Despite the devastation and brutality that the world has witnessed for the past 140 days in Gaza, the International Court of Justice (ICJ) could not establish outright at this stage whether Israel is guilty of genocide.
What it did rule, however, is that South Africa’s accusation of genocide is plausible. It ruled on several provisional measures, including that Israel must abstain from genocidal acts, bring accountability for the normalised genocidal rhetoric from state level to civil society, and allow humanitarian aid into Gaza.
But just hours after the verdict, not only did Israel resume its indiscriminate attacks, it took it even further by going after UNRWA, the UN agency that serves as a lifeline for millions of people in Gaza.
The aftermath of this ICJ ruling highlights the ineffectiveness of the human rights framework, and particularly the implications this will have for the healthcare of the Palestinian people.
Israel was and still continues conducting an “assault on Gaza’s healthcare system, which renders life unsustainable,” as South African lawyers put it.
Health apartheid
South Africa’s own reveal just how extensive Israel’s own apartheid system is a threat to Palestinian healthcare. then, which still exist to this day, reflected the racial hierarchies and dehumanisation embedded in South Africa’s apartheid system.
The rate of infectious diseases increased for Black South Africans due to the lack of wider determinants of health, such sanitation and food. This inevitably led to higher maternal, infant and child mortality rates.
The same thing is happening in Gaza today, and across all occupied Palestinian territories.
The ICJ ruling echoed solutions passed and recorded in the by the United Nations Special Committee against Apartheid in 1981, that centred the health needs of Black South Africans.
The committee rightfully noted that it was impossible to consider the health of Black South Africans in the absence of their political determination.
Similarly, the right to health for Palestinians cannot exist without their right to political determination, and the ongoing health apartheid Palestinians experience is the strongest evidence for this.
From hospital to mass grave
Attacks to Palestinian healthcare infrastructure are not new. For decades, health injustices, such as the arbitrary administrative and geographical barriers to treatment by Israel, have all contributed to years of health apartheid in Gaza and across the occupied Palestinian territories.
Just as Palestinian health is intertwined with self-determination, Israel’s evisceration of Gaza’s healthcare system must be understood as a central part of its settler-colonial project.
The deliberate targeting of healthcare we are witnessing today is now part of the definition and operationalisation of genocide.
Israel’s deliberate attacks and consequential genocide in Gaza have killed more than 29,000 people (including more than 12,000 children), injured more than 69,000 others, and forcibly displaced over 2 million, who are now experiencing famine and the spread infectious diseases.
Presently, 374 health workers have already been killed, many whilst on duty trying to save the most vulnerable, including children like Hind Rajab, in targeted assassinations.
By December 2023, Gaza’s healthcare attacks already accounted for 58% attacks on global healthcare just in that year, and the number of healthcare workers killed the total number of deaths recorded across all global conflicts in 2023.
As with every genocide, the destruction is mapped on women’s bodies. The lack of water and food is rapidly killing mothers. About 180 women give birth per day, but many are unable to access facilities that offer adequate maternal and post-natal care.
Hospitals have become sites of massacres, turned into mass graveyards. Israeli special forces have continuously disregarded the right to health with their raids on Gaza’s hospitals, only 11 of which are still partially functional.
Israeli soldiers even went so far as disguising themselves as health workers to kill Palestinians as seen in Jenin’s Ibn Sina hospital.
Many healthcare workers are as they risk their lives trying to save civilians in hospital vicinities and even kidnapped, as we saw with Dr Muhammad Abu Salmiya, director of Gaza’s largest hospital, Al Shifa, who is yet to be released.
Right to health
The right to health and healthcare only exists when there is access to wider determinants of health including the right to food, water, and self-determination because these are the tenets that uphold and maintain a health system.
The conditions under which Palestinians have been forced to live in and accept as their new (health) realities have completely removed dignity at the centre of their right to health. Palestinians, many of them who are disabled, now in flooded tents, pushing wheelchairs through their floods of raw sewage and medical waste in Rafah.
Biohazards surround maternity hospitals and many women are being forced to give birth in their tents and public bathrooms without anaesthesia. Clean water and food deliveries are being bombed or left to rot as we watch Israelis block aid trucks headed for Gaza.
By destroying Palestinian’s access to healthcare now and in the future, Israel is engaging in a strategic campaign of genocide and ethnic cleaning of Palestinians in Gaza.
In other words, Israel has made it so Palestinians are simply waiting to die.
The ICJ case has finally revealed the smokescreen of human rights and international law - both simply do not exist.
Gaza is the most dire humanitarian crisis of our time.The faux concerns offered by the West about concern for civilians and the need for aid corridors are dishonest and hollow.
The international humanitarian framework has completely failed the Palestinian people, and by extension the rest of the world, because it has illustrated in plain sight the cowardice of multilateral organisations where leaders cannot hold themselves accountable as peers.
A key impact of the ICJ ruling is the implication for other states, who can be implicated for failing to act in a way that prevent’s Israel’s genocide.
But immediately following the ICJ decision, Israel’s allies the United States, the United Kingdom, Finland, Germany and Italy committed to defunding UNRWA, based on Israel's unverified claims that 12 of UNRWA’s 13,000 staff members were involved in the 7th October Hamas attack.
UNRWA provides humanitarian aid, in the broadest sense, to approximately six million Palestinians not just in the occupied territories like the West Bank but also those who are displaced in neighbouring countries - it is a reminder of what has and is being done by Israel to the Palestinian people.
UNRWA is now completely ineffective and could shut down in just weeks, meaning that these countries have violated their own obligation of preventing genocide.
The unconditional support shown to Israel by these Western nations should not be accepted as mere foreign policy positions, but outright violations of the right to health for Palestinian that amount to collective punishment and crimes against humanity.
Underlying the right to health must also be the right to challenge all the violence, systemic racism, apartheid and land theft occurring at the command of Israel and their allies.
The lack of honesty about this at the imperial core, including in academia, politics and especially the field of global health, has completely compromised the right to health for the Palestinian people.
Beauty Dhlamini is a Tribune columnist. She is a global health scholar with a focus on health inequalities and co-hosts the podcast Mind the Health Gap.
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