Health Sovereignty in Palestine: A Conversation Between Mary Turfah and Dr. Ghassan Abu Sittah

The conversation below took place over several months, all before the start of this round of the US-Israeli war against Iran and the renewed Israeli assault on Lebanon. It started in October 2025, in the immediate aftermath of the so-called ceasefire in Gaza, as international NGOs flooded the scene and threatened to dissolve Palestinian sovereignty, particularly through the erosion of what Abu Sittah terms health sovereignty. We discussed the extent of this threat, the forms it takes, and what solidarity through medicine might look like in its place. I followed up with him a few times after, as additional questions came to mind. We spoke most recently, on this record, after Doctors Without Borders (Medicins Sans Frontieres, or MSF) first said, then denied it had said, then withdrew having said—following significant international backlash—that it would give the names of its staff in Gaza to the Israeli occupation; and then again after MSF issued a question and answer document in which it claimed to have witnessed armed men operating within Palestinian hospitals, tacitly providing a basis for Israel’s targeting of Palestinian hospitals, endangering the lives of everyone who has, does, or will provide or seek medical care in Gaza. MSF’s claims prompted medical personnel around the world who had recently worked in Gaza to provide testimonies denying those claims. Friends who worked for the organization resigned. Abu Sittah and I discussed how MSF’s turn reflects something bigger; the organization is simply doing what our new world order—where liberal frameworks are passé and might makes right—requires of it.

[Ed. note: this conversation has been edited for length and clarity].

 

♦♦♦

 

Mary Turfah: Let’s start with where we’re at now.

Ghassan Abu Sittah: Khalas (خلاص —“enough”), the West is no longer flirting with the liberal welfare state. It is now practicing pure violence—and all of its institutions are going along with it, including the humanitarian sector. Since World War II, the humanitarian sector was necessary for the West to portray its cultural superiority. Since the genocide, it is clear that we are down to the bare-knuckle fight of racial superiority. The humanitarian sector—through organizations like the International Committee of the Red Cross (ICRC), like Médecins Sans Frontières (MSF)—is indicating that it’s prepared to also make that turn. The image is that of a Red Cross bulldozer in a Palestinian neighborhood, surrounded by flattened buildings holding Palestinian bodies that have not been retrieved, digging for a single Israeli body. It’s already signaling that it is prepared to engage with Trump’s reservation model. And effectively, Trump’s plan for Gaza is a Native American reservation. With the casinos, with the local managers working for a white man that’s never seen the place—all of it.

I’m in contact with the Ministry of Health (MOH) in Gaza, and they are being inundated with multi-million dollar offers from international humanitarian organizations to buy the remaining hospitals in Gaza.

MT: Buy them?

GAS: Yes, buy them. The International Medical Corps (IMC) wants to buy Al-Shifa.

MT: Who owns it currently? The MOH?

GAS: Yes. And the MOH has also gotten an offer from the Europeans, who are much more structurally hypocritical. They want to rent long-term, for 15 years. And of course, the condition is total control. So that these hospitals are no longer part of the Ministry of Health system. You see immediately how the humanitarian sector falls in line with a vision where Palestinian sovereignty is destroyed. If not by force, then by the need for reconstruction.

MT: The body is the first site of control, right?

GAS: Exactly. And also, it’s part of what Sarah Roy has written about: de-development. And de-institutionalization as being a critical component of de-development.

MT: What is the response of the health ministry to these offers?

GAS: Of course, they see right through them. These are organizations that have had zero interest in Gaza during the war, are now calling up to try to buy these hospitals?

MT: And are these organizations private companies or humanitarian NGOs?

GAS: All humanitarian, all ibn halaal (ابن حلال –“good guys”). Currently, one of my favorite quotes is by Domenico Losurdo, an Italian Marxist. He says these people oppose oppression but they never want you to win.

MT: No, because then their jobs are done.

GAS: Absolutely. And the real job of the humanitarian sector for global capital was to give the pretense of cultural superiority. And now that we’re down to a bare-knuckle fight over whiteness and racial hierarchy, they have to send the bulldozer to look for the Israeli body, surrounded by buildings full of Palestinian bodies under the rubble.

