This is what I do when I am not working as a GP, reading, doing continuing education, blogging, doom scrolling, eating and sleeping.
In 2024 I flew into Osaka, and after wandering around the city for a few days, I hired a bicycle from Gareth who runs Road Bike Rental Japan. From there I rode to Hiroshima via Shikoku, a Shinkansen to Kyoto and rode back to Osaka. Here are my photo books from the journey created by me and Blurb.
Volume One
Volume Two
Volume Three
An interconnected world, a belligerent Trump and greedy Big Pharma may result in either patients directly or tax payers having to pay more for medications and effect availability of new drugs.
Although, I do feel for those in the developed world who struggle with limited therapies for diseases they alone suffer from. Australians may too face this dilemma as drug companies play games to undermine Australia’s history of negotiating a fair price for prescription medicines.
“Australia’s Pharmaceutical Benefits Scheme has been effectively frozen since May, after United States President Donald Trump issued an order to change how pharmaceutical companies price drugs. Industry sources say drug companies have stopped listing new medicines with the scheme, hoping Trump’s order will allow them to lift prices for Australia. At the centre of the dispute is Trump’s May 12 executive order reviving his controversial “Most Favored Nation” pricing proposal, a populist idea floated during his first term. The premise is simple: the United States should pay no more for medicines than the lowest price paid by peer nations. In a globalised pharmaceutical market, the proposal could curtail Australia’s access to cheaper medicines. By linking US prices to those in countries such as Australia – where the federal government uses rigorous health technology assessments to drive hard bargains with drug companies – Trump’s policy threatens to upend the commercial logic of launching new drugs in smaller, lower-priced markets.”
more at
As I sitting here typing away, I am discovering just how my actions impact the environment.
It is easy to consider the materials required to create my keyboard, monitor and desktop. Plastic, steel, copper, aluminium and rare earth elements.
I can appreciate the monthly bill for the electricity that is required to power the technology.
Beyond that?
I have read of the environmental impact electronic waste has on the environment, that is why until recently I tapped away on a PC purchased more than 5 years ago. It worked fine until the hard disc and mother board needed replacing. I left it at the computer shop to be recycled. I do wonder where it ended up?
I hope it didn’t end up being hauled half way around the world to Agbogbloshie in Ghana. This article from NPR discusses what happens there. Interestingly, it is unclear whether recycling continues there. The Ghana Government demolished at least sections of it when it was confronted by western media stories. I am certain there is likely to many other sites that haven’t received attention operating in developing countries.
In the interconnected world of modern computing, I am save some of my to the “Cloud” and articles like this are now also saved to the “Cloud”
The Cloud sounds innocuous enough, fluffy white things floating in the sky. Makes pretty shapes, predicts what you might need to take with you on a walk and how much sunscreen you will need.
The “Computer Cloud” like the ones you see in the sky may hide a few things from view. There are obvious things like I have on my desk – plastic, copper, steel, aluminium and rare earths metals that make up servers and cable. Then there is the power required to run the stack of servers that make up the “Cloud” What I recently discovered was the amount of water and power a data centre needs keep its servers working and cool.
How much?
“The typical data center uses about 3-5 million gallons of water per day – the same amount of water as a city of 30,000-50,000 people,” said Venkatesh Uddameri, professor and director of the Water Resources Center at Texas Tech University.
These are appropriate coloured water pipes in a Google data centre in the dalles Oregon published in New Scientist. They are not small!
This article from MIT uses the term “carbonivore” to describe the “Cloud”. The author highlights “The Cloud now has a greater carbon footprint than the airline industry. A single data center can consume the equivalent electricity of 50,000 homes.” The articles talks about power, water and waste and it is a worthy read.
As computer based artificial intelligence gains a hold on our lives, the computational demand steadily increases. In Spain, there is concern that the demand reduce the availability of water for homes and agriculture. Your Cloud is Dries my River is a Spanish activists site that aims to highlight this issue. Projections showed that the data centre would need 665.4 million litres of drinking water per year.
