How Israeli Doctors Became Accomplices to the Torture and Sexual Abuse of Palestinian Detainees in Sde Teiman - Opinion - Haaretz.com
In 1989, 20 political detainees were hospitalized in Johannesburg after going on a hunger strike to protest nearly three years of being held without trial. William John Kalk and Yosuf Veriava, the attending physicians, declined to sign their release forms after completing treatment. They argued that sending them back to the detention facilities where they had been tortured would violate their ethical duties towards their patients.
Known in medical ethics literature as "Kalk's Refusal," their actions have provided a moral road map for physicians worldwide for over 35 years.
Ethical guidelines forbid physicians from taking part in any form of torture. Kalk's Refusal underscores that a physician's responsibility to patients extends beyond the completion of treatment. If medical findings indicate that a patient has been subjected to torture, ethical standards require the attending physician to use his authority to prevent the patient from being sent back to the facility where the violence occurred. The principle of "primum non nocere," or "first, do no harm," remains a fundamental rule of medical ethics.
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Yet, since October 7, 2023, it seems the ethical principles adopted by the World Medical Association and reaffirmed by the Israel Medical Association (IMA) have been rendered obsolete in this country.
On July 6, 2024, a detained Palestinian was brought to Assuta Hospital in Ashdod from the Sde Teiman detention facility. He arrived in critical condition, suffering from injuries to his neck, chest and abdomen, as well as a ruptured rectum. A few days later, he was returned to military custody.
The medical findings indicate that he had been subjected to torture and sexual violence in custody, resulting in severe physical injuries and endangering his life, which required an emergency medical evacuation. Despite the seriousness of his condition, he was released from the hospital and sent back to the same facility where his abuse likely took place.
Some of the soldiers suspected of abusing a Palestinian detainee in the Beit Lid military court in August.Credit: Nir Keidar
It was not until July 29, 2024 that Israel's military police arrested soldiers in the Sde Teiman detention facility under suspicion of involvement in the abuse. This suggests that the detained Palestinian was not only returned to the site of his abuse, but that the soldiers suspected of abusing him were allowed to continue serving there for weeks after his return. Given this, the hospital's decision to discharge him put his life and health in imminent danger.
On August 27, Physicians for Human Rights – Israel's Ethics Committee contacted the IMA's Ethics Board, urging an inquiry into the case and the conduct of the hospital's professional and management staff, in order to determine the reasons behind the patient's release back to Sde Teiman. PHRI also asked the Ethics Board to establish guidelines emphasizing the duty to ensure patient safety even after discharge, and to develop protocols to prevent returning detained individuals to the custody of those suspected of abusing them.
This case emerges against the backdrop of numerous other ethical violations related to the medical care of detained and incarcerated Palestinians in Israel, as well as the broader treatment of Palestinians by Israeli medical institutions. Israeli public hospitals have turned away detained Palestinians in need of life-saving treatment; dozens of physicians have called for bombing a hospital in Gaza; a public hospital repeatedly informed the police about the arrival of female patients without legal status; the Sde Teiman field hospital provided care that fell below professional standards; and, most alarmingly, over 60 Palestinians have died in Israeli custody in recent months, many due to medical neglect. These deaths have gone undocumented, and no protests have been raised by the medical clinics and hospitals that witnessed their abuse, treated them and opted to remain silent.
Soldiers lock a gate from the inside at Sde Teiman detention facility in southern Israel, in July.Credit: Amir Cohen/ REUTERS
All these cases highlight a severe systemic failure and moral crisis. As members of the medical community, we are inherently part of the society in which we were raised and live. Our pain over the horrors of October 7 is no less than that of the broader community, and we are not oblivious to the incitement propagated by Israeli politicians and media outlets. Nonetheless, despite the personal complexities of interacting with patients from the Gaza Strip, our professional duty is to uphold ethical guidelines. These guidelines mandate an unwavering commitment to treating every patient equally, regardless of their identity. "Both enemy and friend," as the Jewish physician's prayer instructs.
Kalk's Refusal in apartheid South Africa not only stands as a prime example of ethical conduct but also illustrates the courage to resist a cruel and oppressive regime, placing humanity at the core of the medical profession as a counter to a corrupt and violent society. It serves as a reminder that even in the darkest times, when the political leadership hastens society into moral decay, the fundamental humane practice of caring for those in distress can guide us toward a path of correction.
Dr. Guy Shalev, Ph.D, is a medical anthropologist and the executive director of Physicians for Human Rights – Israel.