When medical personnel stand by and watch a murder

Before he was executed on camera by an Israeli soldier, the wounded Palestinian man in Hebron appears to have been refused treatment by two medical teams. One doctor examines the ethical outrage displayed in the video.
A Magen David Adom ambulance attempts to navigate around the body of a Palestinian man who was shot in the head by an Israeli soldier in Hebron, in the West Bank. The man, who took part in stabbing and lightly wounding another soldier, had already been shot and incapacitated. March 24, 2016.[Screenshot/B’Tselem]

The video clip released Thursday of an Israeli soldier shooting in the head an incapacitated Palestinian man, who had stabbed and wounded a separate soldier, doesn’t leave much room for speculation.

Maybe it’s because I’m a doctor, but when I watched the video I couldn’t take my eyes off the Magen David Adom (MDA) medical team at the scene — treating the wounded soldier, completely ignoring the man lying wounded on the street, evacuating the soldier in an ambulance, and then boom. A murder.

I am familiar with both the military and civilian codes of ethics for treating the wounded in the field — I am a civilian doctor who has undergone training by the IDF’s Medical Corps. On the one hand, the rules say that medical personnel are required to treat any wounded person. The decision of who to treat first is made based on the seriousness of the wounds and the ability to treat them in the field, and it is made by the ranking medical personnel at the scene. That means that a doctor, paramedic, or even an EMT outranks a senior military officer when it comes to deciding who to treat first. And it is forbidden to consider the identity of the wounded person when making that decision. The only permitted consideration is the medical team’s ability to save as many lives as possible at any given scene.

However, medical personnel need not unreasonably endanger themselves in order to treat a wounded person. They are obligated to take steps in order to minimize the risk to their own lives and only then treat the wounded. For example, a soldier wounded in a mine field will receive only minimal treatment until he can be extracted to safety. Somebody injured in a car accident on a busy highway must first be moved out of traffic and only then be treated. And in the case in Hebron, the medical personnel needed to check whether the man who stabbed the soldier — and had already been shot himself — posed an immediate danger to anybody attempting to treat him.

Who are medical personnel supposed to save?

Keeping in mind that code of ethics, which to the best of my knowledge both the IDF and MDA are obligated to follow, and which they both teach themselves, let’s analyze the situation depicted in the video from Hebron.

Warning: Although parts of the following video have been blurred, it is extremely graphic and depicts a murder. Viewer discretion is strongly advised.

The video shows a multiple casualty incident. Arriving at the scene were at least two ambulances, one of which has the markings of an MDA ambulance stationed in the Jewish settlement inside Hebron. The second belongs to United Hatzalah. The medical personnel (who I’m assuming are the men with latex gloves on), are shown treating and putting into an ambulance a wounded soldier, who appears conscious, sitting up on his own on the stretcher, and who according to news reports was classified as moderately wounded at the scene, and later as lightly wounded at the hospital. There are two other wounded in the field, who according to the army were involved in stabbing the soldier. One of them, who is further away, is lying on the ground and appears to be bleeding from a gunshot wound to his head. In the video, we do not see the medical personnel approaching him in order to examine him or to declare him dead (was he even declared dead by somebody authorized to do so? Or did they simply assume he was dead?).

In the foreground, a second Palestinian man is lying on the street. It’s hard to say what his condition is but he is clearly alive — he can be seen moving his head and breathing. Through the entire duration of the video we do not see any medical personnel — military or civilian — approach this man in order to determine the seriousness of his wounds or decide a course of treatment. The MDA personnel do not treat him and they do not evacuate him. And no perimeter is maintained around which one might expect if he still posed a threat — nobody makes any effort to stay away from him. Then the ambulance with the wounded soldier on board begins to drive away. Another soldier cocks his weapon and shoots the wounded man in the head, killing him. It’s important to note that nobody else on the scene seems to even flinch at the sound of the shot. Nobody gets angry at the shooter; nobody tries to stop him. And none of the people entrusted with saving lives — all lives — tries to save him.

