See here for NGO Monitor’s Preliminary Critique of PHR-I’s “Independent Medical Fact-Finding Mission”

See here for more on Physicians for Human Rights-Israel.


On January 21, 2015, Physicians for Human Rights-Israel (PHR-I) published “Gaza, 2014: Findings of an independent medical fact-finding mission,” alleging Israeli violations of human rights and international legal norms during the 2014 Gaza War. PHR-I also set up a special website to accompany the report.

According to PHR-I’s press release, the report demonstrates “The failure of the warning mechanisms, the absence of escape routes, the collapse of the mechanism for evacuating the wounded, and the strikes against rescue teams increased the number of civilian casualties.”

However, the incomplete account in the actual publication provides absolutely no proof or evidence for these serious charges. To accurately draw such conclusions requires factual knowledge, considerable military expertise, as well as access to comprehensive data from both the Israeli army and from within Gaza, in particular during the fighting.

As detailed below, PHR-I does not possess any of this information, and the NGO is unqualified to issue its conclusions. In addition, the report does not address central issues such as the types of weapons and fighting methods used by both sides, the obstacles of asymmetric warfare, and Hamas’ systematic use of the civilian population of Gaza as human shields. Instead, PHR-I’s research contains fundamental methodological flaws; ignores Hamas violations and other evidence that does not comport with its one-sided, political agenda; and relies on a panel of eight “medical experts” (pg. 8), of which at least five have backgrounds in anti-Israel advocacy. All of this belies PHR-I’s claim that “The information and materials would be handled in a credible, objective and independent manner” (pg. 16).

PHR-I also creates a false impression of scientific and investigative rigor, presenting 200+ pages of emotive testimonies and forensic details. However, the testimonies are largely unverifiable and are irrelevant to the allegations concerning Israel; likewise, the forensics relate to the nature of the patients’ wounds, not to the main claims of Israeli wrongdoing featured in the press release and report.


PHR-I is funded by the European Commission, Sweden (via Diakonia), Germany (via Medico International and EED), the Netherlands, and Switzerland (via HEKS-EPER). In 2008-2013, the New Israel Fund (NIF) authorized grants worth $1,090,553 to PHR-I (2008, 2009, 2010, 2011, 2012, 2013).

According to PHR-I, the following individuals and organizations provided support, “financial and otherwise,” for the report: “Marwan Diab and Rafeeq Musallam, ActiveStills/ Anne Paq, American Association for the Advancement of Science (AAAS), Science and Human Rights Program, British Shalom-Salaam Trust (UK), Christian Aid (UK), Comboni Sisters, HEKS-EPER, (Switzerland), Manos Unidas (Spain), Medact (UK), Medico International (Germany), Dignity Institute (Denmark), Inge Genefke and Bent Sørensen Anti Torture Support Foundation (Denmark), IRCT (Denmark), Open Society Foundations” (pg. 3).

Panel of “independent medical experts”

In order to conduct this study, PHR-I “recruited 8 independent international medical experts, unaffiliated with Israeli or Palestinian parties involved in the conflict” (p.8). However, many of the fact-finding members are political activists with histories of biased anti-Israel remarks. The inclusion of individuals with this background is in violation of legal and ethical fact-finding standards, such as those outlined in the Lund-London guidelines:

  • Alicia VacasPublished a letter in support of Kairos Palestine, a document written by Palestinian-Christian activists that calls for BDS and denies the Jewish historical connection to Israel. In an article she published following her visit to Gaza, she refused to call the conflict a war, but rather a “massacre” and referred to Israel’s “devilishly sophisticated and flourishing industry of death.”
  • Laurel Baldwin-Ragaven – In an article published in The Lancet medical journal (August 30, 2014), Baldwin and others compared Israel to an apartheid state and called “on South Africa to expel the Israeli ambassador during this current conflict.”
  • Jennifer Leaning – Steering Group member of the highly politicized Lancet Palestine Health Alliance. In 2009, she co-authored a piece in The Lancet, showing a photo of a damaged building described as the Al-Quds Hospital in Gaza. In fact, the picture was off an adjacent building. (The article has been removed.)
  • Önder Özkalipci – Coordinator and co-editor of the UN Istanbul Protocol, which alleged that Israel’s actions concerning the Mavi Marmara (2010) constituted torture. Since 2013, he is a freelance consultant to the UN Office of the High Commissioner for Human Rights and PHR-I.
  • Louis Reynolds – “Founding member and chair of People’s Heath Movement, South Africa” (pg. 19). People’s Heath Movement, South Africa participated in an August 2014 protest “calling for a Free Palestine.” On August 15, the international umbrella of People’s Heath Movement published a statement, “strongly condemn[ing] the brutal armed attack by the Israeli occupation military forces on Gaza Strip….these attacks have to be seen in the context of the decades?long occupation and ethnic cleansing of the territory of historic Palestine….We therefore express full solidarity with the Palestinian people, who have resisted an illegal regime of occupation and apartheid for over 60 years. We condemn the war crimes committed by Israeli forces, which must be held accountable for the sake of universal justice.”

