What’s Unsaid | Is the politicisation of health workers getting worse?

Ali Latifi:

Today on What's Unsaid: Is the politicisation of humanitarian health workers getting worse? 

 

Reprehensible. 

 

That's the word Canada's Prime Minister Justin Trudeau used in his first statement about a protest held outside Toronto’s Mount Sinai Hospital in support of Palestine earlier this month. He continued by saying hospitals are places for treatment and care, not protests and intimidation. 

 

But people were quick to call out the hypocrisy of the Prime Minister of Canada – a longtime ally of Israel – using the neutrality of health facilities to condemn the demonstrations at home, while also continuing to support Israel’s devastating military efforts in Gaza.

 

So, how did we get to this point, where even healthcare has become a political flashpoint in some of today's most protracted conflicts. 

 

Medical missions are a lifeline to stressed health systems. Our guest today has volunteered more than 50 times in the last 13 years, including returning to extreme situations in his homeland, Syria. 

 

Dr. Zaher Sahloul: 

As physicians, as humanitarians, you believe in pure medical neutrality, where you want to provide aid to everyone, equally, based on the needs, regardless of the situation. And sometimes you have to deal with de facto local authorities, even if you don't like them. But unfortunately, every side try to politicise this situation.

 

Latifi:

This is What's Unsaid, a biweekly podcast by The New Humanitarian where we explore open secrets and uncomfortable conversations around the world's conflicts and disasters. My name is Ali Latifi, staff editor at The New Humanitarian. 

 

In today's episode: Is the politicisation of humanitarian health workers getting worse? 

 

Dr. Zaher Sahloul is a pulmonary and critical care specialist in Chicago. He's also the president and co-founder of MedGlobal, which organises medical missions to crisis and disaster-hit zones. He returned from his third mission to Gaza in January.

 

Dr. Sahloul, thank you for joining us.

 

Dr. Sahloul: 

Thank you for having me, Ali.

 

Latifi:

So, to start out, I want to ask you about your last trip to Gaza in January, where you went on a medical mission to volunteer in Nasser and Al Aqsa hospitals, as well as MedGlobal's permanent clinic in Rafah. What was that experience like?

 

Dr. Sahloul: 

It's heartbreaking. I'm still processing the mission. I've been in Gaza multiple times before this war, and also in other disaster areas in Syria, in Yemen, in Bangladesh after the Rohingya genocide, in Ukraine multiple times. What's happening in Gaza right now is the worst humanitarian crisis that the world is witnessing. You have a large number of people – 2.2 million people – trapped in an ever-shrinking area. The fighting is very close to everyone. So, you have a large number of innocent people who are being killed unnecessarily, including a large number of children. One out of 100 children in Gaza has been killed. This is a huge number. That's the equivalent of half a million American children being killed in a matter of three months. Healthcare infrastructure has been destroyed. Seventy-five per cent of hospitals are not operating. The remaining hospitals are under a lot of stress, because of the limited resources, because of the siege, because of the large influx of injured patients.

Frankly, it brings bad memories and nightmares actually, from what happened in my homeland in Syria. Syria was my first encounter with attacks on healthcare in my career. I mean, that's how I started to pay attention. 

 

Latifi:

Now that you've experienced both, do you see a noticeable difference in how the Assad regime, or its Russian and Irani allies, attacking hospitals is covered, compared to what Israel is doing in Gaza?

 

Dr. Sahloul:

I think we have more coverage right now and more awareness because of what happened in Syria. That led to awareness among the public and the media about undermining medical neutrality. This is the essence of protection of healthcare in conflict; that doctors and nurses are supposed to treat the victims of wars – including fighters by the way – and they should be protected and not targeted. The same thing for hospitals and ambulances and clinics. But the main reason that we're seeing what we are seeing right now in Gaza, even though we've witnessed it in Syria and Yemen and Ukraine, is the lack of accountability. 