It has been estimated that it takes three bottles of water to create a 100 word ChatGP email. I managed this article with a cup of coffee.
In The Netherlands residents have successful prevented Meta from building data centres in Zeewolde. An odd choice where precious land has been reclaimed from the North Sea for many years. It was calculated that energy required to run the data centre would have powered 370,000 homes.
Due to community resistance movements in places like Chile, Ireland, Mexico, and Singapore, big tech companies have needed to look for new land on which to build these complexes.
This map used in a Guardian article highlights areas of water scarcity in the world and data centre locations.
Why should I care? You may consider the health effects by those who recycle toxic waste, those who miss out access fresh water, the effect on food crops, the cost of powering banks of servers and the constant sound of data centres. Transparency appears to be lacking from the true impact on the “Cloud”, some of it intentional by Google, Meta, Amazon and friends, some just because we don’t think about it. Maybe we should start with not calling data centres “The Cloud”?
If the world can remain silence about the death of 100 people a day from Israeli-dropped US bombs, what else are we capable of being silent about?
In just 365 square kilometres over 50,000 people have been killed, a large proportion of woman and children who at least in the 19th and 20th century where spared from the effect of conflict.
Imagine the emotions of these parents who spend their day repairing bodies to find their children dead.
https://www.aljazeera.com/news/2025/5/24/outrage-horror-after-israeli-attack-kills-nine-children-of-gaza-doctor
In 2023, nearly 47,000 people died of gun-related injuries in the United States, alone. That may explain why the US Government feels the Gaza casualties are not relevant to them. These deaths are spread across a country 4500 km from coast to coast so the true impact stays relatively hidden.
https://www.pewresearch.org/short-reads/2025/03/05/what-the-data-says-about-gun-deaths-in-the-us/
In 2023 malaria killed 597,000 people, but that is mostly in Africa and sub-Saharan Africa have fewer advocates that Gazans and maybe that is only ecology.
https://www.theguardian.com/news/datablog/2012/feb/03/malaria-deaths-mortality
In 2023, traffic accidents killed 60,028 people in China.
https://www.statista.com/statistics/276260/number-of-fatalities-in-traffic-accidents-in-china
These numbers are all in the shadow of a staggering 1.35 million people in India dying from smoking related harms. That around half the population of Brisbane!
https://www.who.int/india/health-topics/tobacco
The Pharmaceutical Benefits Scheme (PBS) began in 1948, with free medicines for pensioners and a list of 139 ‘life-saving and disease preventing’ medicines free of charge for others in the community. This was the culmination work done by then Curtin’s Labor Government. By the 1960’s it had grown into a more comprehensive scheme of subsidised drugs for many Australian. This article talks more about the history of the PBS if your are interested.
The PBS continues to be a safety for many Australians. Depending upon access to a concession or pension card you pay a certain amount for your medication and if it is more then the Government (aka tax payers) pick up the excess. The current ceiling fee is $31.60 and concession fee is $7.70. There are a number of tiers of safety net fees built in to try to minimise the cost of listed medications. This is link to for further information about how the PBS works and a discussion from a Pharmaceutical Benefits Advisory Committee (PBAC) insider which highlights the PBS is not unique.
Importantly, not every medication available is on the subsidised list. I have been involved (admittedly from a distance) in some of the complex discussions and assessment as to whether a medication gets on the list by the PBAC.
Once more the PBS and the privilege that it provides to Australians is under question. Anyone who has travelled overseas and may have been unlucky to have become unwell may have had to pay a lot more for medication than what they may have paid at home.
Twenty amoxycillin 500mg capsules will cost you up to $21.07 In Australia, although some pharmacy chains discount this to $11.99. In the UK, which operates a subsidised system under NHS, you may pay only £2.27 for 21 capsules. ($4 AUD) In the US this may cost $15.97 USD for 30 capsules ($25 AUD). Indonesian amoxycillin is cheap at $1.23 and is similar in India. Just don’t get caught needing amoxycillin whilst on a cruise ship! But in generally for cheap medications the price is not too bad for Australians.
