Shooting at ambulances in Israel: a cardiologist’s viewpoint

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Shooting at ambulances in Israel: a cardiologist’s viewpoint

Sami Viskin

At the age of 49 years, this cardiologist still volunteers to serve as a field doctor in an infantry troop of the Israel Defense Forces (IDF) reserves. There is nothing unique about this action. Although military service in Israel is compulsory, the ease of evasion of active duty means that those in the front are effectively volunteers. Although some would argue that I am too rusty for this type of activity, being at the front has allowed me to witness first hand what the world press has called “the carnage inflicted by the IDF in the West Bank”1 from a different viewpoint.

On March 27, 2002, Israel celebrated Passover, one of the Jewish holidays still observed by all Israelis, secular and religious alike. A Palestinian terrorist carrying a large bomb walked into an observant congregation and detonated his explosives in the midst of the crowd. Because of the many casualties (29 killed and 130 wounded)2 and the escalation in terrorism (118 civilians killed in 4 weeks) it was clear that Israel was heading towards war. We were mobilised the next morning.

The first night on duty we were dispatched to the Palestinian town of Hares to treat a woman in distress. There is nothing idyllic about doing midnight house calls in the West Bank nowadays, and the possibility of an ambush crossed my mind. What we encountered, in fact, was a very scared family and a woman in frank pulmonary oedema. I could not tell if the fear in the children’s eyes was caused by our military attire or by their mother’s condition. Although nitrates are not carried in military ambulances, we do carry morphine, furosemide, and oxygen and our patient responded promptly to this treatment. Eventually, we transferred the patient (with now audible mitral regurgitation) to a Palestinian ambulance that moved her to a hospital in Ramallah.

In this and in several later encounters with Palestinian ambulance personnel, there were neither smiles nor handshakes. Both sides hurt too much for that now. However, there was professional conduct, collaboration, and courtesy as we exchanged information on treated patients. I would later read in disbelief what the press classified as the indiscriminate firing at Palestinian ambulances by Israeli soldiers.1 That is not what I saw. The guidelines of the IDF are straightforward: Palestinian ambulances must be allowed freedom of passage to zones of conflict unless there is evidence that they are being used to transport military equipment. These guidelines are orders from the General Command of the IDF (as testified by the Command Secretary in an official response to an inquiry by the Israel Medical Association).3 In fact, these are the same orders I heard when working in the field. Unfortunately, Palestinian ambulances were repeatedly used to transport combatants and weapons, prompting the

Published online March 11, 2003

Department of Cardiology, Sourasky Tel-Aviv Medical Center,
Sackler-School of Medicine, Tel Aviv University, Tel Aviv 64239,
(Dr S Viskin MD)


Ambulance of the Palestinian Red Crescent Society used for smuggling explosives into Israel

A: The ambulance stopped in the Ramah roadblock near Jerusalem. PRCS(Palestinian Red Crescent Society) sign is visible on the open door. The Red Crescent symbol and MICU (Mobile Intensive Care Unit) are visible on the front hood. B: The robot used to handle bombs takes the stretcher out of the ambulance. C: The robot drags the mattress of the stretcher to a secure distance. D: The bomb-vest found under the stretcher mattress. Photographed by the IDF in the presence of two representatives of the International Red Cross.

IDF to send an official protest to the International Red Cross on May 2, 2002.4 The communication included reports of terrorists who were disguised as being wounded and transported in ambulances of the Palestinian Red Crescent Society

(the local form of the International Red Cross) in attempts to evade the IDF. Also, flagrant abuse of medical accreditation by Palestinian terrorists was reported on January 27, 2002, after a terrorist bombing in downtown Jerusalem. Both the female suicide terrorist (Wafa Idris), and the attack coordinators (Mohammed Hababa and Munzar Noor) worked for the Palestinian Red Crescent Society.

At the outset of the renewed violence, the IDF had received intelligence reports warning them that some terrorist organisations would use ambulances to smuggle bombs or as car bombs. Based on these reports, on March 27, 2002, IDF forces in the Ramah roadblock signalled an approaching Palestinian ambulance to stop. When the driver ignored the signals, IDF soldiers fired shots in the air and, fortunately, the ambulance stopped. Inside, the soldiers found a woman and three children, aged 4 years, 3 years, and 6 months. A sick child (reportedly with osteomyelitis) was lying on the stretcher. However, under the stretcher there was a 10-kg bomb-vest of the same type that suicide terrorists hide under their clothes (figure). The ambulance driver (Isalam Jibril, age 31 years) testified that he was moving the bomb to Ramallah, a 15-min drive from Jerusalem.

The same intelligence reports on the potential use of ambulances as car bombs led to tragic consequences on March 4, 2002. An IDF infantry unit in Jenin spotted a

THE LANCET • Published online March 11, 2003 •

For personal use. Only reproduce with permission from The Lancet Publishing Group.


Palestinian ambulance approaching rapidly and opened fire, killing two men, including Saliman Halil, director of the Red Crescent Society in Jenin. The IDF conducted an official inquiry. The inquiry discovered that the traffic of Palestinian ambulances in Jenin on that day had been coordinated through the District Coordination Office (DCO). This particular ambulance, however, entered an area of active battle without informing the DCO and the soldiers that saw it approaching at speed were convinced it was a car bomb attack. This was a close encounter and the response came within seconds. Seven shots were fired, with fatal consequences. The IDF prosecutor found the soldiers’ explanations credible. Knowing the people involved, I personally found the explanations credible- nonetheless tragic-but it is clear that different readers will interpret the same facts in different ways, depending on their preconceptions.

