Gaza and the Responsibilities of Bioethics

1.

Special issues are usually justified by a gap in the literature. This one also responds to the uneven attention within bioethics to the destruction of Palestinian life and healthcare in Gaza. When we began assembling it, we worried that events would overtake academic publication. They have. Rather than provide a current record of a changing conflict, the collection examines how bioethics has responded, how political conditions shape health and healthcare, and the points of convergence, tension and disagreement that emerge across the contributions.

The immediate context includes the Hamas‐led attack of 7 October 2023, in which people in Israel were murdered and others taken hostage, and Israel's subsequent military campaign in Gaza, which has devastated Palestinian lives, communities and the institutions on which health and civilian lives more generally depend. Highlighting the attacks and hostage‐taking does not erase the longer histories of Israeli occupation and blockade examined in these papers; nor can the attacks of 7 October justify collective punishment and the violation of civilian immunity under international law and just war theory. The asymmetries of power, control and harm are central to understanding the bioethical questions before us.

The issue focuses on Palestinian health and human rights: the destruction and restriction of healthcare; the treatment of patients; prisoners and health workers; the politics of humanitarian relief; and the responsibilities of bioethicists and institutions. It does not attempt a comprehensive ethical or historical analysis of Israel and Palestine or an accounting of every harm by every actor. The collection includes six Special Issue Articles and five Letters. It brings together normative and political philosophy, qualitative research, human‐rights documentation, health‐systems ethics, methodological criticism, environmental ethics, testimony and visual reflection. This range allows the issue to examine the individual experiences of authors in various contexts of professional practice, institutions and wider political conditions.

The discussion that follows is organised around four recurring questions: why Gaza is and should be a concern for bioethics; how testimony and scholarship represent it; how institutions mediate care and harm; and what humanitarian response and reconstruction require.

2. Why Bioethics?

The opening contributions converge on the need for engagement but differ on why. DeGrazia argues that bioethicists should speak about Gaza, though not because the obligation is distinctively bioethical: it is an obligation we have as human beings [1]. Barış and colleagues locate the issue within bioethics itself, arguing that selective institutional engagement threatens the field's credibility [2]. Salaymeh, Shahvisi and Jannesari shift attention from professional obligation to the political structures that shape health, vulnerability and scarcity [3].

These positions offer different reasons for engaging with Gaza. DeGrazia treats professional identity as secondary to ordinary moral responsibility. Barış and colleagues ask whether a field committed to justice can remain selectively silent. Salaymeh, Shahvisi and Jannesari argue that the political structures shaping health must form part of bioethical analysis. The empirical contributions add another perspective: medical, humanitarian and care ethics are being used and revised by people trying to sustain care under occupation, armed conflict, and destruction.

Whatever boundaries one draws around the discipline, the destruction of healthcare, the political production of access and scarcity, the treatment of patients and health workers, and responsibility for repair are matters of bioethical concern. This does not imply any singular political role for bioethicists. It does, however, invite the field to examine how it selects topics, evaluates evidence and responds to politically produced threats to health.

3. Witnessing and Listening

Alkhodari's Letter turns from the disciplinary debate to personal testimony [4]. She writes as a Palestinian medical student whose education, family life and professional formation have been divided by destruction and displacement. Her text resists reducing Palestinians to casualty figures. She also explains why documenting individual lives is difficult: public reporting can erase their particularity, while trauma can blur the memories on which testimony depends. Her account should therefore be read as testimony from a person directly affected by the events, not merely as material for external analysis.

Liu's visual Letter comes from a different position: a medical student in Hong Kong considering the distance between advanced medical education and conditions of care in Gaza [5]. His disclosed photomontage places the Hong Kong skyline beside ruins in Gaza. Read alongside Alkhodari, it illustrates the difference between distant reflection and testimony from Gaza. Liu does not claim to speak on behalf of Palestinians; he uses the composite image to consider his own distance, privilege and professional responsibilities.

Questions about how Gaza is represented also arise in research methods. Ghali and colleagues approach this question by examining the methods used to classify scholarship on the conflict [6]. They criticise a 2023 review that searched for literature on Israel and Palestine, selected 37 articles from more than 1600 results, and concluded that the literature was disproportionately ‘pro‐Gaza.’ Ghali and colleagues argue that the review does not explain its selection criteria, how articles were classified as ‘pro‐Gaza’ or ‘pro‐Israel,’ or how author nationality was determined. They also question the inference from a larger number of critical publications to bias: the pattern might instead reflect the conduct and harms being studied. Their Letter is therefore about the standards used to select, classify and interpret scholarship on the conflict.

4. Institutions, Care and the Production of Harm

Dronkers and Amro provide the issue's most sustained account of Palestinian health professionals' moral experience [7]. Their qualitative study draws on semi‐structured interviews with staff at Augusta Victoria Hospital in East Jerusalem, supplemented by background interviews. It describes how intensified permit restrictions separated patients from companions, disrupted referral care from Gaza and burdened staff already navigating checkpoints, family obligations and institutional uncertainty. Its distinctive contribution is normative: medical ethics, humanitarian ethics and communitarian commitments each illuminate part of the work, but care ethics reveals the relational labour involved in sustaining connections among patients, companions and professionals. On this account, moral distress arises from constraints that place good care persistently out of reach, not from an individual's failure to choose correctly.

