Article
Comment
Gaza
Middle East
5 min read

The human cost of the Israel-Gaza war

A veteran volunteer surgeon laments a well lived life.

Tim Goodacre is a reconstructive plastic surgeon, and volunteer at a hospital in Gaza.

A young doctor wearing scrubs smiles.
AbdulRahman at work.
Tim Goodacre.

The Israel-Gaza war rages on. Every few days a new tragedy hits our dulled senses. The West Bank and now Lebanon are getting dragged into the conflict. Palestinians and hostages continue to die, and hunger and disease threaten Gaza's displaced people as autumn and winter approach. 

Yet what is often lost is the human face of this conflict. This is the story of one such life. 

AbdulRahman was an intelligent, gentle and diligent young third year medical student in his early twenties, with judgement well beyond his peers. Towards the end of 2023, as the war spread more viciously towards southern Gaza, he was one a group of around 10 students who volunteered to join the team of health care workers at the European Gaza Hospital (EGH). I was volunteering there as a reconstructive plastic surgeon and and met him in the hospital.

Both medical schools in Gaza before the war began were in the north alongside their parent universities. They had been destroyed during the onslaught in the early months of fighting. In the southern town of Khan Younis, the EGH was the sole surviving operational facility to which the wounded could be transferred. It was overwhelmed by the vast numbers of families also taking refuge in what was deemed a safer space than most of the surrounding war zone.  

Many of the senior medical staff and surgeons had retreated to scattered parts of the strip, displaced frequently by the ever-moving conflict and driven by the need to support their families and stay together. ‘Live together-die together’ is an understandable feature in the horror show of war. Students, frequently left with no money or resources, started to volunteer to serve in hospitals in exchange for a little food and a sense of worth in the work they could offer. Any functioning hospital, if briefly ‘deconflicted’ so they could provide relatively safe care, found itself staffed by a disparate crew of local staff, displaced students, and an indeterminate number of more senior surgeons from both Gaza and humanitarian agencies. 

His desire to learn all that could be learnt, and to try to become the best surgeon possible, was palpable.

It was into this chaotic mix that young AbdulRahman walked having fled his family home in the east of Khan Younis in November 2023. A bright young man, with great aspirations to qualify as a surgeon and serve his community, he had spent the first six weeks of the war at home, unable to attend his medical school in Gaza City to the north, but working hard at his studies regardless, using every online and library resource available to him.  

At some point in late November, the battle zone moved south, and his family home was shelled along with many dwellings in the vicinity. Caught in crossfire, he sheltered in his neighbouring relative’s house after his parents and other close family had escaped to Rafah. 

Abdulrahman told me the dramatic story of his escape into the house in which he survived for a week alongside his relative’s family when I spoke to him in late January 2024. This young man not only survived an ordeal of indescribable fear and potential slaughter, but he was then arrested and interrogated in brutal fashion by IDF forces.  

On his release after a harrowing week, he made his way barefoot to the nearest hospital, which happened to be the EGH. In that place of safety, he was given food and water and after recuperation, volunteered to work alongside a reconstructive plastic and burns surgeon who had recently returned to Gaza after training in the UK. 

Although his family were still all alive in Rafah in displaced makeshift shelters, he opted to stay and throw his weight into whatever he could do to support the hospital whilst continuing to learn his profession as a doctor. Travelling occasionally at great personal risk to see and support his family, he devoted all his waking hours to surgical work in EGH operating theatres and wards. His excellent command of English made him immensely valuable to any visiting surgeons who managed to access Gaza during the war months. He was always cheerful, always willing to respond to requests for his time, however stressful the surrounding clamour from desperate patients and relatives might become.  

When his working day was done, in the middle of the night he would arrange for his fellow students to have informal teaching seminars from whoever he could cajole to deliver them, and would absorb knowledge and ideas about best practice like a sponge. His desire to learn all that could be learnt, and to try to become the best surgeon possible, was palpable.  

I had every intention of supporting this fine young man in achieving his professional aspirations by whatever means I could once a ceasefire arose and he could be brought safely to Europe to continue his training. 

In the last week of August, AbdulRahman was sheltering in a relative’s house in Khan Younis. In the small hours of the morning an Israeli attack was launched on the neighbourhood and the house took a direct hit. AbdulRahman was killed instantly. 

He knew, as does every Gazan in these troubled times, that nowhere was safe, and all lives in that tragic zone are at risk. His is a story of a life tragically cut short, of the randomness and destructiveness of war. His death strikes right at the heart of my hopes for the remnant of the fine young population of such a desperately sad nation state. He, and those like him, could have been at the heart of the re-building of Gaza, able to live in what now feels a far-off peace. I cannot translate this into anger, as AbdulRahman himself had a passionate concern for peace and reconciliation, and never once spoke to me in many conversations of support for Hamas, or of hatred for those who had destroyed his country.  

