Dear President Joseph R. Biden, Vice President Kamala Harris, and Dr. Jill Biden,

We are 45 American physicians, surgeons, and nurses who have volunteered in the Gaza Strip since October 7, 2023.

We worked with various nongovernmental organizations and the World Health Organization in hospitals throughout the Strip. In addition to our medical and surgical expertise, many of us have a public health background, as well as experience working in humanitarian and conflict zones, including Ukraine during the brutal Russian invasion. Some of us are veterans of the United States Armed Forces. We are a multifaith and multiethnic group. None of us support the horrors committed on October 7 by Palestinian armed groups and individuals in Israel.

The Constitution of the World Health Organization states:

“The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and States.”

It is in this spirit that we write to you.

We are among the only neutral observers who have been permitted to enter the Gaza Strip since October 7. Given our broad expertise and direct experience of working throughout Gaza we are uniquely positioned to comment on several matters of importance to our government as it decides whether to continue supporting Israel’s attack on, and siege of, the Gaza Strip. Specifically, we believe we are well positioned to comment on the massive human toll from Israel’s attack on Gaza, especially the toll it has taken on women and children.

Image: Ahmad Shabat and his uncle Ibrahim at Al-Aqsa Martyrs Hospital in Deir el-Balah in the central Gaza Strip [Atia Darwish/Al Jazeera]

This letter collects and summarizes our own experiences and direct observations in Gaza. We have also provided links to a much longer and heavily cited appendix summarizing the publicly available information from media, humanitarian, and academic sources on key aspects of Israel’s invasion of Gaza. The appendix is available as a PDF file here. This letter can be accessed electronically as a PDF file here.

This letter and the appendix show probative evidence that the human toll in Gaza is far higher than is understood in the United States. It is likely that the death toll from this conflict is already greater than 92,000, an astonishing 4.2% of Gaza’s population. Our government must act immediately to prevent an even worse catastrophe than what has already befallen the people of Gaza and Israel. A ceasefire must be imposed on both Israel and Palestinian armed groups by withholding military support for Israel and supporting an international arms embargo on both Israel and all Palestinian armed groups. We believe our government is obligated to do this, both under American law and International Humanitarian Law, and that it is the right thing to do.

With only marginal exceptions, everyone in Gaza is sick, injured, or both. This includes every national aid worker, every international volunteer, and probably every Israeli hostage: every man, woman, and child. While working in Gaza we saw widespread malnutrition in our patients and our Palestinian healthcare colleagues. Every one of us lost weight rapidly in Gaza despite having privileged access to food and having taken our own supplementary nutrient-dense food with us. We have photographic evidence of life-threatening malnutrition in our patients, especially children, that we are eager to share with you.

Virtually every child under the age of five whom we encountered, both inside and outside of the hospital, had both a cough and watery diarrhea. We found cases of jaundice (indicating hepatitis A infection under such conditions) in virtually every room of the hospitals in which we served, and in many of our healthcare colleagues in Gaza. An astonishingly high percentage of our surgical incisions became infected from the combination of malnutrition, impossible operating conditions, and lack of supplies and medications, including antibiotics. The pregnant women we treated often gave birth to underweight infants, and they were unable to breastfeed due to malnutrition. This left their newborns at high risk of death given the lack of access to potable water anywhere in Gaza. Many of those infants died. In Gaza we watched malnourished new mothers feed their underweight newborns infant formula made with poisonous water. We can never forget that the world abandoned these innocent women and babies.

We urge you to realize that epidemics are raging in Gaza. Israel’s continued, repeated displacement of the malnourished and sick population of Gaza, half of whom are children, to areas with no running water or even toilets available is absolutely shocking. It is virtually guaranteed to result in widespread death from viral and bacterial diarrheal diseases and pneumonias, particularly in children under the age of five. We worry that unknown thousands have already died from the lethal combination of malnutrition and disease, and that tens of thousands more will die in the coming months. Most of them will be young children.

Children are universally considered innocents in armed conflict. However, every single signatory to this letter treated children in Gaza who suffered violence that must have been deliberately directed at them. Specifically, every one of us on a daily basis treated pre-teen children who were shot in the head and chest.

Image source

President and Dr. Biden, we wish you could see the nightmares that plague so many of us since we have returned: dreams of children maimed and mutilated by our weapons, and their inconsolable mothers begging us to save them. We wish you could hear the cries and screams our consciences will not let us forget. We cannot believe that anyone would continue arming the country that is deliberately killing these children after seeing what we have seen.

The pregnant women we treated were particularly malnourished. Those of us who worked with pregnant women regularly saw stillbirths and maternal deaths that were easily preventable in any third-world healthcare system. The rate of infection in C-section incisions was astonishing. Women underwent C-sections without anesthesia, and were given nothing but Tylenol afterwards because no other pain medications were available.

