding wild and domestic animal host range (5).
Once again, a multidisciplinary, One Health-based approach would be strongly recommended in order to get proper insight into, and adequately counteracT, the alarming risk of getting another "piece of biodiversity" irreversibly lost!
References
1) Pagano, A.M., Rode, K.D., Lunn, N.J., et al. Polar bear energetic and behavioral strategies on land with implications for surviving the ice-free period. Nat Commun 15, 947 (2024). https://doi.org/10.1038/s41467-023-44682-1.
2) O'Leary, A. Stress, emotion, and human immune function. Psychol. Bull.108, 363-382 (1990). doi: 10.1037/0033-2909.108.3.363.
3) Jensen, S.K., Aars, J., Lydersen, C., et al. The prevalence of Toxoplasma gondii in polar bears and their marine mammal prey: evidence for a marine transmission pathway?. Polar. Biol 33, 599–606 (2010). https://doi.org/10.1007/s00300-009-0735-x
4) St Louis, V.L., Derocher, A.E., Stirling, I., et al. Differences in mercury bioaccumulation between polar bears (Ursus maritimus) from the Canadian high- and sub-Arctic. Environ. Sci. Technol. 45, 922-928 (2011). doi: 10.1021/es2000672.
5) Di Guardo, G. The SARS-CoV-2 pandemic at the wildlife-domestic animal-human interface. Pathogens 12(2), 222 (2023). doi: 10.3390/pathogens12020222.
I would like to register my strong support for this viewpoint. I am part of a large group of >200 physicians, researchers, and academics who endorsed and contributed to this article. Unfortunately, as part of a highly disappointing series of editorial decisions, BMJ Global did not allow the authors to publish our names and information as a supplement to this article (which was the original plan). I therefore would like to register a rapid response documenting that I was one of the extremely large group of academics who endorsed this article.
An excellent comprehensive, thoughtful review. Until such time as Israel-- a Jewish homeland and liberal democracy-- is accepted as a reality there can be no peace. To paraphrase Golda Meir, ",,,,,,, if the Arab world put down their weapons, there would be peace.,,,,,,, if Israel put down their weapons there would be no Israel".
Both this commentary and the previous one by Smith et al are both misleading and political attacks on the right for Israel to exist as a free and democratic nation. The Palestinian people of Gaza have been victims of Hamas since they took over in 2005/2006. To dismiss the horrendous terrorist attack of Oct 7 where children and women mutilated and raped, which was actually documented by the terrorists themselves is abhorrent and totally irresponsible of BMJ Global health. In fact prior to Oct 7, thousands of Palestinian Gazans were getting health care in Israel, including family members of Gaza leadership. Thousands of Gazans were crossing the border daily to work in Israeli Farms/Kibbutzim who paid them, fed them and at times housed them, only for them to map out each farm and houses to provide to the terrorists so they know how to attack them. In addition, many of those who worked in those farms/kibbutzim participated in the attacks. Finally, Gaza built an underground network/city under the hospitals and schools to plana and stage their attack on Israel, knowing using the Palestinian/Gazan residents as human shields to they can get sympathy from the world. In addition the communities that were attacked in the Negev, that were formed in the 1920s, were predominantly Jewish, with very few Muslims or "Palestinians" living there. Israel has every right to defend itself against this barbaric attack, as would any country. Health justice and publication of thi...
Both this commentary and the previous one by Smith et al are both misleading and political attacks on the right for Israel to exist as a free and democratic nation. The Palestinian people of Gaza have been victims of Hamas since they took over in 2005/2006. To dismiss the horrendous terrorist attack of Oct 7 where children and women mutilated and raped, which was actually documented by the terrorists themselves is abhorrent and totally irresponsible of BMJ Global health. In fact prior to Oct 7, thousands of Palestinian Gazans were getting health care in Israel, including family members of Gaza leadership. Thousands of Gazans were crossing the border daily to work in Israeli Farms/Kibbutzim who paid them, fed them and at times housed them, only for them to map out each farm and houses to provide to the terrorists so they know how to attack them. In addition, many of those who worked in those farms/kibbutzim participated in the attacks. Finally, Gaza built an underground network/city under the hospitals and schools to plana and stage their attack on Israel, knowing using the Palestinian/Gazan residents as human shields to they can get sympathy from the world. In addition the communities that were attacked in the Negev, that were formed in the 1920s, were predominantly Jewish, with very few Muslims or "Palestinians" living there. Israel has every right to defend itself against this barbaric attack, as would any country. Health justice and publication of this information is not something that should be published in Medical Journals, it is political and with much misinformation.