What can be done however, is to honour his life and commitment with similar tenacity in supporting the pursuit of peace, justice for his people, learning and education for the remnant of the nation, and reconstruction of a Palestine that can proudly and honourably reflect the finest values it possesses. AbdulRahman was a great Palestinian, and his all too short life was one which I want to celebrate as one of the finest I have seen in many students of the next generation of doctors. May he rest in peace, and may a lasting peace come quickly to Gaza, to all of Palestine and the whole of the Middle East.

Essay
Culture
War & peace
7 min read

Swords now, ploughshares later

There’s a moral case for investing in defence capabilities right now.

Tom Simpson is Associate Professor of Philosophy and Public Policy at the Blavatnik School of Government, University of Oxford.

A religious icon is propped on the side of a trench, a soldier can be seen further down the trench.
An icon of St Michael in a Ukrainian army trench.

It is two years since the Russian invasion of Ukraine, on 24 February 2022. We are still sleep-walking, with the British public and political class yet to grasp its implications. The risks of large-scale conflict have surged, and the British military is inadequately prepared for the operations it may soon be called on for. One day, swords will be turned into plowshares. But right now, in this imperfect world, we need more swords. Even if not widely enough, some have realised that the global order has changed. But fewer still are willing to act on that realisation.  

The Russian assault in February 2022 was designed to shock. Repeating the plan which the Soviet Union had used in Afghanistan in December 1979, armoured columns advanced on the capital on multiple axes, preceded by an aviation assault into an airport just outside the main capital, intended to allow invading forces to ‘decapitate’ the government. The 2022 attack was also accompanied by strikes on key targets in Kyiv itself, with Russia mimicking the ‘shock and awe’ campaign with which coalition forces had initiated the invasion of Iraq in 2003.  

The international situation has been parallel, with an immediate shock, galvanising intensive and often heroic action—but the resolve for which has withered with time. Some moments of demonstrated resolve among the public during the early months stand out in my memory. The students in Oxford who were fundraising not just for blankets for refugees, but for body armour, night-vision goggles and, if I remember rightly, even weapons. The stranger who bought a decrepit caravan from me for scrap saying, quietly and undemonstratively, that she would not buy fuel from Shell because it was blood oil. And, the 12-foot-tall statue in Oxford’s Broad Street of a Ukrainian soldier expressing the city’s solidarity.  

This was echoed at the national level. In a welcome act of leadership, Boris Johnson, then Prime Minister, declared that Putin “must fail and must be seen to fail”. This gave the necessary direction for a series of forward-leaning policies, both economic and military, to support Ukraine.  

The shock was short-lived, however, and in its place are concerning questions about both public and political resolve. The underlying issue is the significance of the Russian invasion of Ukraine. While the immediate consequences of this conflict are felt by Ukrainians, it matters more widely—to both the British and the global public. Realising these consequences, and then taking the appropriate action to address them, is now urgent. That action involves serious investment in defence industries, defence capability, and the military.  

The lights on the dashboard of global security are all flashing—some amber, and some red. 

The Russian invasion of Ukraine matters more widely in at least the following four ways. 

First, it has incurred immediate costs on consumers globally. This sounds bland but is not. Soaring energy bills have cost lives, with the Economist estimating that the war indirectly killed more people in Europe in winter 2022 than Covid-19 did; so too do soaring food costs in countries which desperately need a steady, cheap supply of grain.  

Second, the current course of the conflict in Ukraine has dramatically raised the risk of a confrontation between NATO and Russia, which may include either or both of conventional or hybrid conflict. Russia has not succeeded in turning Kyiv into a satellite state. But, unless NATO dramatically increases its supply of materiel, including high-end capabilities, the most likely outcome of the war is that Russia will successfully ‘freeze’ the conflict while controlling approximately a fifth of Ukraine, including the most economically productive part of the country in the East. Such success increases the likelihood of a revanchist Putin, seeking to establish Russian control over its claimed ‘historic’ borders and having put his economy on a war footing, attacking perhaps the Baltic states. Or Russia may simply seek to disrupt NATO countries in forms of conflict that fall short of conventional war, but risk escalation, as witness the recent Estonian arrests of ten people alleged to be part of a Russian destabilisation operation. The collective self-defence pact embodied in NATO’s Article 5 means that UK forces will be involved in any response to such aggression. 