 

Latifi:

Do you think it's talked about with the same fervour and criticism as it would have been had it been the Assad regime doing this?

 

Dr. Sahloul:

No, the short answer is no. 

 

Latifi:

You've worked in so many different environments across the Middle East and also in Ukraine. In your experiences, did you feel like your work, and the work of your colleagues, was politicised by any side, any party to the conflict?

 

Dr. Sahloul:

I mean, definitely. Politics and humanitarian aid, and providing aid in conflicts, and attacks on healthcare are intertwined, unfortunately. So, if you talk, for example, about – and I'm going to talk about the Syrian context – about attacks on healthcare, and you say that this is not right, hospitals should not be bombed, then the Russian side and Syrian side will say ‘Okay, we are bombing terrorists. There is no credibility to your report. You are supporting terrorists.’ So, they undermine your message, and they politicise it, because you are basically telling the world that, you know, this side is attacking healthcare, and it should not. And the same thing, when the West and the United States, of course, try to use these attacks on healthcare by the other side – by Russia and Iran – to score a point against them. And the same thing now we're seeing in the Israeli-Palestinian context in Gaza. Every side is trying to pull the rug to their side, as we say in Arabic, to score points against the other side.

 

Latifi:

As an outsider to all of this, as someone who isn't necessarily involved in the humanitarian field directly, to me it feels like the politicisation of health work is getting worse. As a practitioner of it who has been on the ground in so many different contexts, do you think that this is true?

 

Dr. Sahloul:

I mean, I can say that there's no decrease in attacks on healthcare, despite the awareness, despite the United Nations Security Council resolution to protect healthcare, despite all of this infrastructure in the NGOs to report attacks on healthcare, and the media attention. And maybe the reason behind that is that there's no accountability. There is only basically shaming of the side. I mean, this is what's happening right now. The WHO reports that there are 1,000 plus attacks on healthcare in Ukraine. Okay. And then what happens next? There are many reports about the attacks on healthcare by Physicians for Human Rights, for example, on Syria, detailing every attack. I mean, you have all the evidence, but there was no accountability. There's no effort to make or hold the Assad regime, or the Russian side accountable. And that led now to what we are seeing, in my view, in Gaza. 

 

Latifi:

How would you compare your experience in Ukraine to Syria and Gaza? Was there a major difference?

 

Dr. Sahloul:

Ukraine is a unique situation. It's similar to any other war zone. But at the same time, Ukraine has been an ally of the United States - of the West - so a large amount of medical aid was directed towards Ukraine. And the same thing when it comes to humanitarian aid – it flooded Ukraine. Right now, of course, there's issues in the [United States] Congress in passing aid to Ukraine, but billions of dollars were directed to Ukraine early in the conflict. And that's not the case in Syria. The international system is not morally consistent.

 

Latifi:

You just said the international system is not morally consistent. Would you go so far as to say the way medical staff and humanitarians in places like Gaza and Syria are treated would have elements of, or be forms of, racism and Islamophobia? 

 

Dr. Sahloul:

I mean, I think there's elements of, still, colonisation, where we look at the Global South and countries like Syria, and Gaza, and Yemen, and Sudan, differently than we look at European countries. Part of it’s racism. Part of it is Islamophobia. Part of it is ignorance of the culture,

and the heritage, and the history. Part of it is that our interest in these regions are different than our interest in Europe. I mean, there's all talk about decolonisation of aid, and I think that is the proper way to address this issue, but it's not happening quickly. That should be our priority. It is not the case. It is not the case and I cannot explain it.

 

Latifi:

You and I, we’re both hyphenated Americans – I'm Afghan American, you're Syrian American. And we've seen that the US government and its allies have also targeted medical workers for whatever their agenda is. For example, in 2015, in Afghanistan, the US military fired more than 200 shells on an MSF hospital in the northern province of Kunduz. Do you think that these attacks are viewed in the same way as the attacks carried out by the Assad government or the junta in Myanmar?