All of us observed emergency departments overwhelmed by patients seeking treatment for chronic medical conditions such as renal failure, hypertension, and diabetes. Aside from trauma patients, most ICU beds were taken up by type 1 diabetics who no longer had access to injected insulin, due to the lack of medication and the widespread loss of electricity and refrigeration. Israel has destroyed more than half of Gaza’s healthcare resources and has killed one out of every 40 healthcare workers in Gaza. At the same time healthcare needs have increased massively from the lethal combination of military violence, malnutrition, and disease.

The hospitals where we worked were starved of basic supplies from, surgical material to soap. They were regularly cut off from electricity and Internet access, denied clean water, and operated at four to seven times their bed capacity. Every hospital was overwhelmed beyond the breaking point by displaced persons seeking safety, by the constant stream of patients whose treatment of chronic conditions had been interrupted by the war, by the huge influx of seriously wounded patients who typically arrived in mass casualty events, and by the sick and malnourished seeking medical care.

These observations and the publicly available material detailed in the appendix lead us to believe that the death toll from this conflict is many times higher than what is reported by the Gaza Ministry of Health. We also believe this is probative evidence of widespread violations of American laws governing the use of American weapons abroad, and of International Humanitarian Law. We cannot forget the scenes of unbearable cruelty directed at women and children that we witnessed ourselves.

As we met our healthcare colleagues in Gaza it was clear that they were malnourished, and both physically and mentally devastated. We quickly learned that our Palestinian healthcare colleagues were among the most traumatized people in Gaza, and perhaps in the entire world. Like virtually all people in Gaza they had lost family members and their homes. Most lived in and around their hospitals with their surviving families in unimaginable conditions. Although they continued working a grueling schedule, they had not been paid since October 7. All were acutely aware that their work as healthcare providers had marked them as targets for Israel. This makes a mockery of the protected status hospitals and healthcare providers are granted under the oldest and most widely accepted provisions of International Humanitarian Law.

We met healthcare personnel in Gaza who worked at hospitals that had been raided and destroyed by Israel. Many of these colleagues of ours were taken by Israel during the attacks. They all told us a slightly different version of the same story: in captivity they were barely fed, continuously physically and psychologically abused, and finally dumped naked on the side of a road. Many told us they were subjected to mock executions and other forms of mistreatment and torture. Far too many of our healthcare colleagues told us they were simply waiting to die.

We urge you to see that Israel has directly targeted and deliberately devastated Gaza’s entire healthcare system, and that Israel has targeted our colleagues in Gaza for death, disappearance, and torture. These unconscionable acts are entirely at odds with American law, American values, and International Humanitarian Law.

Image: Dr Suleiman Qaoud surveys the damage at the Rantisi Specialist Hospital, part of the Nasser Medical Complex in Gaza City, following Israeli missile attacks on November 6, 2023 [Abdelhakim Abu Riash/Al Jazeera]

Dr. Biden, you worked with young people throughout your life. We hope and pray that you will not look away from the unspeakable horrors the youth of Gaza face today, horrors only we as Americans can end. We sincerely hope you will do everything in your power to stop what is being done to them.

President Biden and Vice President Harris, any solution to this problem must begin with an immediate and permanent ceasefire.We urge you to withhold military, economic, and diplomatic support from the State of Israel and to participate in an international arms embargo of both Israel and all Palestinian armed groups until a permanent ceasefire is established, and until good faith negotiations between Israel and the Palestinians lead to a permanent resolution of the conflict.

In the meantime:

We are not politicians. We do not claim to have all the answers. We are simply physicians and nurses who cannot remain silent about what we saw in Gaza. Every day that we continue supplying weapons and munitions to Israel is another day that women are shredded by our bombs and children are murdered with our bullets.

President Biden and Vice President Harris, we urge you: end this madness now!

Sincerely and urgently,

Feroze Sidhwa, MD, MPH, FACS, FICS
Trauma, acute care, critical care, and general surgeon
Northern California Veterans Affairs general surgeon
Served at European Hospital, Khan Younis, March 25-April 8 Secretary/Treasurer, Chest Wall Injury Society
Associate Professor of Surgery, California Northstate University College of Medicine
Prior humanitarian work in Haiti, West Bank, Ukraine (3 deployments since 2023), and Zimbabwe
Treated victims of the Boston Marathon Bombing
French Camp, CA

Mark Perlmutter, MD, FAAOS, FICS
Orthopedic and hand surgery
Served at European Hospital, Khan Younis, March 25-April 8 President, World Surgical Foundation
Global Vice President, International College of Surgeons Prior humanitarian work in 30 countries
Treated victims of 9-11 and Hurricane Katrina
Rocky Mount, NC