Let’s look at something a bit more expensive. In Australia, if you have HIV, you don’t pay $1759 a month for Biktarvy, you pay $31.60, letting the tax payers pick up the rest of the cost. In the USA, you could be paying almost $8000 a month if you don’t have health insurance. The number of Americans who have lost access to insurance has suddenly increased since Trump and Musk have been taking an axe to the US Federal Government as employment is tied to health insurance for many. Still we all better off than many who live in Africa who were facing medication shortages even prior to Trump’s gutting USAID.
Recently, there was concern raised that mostly the US-based multinational pharmaceutical industry is try to press Trump to pressure Australia to change the PBS to improve their profits. Drug company profits are not to sneezed at. These are revenues from 2023
1. Johnson & Johnson- $85.2bn
2. F. Hoffmann-La Roche Ltd- $66.4bn
3. Merck & Co – $60.1bn
4. Pfizer – $58.5bn
5. AbbVie – $54.3bn
6. Bayer – $51.9bn
7. Sanofi- $46.9bn
8. AstraZeneca – $45.8bn
9. Novartis- $45.4bn
10. Bristol Myers Squibb- $45.0bn
Just remember that the Novo Nordisk, the Danish manufacturer of Ozempic/Wegovy already revenue is equivalent to 10% of Denmark’s GDP and the market worth of the company is actually greater than Denmark’s GDP. But that maybe okay as Denmark may need Novo’s help to keep Trump out of Greenland.
This ABC article recounts the history of previous attempts to breach the PBS. “In a submission to the US government, it describes the PBS as one of the most “egregious and discriminatory” pricing regimes that actively limits prices and earnings. Calling on the US government to impose punishing tariffs, it claims the scheme “undermines American competitiveness, jobs and exports”.
I was surprised that Australia exports $2 billion of drugs to the US, made mostly of vaccines and blood products (Australians blood must be pretty good). If The US pharmacy lobbyist work that may undermine this little earner. Mind you $2 billion probably only pays for a porthole in one of the Virginia-class submarines that Morrison & Albanese have signed us up to.
Thankfully, I am not the only one telling Trump to bugger off, with more important people like Mark Butler (Health Minister) and Don Farrell (Trade Minister) politely standing firm. Neither party leader have expressed a desire to hand over the keys to the PBS.
Maybe Trump should focus on his fellow billionaire executes pay their fair share of company tax rather than attack sovereign nations like Australia.
“MIRENA is inserted into the uterine cavity. It has been shown to be effective for up to 8 years for contraception, and up to 5 years for the indications of idiopathic menorrhagia, and protection from endometrial hyperplasia during estrogen replacement therapy”
Bayer’s Australian product information is catching up with the rest of the world from the 5th of June 2024. Unfortunately, it is still easy to find outdated PI still on the web and be misguided.
Did I hear this important news from Bayer? No, it was through a GP Facebook page called GPDU, yah social media.
The question is why can’t it be used for endometrial protection also for 8 years? Awaiting research seems to be the answer whether the smaller amount of levonorgesterol released after 5 years is sufficient. Obviously, the drop in release is not going to be stepped but rather gradual.
From the new PI
“The in vivo levonorgestrel release rate 24 days after insertion is approximately 21 μg/day, decreasing continuously to approximately 19 μg/day after 1 year, to 11 μg/day after 5 years and to 7 μg/day after 8 years of use.”
Today, after 4 hours sleep, you head to work in the scrubs you wore yesterday and maybe the day before. You had slept fitfully, thankfully no nightmares. You look down at your hands and try remove the crud collected under fingernails.
Outside in the distance you can hear the heavy thump of artillery and the rapid staccato of machine guns. Overhead a rhythmic thump of helicopter blades. “Incoming” is a thought that comes to mind before you realise you last watches MASH 20 years ago. You can pick out the higher pitched noise of surveillance drone. Well not just surveillance as some also carry weapons, capable of being remotely fired from across the wall in an airconditioned room by someone who probably had a shower and decent breakfast.