PHR-I’s one-sided, political agenda

From the outset, the “principal mandate” of the fact-finding was expressly one-sided and selective – “to investigate the health and human rights impact of events in the Gaza Strip” (pg. 25). As such, PHR-I focused almost entirely on “allegations against Israeli strategy and tactics used in its attack on Gaza” (pg. 15), claiming that it “had no access to evidence regarding the conduct of Palestinian armed combatants within Gaza… beyond what its members were told by interviewees” (pg. 26).

A repeated theme in describing the purpose of the mission was “collecting evidence” and “documentation of evidence” – of Israeli guilt as reflected in the one-sided mandate. In fact, PHR-I “believes that the prima facie evidence it has collected and presented in this Report should be used for the purposes of legal determination of violations of international human rights and humanitarian law, whether through local or international justice mechanisms” (pg. 101). This should be seen in the context of the politicized campaigns surrounding the UN Human Rights Council “investigation” by William Schabas, as well as Palestinian Authority efforts focused on the International Criminal Court.  PHR-I’s advocacy for international prosecutions of Israeli officials is in direct violation of NIF’s policy against “attempts to prosecute Israeli officials in foreign courts as an inherent principle of our dedication to Israeli democracy.”

Further highlighting the political, as opposed to legal and human rights, motivation, PHR-I official Hadas Ziv stated, “The discourse surrounding Gaza is often times limited to the question of whether there were war crimes — but as far as I’m concerned, that’s not the issue. The more important question is why do we take for granted that such things happen every two years. The report’s conclusion, in my opinion, is that you don’t need to fix this or that about the army’s actions, but that we need to prevent the next war” (emphasis added).

Evidence ignored

Reading PHR-I’s press release and summary,  one would not know that Hamas hid its leadership in hospitals; stored weapons in medical buildings, schools, mosques, and private homes; used ambulances to transport combatants and weapons; conducted military operations from within civilian areas, including medical facilities, placing them in extreme danger; and stole humanitarian aid.

A careful reading of the report shows that, in fact, PHR-I had ample evidence of Hamas’ systematic exploitation of medical facilities to illegally shield combatants from Israeli counterattacks. However, this dimension, which does not comport with PHR-I’s political agenda, was not emphasized in the analysis and is missing from the summary, conclusions, and recommendations.

  • During one of the interviews in Shifa Hospital in Gaza, the interviewer recorded, in passing, that “this statement [was made] when a Qassam rocket took off nearby” (pp. 134-137). In other words, PHR-I was aware of, and mission members had personally witnessed, the illegal use of hospitals by Palestinian combatants to shield themselves from counterstrikes.
  • An official from the World Health Organization indicated similar circumstances near another hospital in Gaza: “Al Wafa Hospital was the only rehabilitation hospital in Gaza. In the course of this war, according to Mr. Daher [head of the WHO sub-office in Gaza], he believed there was an actual rocket launching site in the vicinity, but it was more than 200 meters away from the hospital” (pg. 50). (See this video for more evidence of Palestinian combatants fighting from within the facility, having built a tunnel entrance near it, as well as phone calls from the IDF confirming that it had been abandoned before striking it. None of these details appears in the PHR-I report.)
  • PHR-I did not consider alternative explanations for casualties such as misfired Hamas rockets, “work accidents,” secondary explosions, and Hamas summary executions. Additionally, Gaza residents who protested the war were executed, as were at least 26 Palestinians accused of “collaborating” with Israel; a number of Palestinians were killed and wounded by Hamas while waiting for food at a distribution center.
  • PHR-I accuses Israel of using an “indiscriminate device” in residential areas, “the barrel of a Tzefa Shirion, an Israeli mine-clearing system whose barrel is launched from a vehicle ahead of the advancing troops and contains a line (‘python’) of explosives” (pp. 35-36). Israel’s deployment of mine-clearing weapons in Gaza neighborhoods is itself evidence that Hamas had booby-trapped houses and streets, once again exploiting urban areas and turning them into legitimate targets.
  • “During one visit of the first FFM team to Shifa Hospital, they were introduced to a senior Hamas official who was hospitalised alone in a room in a unit that was intended for more patients.” (pg. 57, fn 112)
  • Although PHR-I relied extensively on allegations and supposed evidence provided by Hamas authorities in Gaza, it expressed doubt specifically about Hamas statistics that made the case against Israel less compelling: “It is difficult to estimate the exact number of severely injured among the approximately 11,000 injured survivors of the conflict. According to Dr. Muhammad Al Kashef, General Director of International Cooperation in the Department for the Ministry of Health in Gaza, about 3,000 of the most seriously injured were formally hospitalised and required some form of surgical intervention….The FFM teams were also not able to ascertain whether these numbers, which seem relatively low, were attributable to the limited capacity of the hospitals or to the actual number of severe injuries requiring surgical intervention.” (pg. 32) It is also telling that PHR-I’s skepticism was that the percentage of serious injuries was low, not that the overall number of injuries, provided by Hamas, was high.

