In May 2019, the Safeguarding Health in Conflict Coalition (SHCC) published “2018 Impunity Remains: Attacks on Health Care in 23 Countries in Conflict”. Despite including Syria, Iraq, and Afghanistan—where armed conflict has resulted in the deaths1 of tens of thousands of civilians and over one hundred health workers in 2018 alone2—the report paints Israel as the worst offender of attacks against health care in 2018. The report claims that Israeli forces committed 308 attacks against health workers and infrastructure, the highest number of attacks, with Syria second with a reported 257 attacks, and Afghanistan third with 98.

However, closer inspection reveals a publication rife with faulty methodology, as well as reporting and selection bias that can be traced to highly partisan contributors. This is unsurprising, given that SHCC coalition members include NGOs such as including Human Rights Watch (HRW), World Vision, Medecins du Monde (MdM), Medical Aid for Palestinians (MAP), and Physicians for Human Rights-Israel (PHR-I).

Additionally, “Impunity Remains” devotes extensive attention to the 2018 mass riots along the Israel-Gaza border, yet the authors ignore and whitewash the context of Hamas terrorism, repeated assaults on Israeli civilian communities, and attempts to sabotage the border fence and infiltrate into Israel to commit violence.

Faulty Methodology

In addition to SHCC members, the coalition relied extensively upon the World Health Organization’s (WHO) Surveillance System of Attacks on Healthcare (SSA) for data related to the number of attacks. However, the standards for assessing the certainty of an attack, utilized by SSA, are neither sound nor transparent.

In assessing the likelihood that an attack on a healthcare facility or worker took place, SSA relies on four levels of certainty: “rumour, possible, probable, and confirmed.” However, the criteria for assessing these levels of certainly are woefully lacking. For example, in order for an attack to be confirmed, SSA requires only “one eyewitness account by someone from the SSA partner group” or “two eyewitness accounts of the attack as told to an SSA partner.”3 Reflecting a lack of transparency, SSA does not release the names of organizations or individuals who are SSA partners. This also demonstrates that WHO does not have the capability to corroborate reports of alleged attacks and their details. Rather, they rely on third party groups and/or anonymous individuals who have not necessarily been vetted and whose testimonies cannot be independently verified.

In addition to unreliable reporting mechanisms, the report itself acknowledges issues of selection and reporting bias, particularly in regard to SSA data on Israel, the West Bank, and Gaza. Put into perspective, of all 23 countries surveyed, “Israel/oPt” accounted for the highest number of events SSA provided to the SHCC database—196 events, comprising 63% of all SHCC events for Israel, the West Bank, and Gaza. This overreporting of events related to the Arab-Israeli conflict led report authors to acknowledge (in very understated terms) that “SSA, for example, reported hundreds of attacks in the oPt but only a handful in Yemen, which may not be truly representative of the situation on the ground.”

Manipulated Data

SHCC  also manipulate data so as to artificially portray Israel as the worst perpetrator of attacks on health care. For example:

  • In attempting to determine whether the 308 attacks attributed to Israel were either “intentional” or “indiscriminate,” the report acknowledges that data provided was “insufficient to make a determination” in approximately 78% of cases.
  • In Syria and Afghanistan, 107 health workers were intentionally killed (more than half of Syrian casualties by airstrikes), while only three Palestinian health workers were killed and at least one of which was shown to be accidental as the result of a ricocheting bullet (see below).4In contrast, the publication equates injuries from non-lethal (and legal) crowd control measures used by the IDF, primarily tear gas, with deliberate and illegal bombings of medical facilities in Syria, Yemen, Afghanistan, and other conflict zones.  Moreover, the use of tear gas occurred in the midst of violent riots at the Gaza border with thousands of participants where apparently some health care workers were present. No evidence indicates these workers were deliberately targeted. Yet, more than 66% of the injuries attributed to the IDF in the publication and characterized as an “attack” were the result of tear gas inhalation.
  • The NGOs’ methodology of counting attacks instead of casualties creates a distorted picture of the severity of the incidents and the overall situation. As noted by journalist Raf Sanchez in a Twitter exchange with Omar Shakir, HRW “Israel and Palestine Director,” the publication treats an incident “where a healthcare worker was injured (likely by teargas) as 1 attack,” while treating an August 2 Syria incident “where 3 workers were killed as 1 attack.” Sanchez goes on to comment that “with the understanding that 2/3 of OPT medic injuries are teargas inhalation, gives a much better understanding than saying OPT had 308 [attacks] and Syria had 257.”
  • Publication authors also count “denial of access” to health care as an attack on health, noting that Israel “denied exit permits to people in Gaza who were attempting to access health care.” Report authors fail to acknowledge that Israel is in no way obligated to allow Gazans to enter Israel for any purpose, medical or otherwise. Nevertheless, Israel provides thousands of medical permits to Gazans and treats thousands of Gazans in Israeli hospitals annually.5 Furthermore, the report does not detail how many of the 308 cases of “attacks” on health constitute “denial of access.” The report also acknowledges that “denials of access to health care are infrequently reported” and authors therefore only could document “incidents in the CAR, Myanmar, the oPt, and the Philippines.”6
  • Report authors repeat the unfounded claim that a 21-year-old female medical volunteer, Razan Najjar, was intentionally killed by an Israeli sniper. In fact, the extensive New York Times article examining the case, and cited in the report, concludes that Najjar was accidentally killed by shrapnel from a ricocheting bullet.