Ahead, down the corridor you hear yells and cries. An explosion sounded very near, the building shook. Turning a corner corridor that leads to the emergency room, the noise increased. Patients, some of who you recognise from the previous day, lay on thin mattress covered with sheets, some stained with blood. Mother’, wives, fathers, husbands and children sit accompanying the injured.
Almost into the emergency room, there is another blast, more gunshots nearer. There is a hiss of water leaking from pipes, dust fills the air, panels hang from the ceiling the floor is dirty. Voices cry out for help. Someone lies unmoving next to broken window. Outside the window you see movement and flashes of light, sounds of gunshots. You duck instinctively. Your say to yourself “I wasn’t trained for this.”
from https://www.commondreams.org/tag/nasser-hospital
Another doctor spots you and yells to come over to a bed where two nurses are doing CPR. You see a missing leg. In your mind you know that without blood, an operating theatre, drugs that CPR will be futile but you join in but realise quickly, that it is indeed futile. Shaking your head, you look at a person nearby crying. “Ana asef”
Your day has begun again in a hospital under attack, a place that under international rules should be a sanctuary, a place of healing where suffering can be relieved, not inflicted. More explosions and gunfire. More noise.
This is a brief work of fiction but based on what is happening in Gaza to other doctors….
If you rather read the experience of doctors who are actually working in Gaza here is a link to two reports.
The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) strongly condemns the decision by Israeli forces to issue an evacuation order to thousands of displaced Palestinians who have sought safety from the conflict inside Nasser Hospital in Khan Younis.
https://www.doctorswithoutborders.org/latest/gaza-msf-condemns-israels-forced-evacuation-nasser-hospital
“On my last day, as I returned to the guest house where locals knew foreigners were staying, a young boy ran up and handed me a small gift. It was a rock from the beach, with an Arabic inscription written with a marker: “From Gaza, With Love, Despite the Pain.”
https://www.latimes.com/opinion/story/2024-02-16/rafah-gaza-hospitals-surgery-israel-bombing-ground-offensive-children
In this video, Australian healthcare workers take you on a tour through the hospitals of Gaza. It’s devastating and unacceptable.
https://www.instagram.com/reel/C3cVL2iL03U/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA==
Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack, but shall at all times be respected and protected by the Parties to the conflict. Article 18 of the Geneva Convention stipulates that a building designated as a civilian hospital cannot be the target of attack.
Imagine just for a moment living in a world were if you go to hospital with an injury and someone you think fits a profile a doctor walk up to you and blow your brains out, oh and anyone else in the room with you at the time. No judge, jury, just an executioner.
This is the basis of extrajudicial killing.
This is not a John le Carré or Tom Clancy work of fiction, it is the latest work of Israeli death squads. And it was not a doctor, thankfully, but a team of assassins disguised as a medical team who entered a hospital room and murdered three people. This is a violation of the rules of war. There was no court to judge the evidence just an assassin’s bullet.
This is not a new side to the conflict between Palestine and Israel. There is a long history of extrajudicial killing and assassinations that have blotted Israel’s veneer of civilised society. Probably the most famous were the peacemaker Count Folke Bernadotte. He was acclaimed as saving thousands of POWs from prison camps in WW2, including Australians. After the war he assisted in rescuing people, including Jews, from Nazi concentration camps. Yet in trying to settle conflict between the infant state of Israel and Arabs in 1948 he was murdered by Zionists with links to the Israeli government. In fact, Yitzhak Shamir reputedly played a role in planning the assassination; was never tried and later was elected as Prime Minister of Israel.
Many less notables have been murdered by Israeli death squads around the world. In Lillehammer, Norway, Ahmed Bouchikhi who had a passing resemblance (of Arab descent) to a Palestinian in being who was involved Black September, was murdered in front of his pregnant wife. Racial profiling gone wrong.
