John R. Cohn: Ending Hatred and Intolerance is How to Improve Health in the Middle East, BMJ, October 31, 2006

John R. Cohn is Clinical Professor of Medicine, Clinical Assistant Professor of Pediatrics at Thomas Jefferson University, Philadelphia, PA 19107 USA

Richards and Rehwagen deserve praise for devoting, with considerable difficulty considering the nature of the topic, an issue of the British Medical Journal to the health problems of the Middle East, but the result is disappointing.[1] The goal of scientific journals is to seek and disseminate truth, not as they imply, “avoiding causing offence”. As they demonstrate, sometimes it is impossible to do both.

As the editors noted, there is no formal definition of the “Middle East”. They cited three: from the World Health Organization (WHO), the Arab League and the Gulf Cooperation Council. Israel is excluded from the Arab League and the Gulf Cooperation Council, but it is also not a member of the Eastern Mediterranean Region (EMRO) of the World Health Organization. By contrast Afghanistan, Pakistan and Morocco, none of which even remotely border the Eastern Mediterranean, are included in the EMRO. Palestine, primarily a geographic designation which has never existed, and certainly not in modern history, as a sovereign state, is also included in EMRO.

Richards and Rehwagen provide a clue to the origin of this geographic and political peculiarity, with their observations about the “unprintable response of one Arab reviewer to a request to review a paper from a US author and the Lebanese professor who would not write for us because the issue contains Israeli voices.” Unfortunately, acquiescence to such prejudice is seen throughout this issue.

As Maziak observed in another essay, “Arab countries currently produce less than 0.5% of the papers that are published in the world’s top 200 medical journals.”[2] By contrast, as shown in a study of the top 1% of highly cited publications, authors from Israel, a nation with a population of just over six million, accounted for 1.27% of such publications between 1997 and 2001.[3]

Despite Israel’s success in publishing quality scientific research in other venues, out of 36 Middle East related items in the BMJ’s special issue, only two originated exclusively from Israel. One was a report on Israeli doctors charged with fraud,[4] while a letter by Dr. Shapira discussed the problems Israeli physicians faced over the past years of heightened violence.[5] The BMJ special issue contained no manuscripts addressing the problems of Israeli victims of the Palestinians’ campaign of deliberate and calculated attacks on civilians nor any concerning difficulties experienced in confronting the consequences of terrorist attacks in Israel, Iraq and elsewhere. There were no full length papers of exclusively Israeli origin. Perhaps this reflected the preferences of the external advisors, none of whom were from Israel, despite Israel’s recognized scientific accomplishments.

Four contributions contained the phrase “occupied Palestinian territory”, another term never defined by the BMJ’s editors, although apparently it includes Palestinian ruled Gaza.[6],[7],[8],[9] Implicitly and at times explicitly, Israel is blamed for the region’s problems.

Without any hint of criticism from the editors, Brennan and Sondorp suggest the necessity of working with groups like Hezbollah in providing relief, noting that while Hezbollah “is considered to be a terrorist organisation by many Western governments” it “had a good reputation as a provider of social services before the war and operated a network of clinics and hospitals at lower cost than other providers”.[10] The United Nations, hardly a supporter of Israel, noted in resolution 1701 that the most recent heightened hostilities in Lebanon and Israel began with “Hizbollah’s attack on Israel on 12 July 2006”. [11] Hezbollah and others who engage in deliberate attacks on civilian targets while provoking more violence are the region’s primary problem. Their criminal behavior disqualifies them from being part of this region’s solution.

As Maziak also observes, a notion reiterated by the issue’s editors, “For many people in the region, health improvement must start somewhere else-with education, equality, and security.”ii But that is like focusing on better chemotherapy for advanced lung cancer, rather than keeping teens from smoking.

We can lament the attacks on healthcare workers and misuse of the neutrality of patients and ambulances[12] and decry the destruction violence has brought to Darfur, Iraq, Israel, Gaza and elsewhere; but the common thread through all of these calamities is the deep-seated religious and racial intolerance that causes Iraqis to massacre each other in mosques and markets, the ethnic cleansing of Darfur that has resulted in deaths and displacement by the hundreds of thousands, and the absolute rejection of Israel’s right to exist on a small fragment of the Middle East’s land. Since 1948 Palestinian Arabs have repeatedly rejected sovereignty if the result is that Israel lives. When the hatred stops, everything will be possible. Yet even today, the Palestinians popularly elected Hamas government, along with Hezbollah and others refuse to consider any solution that includes a permanent Jewish state alongside the region’s dozens of Islamic countries.

Physicians know the frustration of trying to help patients determined to engage in self-destructive behavior. Without a commitment to peace and rejection of violence by those in the Middle East now bent on creating havoc and destruction, there is unfortunately little the health care community and editors with even the best of intentions can do.

John R. Cohn, M.D.
john.cohn@mail.tju.edu

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[1] Richards T, Rehwagen C. Messages from the Middle East. BMJ 2006;333 (21 October).

[2] Maziak W. Health in the Middle East. BMJ 2006;333:815-816 (21 October).

[3] King DA. The scientific impact of nations. Nature 430, 311- 316(15 July 2004)

[4] Siegel-Itzkovich J. Israeli doctors are arrested in investigation. BMJ 2006;333:823 (21 October).