Civilians are being killed on both sides. There is, however, a fundamental difference between the civilian losses suffered by Israel and Palestine. I do not pretend to have the absolute truth and I will not pretend to be unbiased. I can only give you the truth as I know it. This truth is so simple that it may be difficult for some to accept. Deaths among Palestinian unarmed civilians, caught in the crossfire between fighting forces, were unintentional.5 This is a tragic, yet unavoidable consequence of war, of all wars. Genuine, continuous efforts are being made by the IDF to keep Palestinian civilian losses to a minimum, at times at the cost of Israeli soldiers’ lives. By contrast, civilian losses in Israel are nothing short of deliberate.

Palestinian terrorists have the most accurate system for delivering bombs. The suicidal terrorists simply walk with their bomb-vests under their clothes and detonate the weapon at the exact point they target. They choose to explode bombs next to large crowds and often target groups of young people and children. For example, on March 12, 2002, a terrorist opted to explode a bomb next to a group of women waiting with their baby carriages outside a Jerusalem synagogue. Among the 12 people killed, four were children aged from 7 months to 7 years. Entire families have been slaughtered in terrorist acts. In August, 2001, Mordechai Schijveschuurder from Holland, his wife, and three of their children (aged 2, 4, and 14 years) were eating at a pizzeria in Jerusalem when a terrorist walked into the restaurant and exploded a bomb. They were among the 15 people killed in that incident, which also wounded 130.

Since the signing of the Declaration of Principles between Israel and the Palestine Liberation Organisation (the Oslo Agreements), terrorists have killed 980 Israelis and injured more than 5000 civilians.6 Some terrorist acts are notorious for the large number of casualties they inflicted. In the bombing of the Dolphinarium discotheque in Tel Aviv, 21 young people (aged 14-21 years) were killed and 120 seriously injured.

Other incidents will be remembered for their cruelty. On May 9, 2001, Yosi Ish-Ran and Kobi Mandel, both aged 14 years, were kidnapped and eventually stoned to death in a cave. In October, 2000, two young reservists took a wrong turn and entered Ramallah by mistake. Originally arrested by Palestinian police, Yosef Avrahami and Vadim Norzhich (both 33 years old) were eventually taken over by a large Palestinian mob that beat them to death. An Italian television crew caught on film how the mob celebrated as the bodies of the fatally wounded young men were thrown out the window of the police station top floor. The picture of an assassin proudly showing off his hands covered with the victims’ blood to the applauding crowd was incomprehensible to all civilised people watching the televised news.7 Incidentally, Riccardo Cristiano, the representative of the Italian state television, later apologised to the Palestinian Authority for filming this event.8

Finally, one incident will be remembered for its irony. When Jonathan Jesner, a young student from Glasgow, Scotland, was fatally wounded in a bus that was blown up in midtown Tel Aviv, his family agreed to donate all organs for transplantation; one of his kidneys was successfully transplanted to a 7-year-old Palestinian girl. Thus, the tragedy inflicted by the Israel-Palestine conflict on a Jewish family became the salvation of a Palestinian family.

To understand the effect of terrorism on Israel, it must be set in the context of the country’s size. Israel’s population is smaller than that of New York City, USA; 70% of Israel’s inhabitants live in the Tel Aviv area, where the width of the country (from the Mediterranean Sea to the West Bank) is only 15 km at its narrowest point. Jenin, the capital of fundamentalist Palestinian terror, is less than 50 min from Tel Aviv and only 20 min from Jerusalem by car. Consequently, being mobilised to the army does not mean flying thousands of miles, but rather driving your own car practically to the battle site. Of note, downtown Jerusalem alone has been attacked 13 times within the past 2 years and selected streets have been repeatedly bombed. At the same time, more than 20 buses or bus stops have been attacked, with large numbers of casualties.

We do not claim to have a monopoly on tragedy and we regret the suffering inflicted on Palestinian civilians. Especially, we regret the losses sustained by Palestinian medical personnel in the course of attending their wounded. However, ascribing these tragic events to revenge or to a disregard for medical neutrality only reflects unawareness of the fact that our best men are at the front of the line. You may call me naive. After all, you need some naivete to remain sane in this corner of the world.


1 Editorial. Failure to address the health toll of the Middle East crisis. Lancet 2002; 359: 1261.

2 Passover suicide bombing at Park Hotel in Netanya: Passover massacre. Jerusalem: Israel Ministry of Foreign Affairs, 2002. (accessed Feb 3, 2002).

3 Blachar Y. Health toll of the Middle East crisis. Lancet 2002; 359: 1859.

4 Harel D. Inappropriate use of ambulances of the Palestinian Red Crescent Society. Tel Aviv: Israel Defense Forces, Head of Operations Office, 2002.

5 Rees M, Ghosh A, Hamad J, Klein A. The battle of Jenin. Time 2002. (accessed Jan 15, 2003).

6 Fatal terrorist attacks in Israel since the declaration of principles (September, 1993). Jerusalem: Israel Ministry of Foreign Affairs, 2002. (accessed Jan 15, 2003).

7 Doron AI. The unfortunate truth: the Palestinian police in action. Karmiel, 2002. Peace_1.htm#act (accessed Jan 14, 2003).

8 Christiano R. Coverage of the October 12 lynch in Ramallah by Italian TV station: special clarification by the Italian representative of RAI, the official Italian television station. Jerusalem: Israel Ministry of Foreign Affairs, 2002. p0#letter (accessed Jan 14, 2003).

THE LANCET • Published online March 11, 2003 •

For personal use. Only reproduce with permission from The Lancet Publishing Group.

Shooting at ambulances in Israel: a cardiologist’s viewpoint

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