Moral responsibility for the scarcity of healthcare in Gaza

In response to Arianne Shahvisi's call for medical ethicists to condemn Israel's having caused extreme scarcity of healthcare in Gaza, two critical commentaries published in this journal attributed primary moral responsibility for the scarcity to Hamas, arguing that its role in initiating the recent conflict, together with its use of 'human shields', justifies Israeli military conduct, up to and including the almost complete destruction of the civilian healthcare infrastructure. This article evaluates and rebuts those claims. First, it challenges the assertion that Hamas's having wrongly initiated the conflict absolves Israel of responsibility for the harms its military action has caused to civilians, arguing that moral responsibility is not zero-sum. Second, it argues that the claim that Hamas's actions 'void' the protections afforded to civilians and medical facilities as a matter of both morality and international humanitarian law is mistaken. The article argues, furthermore, that Israel's war has violated the just war principles of proportionality, necessity, and discrimination, particularly in the destruction of much of Gaza's healthcare delivery capacity. The article concludes that medical ethicists must hold all parties accountable for violations of ethical and humanitarian norms, particularly those that systematically undermine civilian health in wartime.