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.

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

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:

1. All land crossings between Gaza and Israel as well as the Rafah Crossing must be opened to unfettered aid delivery by recognized international humanitarian organizations. Security screening of aid deliveries must be conducted by an independent international inspection regime instead of Israeli forces. These screenings must be based on a clear, unambiguous, and published list of forbidden items, and with a clear independent international mechanism for challenging forbidden items, as verified by the UN Office for the Coordination of Humanitarian Affairs in the occupied Palestinian territory.

2. A bare minimum water allocation of 20L of potable water per person per day must be allocated to the population of Gaza, as verified by UN Water.

3. Full and unrestricted access of medical and surgical professionals and medical and surgical equipment to the Gaza Strip must be allowed. This must include items taken in healthcare professionals’ personal luggage to safeguard their proper storage, sterility, and timely delivery, as verified by the World Health Organization. Incredibly, Israel is currently blocking any physician of Palestinian descent from working in Gaza, even American citizens. This makes a mockery of the American ideal that “all men are created equal” and degrades our nation and our profession. Our work is lifesaving. Our Palestinian healthcare colleagues in Gaza are desperate for relief and protection, and they deserve both.