Partisan Contributors

Safeguarding Health in Conflict relies on a number of politicized NGOs as sources for information, including Human Rights Watch (HRW), World Vision, Medecins du Monde (MdM), Medical Aid for Palestinians (MAP), and Physicians for Human Rights-Israel (PHR-I). These NGOs have long histories of anti-Israel political advocacy and lack the credibility to provide to provide reliable data. For example:

  • Systematic NGO Monitor analyses demonstrate that HRW disproportionately focuses on condemnations of Israel and that publications related to Israel often lack credibility. HRW also promotes an agenda based solely on the Palestinian narrative of victimization and Israeli aggression. HRW also utilizes distorted legal rhetoric to repeatedly accuses Israel of “war crimes,” “[s]erious violations of international human rights and humanitarian law,” “collective punishment,” and fostering a “culture of impunity” all while applying unique standards to Israel as part of its broader delegitimization campaign. Due to the organization’s failures, founder Robert Bernstein published an article in the New York Times (“Rights Watchdog, Lost in the Mideast,” October 19, 2009) strongly criticizing the organization for ignoring severe human rights violations in closed societies, for its anti-Israel bias, and for “issuing reports…that are helping those who wish to turn Israel into a pariah state.”
  • World Vision promotes a highly politicized and biased agenda, placing sole blame for the continuation of the conflict on Israel and paying little attention to legitimate Israeli security concerns or Palestinian terrorism against Israeli civilians. On June 15, 2016, Mohammad El-Halabi, the manager of operations for World Vision in Gaza, was arrested by Israeli authorities after having been revealed as being a Hamas terrorist and is currently standing trial. He was accused of diverting approximately 60% of the World Vision’s Gaza budget to the terrorist organization for tunnels and fund other terrorist activity. The siphoned funds amount to approximately $50 million.
  • MAP is a UK based charity claiming to work “for the health and dignity of Palestinians living under occupation and as refugees.” MAP promotes distorted and false narratives and demonizing rhetoric under the guise of medical expertise and scientific fact. According to NGO Monitor research, MAP’s founder and honorary patron Swee Ang promoted a video made by American white supremacist David Duke, who was expelled from Italy for “allegedly trying to establish a pan-European neo-Nazi group.” The video is described on Duke’s YouTube page as “reveal[ing] how the Zionist Matrix of Power controls Media, Politics and Banking and how each Part of this Tribalist matrix supports and protects each other!” In February 2017, when asked about the antisemitic video at the University College of London Union, Swee Ang responded that she doesn’t “think it’s entirely anti-Jewish.”
    • In March 2019, the Charity Commission for England and Wales warned MAP that it must “take care” in heeding regulatory guidelines, following a complaint that portions of the money raised by the Palestinian organization are being used “towards political propaganda rather than for its stated purpose of providing medical aid.”7
  • In May 2018, during the violence on the Gaza border, MdM published a statement condemning “Israel’s violent response against Palestinian civilians” as the “excessive use of force against Palestinians demonstrating in Gaza is a violation of the right to life, health and freedom of assembly.” The statement ignored the violent nature of the protests, which included Molotov cocktails, arson, and attempts to breach the border fence with Israel.
  • PHR-I repeatedly argues that the sole impediment to Palestinian development is Israeli policy. According to its mission statement, PHR-I “views the ongoing occupation of the Palestinian Territory as a root cause of multiple human rights violations including the right to health and actively advocates for its end.”
    • In May 2018, PHR-I released a statement during the violence on the Gaza border condemning the “reality in which Israeli security forces shoot unarmed demonstrators,” as well as not providing medical care for those injured in the riots, calling these actions an “outrageously cruel act.” Similar to MdM’s statement mentioned above, PHR-I ignores the violent nature of the protests, which included Molotov cocktails, arson, and attempts to breach the border fence with Israel.
    • PHR-I heavily relied on Hamas sources in its 2015 publication “Gaza, 2014: Findings of an independent medical fact-finding mission.” The publication further 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,” of which at least five have backgrounds in anti-Israel advocacy. (For more information. read NGO Monitor’s report, “Physicians for Human Rights-Israel Gaza Mission: No Independence, No Facts, No Evidence“)