 

Dr. Sahloul:

That was a major attack. And, as you know, MSF had a press conference. They had a media campaign on this issue, which led to an investigation by the Pentagon on this attack, and there was a report on this issue, and there was some accountability, although it's not maybe the perfect situation. Well, the fact that MSF was overseeing that hospital made it more likely that the media, and the public, and policymakers, paid more attention, in my view. If it is a local Afghani organisation that is running the hospital, it would not have gathered that attention, in my views. And we're seeing right now that happening in Gaza. We've seen it also in Syria, that if you have a local organisation that does not have the infrastructure and the strength, like MSF, which is a Western-based NGO doing good work all over the world. But because they are MSF, they are treated differently when they report about attacks on healthcare than other local organisations from the Global South. 

 

Latifi:

You brought up that press conference that MSF had in Kabul. I was there for that, and I was shocked to see, as you said, the coordinates of the hospital on a giant banner and them being very open and vocal for years about this attack. But do you think that that was an anomaly? Or do you think that aid organisations now feel more empowered to stand up to physical and political attacks by the powerful, especially because so many of these countries can be their donors?

 

Dr. Sahloul: 

Challenging government and being very vocal on medical neutrality issues is part of the DNA of MSF since its inception in the early ‘70s. And it persisted, and it's a model for organisations like ours, stressing on these issues. Some other organisations, as you mentioned Ali, that are dependent on aid or they won't have access to other countries, they are very timid when it comes to this situation. And we see that all the time. So, if you'd like to have access to Russia, then you're not going to be criticising Russia if you're an international NGO. If you are dependent on the funds from USAID, you're not going to be criticising the US government. And that's the reality. 

 

Latifi:

Do you think that's part of why smaller local organisations, either A, aren't taken as seriously, or B, might feel more afraid to speak out because they are dependent on say, USAID or DFID or whatever, for assistance?

 

Dr. Sahloul: 

Yes, I think there are power dynamics issues here. I mean, the whole essence of decolonisation is to remove these barriers so people have a voice in the Global South, similar to the voice in the North, and this is not the situation. If you are a local NGO, in Palestine, or in Afghanistan, or Pakistan, that receives funding from certain countries in the West, then you will be less vocal against that country or that aid. Decolonisation by itself is a very noble concept, but it's very complicated to apply in practice. And as long as we have these power dynamics where the West or the Global North is paying for the aid to the Global South, these situations will continue.

 

Latifi:

You've testified to the US Congress and the UN Security Council multiple times on defending medical neutrality.

 

Dr. Sahloul:

I am echoing the pleas of my medical colleagues inside the city who are working day and night in the few remaining hospitals to save lives and heal victims of aerial bombings. They are risking their lives every minute to save lives. They deserve your support.

 

Latifi:

Do you feel that your testimony makes a difference?

 

Dr. Sahloul:

Maybe I'm very cynical after what I've witnessed in Syria. And I'm sorry to say that, but the Syrian crisis, and right now what we're witnessing in Gaza, is something that if you live through it, and you understand what happened, because I was in the field in Syria, more than 25 times – witnessed attacks on hospitals, lived in hospitals that were attacked, trained physicians on preparedness for chemical weapons, interacted with members of the [United States] Congress, testified in the [United Nations] Security Council, met with policymakers in all sides – it did not change the situation. The situation in Syria is even worse right now. That made me cynical of the international system that tends to apply a band-aid on crises like this without trying to end it. ‘Give some money to here, some money to there. Let's do this. Let's do that.’ – but we don't address the root causes of these conflicts. 

 

Latifi:

Given your cynicism, if you're asked to testify, either to the [U.S.] Congress or the UN Security Council, about this situation in Gaza, would you do it? And how do you think people would react to what you say? Because again, given the political dynamics, given that so much of the West is allied with Israel, do you think that the reception of what you have to say would be different compared to what you would say about the Assad government?