Third, the current inability for the US and Europe to act decisively, due to domestic political irresolution and polarisation, in the face of a clearly deteriorating security environment, emboldens potential adversaries. This is evident daily at the moment, with Republican politicians refusing to approve the $60 billion support package for Ukraine proposed by the Biden administration; as a result, the Ukrainian army has just withdrawn from Avdiivka, because it lacks the artillery shells to defend it. In a post-2016 timeline, and from an external perspective, the West now looks decadent.  

Fourth, that Russia is likely to succeed in its war aims (unless something changes on the battlefield) further undermines the norms of non-aggression which are central to our currentrules-based international order. The domestic political trajectories of Russia, China, and Iran are not presently encouraging. All have stated goals which would see change in who controls relevant territories, and none rule out the use of force in achieving their goals.  

The Russian invasion of Ukraine in February 2022, then, is an inflection point. The lights on the dashboard of global security are all flashing—some amber, and some red.  

But Javelins do not descend ex nihilo from the clouds: they need to be manufactured by advanced industries.  

In the face of such a deteriorating security environment, the urgent task for a responsible government is to ensure that it has the required military capability. This capability must be at minimum sufficient to defend its own citizens. It must also be sufficient to protect more widely those whom it has undertaken treaty commitments to defend. And, as a contribution to the wider public good, it is desirable that that capability should be sufficient to defend other innocent parties globally, subject to appropriate authorisation. Central to this capability is having a defence industry which will develop and manufacture the arms required.  

The defence industry has frequently attracted criticism and controversy, with the most damaging charge being that it sells weapons to authoritarian regimes in corrupt deals. Exporting arms to regimes that will use them repressively, through corrupt contracts, is plainly wrong. But responding to this criticism does not require banning or otherwise abolishing the defence industry. Rather, the correct response is to reform it and then regulate it effectively, on the grounds that if war itself can sometimes be just, then the production of the tools required for war must itself be just.  

If the state is, as St Paul had it, commissioned to punish the wrongdoer, ‘not bearing the sword in vain’, someone must make the swords. 

The Russian invasion of Ukraine in 2022 was a paradigm of wrongful aggression; if war is ever justified as, I think, an imperfect world forces us to accept, it is in such circumstances. Those who would contest such aggression, in defence of innocent lives and sovereign states, need the weapons to be able to do so, and they need the best weapons that are available. One of the immediate actions that Ben Wallace, then UK Secretary of State for Defence, took in response to the invasion was to surge Britain’s stocks of man-portable anti-tank weapons to Ukraine. One of these, the Javelin weapon, literally gained iconic status, in the meme of ‘St Javelin’, styled as an Orthodox saint. But Javelins do not descend ex nihilo from the clouds: they need to be manufactured by advanced industries.  

The defence industry, then, may certainly play a valuable role in a country’s economy. But more than that, in a world of predatory and repressive states, and violent non-state actors, it is a moral necessity. Isaiah foresaw, prophetically, a time when swords will be turned into ploughshares and spears into pruning hooks. But this side of that new reality, we need states that protect the innocent, and without a defence industry to equip the state to do so, the innocent lie vulnerable. If the state is, as St Paul had it, commissioned to punish the wrongdoer, ‘not bearing the sword in vain’, someone must make the swords. The peace dividend at the end of the US-Soviet Cold War has been spent, and we are in ‘the foothills’ of a new one, as the late Henry Kissinger described it. Ploughshares later; it must be swords now.  

How long have we got? It is a basic principle of military planning that, while you should structure your own operations around the enemy’s most likely course of action, you should also, and crucially, have contingencies for the enemy’s worst-case course of action. That worst-case may be with us sooner that we think. In the lead-up to the recent Munich Security Conference, the Estonian intelligence chief estimated that Russia is preparing for confrontation with the West ‘within the next decade’; the chair of Germany’s Bundestag defence committee indicated five to eight years; and the Danish defence minister suggested three to five years.  

With procurement timelines for advanced equipment—such as main battle tanks, frigates, and next generation fighter aircraft—typically taking over a decade, the urgent priority is for defence investment now. The UK’s Armed Forces are in a parlous state, as the recent cross-party report by the House of Commons Defence Committee makes clear. This investment in defence will not be cheap, and the difficult political task is deciding what spending to cut to allow for this uplift. But this debate cannot wait, and politicians must lead the country now in the required mind-set shift. Poland is the only NATO country to have convincingly demonstrated that it understands the times we live in, by investing seriously in its army. The UK government certainly wills the end, of ensuring the country’s security. The present question is whether it wills the means.   

The St Javelin icon meme

A cartoon female saint cradles a portable missile launcher against the backdrop of a Ukrainian flag.