MT: This is part of the psychological war, because it’s not that you don’t know what the game is. You do and you’re so desperate that you don’t have a choice. The argument for these organizations, from talking to people in MSF over the last two years, has been, well, the Palestinian Red Crescent, or its equivalent in Lebanon, these organizations are going to be targeted by Israel, so at least if we work under an international humanitarian organization, then there’s some possible protection.

GAS: There’s also the assumption that they make a difference. They don’t make a difference. MSF runs its programs in Gaza using Palestinian staff that it has lured away from the Palestinian health system using high salaries. IMC does the same. And most of these organizations operate through Palestinian staff; very few organizations bring in new teams to assist.

MT: So Israel is going to target them anyway, because it’s the foreignness—and the whiteness specifically—that’s been protective, which does not extend to Palestinians regardless of which organization they’re with.

GAS: We saw that with the detention of Mohammad Obied, and we saw that with the attack on Al-Awda that killed the three Palestinian surgeons in the MSF unit. Israel targeted the MSF part of Al-Awda Hospital in Jabalia specifically.

MT: And MSF has used these attacks to lend itself credibility, a sort of, “Look, we’re working against Israel and threatening it.” Another argument I’ve heard in favor of these organizations is that they’re well-intentioned but have their hands tied by Israel, and, even if they’re collaborating, it’s only so that they can be able to continue to do the work they otherwise do. But you’re saying that the Palestinians who are doing this work exist whether or not they’re affiliated with these organizations, and all these organizations do is depoliticize them and take their labor away from their people. And it’s always been like this, and Palestinians have probably seen it like this, but people need money. So they feed off of people’s desperation.

GAS: Yeah. It’s riding the tiger, it’s tolerating the parasite. What is critical is Palestinian health sovereignty. They serve the interests of imperialism by eroding Palestinian health sovereignty.

MT: Everything now is being reduced to the level of survival. Before, we might have recognized these as crumbs, and we still can, but—

GAS: —But we need crumbs. At the moment, because of the famine, we need crumbs.

MT: Yeah, and so it’s a very different kind of calculus than before. And this bind takes away people’s dignity and works to isolate them as individuals, and that’s part of the whole game.

GAS: It’s part of the racialization, which is a return to the original Western imperialist ideology: these people exist at a level where their needs are purely physiological. They need to be fed, they need to be watered, and they need to be housed, but they are not of a higher form that has existential needs, God forbid political needs. And the humanitarian sector really fulfills that. That’s why the newspapers of the British right were very comfortable at the height of the famine, having the pictures of starving Palestinian children on the front page. This is perfect.

MT: You’re a suffering body, and the West can save you. They have no problem showcasing our suffering. It’s a critique of the suffering that’s political, or, worse, our taking matters into our own hands, that becomes a problem.

GAS: It’s our agency. You cannot be a political entity as a Palestinian. You can be a suffering physiological entity worthy of the pity of the superior white man, but that’s about it.

If we step back, we see that healthcare has been central in this genocide—there has never been a war in the history of humanity which has been so fundamentally fought in the clinic. On the one hand, it is central to the Israeli genocidal plan, which uses its attacks on healthcare to force those who remain to leave Palestine. And, on the other hand, the clinic is central to Palestinian society’s resistance. It’s only natural then that this vision of an American-style reservation also has its eye on the health system as the place to start breaking Palestinian sovereignty, using the total destruction of all the components of life and the need to rebuild them, in order to destroy first Palestinian health sovereignty, and through it Palestinian sovereignty more broadly.

MT: Why is healthcare so central?

GAS: Because had it not been for the hospitals holding on, continuing to work, the ethnic cleansing would have happened. Look: the north was not emptied until they broke al-Awda and the Indonesian hospital. Had al-Ahli and al-Shifa not held steadfast, during the last three weeks before the ceasefire, people would have left Gaza City.

MT: Why?