Methodological Flaws

There are numerous methodological flaws and inherent limitations concerning the research (see pp 25-26), which cast doubt on PHR-I’s ability to draw accurate and independent conclusions.

Flaws in the “forensic” evidence

PHR-I claims to have included “four [individuals] with special expertise in the fields of forensic medicine and pathology” (pg. 8) on its panel. This was essential for creating a rhetorical façade of scientific rigor and valuable evidence.

However, a careful reading of the report demonstrates that the forensic value of the evidence therein is extremely limited.

In addition to the problems detailed below, it is important to note that PHR-I did not conduct ballistic tests on the weapons fragments and shrapnel discussed in the report (to the extent that any such evidence existed; certainly none was preserved through an acceptable chain of custody). Moreover, “Because of a lack of military expertise, the FFM was not in a position to provide a comprehensive analysis of the types of weapons used by Israeli forces” (pg. 26). It is, therefore, impossible to conclusively attribute the wounds to Israeli strikes, as opposed to deliberate or accidental attacks by Hamas against civilians in Gaza.

There was also a hint within the report of evidence tampering and manipulation – “One other allegation regarding use of flechettes was made at Khuza’a, where the second FFM team were shown flechette darts by Dr. Kamal Qdeih, a local private doctor, in his clinic. However, these were not embedded in walls but lying on the floor” (pg. 55). As noted above, this central issue was not fleshed out or researched further, nor was it reflected in the analysis and conclusions.

Interviews are not forensic evidence

The publication is replete with interviews with “survivors” and “victims” of Israeli attacks, and PHR-I uses them as “evidence” pertaining to questions of international law, including whether the strikes were “indiscriminate” and “disproportionate.”

  • The accounts are entirely subjective, emotive, and anecdotal. Frequently, there are claims to have identified the type of Israeli plane and/or weapon used in an attack, but in a manner that is physically unlikely if not impossible. Nonetheless, PHR-I repeats them.
  • “Most of the interviews were held in Arabic with the assistance of an interpreter if the interviewer was not an Arabic-speaker” (pg. 23). The identity of this interpreter (or interpreters) is not provided; as such, any connections to Hamas or other conflicts of interest cannot be determined.
  • It is unknown how many of the interviewees are members of Hamas or other terror groups, or were intimidated or otherwise approached by Hamas before meeting with PHR-I.
  • In some instances, the interviews were conducted with relatives or acquaintances of the wounded individual, further removed from an objective account of the incident in question.
  • “Fieldworkers of PHR-Israel, Al Mezan, PCHR, GCMHP…accompanied the FFM teams to interviews” (p.20). As noted below, these are highly politicized, anti-Israel groups, and they lack credibility; their effect on the accuracy of the interviews is unknown.

Hamas provided some, if not all, the “evidence”

The overall dependency on information from Hamas undermines the independence of the investigation and any forensic claims made in the report.

  • PHR-I was “granted access to relevant evidence by officials of the [Hamas] Ministry of Health, but encountered difficulties and some lack of transparency regarding the necessary procedures for access to forensic pathology materials, specifically tissue samples and X-rays, which fall under the responsibility of the Ministry of Justice.” (pg. 26)
  • There is ambiguity as to whether the photographs to PHR-I for use in the report were obtained from the “Shifa Hospital Forensics Department photo archive” (pg. 30) or government forensic department (“Gaza’s Forensics Department photo archive,” pg. 225). Regardless, “Authority for access to photographs, X-rays and tissue samples resides with the Ministry of Justice” (pg. 24).
  • All files and photographs pertaining to fatalities were provided by Hamas government officials.
  • It is unknown whether the physicians interviewed in the hospitals were affiliated with and/or intimidated by Hamas.
  • As mentioned above, it is unknown how many of the interviewees are members of Hamas or other terror groups, or were intimidated or otherwise approached by Hamas before meeting with PHR-I.
  • “Regarding tissue samples, a Ministry of Health official at Shifa Hospital…described the collection as haphazard and often unlinked to a particular patient….He showed the first FFM team tissue samples, some of which he said had been collected during the current armed conflict, which he said are kept in formalin (for tissue samples) or in acetone (for other material samples). The team observed that the sample containers with acetone were not sealed properly.” (pg. 24, emphasis added)

Photographs, not autopsies

  • All the claims about fatalities, including cause of death and the nature of the wounds, are based on “medical files” and “photographic materials from the morgue of Gaza’s main hospital, Shifa Hospital, in Gaza City.” Pointedly, “the forensic experts did not perform autopsies.” Nor were autopsies performed at the time of death, “due to religious and traditional customs prohibiting the practice” (pg. 23).
  • The report acknowledged “limitations of evaluating the injuries,” but deemed the photographs “authentic” (pg. 30). The basis for this estimation is not provided.