Weishut and Steiner‐Birmanns, two Israeli scholars, examine a different institution: Israeli prisons [8]. From 19 legal dossiers concerning Palestinian prisoners not implicated in the 7 October attack, they document allegations of physical violence, degrading treatment and sexual humiliation across several facilities. Given the sample, the findings cannot establish prevalence. The authors acknowledge important limitations, including selection through legal and human‐rights organisations and the absence of direct clinical assessment. Even with these limitations, the recurrence and severity of the reports support the authors' call for independent investigation and closer scrutiny of custodial practices.

Kadioglu considers the environmental effects of war [9]. Her Letter is agenda‐setting rather than a Gaza‐specific environmental study. It argues that damage to water, soil, air, food systems and habitats affects health long after hostilities. It therefore places environmental destruction within bioethics as well as international law and environmental policy.

Together, the authors extend bioethical analysis of Gaza beyond bedside decisions. Clinical relationships, referral systems, detention practices, scholarly methods and environmental conditions all affect who receives care and under what constraints.

5. Humanitarianism, Repair and Disagreement

The papers also differ in how they assess and rely on humanitarian ethics. Dronkers and Amro show how humanitarian principles help a hospital preserve access and impartial care [7]. Salaymeh and colleagues argue that repeatedly framing Gaza as a humanitarian emergency can prioritise short‐term relief while displacing questions of rights, political agency and responsibility [3]. On their account, aid remains necessary but can sustain a system that manages scarcity rather than removing its causes. The tension is partly one of scale: humanitarian neutrality may help a particular institution preserve care, while an aid‐dependent political order can reproduce the conditions that make such care precarious.

A related question concerns reconstruction. Hurst and Bobier, working within jus post bellum, argue that Israel has an obligation to rebuild Gaza's healthcare infrastructure, grounded in its causal role in the destruction [10]. They maintain that this conclusion holds even if particular attacks are judged lawful, because the foreseeable humanitarian consequences still generate responsibilities of repair. They identify restoration to the pre‐war health system as a minimum, supported by international cooperation.

Salaymeh and colleagues approach reconstruction through political and biopolitical analysis rather than jus post bellum and do not directly answer Hurst and Bobier [3]. Their account nevertheless raises a further question about whether restoration to the pre‐war system is an adequate endpoint. That system, they argue, was already constrained, underdeveloped and dependent on humanitarian management. Together, the papers distinguish a minimum from an endpoint: immediate restoration may be necessary without being sufficient, while longer‐term reconstruction raises the question of whether the conditions of dependence should themselves be transformed.

The issue also contains a more direct disagreement. Lucas's Response challenges an article by one of us about the immunity of hospitals [11]. He argues that legal conventions alone do not themselves explain their moral authority. He warns that a more restrictive immunity rule could create incentives for armed groups to use medical facilities for military purposes. Lucas further suggests, drawing on Steinhoff, that civilians who endorse or celebrate killing of innocents—which he says occurred in Gaza—may forfeit or diminish their moral authority to ask others to place greater value on their lives. It is a suggestion that departs from the settled position in international humanitarian law, and in much just war theory, that civilian protection does not vary with the opinions civilians hold or express; and it generalises, bearing on civilians in Israel who have publicly welcomed Palestinian deaths no less than on civilians in Gaza. Including the Response makes the disagreement over the grounding and scope of hospital immunity explicit.

Contributors also differ in their use of the term genocide. Barış and colleagues, Salaymeh and colleagues, and Alkhodari apply the term to Israel's conduct in Gaza; Alkhodari explains why she adopts it [2, 3, 4]. Dronkers and Amro use it in attributed and qualified form, Weishut and Steiner‐Birmanns report the relevant legal claim, and DeGrazia expressly declines to use it [1, 7, 8]. The remaining contributors do not use the term. These differences matter because the contributors do not start from the same legal or conceptual framing. They nevertheless address overlapping questions about civilian protection, the conditions necessary for health, institutional responsibilities and repair.

6. Institutional Responses and Remaining Gaps

Barış and colleagues argue that bioethics institutions have responded inadequately to Gaza [2]. Their evidence concerns professional associations, conferences and journals, which they compare with institutional responses to other wars. Individual bioethicists and some journals have published relevant work, including collections preceding this one. The paper's more specific concern is therefore with the timing, consistency and institutional character of the response, as well as the pressures faced by scholars who speak publicly.

The collection has clear limits. It contains no sustained treatment of hostage health or Israeli civilian health, no full ethical analysis of Hamas's governance and military conduct, and no dedicated contribution on paediatric ethics, disability and rehabilitation, or mental health. It includes a Palestinian medical student's testimony, but not a paper by a clinician currently practising inside Gaza. These absences identify areas requiring further work.

The contributions envisage different roles for bioethicists. Some call for advocacy and institutional action; others contribute conceptual analysis, documentation, methodological criticism or testimony. No single role follows from the collection. Whatever the role, familiar standards apply: claims should match the evidence, authors' experiences should not be sharpened beyond what they report, and relevant conflicts of interest should be disclosed.

We thank the Editors‐in‐Chief of Bioethics for making space for a collection that questions prevailing definitions of bioethics and criticises views published within the journal. Readers can assess the competing positions directly.

Rebuilding Gaza's health system requires restoring services while confronting the political conditions that repeatedly place them at risk. The immediate task for bioethics is to keep three questions in view: how reconstruction can avoid reproducing dependence, how Palestinian professionals and communities can shape it, and how professional institutions should respond when political violence determines access to care. These questions will remain after the present phase of the conflict has changed.

Data Availability Statement

The authors have nothing to report.