With only marginal exceptions, everyone in Gaza is sick, injured, or both. This includes every national aid worker, every international volunteer, and probably every Israeli hostage: every man, woman, and child. While working in Gaza we saw widespread malnutrition in our patients and our Palestinian healthcare colleagues. Every one of us lost weight rapidly in Gaza despite having privileged access to food and having taken our own supplementary nutrient-dense food with us. We have photographic evidence of life-threatening malnutrition in our patients, especially children, that we are eager to share with you.

Virtually every child under the age of five whom we encountered, both inside and outside of the hospital, had both a cough and watery diarrhea. We found cases of jaundice (indicating hepatitis A infection under such conditions) in nearly every room of the hospitals in which we served, and in many of our healthcare colleagues in Gaza. An astonishingly high percentage of our surgical incisions became infected from the combination of malnutrition, impossible operating conditions, lack of basic sanitation supplies such as soap, and lack of surgical supplies and medications, including antibiotics.

Malnutrition led to widespread spontaneous abortions, underweight newborns, and an inability of new mothers to breastfeed. This left their newborns at high risk of death given the lack of access to potable water anywhere in Gaza. Many of those infants died. In Gaza we watched malnourished mothers feed their underweight newborns infant formula made with poisonous water. We can never forget that the world abandoned these innocent women and babies.

We urge you to realize that epidemics are raging in Gaza. Israel’s continued, repeated displacement of the malnourished and sick population of Gaza, half of whom are children, to areas without running water or even toilets available is absolutely shocking. It was and remains guaranteed to result in widespread death from viral and bacterial diarrheal diseases and pneumonias, particularly in children under the age of five. Indeed, even the dreaded polio virus has reemerged in Gaza due to a combination of systematic destruction of the sanitation infrastructure, widespread malnutrition weakening immune systems, and young children having missed routine vaccinations for nearly an entire year. We worry that unknown thousands have already died from the lethal combination of malnutrition and disease, and that tens of thousands more will die in the coming months, especially with the onset of the winter rains in Gaza. Most of them will be young children.

Children are universally considered innocents in armed conflict. However, every single signatory to this letter saw children in Gaza who suffered violence that must have been deliberately directed at them. Specifically, every one of us who worked in an emergency, intensive care, or surgical setting treated pre-teen children who were shot in the head or chest on a regular or even a daily basis. It is impossible that such widespread shooting of young children throughout Gaza, sustained over the course of an entire year is accidental or unknown to the highest Israeli civilian and military authorities.