Amnesty International has documented an enormous number of extrajudicial killings of Palestinians by Israeli death squads. This article is from 2016 https://www.amnesty.org/en/latest/news/2016/09/israel-opt-pattern-of-unlawful-killings-reveals-shocking-disregard-for-human-life/ and 2022
https://www.amnesty.org/en/latest/news/2022/05/israel-opt-increase-in-unlawful-killings-and-other-crimes-highlights-urgent-need-to-end-israels-apartheid-against-palestinians/
Human Rights International is another source of information of extrajudicial killings.
https://www.hrw.org/news/2017/01/02/israel/palestine-some-officials-backing-shoot-kill
Its not difficult to find other stories doing a simple Google Search of reputable sources.
This is the life you live in an institutionalised racial segregation system. Where a man with an automatic weapon can enter a mosque and killing 29 and injuring about 150 Palestinians praying and be held up as a hero by segments of the Israeli society, including some members of Netanyahu’s government.
https://www.middleeasteye.net/news/israel-ben-gvir-baruch-goldstein-meir-kahane-memorial-martyrs-
Imagine an Australia were Brenton Tarrant is celebrated?
Similar weapons are being handed out to settlers and can be freely seen on images of the streets Israel.
Now, back to the latest extrajudicial killing. In this a man who was alleged to have tied to Hamas, is murdered in a hospital bed whilst receiving treatment for his injuries. Two others were with him at the time.
Imagine being part of the medical team that had cared for him?
The Israeli death squad were dressed in scrubs just like his health care team. Now how do you feel?
Imaging being a patient who now sees a nurse in scrubs providing care thinking is this person going to shoot me, what’s in that syringe….?
Imagine going to work in a Gaza hospital not knowing if a 2000 pound bomb is going to end your day?
Prior to the Israeli attack on Gaza, violence was a common problem in Palestinian hospitals as documented in this 2012 cross sectional study. The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. The assailants were mostly the patients’ relatives or visitors, followed by the patients themselves, and co-workers. Since October, I am sure any sense of being able to control the violence in your workplace has been lost.
Thankfully in Australia, we don’t need entertain such extreme thoughts of “will I live or die by being at work”, but across the world violence against hospitals, doctors, nurses and the people that come for healing these thoughts maybe real. How is their mental health.
What side of history will you be on and what are you prepared to ignore?
The Australian Government has announced they will no longer fund state health department as they have heard that some employees may be antivaxxers.
An unlikely scenario but what is happening to Gazans dependent upon UNRWA just adds to their sense of collective punishment.
Since 1948, the UN agency for Palestinian refugees (UNRWA) has funded almost entirely by voluntary contributions from UN Member States. UNRWA also receives some funding from the Regular Budget of the United Nations, which is used mostly for international staffing costs.
So Israel has alleged that 12 UNWRA staff may have aided Hamas. UNWRA employs 13,000 to provide vital aid to Gazans who have driven from their destroyed homes by Israeli bombs, leaving dead relatives behind.
Philippe Lazzarini, UNRWA Commissioner-General from Ammna, Jordan has said, “The Israeli Authorities have provided UNRWA with information about the alleged involvement of several UNRWA employees in the horrific attacks on Israel on 7 October. To protect the Agency’s ability to deliver humanitarian assistance, I have taken the decision to immediately terminate the contracts of these staff members and launch an investigation in order to establish the truth without delay. Any UNRWA employee who was involved in acts of terror will be held accountable, including through criminal prosecution. UNRWA reiterates its condemnation in the strongest possible terms of the abhorrent attacks of 7 October and calls for the immediate and unconditional release of all Israeli hostages and their safe return to their families. These shocking allegations come as more than 2 million people in Gaza depend on lifesaving assistance that the Agency has been providing since the war began. Anyone who betrays the fundamental values of the United Nations also betrays those whom we serve in Gaza, across the region and elsewhere around the world”.
Hamas has been the de facto authority in Gaza since shortly after Israel withdrew from the territory in 2005. It provides social services to Gazans, including health care, education and religious instruction. These roles gave forgotten about as it also has a military wing in conflict with Israel.