GAS: These places anchor people. They are places of life. They are zones of being in zones of non-being. Being is about sovereignty as much as it is about the technicalities of human health.

MT: Are you saying the effect is psychological? That you still have this node where there’s a commitment to life, and people reach for it?

GAS: I mean, we saw it. Even if we didn’t believe it, we saw it.

MT: And it wasn’t just that people were sheltering at the hospitals.

GAS: It was more than that. It’s both, it’s beyond the psychic thing. I mean, the psychic comes from the practicality of things. It exists at the edges of life and death. People in the West don’t hold medicine in the same regard because it’s in abundance, and in the States, it’s become the enemy. Because of the corporatization of medicine, health has become a commodity, you know, it’s no longer viewed by people as indicative of sovereignty or non-sovereignty. But in Palestine you have people—medical workers—walking off the ICRC bus from Israeli prisons straight to the hospital. You have people within two days of losing their wives and their kids, coming back to the hospital. There was an orthopedic surgeon at Nasser hospital, a few days after losing his wife and small children, who returned to work.

In Gaza, as a doctor, you’re part of the society. The people you’re treating are your neighbor’s kids and your cousin and your friend with whom you went to school.

MT: It’s harder to lose sight of the person in front of you.

GAS: Because you still have social value as a human being.

MT: This brings us back to the concept of health sovereignty, let’s talk about what that looks like. Let’s say I’m going into a clinic as an MSF volunteer versus as a doctor who’s committed to health sovereignty, how does my practice change?

GAS: If you’re committed to health sovereignty, let’s say in the case of Palestine, you work under Palestinian leadership. At the macrocosmic level, at the organizational level, and within the hospital—MSF, for example, insists instead that it have its own space. And, you do not assume, purely by virtue of your whiteness, that you are more of an expert than the doctors who’ve been doing this work for decades.

MT: Western doctors might argue that they have access to more resources. I’ve heard several doctors who’ve come back from Palestine say things like, “Oh, they don’t have this or that, don’t have access to this training, so we need to help them.” It’s not that they know better because they’re from the West, it’s an access gap issue.

GAS: You have more access by virtue of what? By virtue of your position within the empire. The other thing: there’s a lot of pathology. This obsession with gratitude. They want you to be grateful. They want the Palestinians to be grateful for their presence. On an institutional level, it keeps coming up in their meetings. And on a personal level.

MT: What’s an example?

GAS: I was told, while I was at the Turkish hospital, that the problem MSF had was that they didn’t feel that the staff and the patients were grateful. This obsession is beyond what’s normal. And the amount of hubris. Imagine, you’re in a situation where as an NGO you have two operating rooms. And on a nightly basis, there are 300 wounded. They’re convinced they’re making a difference. And this delusion is some of why I think this genocide marks the end of humanitarianism. Regardless of the fact that this is the worst thing ever to happen to humanity in terms of the magnitude, they still feel that they’re making a difference.

MT: Everyone wants to feel like they’re doing something, you know? But you’re saying this insistence on their efficacy is rooted in arrogance.

GAS: Absolutely. And the feeling that those you are serving have no agency. Are you there to support your comrades in their struggle, or are you there to struggle in these people’s place?

MT: What makes you think that they think Palestinians don’t have agency?

GAS: They have always had this sense that, if they take over the hospital, they’ll run it better.

MT: What does care look like with health sovereignty in mind?

GAS: Then you go and bit sallim 7aalak (بت سلّم حالك —“offer/submit yourself”) to the division head at a hospital, and you say, consider me like any one of your employees. For 30 years, I would land in Gaza, I would go to Abu Salmiya, or to Ahmad Mhanna at Al-Awda, and I would say, put me wherever you see fit. I’m just an added resource. And every war they’d send me somewhere different.

You have to submit yourself to the will of the indigenous structures. You have to recognize today what injures and makes people sick is power, is colonial power in its many manifestations, say in the most abrupt manifestation of the bomb, or in its insidious manifestations of pollution, or social murder, etc. You have to start by acknowledging that there is no such thing as a power-neutral position, and you have to see health sovereignty as being critical to trying to offset this power that exists in the wounding, and in the structure that you live in.

