Gaza: Our third open letter to the UK Government

On Monday, Médecins Sans Frontières / Doctors Without Borders (MSF) published a new report – Gaza's silent killings – which detailed the devastation of the healthcare system and the increasing physical and mental health risks faced by men, women and children caught in the ongoing conflict.

In our third open letter to the UK Government, Dr Natalie Roberts, Executive Director of MSF UK, has written to Prime Minister Rishi Sunak and Foreign Secretary Lord David Cameron to share the stark findings of the report and urge that the UK does not remain complicit in the brutality by exporting arms to Israel.

Dear Prime Minister and Foreign Secretary,

Yesterday we at Médecins Sans Frontières (MSF) released a report named ‘Gaza’s Silent Killings: The
destruction of the healthcare system and the struggle for survival in Rafah’. It outlines the massive struggle
faced by Palestinians in Gaza to access medical care and warns of large numbers of preventable deaths
which are caused by disruptions to critical healthcare.

Médecins Sans Frontières continues to bear witness to the immeasurable suffering inflicted on the people
of Gaza. Since the horrific mass killings of civilians by Hamas on 7th October, at least 34,000 people have
been killed by Israeli forces in Gaza - 13,800 of whom are children – and an additional 74,000 people have
been injured.

Hospitals across the Gaza Strip, including those supported by MSF, have been destroyed by Israeli
airstrikes and ground forces. Medical staff, including our colleagues, have been arrested and killed.
Essential medical supplies are blocked from entering Gaza by the Israeli authorities. The health system in
Gaza is being annihilated just as the needs are expanding exponentially, with devastating consequences
for the Palestinian people.

The report outlines how, as a result of the Israeli siege of Gaza, acute malnutrition is emerging with alarming
rapidity - the first time we have seen it in our 36-year history of working in the Gaza Strip. From January to
March 2024, MSF teams registered 216 cases of moderate and severe acute malnutrition in two primary
healthcare centres in Rafah alone. Meanwhile, people living with chronic diseases such as diabetes,
hypertension and cancer are left with no place to go for medical care.

People’s access to safe drinking water is also severely limited. Much of the water infrastructure in Gaza has
been damaged or destroyed during the conflict and is no longer usable. In addition, Gaza’s water
infrastructure and distribution system relies heavily on fuel, and the Israeli siege severely limits the supply
of fuel to Gaza. Without fuel, it is impossible to pump water from underground aquifers – the source of 80%
of Gaza’s clean water. It is also impossible to desalinate water, pump it through the main supply network,
or transport bottled water. The people of Gaza are now forced to drink from unsafe sources – increasing
the risk of severe dehydration and communicable disease outbreaks.

Those who fled bombs in the north are now at high risk of death by disease in the south.

A recent study on expected excess mortality in Gaza concluded that a continuation of the current situation
could result in tens of thousands of non-trauma-related excess deaths in the next six months alone. These
deaths would not have occurred in the absence of this conflict.

This crisis is entirely man-made.

Every effort must be made to scale up the humanitarian response. Yet, as the catastrophe unfolds, the
capacity of the humanitarian community to respond at the scale needed has been massively impaired.

UNRWA, the largest UN agency operating in Gaza, is a lifeline for millions of Palestinians in the Gaza Strip,
the West Bank, and the wider region. The agency has a vital role to play to improve access to humanitarian
assistance to the population of Gaza. Yet several nations, including the UK, have halted their funding of
UNWRA. Following the recent findings of an independent review of UNRWA’s neutrality, MSF calls on the
UK to resume its funding of the agency to allow it to continue its delivery of life saving assistance.

As part of the devastating civilian death toll, 200 humanitarian workers have been killed in Gaza, including
five MSF colleagues. These humanitarians were killed while providing care for patients, attempting to deliver
aid, or simply sheltering with their families.

Despite taking every precaution to identify ourselves and demanding the protections afforded us under
international law, we have been attacked by Israeli airstrikes or forces more than 20 times. The latest attack
on World Central Kitchen, which killed three British humanitarians, shows not only the failure of
deconfliction measures; it shows the futility of these measures in a war fought with no rules. We, like other
international humanitarian organisations, continue to work in Gaza, but in doing so we know that we are
asking our staff to accept a frankly unacceptable level of risk.

That these attacks on humanitarian workers are allowed to happen is a political choice – yet Israel faces no
political cost. Instead, the UK is morally and politically complicit in enabling this brutality with impunity, by
continuing to export arms that Israel uses to maim and kill civilians.

The Secretary of State for Defence, Grant Shapps, says that UK defence exports to Israel are ‘relatively
small,’ amounting to £42 million in 2022. This does not absolve the UK government from responsibility.
According to the Campaign Against Arms Trade, UK industry contributions to F-35 combat aircraft are
‘currently being used in the bombardment of Gaza.’

MSF staff see first-hand the devastation caused by these weapons. One MSF surgeon has talked about
dressing the wounds of babies who had lost their legs - babies who never learned to walk and never will.

Despite the challenges, our teams continue to provide surgical care, physiotherapy, maternal healthcare,
primary healthcare, malnutrition treatment, vaccination and mental health services in Gaza; but
systematic sieges and evacuation orders on hospitals by Israeli troops, as well as the terrifying security
situation, have pushed our activities onto an ever-smaller territory, massively limiting our response. MSF
stands ready to increase our activity in Gaza, but without a ceasefire, we will inevitably fall short.

Right now, Israeli forces are preparing for a long-threatened ground offensive on the city of Rafah – the
prospect of which is utterly terrifying. There are around one and a half million people trapped in this tiny
area, which remains one of the few places in Gaza where humanitarian organisations can work, albeit
insufficiently. The consequences of a ground invasion would be utterly catastrophic.

Last month, the United Nations Security Council passed a resolution calling for an immediate ceasefire in
Gaza. If the ceasefire is not implemented, this resolution was meaningless political theatre. We expect more
than condemnations from Israel’s allies. We demand accountability. We demand that the UK government
avoids being complicit with enabling Israel's war on civilians and humanitarian workers; and does everything
within its power to ensure the Israeli ground invasion of Rafah does not go ahead and that there is an
immediate and sustainable ceasefire.

Yours Sincerely,

Dr Natalie Roberts
Executive Director, MSF UK

Download: Our open letter to the UK Government