As many have said Palestine is not Hamas. Just as not all Israeli are engaged in the conflict in Gaza. For example, B’Tselem calls for a ceasefire. It calls out Israeli’s regime of apartheid and occupation and human rights violations. It strives future in which human rights, democracy, liberty and equality are ensured to all people, both Palestinian and Israeli
Netanyahu and his government has for year supported Hamas with a financial pipeline from Qatar, cynically to divide the Palestinian people. This has been highlighted in a number of articles such as these Times of Israel and NY Times.
Australia exported to Israel totaled $13m of “arms and ammunition”, over the past five years, including $2.3m in 2022. As Australia has announced a pause for UNWRA funding, why does the Australian Government continue to support Israel?
In the meantime Israel Defense Force has killed 26,000 Gazans and severely restricts any humanitarian aid into Gaza to the Rafah border crossing.
Update 17 March 2024
The Australian Government is reinstating funding to UNWRA.
https://www.afr.com/…/australia-ends-freeze-on-6m-for…
Meanwhile, the shadow home affairs minister wants Gazans to wait until the US builds its pier or scurry around hoping not to have aid dropped on their head. I also doubt Israeli school textbooks talk about any Palestinian ethnic cleansing and massacres in 1948. And, no Israelis are not taught to hate and dehumanise Palestians, no not at all. The death toll continues to climb – 31,490 as of 15 March.
Paterson repeats Israeli allegations about UNWRA
“My view is we shouldn’t tolerate a single Australian dollar going to a to potential terrorist. This is not the only accusation against them. There is a Hamas datacentre underneath their headquarters in Gaza, [getting] mains power from UNWRA, who admitted in the past their textbooks in UNWRA schools in Gaza had antisemitic [material] that promotes hatred against the Jewish people. Israel have been warning us for years about the behaviour of UNWRA and the warnings were ignored. And the employees participated then on the worst attack on Jewish people since the Holocaust.”
UNRWA has 13,000 staff; there were 12 people alleged by the Israeli government to have been involved in the 7 October attacks. UNRWA has admitted it fired those accused without investigating the claims as a pre-emptive measure in an example of “reverse due process”. Israel has also claimed one-in-ten UNWRA employees are Hamas supporters and called for the organisation to be dismantled. The Israeli government has been repeatedly asked to supply evidence to support its claims but has so far failed or refused to do so.
I am a doctor, my wife a nurse & midwife, so I have a pretty selfish conflict of interest in sharing this post. I don’t want to be killed during my working life providing care for people who have come for help. In Mackay, that is going to be pretty unlikely. Although, recently a doctor in Nowra faced down a patient with a gun and an Adelaide doctor was bashed during a robbery at home (he later died from his injuries) this is not the usual narrative in Australia.
There are places in the world where a doctor, midwife, nurse or any healthcare profession may well face this narrative on a daily basis.
Although with a bias towards US interest risk, the Centre for Preventive Action hosts a website in which world conflicts are tracked. It aims to “inform the general public about threats to international peace and security by providing a reliable and regularly updated online source of information about ongoing conflicts.”
Today, I counted conflict on every continent bar Australia and Antarctica. For example, there is obviously Gaza and Ukraine which have been in the headlines recently. There has been a rise in conflict in Democratic Republic of Congo as the country went to elections last in 2023. Even though President Tshisekedi was returned there is concern about ongoing violence there. Civil wars affect Syria, Sudan and Yemen, Somalia just to name a few. Another website which lists countries in armed conflict is The Geneva Academy.
In all of those conflicts doctors and nurses are called on to deal with injuries to civilians and in maybe even combatants. Hospitals provide a place to provide that care, open spaces, specialised equipment, medications, an operating room, an emergency department, a place where a team manages the patient. Providing medical, social and humanitarian care and simple things like food, water, blankets, protection from the weather. At the same time hospitals and health care facilities still need to deal with the usual medical care. I see 30 to 40 patients a day- none with bomb fragments or bullet wounds.