Thalia Pachiyannakis, MD, FACOG
Obstetrician and gynecologist
Served at Nasser Medical Complex, Khan Younis, June 20-July 11 South Bend, IN

Adam Hamawy, MD
Plastic and reconstructive surgeon
Served at European Hospital, Khan Younis, May 1-21 Lt. Colonel, U.S. Army (Ret.)
Princeton, NJ

Bing Li, MD
Emergency medicine
Served at European Hospital, Khan Younis, June 6-13
Served at Nasser Medical Complex, Khan Younis, June 14-20 Served at Indonesian Hospital, Beit Lahia, June 21-July 3 U.S. Army Veteran
Peridot, AZ

Thaer Ahmad, MD
Emergency medicine
Served at Nasser Medical Complex, Khan Younis & al-Aqsa Martyrs Hospital, Deir el-Balah, January 8-24
Director of Global Health, Advocate Christ Medical Center Assistant Clinical Professor, University of Illinois Chicago College of Medicine
Chicago, IL

Tanya Haj-Hassan, BM BCh, MSc
Pediatric intensivist
Served at al-Aqsa Martyrs Hospital, March 11-25
Prior humanitarian work in the West Bank with Doctors Without Borders
Rhodes Scholar
Philadelphia, PA

Mohammad Subeh, MD, MS
Emergency medicine and ultrasound
Served at the International Medical Corps Rafah Field Hospital, February 14-March 13
Served at the International Medical Corps Deir el-Balah Field Hospital, June 25-July 18
Mountain View, CA

Nahreen Ahmed, MD, MPH
Pulmonary and critical care intensivist
Served at Nasser Medical Complex, Khan Younis, January 8-21 Served at the MedGlobal/WHO Nutrition Center, Rafah,; al-Awda Hospital, Gaza City & Kamal Adwan Hospital, Beit Lahia March 4-18
Former medial director, MedGlobal
Previous humanitarian work in Yemen, Syria, Ukraine, and Sudan Philadelphia, PA

Ahmed Hassabelnaby, DO
Emergency medicine
Served at European Hospital, Khan Younis, March 18-April 1 Served at Indonesian Hospital, Beit Lahia, June 20-July 3 Orlando, FL

Talal Khan, MD, FACP, FASN, FRCP
Nephrologist
Served at Nasser Medical Complex, Khan Younis, July 16-August 13
Clinical Associate Professor, University of Oklahoma College of Medicine
Currently serving in Gaza
Oklahoma City, OK

Mahmoud G. Sabha, MD
Family medicine
Served at al-Aqsa Martyrs Hospital, Deir el-Balah, March 25-April 3
Served at European Hospital, Khan Younis, May 1-17
Dallas, TX

Asma A. Taha, PhD, RN, CPNP-PC/AC, FAAN
Pediatric nurse practitioner
Served at Emirati Hospital for Women and Children, Rafah, February 15-March 1
President, Association of Faculties of Pediatric Nurse Practitioners Professor of Nursing, Oregon Health & Science University School of Nursing
Portland, OR

Imad Tamimi, DMD
Oral and Maxillofacial Surgeon
Served at European Hospital, Khan Younis, February 8-20 Clinical Associate Professor, Rutgers New Jersey School of Dental Medicine
President, Palestine Children’s Relief Fund Medical Advisory Board
Clifton, NJ

Chandra Hassan, MD, FACS, FRCS
General, bariatric, minimally invasive, and robotic surgeon Served at Nasser Medical Complex, Khan Younis & al-Aqsa Martyrs Hospital, Deir el-Balah, January 9-23
Board Member, MedGlobal
Prior humanitarian work in Ukraine and Syria
Associate Professor of Surgery, University of Illinois College of Medicine
Chicago, IL

Hani El-Omrani, MD
Obstetric and regional anesthesiologist
Served at European Hospital, Khan Younis, March 4-18 Assistant Professor of Anesthesiology, University of Washington School of Medicine
Seattle, WA

Zaher Sahloul, MD, FCCP
Pulmonary and critical care intensivist
Served at Nasser Medical Complex, Khan Younis, January 9-25 President, MedGlobal
Associate Clinical Professor of Medicine, University of Chicago Pritzker School of Medicine
2020 Gandhi Peace Award recipient
Chicago, IL

Mike M. Mallah, MD
Trauma, acute care, critical care, and general surgeon Served at European Hospital, March 4-18
Assistant Professor of Surgery
Director of Global Surgery Program
Charleston, SC

Mohamed Elfar, MD, MSc, FACS, FCCM
Plastic and reconstructive surgeon
Served at European Hospital, Khan Younis, February 8-20 Assistant Professor of Surgery, SUNY Upstate Medical University Adjunct Professor of Surgery, Touro University New York College of Osteopathic Medicine
New York City, NY

