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Anglo-Israel Cardiology Forum

On 1st September the Anglo-Israel Cardiology Forum held a welcoming reception to bring together British cardiologists with their Israeli colleagues attending the London European Society of Cardiology meeting. Dr Duncan Dymond, co-founder of the Forum, introduced the event and Prof Stephen Brecker, who organised the event, expressed his appreciation of the way that attendees had responded with enthusiasm to the invitation. Both speakers said that we could take pride in the innovative approach to cardiology taken by our Israeli friends and colleagues. They showed a video message from Douglas Murray (author and political commentator), expressing support for cardiologists fostering co-operation between British and Israeli medicine. Prof Amit Segev, President, Israel Heart Society, introduced his talk by calling for a minute of silence in memory of the six hostages whose death had just been announced. He said that linking us together in this way was a key priority in every way - for social, medical and professional reasons. Prof David Katz spoke about the role of the Jewish Medical Association UK – how much energy had had to be diverted recently to handling antisemitism and prejudice; he hoped that we could soon return to focussing on the positive linkages between the two countries, which is what this event represented. The final speaker was Dr Ilya Kumets, who is a Cardiology Fellow at Barts Health NHS Trust, and who described the process of transfer – both formal and cultural - from the Israeli to the British system; and how he had gained so much from the experience.

Occupational therapist - Carmel Gat z”l

Carmel Gat - one of the six hostages whose murder was reported on 1st September - was an occupational therapist. The Hostages and Missing – Families Forum wrote to the World Health Organisation (WHO) and the International Committee of the Red Cross condemning the murder. The full letter (which can be accessed here) was signed by the heads of Israeli Medical Schools and of Israeli Occupational Therapy organisations. In this letter the signatories called for action about three other healthcare professionals (one of whom is reported as dead but his body has not been retrieved yet) who are still missing.

International Federation of Medical Students Associations

In early August the International Federation of Medical Students Associations (IFMSA) suspended the Israeli Medical Students Association (IMSA) from membership. Uniquely even in anti-Israel quarters it is unusual that the IFMSA refers to Hamas and Palestinian deaths on October 7th 2023 without reference to Israeli deaths. IFMSA meetings (and support) is provided by both the World Health Organisation (WHO) and the World Medical Association (WMA). This decision can only be reversed by a two thirds majority. The IMSA have now formally lodged a complaint about the process whereby this decision was taken. A group of Jewish physicians and educators from different countries (including Prof David Katz) have written to the IFMSA to protest against this decision and their letter can be accessed here. British medical students were represented at IFMSA by an organisation called “Students for Global Health”, and the IMSA report that this group were strongly in support of suspension. This is being investigated further.

NHS England Antisemitism Education Courses

NHS England has organised several training courses about antisemitism which have been provided and run by the Antisemitism Policy Trust (APT). The latest of these attracted over 900 participants. Unfortunately, shortly before it took place a communication was sent out by a central London Trust saying that complaints had been received about the course. Staff were discouraged from attending. The JMA responded immediately, were in communication with Danny Stone of the APT, and Dr Fiona Sim and Prof David Katz wrote to the Chief Executive Dr Claire Murdoch:

An item featured in your Trust All Staff Weekly Bulletin of 2 September 2024 has been brought to our attention. Its content is of considerable concern to the Jewish Medical Association, as well as to Jewish medical and other staff working in CNWL NHS Foundation Trust. Whilst we have no interest in the provider of this training, the Antisemitism Policy Trust (APT), we are aware that this organisation has been carefully selected by NHSE, who have commissioned it to provide antisemitism training via Teams to anyone who works anywhere in the NHS.

The APT’s first two sessions, delivered for NHSE some months ago, were well-received by hundreds of NHS staff of all backgrounds and roles, leading NHSE to evaluate and then proceed to commission nationally an ongoing programme of training, to enable as many NHS staff as possible to learn about the often poorly understood, but vile, threat of antisemitism and to counter it. We very much welcomed the decision by NHSE to commission this training.

