Gaza: Second MSF UK open letter to the UK Government

MSF UK general director Natalie Roberts, and President and Chair of the Board of Trustees, Nicola McClean, have written for the second time to the Prime Minister and Foreign Secretary urging them to do everything in their power to bring about an end to the siege and an immediate ceasefire in Gaza.

Dear Prime Minister and Foreign Secretary,

We are writing further to our letter of 1 November regarding the situation in Gaza. While we received a response from the FCDO on 3 November, it unfortunately did not engage substantively with any of the points we raised.

We felt it therefore imperative to update you on the situation our medical teams in Gaza have witnessed and experienced over the past month, and to ask once again that you publicly support:

1. an end to the siege
2. an immediate and sustained ceasefire to allow the delivery of humanitarian aid
3. an end to attacks on hospitals and medical staff.

Three of our MSF colleagues have already been killed, many more have lost family members. Numerous other colleagues have been injured. Hospitals and other health facilities are being hit by strikes, fired upon by tanks and guns, and encircled and raided, killing patients and medical staff. The World Health Organization has documented 178 attacks on health care, including 22 fatalities and 48 injuries of health workers on duty.

On 18 November 2023, an evacuation convoy comprising MSF staff and their families came under fire in Gaza City. Two people were killed in what immediately appeared as a deliberate attack against clearly identified MSF cars. After going through a thorough debriefing of MSF colleagues who were part of the convoy, we consider that all elements point to a clear responsibility of the Israeli army for this deadly attack.

On 21 November 2023, the 3rd and 4th floors of Al Awda Hospital, where an MSF Limb Reconstruction Unit is located, were hit by a strike, killing three doctors (two of them MSF staff), and injuring other patients and staff inside the hospital.

Medical staff, including our own, are utterly exhausted and beyond despair. They have had to amputate limbs from children without anaesthesia or sterilized surgical tools. Due to forcible evacuations by Israeli soldiers, some doctors have had to leave patients behind, forced to face an unimaginable choice between their lives and those of their patients.

In addition, every person in Gaza today is impacted by the state of siege imposed by the Israeli Government that has deprived the entirety of the population in Gaza of essential supplies such as food, water, shelter, and medical care. Even if some supply trucks are now entering Gaza, huge bottlenecks at the Rafah crossing, combined with the Israeli authorities’ screening processes and restrictions on essential products including fuel and certain medical items, mean that the aid deliveries that arrive are entirely inadequate. The general humanitarian needs our teams see are massive and widespread: food, water, cooking gas, fuel, winterization items, cleaning materials, etc. Medically, on top of the need for surgical, burn and wound care from the bombing and the shelling, our teams are observing significant unmet requirements for primary and secondary healthcare, including maternity, general medical and mental health care.

MSF has sent an international emergency team to Gaza to support our over 300 Palestinian colleagues by bringing increased medical and surgical capacities to health facilities. Regrettably, their impact is severely limited due to the immense scale of the casualties, the destruction of infrastructure, the lack of essential supplies such as fuel, and the ongoing insecurity. Our teams welcomed the recent all-too-brief respite in the bombing of civilians, but such short-lived ‘pauses’ in the conflict are no solution of any kind. Since the hostilities restarted on Saturday morning there are reports of hundreds killed in airstrikes, and already-overwhelmed hospitals and health workers are once again facing an influx of injured men, women, and children.

We want and ought to be able to do so much more. Today this is just impossible due to the siege and unrelenting generalised warfare being unleashed by Israel.

The FCDO’s response to our first letter stated that:

In all our engagements with Israeli counterparts we have underscored the UK’s firm belief in Israel’s right to self-defence in accordance with International Humanitarian Law. Israel has a duty to minimise civilian casualties and we have called on Israel to take every possible precaution to avoid harming civilians.

Reports of thousands of casualties, many of them children, suggest such appeals have fallen on deaf ears. Civilians have been forcibly ordered to move south but Israel forces are also bombing that area. Nowhere is safe. Our emergency teams in Khan Younis in southern Gaza report receiving massive influxes of wounded after nearby intense bombing and airstrikes, including on overcrowded squalid refugee camps where people are barely surviving on the sparse humanitarian aid available. If the bombs do not get them, infectious diseases and starvation will.

The FCDO’s response also stated that the Government was advocating for humanitarian pauses, and that:

An acute humanitarian crisis is unfolding in Gaza, which requires a global response. The UK is calling for immediate, unimpeded, and safe humanitarian access for life-saving aid to reach civilians. This includes adequate volumes of food, water, fuel and medical supplies […] The safety of civilians and humanitarian personnel is critical to enable aid to reach those who need it most.

However, as set out above, our colleagues’ ability to deliver medical humanitarian aid has been severely limited by the siege of Gaza and by the indiscriminate attacks which have taken place, including on health facilities and workers. Gaza now lies in ruins, and the majority of the population has been displaced. People are forced to live in unhealthy and overcrowded conditions, with many sleeping outdoors, exposed to rains that are increasingly frequent and heavy. Pauses of a few days are not nearly enough to enable delivery of sufficient aid to meet the enormous needs that we see.

We note the Prime Minister’s recent announcement of an additional £30m in humanitarian aid for Gaza, bringing to £60m the aid announced by the UK for Palestinian civilians since the crisis started in October. While we do not doubt the good intentions behind such a gesture, as stated above we are pessimistic that delivery “to those who need it most” will be anywhere near sufficient unless there is a lasting ceasefire, which the UK Government is yet to publicly support.

In addition, we would caution the Government to think very carefully about the specific activities it intends to support, and to put in place measures to mitigate the risk of UK aid unintentionally reinforcing an Israeli military strategy that continues to cause such catastrophic harm to Palestinian civilians. For example, even while we recognise that hospitals in Gaza are overflowing, the establishment of stand-alone field hospitals separate from existing medical structures could inadvertently facilitate the Israeli military’s unjustified targeting of Palestinian civilian medical facilities, ambulances and health workers.

We would therefore be very grateful if you could answer the following questions, in light of the information we have shared above:

• What is the UK Government’s assessment of whether the Israeli Government is taking “every possible precaution to avoid harming civilians” – and, in particular, to avoid attacks on healthcare facilities and workers?
   
• What is the UK Government’s assessment on whether “pauses” of 4-6 days are adequate to the delivery of the humanitarian aid required in Gaza?
   
• Does the UK Government believe that the “immediate, unimpeded and safe humanitarian access” which it has called for is being provided?
   
• What assessments has the UK Government undertaken of proposed aid to ensure it does not inadvertently result in complicity with military strategies?

Finally, we reiterate our urgent request to you to call publicly for an immediate and sustained ceasefire, and the establishment of an independent mechanism to oversee the adequate flow of humanitarian supplies into Gaza.

We need to see an end to the indiscriminate and relentless attacks on civilians which have been taking place in Gaza, an end to forcible displacements, an end to assaults on hospitals and medical staff, and the immediate lifting of the siege and restrictions on aid.

We would of course be happy to provide you or your colleagues with further details on the direct experiences of MSF’s medical teams in Gaza, either in writing or a meeting.

Yours sincerely,

Dr Natalie Roberts, Executive Director, MSF UK

Nicola McLean, President and Chair of the Board of Trustees, MSF UK