Health sovereignty is part of the struggle, and unless you want the Palestinians to win, you shouldn’t be helping the Palestinians. The problem historically with Western leftists, is they oppose oppression, but they don’t want you to win. And it’s the same with these people. They’re unable to lose the sense of their own importance. Your sense of your own importance is coloniality.

MT: Someone might say, well, you can get medical care as medical care, and then you can engage in the political, the aspirational, outside of the clinic.

GAS: What is politics other than life? And what is health other than life?

MT: The part that’s difficult to envision, and which Israel has worked hard to make it difficult to envision is, how we move from the current situation to anything that looks like life, because everything—

GAS: This is the problem, you can’t negotiate with the current position. You have to end the current position. You can’t ameliorate the current position. You can’t create a better Native American reservation. Nothing will get better until Zionism is defeated—not until there’s a Palestinian state, until Zionism, as the ideological machine that produces Israel, that produces these policies of murder and genocide and destruction, is defeated. In the interim, you keep resisting, you keep resisting, because the project is still genocidal. Resistance is survival.

♦♦♦

MT: There are two things that have happened since we last spoke. There’s MSF almost giving the list of its staff in Gaza to the Israelis, and then reversing course and not giving the list. And then, there’s MSF claiming that there were gunmen in hospitals in Gaza. We can start with the staff list.

GAS: So, what happened was that MSF leadership was in the process of agreeing to submit a list of its employees, as the Israelis requested. And they had gone through a rubber stamp exercise in which the organization didn’t ask its employees in Gaza, but instead merely informed them that this was happening, then registered the process as a consultation, as in they told them and framed it as though they had been asked.

MT: I was reading through the Q&A that they wrote—it’s all PR and legal jargon, there’s no humanity in any of this.

GAS: The idea that someone in Gaza who has a job in the only functioning part of the labor market is capable of consent, when they are probably not just feeding their own kids, but also their siblings’ kids, their whole extended family because there’s no part of the labor market in Gaza where people are earning wages except the NGO sector in Gaza—the idea that this is free will is obscene on a moral level. Then, there’s the legal issue. You know, European Union law says that you, as a European employer, have a duty of care towards your employees, even if they’re not European or within Europe. And the data protection laws of the EU says that you can’t share a database if it puts at risk the lives of the subjects in the database. So you want to share the database of your employees with a government that has killed over 1,700 health workers, has killed 563 aid workers, of whom 15 were your own employees, a government that—as the UN has written about—during the siege, used to blackmail the applicants seeking exit permits for cancer treatment outside Gaza, and the parents of kids who needed life-saving surgeries. Knowing all of that, and you still decide that it’s a good idea to share the data.

MT: Did Israel ask them for the data, or did they volunteer it?

GAS: It was a precondition. Any Palestinian who’s over the age of two, anyone who’s lived with Israel for any of the last 100 years, will tell you that the Israeli security mind will always ask you for information that they already have, initially. And then, they’ll ask you for the stuff that they don’t have. And then they’ll ask you for more, because you’ve become compromised. And this is what’s going to happen. We’re gonna start with a list of employees, we’re gonna move to a list of shortlisted potential employees to be vetted before they’re given the job. Then we’re going to move to a list of patients. Then we’re going to move to vetting who are acceptable patients that can be treated by MSF, and who are not. As used to happen with USAID NGOs.

MT: And the presence of gunmen, per MSF. Could you touch on that?

GAS: When you talk to people in other NGOs, everyone’s saying that no one saw them. Basically, in its Q&A section, MSF posted that they’ve had to withdraw from Nasser Hospital because there were Palestinian gunmen in Nasser. First of all, it’s an acceptance of the narrative of the destruction of the health system. It signifies to Israel that despite the local difficulties with the natives, MSF accepts the narrative that it only attacked hospitals because there were Palestinian gunmen inside. I have inside sources in MSF that tell me that these were hospital police charged with keeping the hospital safe. And that’s why none of the other NGOs said it.