If CNWL has conducted a thorough review of available antisemitism training, guided by experts on antisemitism and training, which has led you to believe, as stated in your Bulletin, that “this training and its content is inappropriate”, we would ask you to share with us this information as a matter of urgency.

If, however, no such review has been undertaken, we would, respectfully, advise you that it is utterly inappropriate for the Trust to reach this conclusion and share it with all of your staff, thus effectively removing the opportunity for them to access this nationally commissioned training on an important topic, as well as casting aspersions on the provider of the training, who, it seems, was not advised by the Trust of its opinion prior to publishing it to all staff, nor given the opportunity to respond.

We trust that CNWL staff, along with all other NHS staff in England, will be offered the opportunity and also encouraged to attend this antisemitism training on 5 September, through the urgent reversal of this content of this Bulletin.

Dr Murdoch interrupted her holiday to clarify that the communication was an error:

“In the Weekly Bulletin that was sent out across the organisation on Monday (2 September), there was a note concerning Antisemitism training which is sponsored by NHSE and provided by the Antisemitism Policy Trust. I want to apologise for the communication which did not go through our usual sign off processes. I have asked that colleagues look into how such a message was communicated in error and we will get to the bottom of it.

There are a few things that I want to say to you all about what is written here. CNWL is supporting and advocating that staff who were planning to attend the NHSE-sponsored training, which is scheduled for tomorrow (5 September) are still encouraged to do so”.

Medical Examiner and Death Certification

The Royal College of Pathologists (RCPath) (the College responsible for training medical examiners) held a reception on 5th September to mark the forthcoming long-anticipated statutory medical examiner launch on 9th September. The guidance document for this can be accessed at https://www.england.nhs.uk/long-read/national-medical-examiners-guidance-for-england-and-wales/

The Jewish community was represented at the reception by Prof David Katz and Mr Sidney Sinitsky. The event was chaired by the RCPath lead on the subject, Dr Suzy Lishman. The Chief Medical Examiner, Dr Alan Fletcher spoke, Sir Robert Francis summarised the progress that had been made, and Mr Mohammed Omer spoke on behalf of the Muslim community.

Prof Katz also spoke, saying that today “cultural competencies” are regarded as desirable if not mandatory in public dialogue. The UK Government excelled themselves in this instance, as the launch date is during the week “Ki Tayzay”: “thou shall surely bury him the same day” (Deuteronomy

21:23). This rule is applicable to those that die by hanging; Nachmanides’ highlights “if you do so for a wrongdoer, how much more for all others”. However, this is not the first mention of death and burial: Abraham purchased land to bury Sarah; Rachel’s death and burial is described; as is Jacob’s death; and the transfer of Joseph’s remains all indicate the significance of the question. Hence issues of death and burial rank very highly in the religious freedoms that Jews have requested and required from host societies. The UK Jewish community traditions in this regard have been broadly tolerated if sometimes misunderstood. This question unites the Board of Deputies and the more strictly observant groups even though they may differ in other respects, and the Jewish burial societies (“chevrot kadisha”) work hard to maintain both religious and legal standards.

He said that “the 1970s Coroner Reform and the Broderip Report may seem to some as remote as Biblical narratives”. But he has worked for over 25 years with Eleanor Platt KC (Family Law) and David Frei (Beth Din Registrar) scrutinising and responding to such documents including those from Dame Janet Smith and Sir Robert Francis. The pilot medical examiner studies done by Dr Adrian Tookman demonstrated that - with good will - feasibility is possible without causing undue delay”.

His view was that in celebrating the launch the Jewish community needs to look forward rather than backward. “We need to play a role not only for our own community but also for other faith and ethnic groups. We need to promote the concept outlined by Sir Bruce Keogh – that failing healthcare systems are those that do not scrutinise and analyse deaths properly. It is impossible to do this without resources – not only staff, but also staff education and training (in which the RCPath is making a critical contribution), facilities to develop new techniques, and initiatives ranging from electronic death certification to scanners and molecular laboratory analysis. Failing systems are bad for all patients. They do not discriminate. Furthermore, in Judaism handling death is not only a matter of a dead body. It is a bereaved family who have traditions and practices that at time of distress need to be respected and honoured. This, too, is common to all”.