I am Jewish. My father escaped Nazi Germany in Spring 1939, age 17. He left his mother behind, and she was later gassed in Meinz. This was my unspoken and unspeakable heritage.
I commend the brave article by Layth Hanbali, Edwin Kwong, Amy Neilson, James Smith, Sali Hafez, and Rasha Khoury, who tell the truth as it is. With them, and with billions around the world, I call on the Israeli government to end the genocide they are committing in Palestine and to bring about an immediate ceasefire. I call on Israel’s allies to act as true allies and let go of vested interest, stop trading arms, and instead engage with Israel to forge a true and just peace.
We humans have, individually and collectively, suffered severe traumas at each other’s hands. Not only the traumas caused by genocide or war, but also trauma caused by the hunger, displacement, exploitation that go hand in hand with colonisation, extreme inequity, ecological destruction, and with excessive pollution, including carbon pollution. Many humans who are in positions of power may suffer their own legacy of trauma. For example, there is a tradition in the UK to send children as young as eight to boarding school, which is known to leave children scarred and adults with reduced empathy who struggle to engage in and maintain loving relationships.
Many humans have suffered traumas directly. Others, like myself, have grown up with inherited traumas. We are all interconnected and we are all affected. Our...
I am Jewish. My father escaped Nazi Germany in Spring 1939, age 17. He left his mother behind, and she was later gassed in Meinz. This was my unspoken and unspeakable heritage.
I commend the brave article by Layth Hanbali, Edwin Kwong, Amy Neilson, James Smith, Sali Hafez, and Rasha Khoury, who tell the truth as it is. With them, and with billions around the world, I call on the Israeli government to end the genocide they are committing in Palestine and to bring about an immediate ceasefire. I call on Israel’s allies to act as true allies and let go of vested interest, stop trading arms, and instead engage with Israel to forge a true and just peace.
We humans have, individually and collectively, suffered severe traumas at each other’s hands. Not only the traumas caused by genocide or war, but also trauma caused by the hunger, displacement, exploitation that go hand in hand with colonisation, extreme inequity, ecological destruction, and with excessive pollution, including carbon pollution. Many humans who are in positions of power may suffer their own legacy of trauma. For example, there is a tradition in the UK to send children as young as eight to boarding school, which is known to leave children scarred and adults with reduced empathy who struggle to engage in and maintain loving relationships.
Many humans have suffered traumas directly. Others, like myself, have grown up with inherited traumas. We are all interconnected and we are all affected. Our joint survival depends upon acknowledging and investigating our traumas both collectively and individually, to allow true healing.
It is not only the Palestinians of Gaza who urgently need the world to acknowledge their suffering and their right to life, but also ourselves.
Additional notes:
Moving towards alternative technological systems, such as those analysed by Project Drawdown, https://drawdown.org/, and alternative ways of living in communities, are not only possible but imperative for our children and grandchildren’s sake and for our own health and survival.
This hour-long talk by Mr Ashish Kothari, starting twenty minutes into the YouTube video, gives a worthwhile overview of some diverse and successful community initiatives from a Buddhist perspective: https://www.youtube.com/watch?v=0EEYSAwtBXc
Dr Diana Warner
Dr Warner is a retired GP living in Bristol, UK, and present environmental protector
We were absolutely horrified to read the blatantly political editorial entitled "Violence in Palestine demands immediate resolution of its settler colonial root causes" in the BMJ Global Health, which according to its website is an "online journal from BMJ dedicated to publishing high-quality peer-reviewed content". The article lacks any scientific value.
The editorial completely ignores the events of October 7, when Hamas terrorists raped, burnt, mutilated, tortured and killed entire families and took women, children and the elderly hostage. In addition, it is full of distortions and obfuscations.
The article refers to alleged "implementation of eliminatory settler colonial strategies by the Israeli occupation that aims to increase morbidity and mortality ". Besides the fact that Gaza has not been occupied by Israel since 2007, and putting aside for a moment the thousands of patients from Gaza (including Hamas terrorists!) that have been treated in Israeli hospitals, and Gazan physicians trained in Israeli hospitals, on the most objective level, the population in Gaza City has grown from 117423 in 1967 to 778187 in 2023. If Israel is trying to increase morbidity and mortality, she is doing a very poor job of it.