Repetition of unverifiable allegations

As noted above, PHR-I dismissed Israeli claims concerning the circumstances of civilian casualties and other mitigating factors because the investigators:

  • “did not have access to UNRWA facilities…They could therefore investigate neither the public health impact of displacement in these facilities, nor the allegations made by the Israeli government regarding the abuse of such facilities for military purposes – an allegation used to justify several attacks on such facilities.” (p.26)
  • “also had no access to evidence regarding the conduct of Palestinian armed combatants within Gaza, and the teams were not able to examine official Israeli allegations regarding misuse of civilian or medical facilities for military purposes…” (p.26)

In sharp contrast, unverified and unverifiable accusations by Palestinian representatives are quoted extensively throughout the report. Even when claims could not be verified or members of Hamas were present during the interview, PHR-I repeats inflammatory and provocative allegations despite the absence of any evidence or corroboration. This is a blatant violation of professional fact-finding standards.

“Irregular weapons”

For example, the authors of the report admit that they were unable to verify claims by Palestinian doctors regarding the use of “irregular weapons” and other “phenomena they saw as strange or inexplicable.” Although “none of the tissue samples taken in the possession of the forensic experts of the Ministry of Justice of Gaza were taken out of Gaza for further toxicological, biological or chemical examinations to confirm or refute these allegations” (pp. 53-55), nonetheless, PHR-I repeated the accusations “verbatim as described to the team” (p.54):

  • “A suspicion of the use of Dense Inert Metal Explosives (DIME)” – DIME are an experimental group of tungsten-based munitions, intended for “low collateral” damage blasts. There is unproven speculation that they are “highly carcinogenic and harmful to the environment.” Conspiracy theorists (such as Dr. Mads Gilbert) and other partisan sources have speculated that Israel has used them in Lebanon and Gaza, although it has never been established that Israeli even possesses DIME weaponry or that any military has ever used them. Rather, the speculation about DIME is an attempt to demonize Israel.
  • Allegations that “‘Computer chips’ with Sony markings embedded as shrapnel in people’s bodies.” In addition, “the team was shown remains of explosives with the Motorola logo embossed in them. It is unclear what these remains are and which patients they were associated with, and the team could not ascertain their source.” (pg. 55)
  • Allegations of “the possibility of a gas of unknown type being used,” “a sewage-like smell,” and “smelly smoke.”

Some of these claims border on conspiracy theories. It is shocking that supposed scientific experts would deem them credible enough to be repeated. Furthermore, including permitted weapons such as white phosphorous (which was not deployed), flechettes, and tear gas in a section on “irregular weapons” is a fundamental distortion and appears designed to mislead.

Reliance on anti-Israel political advocacy NGOs

In addition to Hamas officials, Gaza-based political advocacy NGOs played a central role in facilitating “access and meetings.”

  • “Access and meetings were facilitated by PHR-Israel in partnership with local Palestinian non-governmental organisations: Al Mezan, Gaza Community Mental Health Programme (GCMHP), and Palestinian Center for Human Rights (PCHR)” (p.8). These groups are all involved in delegitimization campaigns against Israel, including the lawfare attacks recommended by PHR-I, and lack medical expertise.
  • Reliance on these groups is further evidence of the lack of independence and objectivity of the investigators.
  • PHR-I was forced to rely on the Hamas government forensics department, which “is under the authority of the Ministry of Justice, and has been active in the last three or four wars. Authority for access to photographs, X-rays and tissue samples resides with the Ministry of Justice” (p.24).

Distorted legal claims

Despite drawing legal conclusions and providing interpretations of international law in its publications, PHR-I does not possess expertise in these issues.

One example is PHR-I’s accusation that Israel failed to provide “precautions to protect civilians, including the absence of effective warnings.” PHR-I even cited to the discredited Goldstone Report in an attempt to bolster its allegations that Israel’s warnings were insufficient, if not themselves violations of international law.

The fact that in some cases warnings were not 100% effective does not indicate any violation of law; there is no requirement under international law to provide 100% effective warnings. In fact, under IHL, Israel is only required to give general warnings to the extent they are feasible and only when doing so would not hamper Israel’s chance of success in military operations or compromise the element of surprise. Nevertheless, Israel’s warning procedure far exceeds the legal requirements and is more extensive than that of any other army. In many instances, Hamas directed the civilian population to disregard warnings and even directed people to return to targeted sites as human shields.