And because care may be provided to an opponent (real or perceived), doctors and nurses become a target. Or even if this world of “precision” targeting become collateral damage. Perversely, the destruction of hospital may be factored into some calculus of proportionality. Although difficult to predict the fragmentation pattern and range of a 2,000lb Mk 84 bomb is generally said that this weapon has a ‘lethal radius’ of up to 360m. The blast waves of such a weapon can create a very great concussive effect; affects humans up to 800 metres from the point of impact. Yet these weapons are used multiple times in civilian-dense regions like Gaza. Remember 2 million people live in Gaza; 41 km long up to 12 km wide. I can ride my push bike 41 km in under 2 hours. At ground level you can see almost 5 km.
During the Syrian Civil war, which I read is finally winding down, Amnesty International alleges that hospitals were targeted intentionally by both the Syrian government forces and their Russians supporters. In 2016, Amnesty International noted “The latest string of attacks on health facilities north of Aleppo appears to be part of a pattern of attacks on medics and hospitals, a strategy that has destroyed scores of medical facilities and killed hundreds of doctors and nurses since the start of the conflict.”
In 2015, during the last Afghan war, the US intentionally destroyed a Medicine San Frontier hospital in Kunduz killing 42 people. The US claimed the hospital was occupied by militia, the MSF say it was treating wounded militia along with civilians.
The International Health Law implications of attacking medical facilities are discussed in this paper.
In Yeman, hospitals have been destroyed by the US backed Saudi coalition. August 2016, a hospital supported by Medicine San Frontier was bombed Saudi airstrike in the northern town of Abs, Yemen. By placing themselves in conflict zones, MSF does seem to be dealing with damaged health infrastructure more than others.
During the Rwanda Genocide hospitals and churches did not save victims of violence’s. In fact some would say that in the mistaken belief sanctuary, such institutions made it easy for the orgy of death to continue. For doctors in these hospital a stethoscope draped around a neck was not a free pass to life.
As reported in the BMJ, human right group allege in Destruction and Devastation: One Year of Russia’s Assault on Ukraine’s Health Care System, that there were an average of two attacks every day between 24 February and 31 December 2022. These included hospitals being bombed, medics being tortured, and ambulances being shot at. Russian troops occupied a hospital knowing that under Rule 35, the Ukrainians would not return fire. In this case the hospital is a often a big, expansive sturdy building with many things soldiers need to prosecute a war.
Destroying hospitals is a war crime pure and simple. It is a crime to use a hospital for military purposes, something that Hamas amongst other have been alleged to do. But that does not morally justify another aggressor targeting the hospital. They make that choice to drop that 2000 pound bomb knowing full well the consequences.
Some of the examples mentioned about discuss targeting the infrastructure in which we work. Unfortunately in recent conflicts individuals have also been targeted. For example Dr Tetsu Nakamura from Japan. After qualifying as a doctor he moved to Pakistan in 1984 to treat patients with leprosy, then crossed into Afghanistan, where he opened his first clinic in a remote village in Nangarhar and established a NGO, Peace Japan Medical Services. Honorary Afghan citizenship was his reward for dedication to humanitarian projects. He was killed along with five others during an ambush on the outskirts of Jalalabad in December 2019 at the age of 73. Dr Egil Tynaes, a Norwegian doctor died also in Afghanistan in an ambush in June 2004. There are many more dedicated individuals whose stories can be found by searching Google, and many more whose death goes unnoticed outside of their community.
Killing doctors and nurses means that from that day that highly trained individual no longer is there to help keep their community healthy. I not putting myself on some sort of pedestal here as health also means access to fresh food, water, sanitation protection from the elements. But in the indiscriminate bombing we have seen in Gaza those things have also been taken away.
This confronting article published today by Aljazeera details better than I the impact the Israeli war on Gaza is having on health care. Would I choose to be a doctor there?
https://www.aljazeera.com/features/longform/2024/1/23/how-doctors-in-gaza-persevere-amid-israel-attacks
Mark Raines 