An open letter dated October 2, 2024 to President Joe Biden and Vice President Kamala Harris, written and signed by 99 American physicians, surgeons, nurse practitioners, nurses and midwives, calls on the White House to bring the genocidal attack on Gaza and the Palestinians to an immediate end. All of the signatories are volunteers to the Gaza strip who have spent a combined total of 254 weeks at Gaza’s hospitals and clinics since October 7, 2023.

They demand of Biden and Harris:

A ceasefire must be imposed on the warring parties by withholding military support for Israel and supporting an international arms embargo on Israel and all Palestinian armed groups. We believe our government is obligated to do this, both under American law and International Humanitarian Law.

The personal accounts set forth in the letter are harrowing, to say the least.

Dr. Feroze Sidhwa, a trauma and critical care surgeon, Veterans Affairs general surgeon, and organizer of the letter, writes:

I’ve never seen such horrific injuries, on such a massive scale, with so few resources. Our bombs are cutting down women and children by the thousands. Their mutilated bodies are a monument to cruelty.

The letter states that essentially every person in Gaza has been physically affected by the genocide, having become sickened or injured or both. The impact on children under five has been particularly devastating.

They write:

Virtually every child under the age of five whom we encountered, both inside and outside of the hospital, had both a cough and watery diarrhea. We found cases of jaundice (indicating hepatitis A infection under such conditions) in nearly every room of the hospitals in which we served, and in many of our healthcare colleagues in Gaza. An astonishingly high percentage of our surgical incisions became infected from the combination of malnutrition, impossible operating conditions, lack of basic sanitation supplies such as soap, and lack of surgical supplies and medications, including antibiotics.

Clearly, the purpose of their letter is to provide an accurate, first-hand account of a genocide that history has rarely encountered in the modern era.

As they explain:

We are among the only neutral observers who have been permitted to enter the Gaza Strip since October 7. Given our broad expertise and direct experience of working throughout Gaza we are uniquely positioned to comment on several matters of importance to our government as it decides whether to continue supporting Israel’s attack on, and siege of, the Gaza Strip. Specifically, we believe we are well positioned to comment on the massive human toll from Israel’s attack on Gaza, especially the toll it has taken on women and children.

The malnutrition is causing high rates of miscarriages, infants born underweight, and mothers unable to breast feed due to severe calorie restrictions. Lack of potable water means infant formulas are being mixed with “poisonous water.” Many of these infants inevitably perish, their condition made worse by the host of infectious diseases running roughshod through makeshift encampments.

With respect to trauma and children, Dr. Mark Perlmutter, an orthopedic surgeon, remarks, “Gaza was the first time I held a baby’s brains in my hand. The first of many.”

The letter continues:

[Every] one of us who worked in an emergency, intensive care, or surgical setting treated pre-teen children who were shot in the head or chest on a regular or even a daily basis. It is impossible that such widespread shooting of young children throughout Gaza, sustained over the course of an entire year, is accidental or unknown to the highest Israeli civilian and military authorities.

Meanwhile, women were having to endure vaginal deliveries and C-sections without anesthesia, or even pain medication such as Tylenol. Even medicines like insulin are unavailable to diabetics. Without antibiotics, electricity, clean water and food, disease and infection are inevitable. The deliberate targeting of healthcare workers and hospitals is noted by these healthcare workers in first-hand accounts and condemned as quite egregious.

They write:

Israel has destroyed more than half of Gaza’s healthcare resources and has killed nearly one thousand Palestinian healthcare workers, more than one out of every 20 healthcare workers in Gaza. At the same time healthcare needs have increased massively from the lethal combination of military violence, malnutrition, disease, and displacement.

They add:

As we met our healthcare colleagues in Gaza it was clear that they were malnourished, and both physically and mentally devastated. We quickly learned that our Palestinian healthcare colleagues were among the most traumatized people in Gaza, and perhaps in the entire world. Like virtually all people in Gaza they had lost family members and their homes. Most lived in and around their hospitals with their surviving family in unimaginable conditions. Although they continued working a grueling schedule, they had not been paid since October 7. All were acutely aware that their work as healthcare providers had marked them as targets for Israel. This makes a mockery of the protected status hospitals and healthcare providers are granted under the oldest and most widely accepted provisions of International Humanitarian Law.

The appendix to their letter provides further evidentiary documentation of the brazen and criminal endeavor of Israel, and, by extension, the US and the EU, to eradicate all trace of Palestinians through a policy of large-scale violence with deadly weapons and mass starvation as a deliberate war tactic. The document further corroborates the report published last month by UN Special Rapporteur Michael Fakhari on the “deliberate starvation” of Gaza. 

That report stated in no uncertain terms:

Never in post-war history has a population been made to go hungry so quickly and so completely as was the case for the 2.3 million Palestinians living in Gaza. On October 9, 2023, Israel announced its starvation campaign against Gaza. By December, Palestinians in Gaza made up 80 percent of the people in the world experiencing famine or catastrophic hunger.

As the appendix to the open letter notes, such conflicts have a disproportionate toll on civilians, even more than battlefield injuries and deaths. Their health and social services are completely disrupted and they face heightened risk of disease transmission from “indirect” sources. As studies have shown, civilian excess mortality in wars can be 25 times higher than deaths caused by direct violence.