He noted that “several Jewish doctors have undergone the medical examiner training and will be sharing the responsibility. Alan Fletcher and the London Chief Examiner, Mette Rodgers, and their staff, took the buzzwords “consultation”, “task and finish” and “cultural competency” seriously; and Sidney’s son Moshe Sinitsky has played an important role in Manchester. Looking ahead there are signs that properly trained staffing to meet the needs of the Jewish – and Muslim – community may be in short supply, as are imagers, pathologists and counsellors. Resourcing – funding – is crucial. Going out more into the community, and the interface between primary and secondary care, will present new challenges. But Jewish principles - of investigating how and why death occurs to learn lessons which help to prevent future illness and possibly death, and of supporting bereaved families – are the shared major objectives. Thus, 9th September 2024 is an important milestone”.

To coincide with this launch, revised guidance about Medical Certificates of Cause of Death (MCCD) in England and Wales were published on the same day. These include some of the changes introduced during the pandemic and found to be useful. The main feature of note is that the “28 day” rule (about when the deceased last saw a doctor) has been abolished. Now the MCCD does not need to be from a medical practitioner who has seen the patient in the past 28 days but has to be someone (i) who has cared for the patient; (ii) who is familiar with the patient’s medical history, investigations and treatments; and (iii) who has access to relevant medical records and the results of investigations. In hospitals the final responsibility lies with the consultant in charge of the patient’s care. Guidance for medical practitioners completing medical certificates of cause of death in England and Wales - GOV.UK (www.gov.uk)

WONCA Europe - World Organization of Family Doctors

Pro-Palestinian medical groups in the UK and Eire are proposing a motion to expel Israel from WONCA membership at a conference in Dublin in September 2024. Dr Fiona Sim and Dr Charlotte Benjamin wrote to the President of the Royal College of General Practitioners (RCGP) seeking reassurance that the College would not be supporting this proposal. The response was that the RCGP do not support calls for removal of any professional organisation representing GPs, family doctors or other health professionals from participating in international events and networks as they are not responsible for the actions and decisions of their respective governments.

General Medical Council

One of the high-profile cases reported to the GMC since 7 October 2023 was Dr Ghassan Abu-Sittah. The GMC took his case to a Medical Practitioner Tribunal Service (MPTS) Interim Orders Panel. The Panel did not make such an order. Unusually his defence asked to be able to release information about the case even though the actual determination had not been released. This defence statement too attracted wide media publicity. The JMA wrote to the GMC about this and were informed that the doctor continues to be under investigation with a view to a full MPTS hearing.

Dr Lionel Balfour – Lynn z”l

Sadly, Dr Lionel Balfour – Lynn, who was a stalwart in the British Friends of the Israeli Medical Association (one of the two major forerunner organisations of the Jewish Medical Association (UK), has died at the age of 97.

Dr Mervyn Jaswon, who was a fellow paediatrician and worked closely with him on the scholarship scheme, wrote:

Lionel qualified in medicine from Cambridge and Guys Hospital and subsequently trained as a paediatrician. He was an Honorary Consultant at the Hammersmith Hospital where he conducted a longitudinal study on growth in asthmatic children which showed that their asthma had no effect on their final height, but caused a delay in puberty which gave the impression of short stature as their pubertal growth spurt was delayed. This study published in Archives Diseases of Childhood in 1986 was a seminal and much quoted paper. Lionel was also paediatrician to the American Hospital in Hillingdon in addition to running a thriving private practice in Central London.

Lionel was a passionate Zionist and as his surname indicates he came from a Zionist family. He was a founder member of the BFIMA, and introduced its elective bursary scheme. He would write to the Deans of the UK medical schools each year to publicise this scheme whereby students of all creeds could apply to spend their elective at a recognised Israeli medical establishment. Lionel would vet the applications and arrange the bursaries. Over the years several hundred UK students would have benefited, as would Anglo-Israel relations.