Regarding the medical personnel, as far as I can discern there are two possible explanations for what we see in the video. The first concerns their own safety. It’s possible that the soldiers did not let them treat the wounded man out of fear that he might still pose a danger. (Maybe he’s wearing an explosive vest? Maybe he could still pull out a knife and stab them, too?) If that was indeed the case, which has some legitimacy according to the ethical doctrines explained above, this would appear to be a case in which the army prevented the wounded man from receiving medical treatment, and then murdered him. That would mean the medical personnel stood idly by and did not even try to save either the life of a wounded man, or their own professional integrity.

The second, far worse explanation is that the medical personnel decided on their own not to treat the wounded man without receiving any such orders from the army, that they decided whom to treat based on considerations other than the seriousness of their wounds; that they simply decided to treat the soldier first. That would have been forbidden, unethical, and unequivocally contradicts all codes of medical ethics.

So which of those two scenarios actually took place? Did the IDF prevent the wounded man from receiving medical treatment and then murder him? Or did the MDA and Hatzalah medics from the Jewish settlement in Hebron refuse to treat Palestinians, instead letting them die on the scene?

Who’s supposed to give the all-clear?

Asked about the behavior of the medical staff at the scene on Thursday, Magen David Adom spokesperson Zaki Heller told journalist Hagar Shezaf the following: When it comes to terrorists, there have been cases when they came booby-trapped, and it’s forbidden to touch a terrorist as long as they have not undergone a security check. The moment they are checked by a sapper to make sure there aren’t any explosives on them we treat them. It depends on the situation. The order is to try and not get blown up. There is always a danger that they are booby-trapped, [and that even happened recently] at Damascus Gate. The security forces’ orders are that until the terrorist is neutralized, don’t treat them.

One tactic of these evil terrorists is to booby-trap themselves, and in order to prevent something like that, God forbid, and with all due respect to the wounded terrorist, as long as the security forces haven’t checked them, that is, until a sapper checks that they’re not booby-trapped and there aren’t any explosives, Magen David Adom doesn’t treat anybody. In a situation in which somebody had checked him and there were other wounded in the field, he would have been treated first. Here, however, there are suspicions of other things, this is a terrorist attack in which Jews were murdered for being Jews.

Indeed, the MDA spokesperson shifts responsibility onto the army, which he says orders medics not to treat the wounded until any threat they pose is neutralized. However, he also notes a standing internal for the medical personnel that the wounded must undergo a security check before treatment. But delaying medical care for security reasons must be determined in each specific situation; there cannot be a broad, standing order not to give treatment. Medical personnel must be the ones to insist on providing lifesaving treatment. It is their role to advocate for human life, of every wounded or injured person.

Even if we assume that medical personnel must indeed wait for sappers to determine that a wounded person doesn’t pose any danger – where was that sapper? Why doesn’t he or she automatically show up alongside the medical personnel? These types of incidents have been happening almost every day for half a year. Has MDA really refrained from treating wounded people suspected of being attackers in all of those incidents? How many such people have been taken away by ambulances while they were still alive in the past six months? Is the reason for delaying lifesaving treatment that there isn’t a sapper to determine if the situation is safe? I would expect that an organization which treats wounded people, and which values human life, to demand that such security personnel always be present.

The apathy toward the wounded man lying in the middle of the street of all those filmed on Thursday, the way they shuffle around him as if he doesn’t even exist, and then the apathy exhibited toward the execution of a wounded man who posed no threat to anybody, that’s the real story here. The soldierswere trained to fight and kill; it’s even legitimate to discuss what exactly constitutes a normal response by a soldier standing over someone who just tried to kill them. But doctors, paramedics, medics — all medical personnel — are there to save human lives. They are the ones who are supposed to sanctify all human life and to fight for it with everything they have.

Dr. Tslil Regev is a doctor at one of the major hospitals in Israel. This post was first published in Hebrew on Local Call. Read it here.

[Source: +972Magazine]

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