Despite this, no one would deny the intolerable living conditions of Gaza residents. Indeed, since Hamas's takeover of the Gaza Strip, they have done everyt...
We were absolutely horrified to read the blatantly political editorial entitled "Violence in Palestine demands immediate resolution of its settler colonial root causes" in the BMJ Global Health, which according to its website is an "online journal from BMJ dedicated to publishing high-quality peer-reviewed content". The article lacks any scientific value.
The editorial completely ignores the events of October 7, when Hamas terrorists raped, burnt, mutilated, tortured and killed entire families and took women, children and the elderly hostage. In addition, it is full of distortions and obfuscations.
The article refers to alleged "implementation of eliminatory settler colonial strategies by the Israeli occupation that aims to increase morbidity and mortality ". Besides the fact that Gaza has not been occupied by Israel since 2007, and putting aside for a moment the thousands of patients from Gaza (including Hamas terrorists!) that have been treated in Israeli hospitals, and Gazan physicians trained in Israeli hospitals, on the most objective level, the population in Gaza City has grown from 117423 in 1967 to 778187 in 2023. If Israel is trying to increase morbidity and mortality, she is doing a very poor job of it.
Despite this, no one would deny the intolerable living conditions of Gaza residents. Indeed, since Hamas's takeover of the Gaza Strip, they have done everything possible, including diverting humanitarian aid for terrorist purposes, to ensure these conditions persist. Recently the terrorists even stole 24,000 litres of fuel meant for Gazan hospitals and schools (https://unwatch.org/unrwa-reports-hamas-stole-humanitarian-aid-hillel-ne...). Israel provides the Gaza Strip water, food, and electricity from its own supplies during times of peace and allows the transport of basic humanitarian aid even during times of war and even now, when its own children, women, frail and sick elderly people are being held hostage there. These shipments are ongoing as I pen this response. The process can be observed in real time on international TV.
We do agree with the authors' call to identify root causes. But the root cause is not the lack of opportunity for Palestinian national determination. It is rather the total and nefarious intolerance of Jewish presence, let alone sovereignty, on even the most minimal swath of land in any part of land that was partitioned by the UN for Palestinian and Jewish national self-determination. This part of land now constitutes sovereign Israel, West Bank and Gaza, with Jews and Arabs in different population proportions in each subregion. The evidence for this is overwhelming in at least five historic missed opportunities all coupled with deadly violent consequences, initially by surrounding Arab nations and subsequently by Palestinian national movements and their supporting terrorist non-Palestinian allies (Hezbollah, Iran, others) in various guises.
It is sad when health professionals weaponize data to try make an invidious political (not health-related) point. And worse when their claims are so untrue.
Zion Hagay MD, President, Israeli Medical Association, Dean of the Faculty of Health Professions, Peres Academic Center
A. Mark Clarfield MD FRCPC
Emeritus Professor of Geriatrics
Chair, National Council on Ageing, Ministry of Health
Rivka Carmi MD, Former president, Ben Gurion University, President of the Israeli National Academy of Science in Medicine
Karl Skorecki MD FRCP(C) FASN
Professor Emeritus and former Dean, Azrieli Faculty of Medicine, Bar-Ilan University, Consultant in Nephrology and Population Genetics, Clinical Research Institute at Rambam Health Care Campus
Malke Borow JD, Director of the Division of Law and Policy, Israeli Medical Association
We would like to thank Professor Holst for taking the time to read and respond to our article. Indeed, in developing the piece, we read with great interest Professor Holst’s 2020 article on emergence, hegemonic trends and biomedical reductionism in global health. We acknowledge that global health is a broad and complex field, and ongoing discourse around terminology is welcome and encouraged.
As Professor Holst himself states, “the predominant Global Health concept reflects the inherited hegemony of the Global North”.(1) With this is mind, we sought in our paper to articulate a practical interpretation of global health that emphasises the critical barriers to universal health coverage and optimal health outcomes. The challenges of access, resource and context limitation are global in nature, and do not relate exclusively to the provision of “humanitarian aid”. We agree with Professor Holst that addressing these issues requires trans-national solutions and multi-sectoral engagement.