We know that infectious diseases do not recognise boundaries and wars. The continuing need for robust effective vaccination policies is critical, and recent reports about poliovirus in Gaza are disturbing. A group of eminent Israeli health policy and public health experts, alarmed by the threat of a polio outbreak, wrote an article to the effect that ceasefire is not only to end violence but also to prevent disease: Cease-fire. The Only Way to Prevent a Polio Epidemic Among Gazan and Israeli Babies.

Equality, diversity and inclusion policies play a role in healthcare settings. Whether they take into account and affect Jews (and Muslims) is often neglected and was discussed in JAMA: The Evolving Role of Diversity, Equity, and Inclusion Programs in Academic Health Institutions.

The US Office of the Special Envoy To Monitor and Combat Antisemitism (Prof Deborah Lipstadt) has issued “Global Guidelines for Countering Antisemitism”, which was launched to coincide with commemoration of the 30th anniversary of the bombing of a Jewish community centre in Buenos Aires. As of 23rd July 2024 these guidelines have been endorsed by over 30 countries, and by the Council of Europe and Organisation of American States. Both Israel (Michal Cotler-Wunsh, Special Envoy for Combating Antisemitism) and the UK (Lord Eric Pickles, UK Government Special Envoy for Post-Holocaust Issues) have endorsed it. The full text can be accessed here.

Violence against women, Prof Ruth Halperin – Kaddari, and the Dinah project

There has been some controversy about the issue of violence against women during the war which started on October 7th 2023.

For the Times supplement about this violence on Saturday 8th June 2024 Prof Ruth Halperin-Kaddari, who gave an outstanding webinar on the subject to the JMA in March 2024, was quoted as the most highly respected Israeli expert on this.

You can access her JMA talk here.

In her talk Prof Halperin-Kaddari referred to the Dinah Project 7/10. More information about this project can be accessed here.

You can also see her specific response to the Times article:

LinkedIn: https://www.linkedin.com/posts/ruth-halperin-kaddari-908311146_thedinahproject-un-cedaw-activity-7205578304861462528-2s1F?utm_source=share&utm_medium=member_ios

Facebook: https://www.facebook.com/share/kMo9e11ku6mr8D5L/?mibextid=WC7FNe

X: https://x.com/kaddariruth/status/1799814568660832394?s=46

Instagram: https://www.instagram.com/p/C7_7bkRM4yG/?igsh=cGpka3ZheGR4ZThl

Psychological Trauma post 7th October 2023

Following the recent IMA international webinar on 28th May , their next such event will take place on 18th July. Advance details are on the flyer. Further information will be announced shortly.

Israeli Medicine: A story of Inspiration

IMA arranged a webinar on this theme which took place on May 28th, 2024”.

The video recording of this session can be accessed here.

The Lancet published an article by Dehghan et al several months back. Some of the authors of that article have called previously for “decolonisation” as a solution to the current conflict.

Three responses to this have been published - eventually.

One of these is from several members of the JMA: ”Duty and advocacy for Palestine: Jewish doctors’ response” by Nadel et al – which can be accessed here.

The other two are from an American group: “Hypocrisy of moral imperatives in the Israel–Hamas war” by Roth et al – which can be accessed here; and from an international group: “When medical duty and advocacy are one-sided, both sides suffer” by Katz et al – which can be accessed here.

These three items remain very relevant to public debate.

The Lancet Commission Report on Medicine, Nazism and the Holocaust was published in November 2023, in the immediate aftermath of the Hamas massacre of 7th October 2023. In an article published in the Israeli Journal for Healthcare Policy Research two of the authors of that report (Reis and Wald) say that it has striking relevance to ongoing discussions about current events.