The letter states:

These so-called indirect deaths are driven by respiratory infections, gastrointestinal infections, and maternal and neonatal deaths. The more severe and prolonged the societal disruption the higher these deaths rise. Children under five years of age and adults over 69 years of age experience the greatest increase in mortality, and these effects often persist for two years after the fighting ends.

The authors of the letter cite the Lancet study, noting that by June 19, 2024, conservative estimates had placed the excess death toll at 187,000 fatalities. If one were to update that estimate today, the figure would be more than 208,000 killed, or nearly 10 percent of the enclave’s population.

The current official figure for the death toll in Gaza since last October 7, almost one year ago, given by the Health Ministry in the decimated enclave is 41,689. The mass killing continues. On October 2, 2024, while the war campaign in Lebanon was underway, another 51 Gazans were killed and another 165 injured in five massacres of families.

Almost 100,000 have been injured on the ongoing one-sided conflict, where the inhabitants of the open-air prison are simply targets of their captors’ bullets and bombs. The breakdown of these grim figures finds that 33 percent of the casualties are among children, 18 percent are women, and 7 percent are elderly.

Two-thirds of Gaza’s infrastructure has been razed and untold thousands are buried under the rubble, essentially disappearing from the official fatality figures. In its last estimate, on May 2, the Gaza Health Ministry placed the figure at 10,000 bodies. Certainly, many thousands more have been lost under piles of rubble that once were their homes.

In the letter, the healthcare workers inform the occupants of the White House that

[In] the 100 days from October 7, 2023 to January 14, 2024, Israeli forces killed more than one percent of Gaza’s population according to the Ministry of Health data. A UN ESCWA report noted that “No other armed conflict in the twenty-first century” has had “such a devastating impact on a population in such a short time frame. To find a 100-day period with greater bloodshed, it is necessary to go back to the 1994 genocide against the Tutsi in Rwanda.”

One of the important sections of the letter discusses deaths from malnutrition, which has been a difficult number to pin down and not widely reported by media sources covering the genocide. Using the estimates provided in the Integrated Food Security Phase Classification (IPC) report on Gaza, the authors write, “In total, it is likely that 62,413 people have died of starvation and its compilations in Gaza from October 7, 2023 to September 30, 2024. Most of these will have been young children.” This would mean that deaths from starvation have now outpaced deaths from direct violence.

Lastly, taking account of the estimates of deaths caused by infectious diseases, the authors of the letter project very conservatively that at least 118,908 people have died.

They write:

It is impossible to accurately estimate how many Palestinians in Gaza have died since October 7. As the above evidence makes abundantly clear the number is far, far higher than the 41,495 who are confirmed killed by military violence as of September 25, 2024.

With the known violent deaths, the estimated ten thousand people buried under the rubble and certainly dead, a conservative estimate of 62,413 deaths from malnutrition and disease, and a conservative estimate of 5,000 deaths in patients with chronic diseases, we estimate that the current death toll is at least 118,908, approximately agreeing with the projected estimates cited above. This represents a shocking 5.4 percent of all people in the Gaza Strip. These are the most conservative estimates of the death toll that can be made with the given available data as of September 30, 2024. It is highly likely that the real number of deaths in Gaza from this conflict is far higher than this most conservative estimate. Without an immediate ceasefire the death toll will only continue to mount, especially among young children.

Of the young children killed, 710 have been identified as newborns and 1,400 as toddlers or children under the age of two. In addition, Save the Children estimated that as far back as February more than 17,000 children were unaccompanied and separated from their families. The United Nations Human Rights Office of the High Commissioner released a report on May 6, 2024 stating that mass graves had been unearthed in the Gaza strip at Nasser and Al Shifa hospitals. Over 390 bodies had been discovered, including women and children whose bodies showed signs of torture and summary execution or who had been buried alive.

The open letter states:

No other conflict in living memory has killed an absolute minimum of 1% of the children in any territory in eleven months through violence alone. This is the population adjusted equivalent of 743,700 children being killed in the United States, an atrocity that is simply unfathomable!

In closing their letter, these healthcare workers beseech Biden and Harris to call for an immediate and permanent ceasefire. They write:

We appreciate that you are working on a ceasefire agreement between Israel and Hamas, but you have overlooked an obvious fact: the United States can impose a ceasefire on the warring parties by simply stopping arms shipments to Israel and announcing that we will participate in an international arms embargo on both Israel and all Palestinian armed groups. We stress what many others have repeatedly told you over the past year: American law is perfectly clear on this matter, continuing to arm Israel is illegal.

The independent substantiation of the crimes being committed is critical and the authors should be applauded for their courage in drafting this open letter to the White House.

However, such calls will fall on deaf ears. As the WSWS has stated frankly, American imperialism is using Israel as an attack dog to conduct its foreign affairs through a deal whereby Israel engages in a war of annihilation against its regional neighbors supported by mass logistics transfers from the US military and backed by the US media. In the course of one year, more than 50,000 tons of military equipment has been sent to Israel, at a rate of 150 tons per day. Israel has received 600 shipments of weapons from the US. The Financial Times has boasted of the profits made by corporations financing these efforts.