In articulating the ARC-H principle, we acknowledge that we have applied a “clinical-biomedical” frame. This reflects our work as emergency physicians who have borne witness to the direct and indirect consequences of access-, resource- and context-limited healthcare. Our interpretation is pragmatic, and deliberately serves to emphasise the expertise and lived experience of ARC-H populations.
In no way do we seek to minimise the social, environmental, political and commer...
Show MoreIn a February correspondence to BMJ, Greenland et al opined that an end to violence in Palestine “can only occur when Hamas ends its war to destroy the state of Israel...”.[1] The Israeli offensive, the authors argued, is legitimised by the support of “the governments of the UK, the USA, Germany, France, Italy and other sovereign states”[1] and purported “evidence” contained within predominantly North American news outlets including the New York Times, CNN, and the Washington Post.
What the article glaringly omits are the evidence-based analyses and unified first-hand accounts of global health, humanitarian, and human rights organisations operating in Gaza – organisations borne in direct response to war atrocities and mandated to alleviate suffering, protect rights, uphold international law, and maintain neutrality, peace, security, and diplomacy. How far we have fallen if the experiences of such organisations are no longer considered valid and worthy of reference, but violence and oppression are legitimised through citing unreliable sources at best, and biased standpoints of political and vested interest at worst. Disappointingly, such citations undermine the high ethical standards of journals like the BMJ. In the interests of respecting evidence and facts, we highlight experiences from global bodies to refute Greenland et al’s baseless claims.
First, the authors dispute the occupation of Gaza itself, claiming – using a misquoted Wikipedia reference[2] – “t...
Show MoreThe authors are to be commended on an important article which makes a compelling point.
Out of interest, where authors are appropriately credited as joint first and joint last, should their names then be listed alphabetically? In the example of this paper, this would place authors based in more resource-poor countries as the first and last listed authors, and would also seem the more rational ordering if authorship is jointly shared. There is some evidence that the ordering of 'joint first' authors does involve some implicit biasing in terms of gender balance - might this not also be an issue in work published as part of an global partnership? Attributing authorship can be genuinely difficult, but where equivalence is recognised it then seems concerning that the chosen (but not explained) order still places the high-income authors in the traditional positions of distinction.
Recently, in BMJ Global Health, Nasir Jafar and colleagues made another attempt to redefine 'global health'. They aim for 'greater clarity and precision' in a pragmatic and more inclusive sense, with the noble objective '‘to offload colonial vestiges present within the field and terminology of ‘global health’.‘ While this goal is undoubtedly right, important and overdue, the argument is alarmingly unconvincing and narrow. In their attempt to redefine, or rather reinterpret, global health, the authors make two important restrictions. Their proposal is based on an understanding of global health that is limited not only to a single country, but also to the field of humanitarian aid. Health emergencies and relief are only part of global health, so reducing the latter to humanitarian aid is absolutely unacceptable. It blatantly neglects both the meaning of "global" as "universal" and the complexity of global health as an explicitly political concept.
The second, unacceptable limitation is the authors' narrowing of global health to healthcare and healthcare systems. It may be that a clinical-biomedical understanding dominates the theory and practice of global health, but the call for an a posteriori recognition of pragmatic development should not distract from the fact that global health is much more complex, encompassing the social, environmental, political and commercial determination of health, as well as inequalities...
Show MoreA recently published article addresses the worrysome connections existing between the progressively increasing Arctic Sea ice melting and the chronic starvation experienced by polar bears (Ursus maritimus) (1). Indeed, the progressively declining Arctic Sea ice thickness represents a leading cause of the profound ecological, behavioural, feeding and dietary pattern modifications reported with an increased frequency in this highly threatened apex predator (1).
Show MoreWithin such an alarming context, the animals' chronic stress deriving from prolonged starvation is an additional matter of concern. Indeed, besides being a powerful and efficient machinery allowing us and all the other living organisms to cope with a huge number of environmental stressors, chronic stress responses are invariably characterized by immunosuppression, originating from enhanced cortisol production (2). Therefore, while increased cortisol levels should be reasonably expected to occur in the blood of polar bears experiencing chronic starvation (1), it should be emphasized they may also become, at the same time, much more susceptible to microbial pathogens impacting their health and conservation status.
This could be especially true for Toxoplasma gondii, a cosmopolitan and zoonotic protozoan parasite infecting humans and a large number of terrestrial and aquatic mammal species, including polar bears. In this respect, anti-T. gondii antibodies were previously reported in almost half of the p...
