As healthcare providers in the Bronx, we are no stranger to the ways in which unjust social forces impact the lives and health of our patients. We see how differential access to resources, mistrust in a healthcare system founded on histories of abuse and manipulation, and bias in the delivery of care conspire to delay diagnoses, disrupt the continuity of care, and turn what ought to be manageable chronic disease into life threatening challenges. We recognize that the illnesses we treat rarely begin with the first healthcare encounter, but have roots in our collective structural and social surroundings. We draw these connections, understanding that to comprehensively treat our patients’ illnesses means to also draw attention to these underlying factors. Indeed, many of us have chosen to train or work at Montefiore specifically to do our part in addressing these deep inequalities in the day to day care of our patients, our academic pursuits, and/or the development of innovative systems-level solutions. 

As we work to advance health equity in our Bronx community, we are also witnessing a humanitarian crisis unfolding before us. In just over 100 days, over 20 000 people have been killed in Gaza. Hospitals, schools, and universities have been decimated, and the healthcare infrastructure of Gaza is crumbling with the United Nations stating none of the hospitals in Gaza are fully functioning and only 16 out of 36 hospitals in the area are minimally or partially functioning. On January 24th, the International Committee of the Red Cross stated that for over 2 million people, there were only 2 referral hospitals with advanced surgical and medical capacities. Care has been severely curtailed in a region where half of the population is under the age of 18. Over 22% of agricultural fields in northern Gaza have been destroyed, exacerbating food insecurity, and up to 1.7 million people, almost 75% of the entire population, have been displaced. Humanitarian organizations such as Doctors Without Borders have repeatedly called for a ceasefire. Recently, the International Court of Justice ruled that Israel must take measures to provide much needed basic services to the Gaza Strip. The crisis and the destruction of the healthcare system will likely have devastating ramifications for generations to come. 

As we witness the devastating impact of this violence against civilians, we feel compelled to raise our voices, as we do when we face threats to the health and wellbeing of our Bronx community. However, we have heard from colleagues, trainees and friends within our department who are grieving, who feel alone, or feel unable to express themselves for fear of harming relationships or even facing disciplinary action. It is clear that many in our Montefiore community have strong and varied feelings about the nature and context of the current conflict. It is also clear that simply ignoring what is happening is not only impossible, but also goes against our values as providers, researchers and educators. Ongoing silence in the face of the violence unfolding before us is not consistent with the commitment to justice that we hold.

It is not, however, too late for us to course correct, and to reaffirm our commitment to justice, diversity, equity and inclusion. How can we put that commitment into practice? We can create safe spaces for difficult conversations, to allow for a range and diversity of opinions, and to allow those who may feel silenced to have the security to speak without threat of retaliation. Just as we discuss the health effects of other social and structural determinants of health, we can engage with the health impacts of the current conflict in our educational content. As educators and researchers who prize critical thinking and a foundation in evidence, we can apply those principles here: to critically evaluate the evidence before us, to investigate our sources, and to hold multiple truths at once. And as a community of colleagues and mentors, we can continue to put our shared humanity at the forefront, to assume that we come to these conversations with best intentions and a desire to listen to each other. We can create community with each other, and ensure that those who are struggling are getting the support they need.

Our work by its nature is full of difficult conversations and conflicting ideas. But by holding true to our values, our commitment to justice and inclusion, and our sense of community, we are able to navigate challenging terrain together. We can do so again now, not by remaining silent but by speaking our minds openly and honestly, and by naming and confronting injustice where we see it.