The authors regard the massacre as a crime against humanity including genocide. For Israel self-defence is a legitimate objective. The use of one’s own civilians as human shields, including in health facilities, and at the same time causing immense ongoing suffering in Israel, is unacceptable. They deplore that (with some exceptions) the medical literature has not condemned Hamas’ atrocities and has criticised the Israeli military. This has been followed by a surge of antisemitism, and the Report asserts that healthcare professionals have a special responsibility to combat this as well as other forms of discrimination. This requires issues of antisemitism and religious discrimination to be included within all EDI programmes, including those on campus; and with this an evidence-based approach to 7th October and its aftermath. The relevance of this must be seen by healthcare professional not only within medicine but also within global citizenship. International community accusations and anti-Israel libels need to be refuted.

The authors conclude by reviewing the report’s implications for contemporary medicine in general. They assert that four approaches are required: 1) provision of skills required to detect and prevent crimes against humanity and genocide; (2) care for victims of atrocities; (3) upholding the healing ethos central to the practice of medicine; and (4) fostering history-informed morally courageous health professionals who speak up when necessary.

The full article can be accessed here.

Soroka Hospital published an article on their experience on the frontline on October 7th 2023. This article can be accessed here.

Strous and Modovich (from Mayanei Hayeshua) published an article on the ethics of psychiatric management in time of disaster and war based upon October 7th. This article can be accessed here.

In early November 2023 there was extensive media coverage of the WHO Director – General’s call for cessation of hostilities between Israel and Gaza. The Lancet praised his comments for moral clarity, and a group of senior Israeli academics and physicians responded to this. Their letter can be accessed here.

The International Journal of Public Health has published a report that delves into the rapid medical response spearheaded by Israel’s civilian Emergency Medical Service, Magen David Adom (MDA), during the crisis of October 7th 2023. The authors are from the MDA itself and from Emergency Medicine and Public Health Departments at Ben Gurion University. The report can be accessed here.

Proportionality in war -  two eminent Israeli physicians comment

There has been much discussion about what is a proportionate response in war and an important contribution on this topic was made in the House of Lords by Lord Verdirame in October 2023.

This topic continues to be discussed. In a blog on 25th January two distinguished Israeli medical academics, Prof Shimon Glick and Prof Mark Clarfield have put forward their views how to approach it. Their blog can be accessed here.

There continue to be reflective medical articles about the early days of the war which have appeared in both general and medical media.

Dr Pesach Lichtenberg from Kiryat Shaul Hospital wrote in The Atlantic about how Jews and Arab doctors work together and communicate following October 7th and his article can be accessed here.

Prof Mark Clarfield reflected on the fate of older people, both on October 7th itself, and subsequently. These people suffer disproportionally during humanitarian crisis. His article can be accessed here.

Misinformation about the events of October 7th and about the role of Hamas in particular continues to appear. Dr Philip Robinson responded to a BMJ article and highlighted the importance of being clear that Hamas is indeed a designated terrorist organisation in the UK. His letter can be accessed here.

A Gazan physician, Dr Khamis Elessi, published a letter in the Lancet (28th October 2023): “Save the Gaza residents from imminent catastrophe” about the deteriorating situation in Gaza. There were several inaccuracies in this letter.

In a response to Dr Elessi “The conflict in Gaza: a view from Israel” (published on 1st November 2023), Shelley Sternberg and Edward Breuer say that they share his concerns, and that they pray for the protection of innocent lives on both sides of the border, but that these concerns must begin with recognising that a terrorist organisation currently governs Gaza. Sternberg and Breuer’s letter can be accessed here.

A reflective comment about the ethical issues that healthcare professionals are encountering during the current conflict was published in the Journal of the American Medical Association on 8th November and can be accessed here.

One of the most disturbing features since 7th October 2023 has been the silence of many of the International Healthcare Organisations about violence to women and children. The Israeli medical community have united to call for condemnation of gender – based crimes, for safe return of victims, and for support of those who are victims of such trauma. The full statement can be accessed here.

The issue of gender – based violence (GBV) on 7th October was also taken up by the Lancet, saying that medical societies, journals, and governing bodies must take a clear moral stance by vocally condemning the GBV atrocities. Their article can be accessed here.