 

Dr. Sahloul:

I will do it. I recently met with several members of the [U.S.] Senate who are trying to improve aid to Gaza, and I believe that they are sincerely trying to do that, and navigate within the complex system of foreign policy in the United States. These things are not easy to navigate, especially in conflicts like this. And I think it's our duty as humanitarians who understand the context, who understand what's going on in the field, and who's who and why this is happening, to share these insights, with pictures, with stories, with videos, with policymakers, and then let them decide about these issues. And also, it’s for the record. And also because I will feel much better if I share these testimonies with policymakers and the media than just keep it inside me.

 

Latifi:

In general, what kind of effects does working in situations like these crises have on the mental health of health workers themselves?

 

Dr. Sahloul:

They are human. We have an epidemic of burnout in the United States, which got worse during the COVID pandemic. Fifty per cent of critical care specialists – this is my specialty – have burnout, because of the severity of illness that they are encountering, the high demand on them in the United States, in the West, where you have abundance of supplies and resources. So, imagine yourself a physician in Gaza right now, who is displaced yourself with your family, who probably lost several members of your family because of bombing, who ended up in a tent – and I've seen many of them living in a tent – and you don't have salary for the past four months because of the war, and then you have to go to the hospital to treat patients with very limited supplies, knowing that you won't have access to MRI or CT scans or even simple medications like morphine to treat the pain of your patients, and you're dealing with a large influx of injured patients because of the mass casualties event that is happening near your hospital, and your hospital is a threat to be targeted, and you've seen how they were detained and humiliated. These are huge, stressful events that are happening every minute in Gaza, and people sometimes feel that they are left alone and that we're not paying attention to them. 

 

Latifi:

For a final question, this podcast is obviously called What's Unsaid? So, I want to ask you: What do you think is not being spoken about around this issue of the politicisation of health work in conflict zones and in areas of need that you would want our audience to continue to think about? 

 

Dr. Sahloul:

I mean, that's really a tough question. I think what is not spoken about is the voice of the local communities that are impacted in crises like this…

 

Latifi:

In that they aren't given a voice? 

 

Dr. Sahloul:

Especially in the Global South, especially when the access to areas are very restricted, like what's happening in Gaza, or Syria, or Sudan. You rarely hear voices from local doctors and victims of the war, because we don't provide equal time of coverage to people who are victims of these disasters in Gaza, in Syria, in Yemen, in Sudan. So that's why when I go to Gaza and talk about this child, his name is Mohamad, he's 12 years old, he is from Bani Suhaila in eastern Khan Younis – Khan Younis is a city in southern Gaza – and he was displaced with his family to an area around Nasser Hospital, which I worked in, and the area was bombed, and 32 patients flooded the emergency room where I was working. He had a brain injury, and we had to tube him, put him on life support, and the next day he died. And we could not communicate with his family because there was no communication. And he was sent to the morgue, and he's one out of those 11,500 children. This will make any person pay attention to what's going on in Gaza. So, this is not Hamas. This is not IDF. This is a child that was killed. And he's innocent. 

 

Latifi: 

Dr. Sahloul, thank you so much for being with us. 

 

Dr. Sahloul:

Thank you, Ali.

 

Latifi: 

Dr. Zaher Sahloul is the President and co-founder of MedGlobal, a medical NGO that provides healthcare in crisis and disaster areas. He is also a pulmonary and critical care specialist in Chicago.

 

Please visit TheNewHumanitarian.org for ongoing reporting on humanitarian and medical workers in crisis zones around the world. 

 

Let us know: What are people afraid to talk about in today’s crises? What needs to be discussed openly but isn’t? Send us an email at [email protected]. 

 

Subscribe to The New Humanitarian on your podcast app for more episodes of What’s Unsaid – our new podcast about open secrets and uncomfortable truths, hosted by Obi Anyadike, and me. 

 

This episode is produced and edited by Freddie Boswell, sound engineering by Mark Nieto, with original music by Whitney Patterson, and hosted by me, Ali Latifi.