[5] Shapira SC. Lessons learnt from the front line in Israel. BMJ 2006;333:862 (21 October).

[6] Hill AG, Clark CJ, Lubbad I, Bruderlein C. Hope and despair over health in Gaza. BMJ, Oct 2006; 333: 845 – 846.

[7] Musani A,Shaikh I. Preparedness for humanitarian crises needs to be improved.BMJ, Oct 2006; 333: 843 – 845

[8] Jabbour S, El-Zein A, Nuwayhid I, Giacaman R. Can action on health achieve political and social reform? BMJ, Oct 2006; 333: 837 – 839

[9] Editor. Learning from conflict and disaster in the Eastern Mediterranean region.BMJ, Oct 2006; 333: 843

[10] Brennan RJ, Sondorp E. Humanitarian aid: some political realities. BMJ 2006;333:817-818 (21 October)

[11] UN Security Council Resolution 1701, Adopted by the Security Council at its 5511th meeting, on 11 August 2006

http://daccessdds.un.org/doc/UNDOC/GEN/N06/465/03/PDF/N0646503.pdf?OpenElement

[12] Cohn JR, Romirowsky A, Marcus JM. Abuse of health-care workers’ neutral status. Lancet. 363:1473, May 1, 2004

Competing interests: None declared

AUTHOR

John R. Cohn

John R. Cohn, Thomas Jefferson University, SPME Board of Directors

John R. Cohn, M.D., is a physician at Thomas Jefferson University Hospital (TJUH), in Philadelphia, PA, where he is the chief of the adult allergy and immunology section and Professor of Medicine. He is the immediate past president of the medical staff at TJUH.

In his Israel advocacy work he is a prolific letter writer whose letters and columns have been published in the New York Times, the Wall Street Journal, the Jerusalem Post, the Philadelphia Daily News, the Philadelphia Inquirer, Haaretz, the Jewish Exponent, Lancet (an international medical journal based in the UK), and others. He was CAMERA’s “Letter Writer of the year” in 2003. He maintains a large email distribution of the original essays which he authors on various Israel-related topics.

He has spoken for numerous Jewish organizations, including Hadassah, the Philadelphia Jewish Federation and to a student group at Oxford University (UK). He and his wife were honored by Israel Bonds.

He wrote the monograph: “Advocating for Israel: A Resource Guide” for the 2010 CAMERA conference. It is valuable resource for all interested in maximizing their effectiveness in correcting the endless errors of fact and omission in our mainstream media. One piece of very valuable advice that he offers to other letter writers is: “Journalists and media are not our enemies, even those we don't agree with". Particularly for those of us in the academic community he urges a respectful and educational approach to journalists who have taken a wayward course.

In addition to the SPME board, Dr. Cohn is a member of a variety of professional and Jewish organizations, including serving on the boards of Hillel of Greater Philadelphia, the CAMERA regional advisory board, and Allergists for Israel (American allergists helping the Israeli allergist community). In the past he served on the board of the Philadelphia ADL. He participated in the 2010 CAMERA conference (“War by Other Means,” Boston University) where he led a panel with students on “Getting the Message Out,” and a break-out session called “Getting Published in the Mainstream Media.”

He is married, has three children and one grandchild. He belongs to two synagogues--he says with a chuckle, "So I always have one not to go to". He has been to Israel many times, including as a visiting professor at the Hadassah Medical Center in Jerusalem. His first trip was at age 10, when Jerusalem was still a divided city; and he remembers vividly standing before the Mandelbaum Gate, wondering why he could not go through it to the Old City on the other side.

He adroitly balances his wide-ranging volunteer activities on behalf of Israel with his broad and complex medical and teaching practice (including authoring numerous professional publications) while successfully maintaining good relations with a broad spectrum of Jewish community leaders and organizations -- no small feat.

Regarding his involvement with SPME, Dr. Cohn acknowledged first and foremost SPME’s Immediate Past President, Professor Ed Beck. Dr. Cohn has long perceived that under Professor Beck’s guidance, SPME has been doing an essential job on college campuses; so he was honored when Professor Beck invited him to join the board.

He finds it easy to support and be active in SPME because being a Jewish American and a supporter of Israel presents no conflict due to the congruence of both countries’ interests, policies and priorities. It is clear that Israel’s cause is not a parochial issue. It is a just cause and its advocacy is advocacy for justice.

For Dr. Cohn, the need for SPME is clear. The resources of those who speak out on behalf of Israel are dwarfed by the funding sources available to those who seek to denigrate Israel. Israel's supporters don’t have large oil fields to underwrite their work. And the campus is a critical arena for work today on behalf of Israel, because this generation’s students are next generation’s leaders.

For advancing SPME’s work in the future, he would like to see the continued development of academically sound analyses to counter the prevailing anti-Israel ideology of all too much academic research and teaching on campuses and in professional fields today. He points to Lancet’s creation of a “Lancet Palestinian Health Alliance,” which asserts that Israel is to blame for poor health care for Palestinians in the West Bank and Gaza Strip. The documented reality, however, is that life expectancy, infant mortality and other measures of health are better for Palestinians in the West Bank and Gaza than in many of the countries so critical of Israel This is in large part thanks to Israel.

Dr. Cohn asserts that we need more research, analysis and publications to counteract such misleading allegations.

Read all stories by John R. Cohn