Hisham Qandeel, MD
Cardiac and thoracic surgeon
Served at European Hospital, Khan Younis, March 18-April 1 Clinical Assistant Professor, Michigan State University Medical Schools
Lansing, MI

Mohammed J. al-Jaghbeer, MD, FCCP
Pulmonary and critical care intensivist
Served at European Hospital, Khan Younis, March 25-April 8 Cleveland, OH

Waleed Sayedahmad, MD, PhD
Anesthesiologist
Served at European Hospital, Khan Younis, March 25-April 8 Parkland, FL

Amer Afaneh, MD, FACS
Trauma, acute care, critical care, and general surgeon
Served at European Hospital, Khan Younis, March 25-April 8 Toledo, OH

Omer Ismail, MD, FACS
Trauma, acute care, critical care, and general surgeon Served at European Hospital, Khan Younis, May 1-21 Des Moines, IA

Ammar Ghanem, MD, FCCP
Pulmonary and critical care intensivist
Served at European Hospital, Khan Younis, May 1-17
Clinical Assistant Professor, Michigan State University College of Osteopathic Medicine
Lansing, MI

Abeerah Muhammad, MSN, RN, CEN
Emergency and critical care nurse
Served at European Hospital, Khan Younis, May 1-17
Dallas, TX

Abdalrahman Algendy, MD
Anesthesiologist
Served at European Hospital, Khan Younis, February 19-March 5
Toledo, OH

Ayman Abdul-Ghani, MD, FACS, FRCS
Cardiac and thoracic surgeon
Served at European Hospital, Khan Younis, March 25-April 8
Honolulu, HI

Mohamad Abdelfattah, MD
Pulmonary and critical care intensivist
Served at European Hospital, Khan Younis, May 1-17
Los Angeles, CA

Irfan Galaria, MD, MBA
Plastic and reconstructive surgeon
Served at European Hospital, Khan Younis, January 29-February 7
Chantilly, VA

Mohammed Khaleel, MD, MS
Orthopedic and spine surgeon
Served at European Hospital, Khan Younis, April 3-10
Fort Worth, TX

Salman Dasti, MD
Anesthesiologist and interventional pain specialist
Served at European Hospital and Nasser Medical Complex, Khan Younis, June 20-July 4
San Francisco, CA

Bashar Alzghoul, MD, FCCP
Pulmonary and critical care intensivist
Served at European Hospital, Khan Younis, March 25-April 8
Gainesville, FL

Lana Abugharbieh, BSN, RN, CEN
Trauma, operating room, and emergency nurse
Served at European Hospital, Khan Younis & Primary Care Clinics, Rafah, January 24-February 7
Ashburn, VA

Rana Mahmoud, RN, BSN
Emergency and critical care nurse
Served at European Hospital, Khan Younis, January 22-February 6 & March 25-April 8
Wesley Chapel, FL

Tarek Gouda, RN, AACN
Critical care nurse
Served at European Hospital, Khan Younis, March 5-13
San Diego, CA

Ndal Farah, MD
Anesthesiologist
Served at European Hospital, Khan Younis, February 8-20
Toledo, OH

Hina Syed, MD
Internal medicine and geriatric medicine
Served at al-Aqsa Martyrs Hospital, Deir el-Balah, April 1-10
College Park, MD

John Kahler, MD, FAAP
Pediatrician
Co-founder, MedGlobal
Served at Primary Care Clinics, Rafah, January 8-24
Served at Kamal Adwan Hospital and Nutrition Center, Beit Lahia, March 4-25
Chicago, IL

Aman Odeh, MBBS, FAAP
Pediatrician
Served at Emirati Hospital for Women and Children, Rafah, March 20 to April 1
Assistant Professor of Pediatrics, Dell Medical School
Austin, TX

Tamer Hassen, BSN
Trauma and emergency nurse
Served at European Hospital, Khan Younis, April 29-May 22
Bedford, MA

Gamal Marey, MD, FACS, FACC
General, cardiac, and thoracic surgeon
Served at European Hospital, Khan Younis, March 25-April 8 Lt. Colonel, U.S. Army Reserve
Stockton, CA

Ahmad Yousaf, MD, MBA
Internal medicine physician and pediatrician
Served at al-Aqsa Martyrs Hospital, June 24-July 16
Little Rock, AK

Ahmed Ebeid, MD
Anesthesiology and pain specialist
Served at Kamal Adwan Hospital, Beit Lahia, March 25-April 13
Portland, OR

Nadia Yousef, MD
Nephrologist
Served at Nasser Medical Complex, Khan Younis, June 18-July 3
Modesto, CA

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