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.
|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.
Israeli doctors are complicit in the shoot to kill policies of Israel’s military. The new guidelines are purely for international consumption.
|Israeli soldiers invade hospital demanding records|
Dan Cohen March 23, 2016
Last 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.
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.
“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.
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.
Changing Israeli Protocol on Triage
In 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.
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.
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.
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.
“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.
A Twitter poll 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.
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.”
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.
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.”
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.
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.
But 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.”
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.
“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.
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?”
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.”
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.
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.
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.”
“It 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.”
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.
Rabbis 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.”