I would like to register my strong support for this viewpoint. I am part of a large group of >200 physicians, researchers, and academics who endorsed and contributed to this article. Unfortunately, as part of a highly disappointing series of editorial decisions, BMJ Global did not allow the authors to publish our names and information as a supplement to this article (which was the original plan). I therefore would like to register a rapid response documenting that I was one of the extremely large group of academics who endorsed this article.
An excellent comprehensive, thoughtful review. Until such time as Israel-- a Jewish homeland and liberal democracy-- is accepted as a reality there can be no peace. To paraphrase Golda Meir, ",,,,,,, if the Arab world put down their weapons, there would be peace.,,,,,,, if Israel put down their weapons there would be no Israel".
Both this commentary and the previous one by Smith et al are both misleading and political attacks on the right for Israel to exist as a free and democratic nation. The Palestinian people of Gaza have been victims of Hamas since they took over in 2005/2006. To dismiss the horrendous terrorist attack of Oct 7 where children and women mutilated and raped, which was actually documented by the terrorists themselves is abhorrent and totally irresponsible of BMJ Global health. In fact prior to Oct 7, thousands of Palestinian Gazans were getting health care in Israel, including family members of Gaza leadership. Thousands of Gazans were crossing the border daily to work in Israeli Farms/Kibbutzim who paid them, fed them and at times housed them, only for them to map out each farm and houses to provide to the terrorists so they know how to attack them. In addition, many of those who worked in those farms/kibbutzim participated in the attacks. Finally, Gaza built an underground network/city under the hospitals and schools to plana and stage their attack on Israel, knowing using the Palestinian/Gazan residents as human shields to they can get sympathy from the world. In addition the communities that were attacked in the Negev, that were formed in the 1920s, were predominantly Jewish, with very few Muslims or "Palestinians" living there. Israel has every right to defend itself against this barbaric attack, as would any country. Health justice and publication of thi...
Show MoreI am Jewish. My father escaped Nazi Germany in Spring 1939, age 17. He left his mother behind, and she was later gassed in Meinz. This was my unspoken and unspeakable heritage.
I commend the brave article by Layth Hanbali, Edwin Kwong, Amy Neilson, James Smith, Sali Hafez, and Rasha Khoury, who tell the truth as it is. With them, and with billions around the world, I call on the Israeli government to end the genocide they are committing in Palestine and to bring about an immediate ceasefire. I call on Israel’s allies to act as true allies and let go of vested interest, stop trading arms, and instead engage with Israel to forge a true and just peace.
We humans have, individually and collectively, suffered severe traumas at each other’s hands. Not only the traumas caused by genocide or war, but also trauma caused by the hunger, displacement, exploitation that go hand in hand with colonisation, extreme inequity, ecological destruction, and with excessive pollution, including carbon pollution. Many humans who are in positions of power may suffer their own legacy of trauma. For example, there is a tradition in the UK to send children as young as eight to boarding school, which is known to leave children scarred and adults with reduced empathy who struggle to engage in and maintain loving relationships.
Many humans have suffered traumas directly. Others, like myself, have grown up with inherited traumas. We are all interconnected and we are all affected. Our...
Show MoreOctober 24, 2023
To the Editor:
We were absolutely horrified to read the blatantly political editorial entitled "Violence in Palestine demands immediate resolution of its settler colonial root causes" in the BMJ Global Health, which according to its website is an "online journal from BMJ dedicated to publishing high-quality peer-reviewed content". The article lacks any scientific value.
The editorial completely ignores the events of October 7, when Hamas terrorists raped, burnt, mutilated, tortured and killed entire families and took women, children and the elderly hostage. In addition, it is full of distortions and obfuscations.
The article refers to alleged "implementation of eliminatory settler colonial strategies by the Israeli occupation that aims to increase morbidity and mortality ". Besides the fact that Gaza has not been occupied by Israel since 2007, and putting aside for a moment the thousands of patients from Gaza (including Hamas terrorists!) that have been treated in Israeli hospitals, and Gazan physicians trained in Israeli hospitals, on the most objective level, the population in Gaza City has grown from 117423 in 1967 to 778187 in 2023. If Israel is trying to increase morbidity and mortality, she is doing a very poor job of it.
Despite this, no one would deny the intolerable living conditions of Gaza residents. Indeed, since Hamas's takeover of the Gaza Strip, they have done everyt...
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