MT: And the thing is, all MSF has to do is say this once, and it increases the possibility of attacks against hospitals in the future.

GAS: Yes. You see how quickly Haaretz wrote about it. And AP picked it up. And Reuters picked it up.

MT: Yeah, after you texted me I googled it and saw that it was everywhere already.

GAS: Everybody working on cue! That’s it! Our fundamental problem is that the West is our enemy. We live in their world and can’t function if we believe that, and so we try to suppress it.

MT: Could you elaborate on that?

GAS: This genocide has shown this: the West is the enemy of the Palestinian people. Israel is an appendage. It’s a weapon. It’s a weapon they use against us. And that lie that they manage to convince the Palestinian compradorial elite, that somehow the West is a misguided third party, that lie has expired during this awakening. People see that organizations like IMC are tools of Western imperialism—different faces of the arms manufacturers, but still tools of these Western institutions that committed the genocide. They didn’t allow the genocide. They didn’t fail to stop the genocide. It’s theirs. They all went to Israel. The leadership of the Western world descended on Tel Aviv on October 8th, and everything was decided from there. And if you listen to Keir Starmer’s support of starvation, back in November 2023, you realize all of the weapons of the genocide were agreed upon.

MT: So now the question is, what made them stop going at full force?

GAS: They failed! Because they failed.

MT: Yes, but Israel is in a bind: it has to keep committing genocide at this point.

GAS: True. And the genocide started to do the one thing Western elites do not want to happen. It started to destabilize the western street. Take the general strike in Italy, the election results in the UK, all of these are red lines for a class that has spent decades pacifying its own populations. So, now we need to move to the quiet phase of the genocide. The less dramatic phase of the genocide.

MT: Yes, until they bomb Lebanon. Or Iran. Or Gaza. It has to start again—

GAS: The difference between Israel and other settler colonial projects, is it pretended to be something it wasn’t. And this genocide has come partly as a result of, and partly to accelerate, the decay of the paraphernalia of Zionism as a multi-layered, multifaceted ideology. It’s just about killing the indigenous.

MT: It’s so simple. You were saying that MSF, and these other organizations, are playing along with this rightward turn. Do you think it is a shift in what these organizations are about, or a loss of pretense?

GAS: A loss of pretense.

MT: When do you think that happened?

GAS: Again, it’s the genocide. The genocide is the end of Western liberalism. Because 90% of the genocide happened under Western liberal political parties, either the Democrats, or the Labour Party in the UK, or continental Europe.

MT: Well, they trialed raw violence, and, sure, people got mad, they took to the streets, but nothing really happened. I mean, there were some flotillas.

GAS: I was talking to some of the South African comrades, and I was saying, one of the things that the West, and especially Western liberals, did is they rewrote the narrative of the South African struggle, to make it so that it’s the anti-apartheid movement in the West that brought down apartheid, and that the struggle of the South African people was less important than that movement. In this version of events, the mobilization of the street and the armed struggle of the ANC were either counterproductive or trivial, if they want to be kind.

Although it’s critical for us to continue to destabilize the West, through anti-imperialist demonstrations against these most barbaric manifestations of Western imperialism, which include the genocide, it’s not gonna liberate Palestine.

MT: At best it will liberate people here. I wrote an essay a few months ago about the photo of Napalm Girl and the limits of war photography. Like you said, there’s this idea here in the US that the right photograph is enough to, say, stop a war. That the millions of Vietnamese that were killed didn’t make a difference, and instead it was one photograph that raised the consciousness of the antiwar movement here, who were the primary drivers for the end of the war. Getting back to the complicity of Western NGOs, there’s been some mention of a fallout between you and MSF, and you and MAP.

GAS: It wasn’t a fallout. On the 17th of October, the al-Ahli hospital massacre happened. The day after, I was asked by MAP, Medical Aid for Palestinians, to leave the Board of Trustees.

MT: Which is crazy, because you’re friends with the founder. But I guess they sidelined her too.

GAS: Completely. Years ago.

MT: And now it’s more of a British-centric organization. I remember talking to her once, and she told me that she’d initially wanted to call it Medical Aid for Palestine, to be explicit about the fact that this was about liberating Palestine—

GAS: And they wouldn’t let her. And then two days later, I got a phone call from the head of comms of the Jerusalem office [of MSF] to say, “can you please stop referring to yourself in the media as an MSF volunteer.”

MT: Because of the language you were using around the Al-Ahli massacre?

GAS: Because of the language that I was using, because of my refusal to accept what they had all accepted, the lie about the Al-Ahli massacre being caused a misfired Palestinian missile, because I was part of the press conference with [Yousef] Abu al-Reesh and Fadel Naim and the Ministry of Health. All of that.

MT: If we were to peel these international organizations away, what’s left? How does one begin to rebuild at a time when you’re desperate?

GAS: Well, the rebuilding that has happened—and of course, they would rebuild and it would get destroyed—but for example, the Indonesian hospital was rebuilt two times before it was overrun, during the last two years. The administrative building of Shifa was rebuilt and turned into an emergency department. All of this was done by charitable organizations based in the Global South. Malaysians and Indonesians and popular committees from Jordan. They were never done by Western NGOs. Western NGOs made sure that they never invested in structural repair of Palestinian hospitals.

There’s also a need for capacity building. MSF never used to teach courses. The overwhelming majority of the large NGOs did not believe in capacity building. The very little capacity building that occurred either happened through South-to-South cooperation—the Malaysians sent help, the Qatari red crescent trained some doctors—Mahmoud Matar, Adnan Al-Bursh, all these guys trained via south-to-south cooperation.

The only Western NGOs that believed in this were the small organizations, like IDEALS. Of all of the western organizations, IDEALS believed in training, and in the centrality of capacity building.

MT: What does capacity building look like here?

GAS: If you believe that by virtue of your proximity to the center of the empire, you have access to knowledge and technologies that those at the periphery don’t have, then what you do is you make yourself a conduit for empowering them. If you believe that what they’re lacking is purely technical knowledge, rather than knowledge bestowed upon you by a superior civilization, then you help build the structures to narrow the gap between you, not emphasize it to justify your presence.

MT: What did IDEALS do differently?

GAS: After the 2014 war, when Ideals realized that complex limb reconstruction was going to play a big role, took Adnan Al-Bursh and Mindar Al-Astal, to King’s College, trained them, and then, when they went back, they would mentor them as needed through their cases. So train them on the job. All of the IDEALS missions were training missions, and all of the cases were training cases. Adnan Al Bursh trained Muhammad Obeid, who is in prison now, and he became a limb reconstruction guy, not trained by IDEALS, but by the trainee of IDEALS. Dr. Al-Astal did the same thing when he went back to Khan Younis.

MT: Would IDEALS facetime into cases or something?

GAS: They’d go on missions. But the aim of the missions was not to do cases on their own; the aim was to do it with trainees, exactly as is done at a teaching hospital. Or, they’d have a joint multidisciplinary team through Zoom. And then, they would visit as often as they could, sometimes every three months, and they would do the complex cases with Mahmoud Matar, Dr. Al-Astal, all of them.

MT: What about the question of resources?

GAS: They would present themselves to the Health Ministry, which would tell them where to come and go. There were times then where they worked at Shifa, there were times when they worked at Nasser. That’s how you develop South-South solidarity.

MT: What does that solidarity look like?

GAS: I mean, it’s very simple. It’s much simpler than people make it out to be. The essence is health sovereignty, real health sovereignty, not the bullshit of corporate medicine. Are you prepared to work with Palestinians, be led by Palestinians, to further Palestinian health sovereignty? Are you prepared to, as under the basic tenets of public health, help end the causes of ill health in the colonial situation, which means to join the struggle against colonialism? If these two conditions fit with the kind of work that you do, then welcome. And if they don’t, then you need to leave. Or, to formally join the other side.

————

MT: What’s the state right now [mid-October 2025] of these hospitals, and the health sector in general?

GAS: Nothing has gone in, even consumables and medication. Nothing has gone in.

MT: So there’s some reliance, then, on these humanitarian NGOs, whether we like it or not?

GAS: No bil3aks (بالعكس – the opposite is true). There were times when these organizations were relying on the Ministry of Health, because the Israelis were not allowing in consumables. For example IMC was asking for consumables from the Ministry of Health stores because the Israelis would not let them bring in their own. But they were told, as part of their mission in Gaza during this war, that they were to have no formal relations with the Ministry of Health. And the same is true with UK Med, and the same with all of these organizations.

MT: This is shocking, honestly. Especially considering the ways these organizations have presented themselves as providing life-saving care and resources to these people, as a lifeline for Gaza from the outside world.

GAS: I’m someone who has worked with MSF in the past, because there are remnants of individuals in MSF who hold anti-imperialist views. That was the case when we were there during the March of Return protests. I had worked with MSF Belgium, I provided care for their move into Gaza, and then I coordinated between them and al-Awda to help set up a limb reconstruction unit, which lasted until the spring of 2023. The problem with MSF, however, is that once these people move on, you’re again faced with people who are not anti-imperialist.

MT: Yeah, they’re treating bodies, not people. And they justify this because of the existential nature of the fight.

GAS: The reason I believe that this genocide will be the end of these organizations is that there’s an internal crumbling happening in organizations like MSF, because MSF believes that it can function, in war, in an ideological vacuum.

MT: Well, to that MSF might respond, as they did to me after I wrote that essay about them, that no, the organization is issuing press releases, calling it a genocide, etc…

GAS: Liberal Zionists have also released a press release calling it genocide. And if you read that B’Tselem report, it’s still the most colonial report ever written. You can’t say “someone died” when the stench of their decaying body fills the room. You say that they’re being killed, as they’re being killed, while there is a chance of stopping them from being killed. These monsters, at the end of the day, do not want to do anything to jeopardize their class interest. And! They still think that you can function in an ideological vacuum.

MT: I think that a lot of that is how we’re socialized as doctors in the West. There is this idea that I, as a doctor, should have solidarity with Palestinian doctors. Doctor to doctor. You have solidarity with people based on common cause, not based on common profession, but there is this idea that medicine is a cause in its own right.

GAS: It’s a calling.

MT: Yes. And my sense is that these organizations have managed to survive in part based on that. They make statements accordingly. Many of the doctors in the U.S. who were rallying for Palestine were calling for solidarity with our medical colleagues. Doctors in the Lancet called for solidarity with Gaza on the basis of “medical duty.” It’s a warping of what solidarity means. It’s no longer about a common political cause, it’s about a common guild.

GAS: It’s not even about being a “humanitarian” in the political humanitarian sense, about humanitarian identification. It’s about class identification. It’s like, you know, when artists sign a petition to defend the rights of Palestinian artists.

MT: I want to go back to MSF’s request that you not speak on their behalf. Was the issue that you weren’t in Gaza through them at that time?

GAS: They were in Gaza through me. The agreement with MSF has always been, I go in because they are so cumbersome, organizationally. By the time they’ve gotten their act together, the borders are closed. So I would go in, and this I did in 2023, and in 2021, and during the Marches of Return. I go in, and once I’m in, I let them know, and then they say that I’m MSF. So that MSF can turn around and say they have someone in Gaza. And I did that for Medical Aid for Palestinians (MAP). MAP was against me going in with Ang Swee Chai [cofounder of MAP] in 2009. But once we were in, they decided there was a funding communications potential. And I did that for MAP in 2014.

MT: Why did you do it for them?

GAS: Because they suited my purposes for that moment in the struggle.

MT: So let’s say we’re in a post-humanitarian organization world. You have the Ghassan Abu Sittah Children’s Fund. There’s a question of scalability, because we don’t have the bandwidth that these organizations have. And then, what to do with the fact these organizations are now targets. Maybe in Beirut in 2024 they didn’t bomb hospitals directly, only very close to them, but they’ve already bombed medical infrastructure in southern Lebanon, and it’s just a matter of time.

GAS: It’s a matter of time globally. My theory is this: one of the reasons this war centered the hospital and the health system, made it really the main thrust of the conduct of the war, is that, unlike in the 50s and 60s and 70s, where enacting a scorched earth policy meant burning the countryside—because then the majority of the third world lived in the countryside—today the majority of the third world lives in urban slums like Gaza. In Nairobi, in Manila, in Sao Paulo. And so what scorched earth means now, militarily, is the destruction of the sewage system, is the destruction of the health system. Moving forward, imperialist wars will now be predicated on the destruction of the health system.

MT: You said somewhere that Palestinian health workers make up 0.8% of the population but were 9% of those killed.

GAS: And these numbers are based on the 69,000 killed. Not just that. There’s an AI software called Where’s Daddy that was programmed to track and kill people designated as targets once they returned to their homes, including doctors and health workers.

MT: The name is so—

GAS: It’s demonic! I mean, the thing about Israel…the difference between a mass murderer and a serial killer is that a mass murderer does not care about the details, it’s about the numbers. A serial killer is all about the details.

MT: Israel is both. I remember I was reading some Israeli coverage about the pager attacks, and they said that it was by design that these thousands of people were maimed, not killed. They were injured in ways that would mark them forever.

GAS: Yes, they could have killed them easily. I treated many of the injured from day one. I got to Beirut on the Wednesday after the Tuesday when they were injured, and I’ve been treating them since then. All it would have taken was a change in the chemical formula of the explosive device, and it could have killed them. But they didn’t want to kill them. And they said they didn’t want to kill them.

MT: Yes, they said they wanted to mark them, as reminders of Israeli supremacy.

GAS: As with the marches of return, when the external fixator [a device used to hold broken bones in place] became that signifier.

MT: I was reading something recently about a couple of the boys you’ve treated: Ali and Omar are their names.

GAS: Ali is from Sarafand. His parents and his siblings were killed. And he is now being raised by his aunt. And Omar, his parents and his siblings were killed in al-Braj (in Gaza), and he’s being raised by his aunt. And they both lost their upper limb. And the bizarre thing is that both of them are so afraid of going under: both of them were screaming, “I might not wake up if you put me to sleep.”

MT: I’m sure these kids are traumatized in ways that they don’t have the language to express. And when they go through the therapy models that are available, it gives them a language that doesn’t just not map onto their experiences, but that also reshapes the way that they perceive themselves. Omar, I read, had some kind of procedure done in the US, but he wasn’t fitted for a prosthetic limb or anything; they just sent him back to Egypt after he recovered?

GAS: The Germans are even better. The Germans give you a month, and then throw you out. I have another kid who had one surgery completed in that month, and then had to leave Germany. That’s the irony: they want to empty Palestine, but these right-wing governments
are in power on an anti-immigration ticket, so the last thing they want is to be seen by their constituencies as bringing in more brown people.

MT: Even as we build up our own organizations, we’re still at their mercy. After the pager attacks, the U.S. was blocking the entry of corneas into Lebanon. A lot of these supply chains belong to the US. So you can build your own hospitals, but how do you get the tools you need? A thing that’s unresolved so far: aid can’t get in unless people are willing to comply.

GAS: I think aid is part of the colonial project. I’m not belittling the efforts of people trying to get aid in. But we need to accept that what gets in and what got in and who got in over the last two years, happened because that was part of the project, the humanitarianization was part of the project, and humanitarianization was critical both in Palestine, and also in the West because it allowed people to believe that they were making a difference. It’s humanitarianization in lieu of meaningful change.

MT: On our side, where’s the room for agency in this way of thinking? If everything is part of a grand calculation.

GAS: The fact that 80,000 people who left Gaza for Egypt have registered to come back, which is really freaking the Israelis out. The performative brutality and the total destruction of the things that make life liveable, has not stopped people from wanting to go back. People’s wa3i (وعي – consciousness) hasn’t been broken.

[Ed. note: Donate to the Ghassan Abu Sittah Children’s Fund here]♦