The graves of unknown soldiers and the memorials to those who have no known resting place are the visible reminders of the enormous human toll due to conflict in the twentieth century, a toll that continues to this day. Over the past century, our ability to kill each other has increased far beyond what could have been imagined by those sitting in the trenches in the First World War, as fragile biplanes that posed a greater risk to those flying in them evolved into modern jet fighters firing precision guided missiles. Yet this “progress” contrasts starkly with our failures in other areas, including our ability to count the human cost of conflict. Despite the use of intense surveillance from satellites, pilotless drones and the like, the coalition forces in Iraq seem to have no idea about how many Iraqi civilians have been killed since the country was invaded. It has been left to non-governmental organisations and academics to produce the figures, which may be as high as 100,000 deaths.1

The continued lack of information on the health impact of conflict is a direct challenge to the global public health community. We have a duty to make visible the scale of avoidable disease and premature death, from whatever cause, as exemplified by the landmark Global Burden of Disease study. However, work such as this is dependent on primary research undertaken in difficult and often dangerous circumstances. For this reason, we welcomed a paper by Giacaman et al.2 that reported on the impact of the Israeli invasion of five West Bank towns in 2002. The paper provided a detailed account of the suffering experienced by the Palestinian people, which went far beyond headline numbers of deaths to include destruction of homes, shortages of food and essential medications, and marked psychosocial stress. We similarly welcomed a paper by Rosa Gofin, published in this edition, who writes from Israel about the public health implications of terrorism.3

It was almost inevitable that the publication of the paper by Giacama and colleagues would produce controversy and, in this edition, we publish a letter from Elihu Richter, an Israeli doctor, who argues that the suffering described should be placed in the context of the many Israelis who have died as a result of attacks originating from these five towns. Beside it, we publish Dr Giacaman's response. These letters highlight the tragic polarisation that afflicts this part of the world. However they also raise some important issues of principle.

A first principle is that no life is worth less than another. Yet this principle is routinely violated by the news media. It has often been noted how 100 deaths in a plane crash elicit vastly more coverage that 10,000 on the roads. This is equally true in situations of conflict. A detailed academic study of television news coverage of the Middle East situation in the United Kingdom, undertaken by the highly respected Glasgow University Media Unit in Glasgow University, found that Israeli casualties received much greater coverage than Palestinian casualties.4

A second principle is that we must take care in our use of language. This is exemplified by the highly emotive word “terrorist”, as illustrated by the cliché that “one man's terrorist is another man's freedom fighter”. This word has so often been abused that it has become almost meaningless. In the 1960s it was used to describe Nelson Mandela; today it is used to justify widespread human rights abuses in Guantanamo Bay, Chechnya, and many other parts of the world. However the main problem with terms such as this is the asymmetry. Few would argue that the murder of Israeli schoolchildren by a suicide bomber or the massacre of schoolchildren in Beslam is an act of terror. Yet some people seem reluctant to use the same term to describe the shooting by the Israeli army of Palestinian children,5 the deaths of passers-by that are the “collateral damage” resulting from “targeted killings” (not “assassinations”) of Palestinian leaders by missiles fired from helicopters into crowded streets, or the shelling of villages by Russian troops in Chechnya.6

A third principle is that we should look at the circumstances behind the headlines. A key finding from the study by the Glasgow Media Unit was how broadcasters felt unable to challenge the perceived short attention span of viewers by looking at the underlying issues. Yet we cannot hope to understand conflict without being aware of their origins and the factors that perpetuate them, such as rights to land, water, and employment prospects. Yet those few politicians that have sought to broaden the debate to include these issues risk being accused of justifying terrorism.7

These principles imply a need for mutual respect and understanding in the face of conflict, although this should be balanced by condemnation where it is due, whoever is responsible. We are not sufficiently naïve to believe that the quest for a shared understanding alone can solve the many problems that exist in this world, and nor do we underestimate how difficult this will be for those who continue to be affected personally by violence. However it is at least a start. For this reason we desperately hope that Dr Giacaman is wrong in her contention that co-operation between Israeli and Palestinian public health professionals is ineffective and undesirable. Surely there is scope for them to work together to make visible the human cost to both nations of the failure by their political leaders to reach a fair and meaningful settlement of this continuing tragedy.

Competing interest: MM is a member of the international advisory board of the Hadassah School of Public Health in Jerusalem, Israel. Both MM and SJ have had first hand experience of civil conflict, in Northern Ireland and the Middle East.


Roberts L, Lafta R, Garfield R, Khudhairi J, Burnham G. Mortality before and after the 2003 invasion of Iraq: cluster sample survey.
Giacaman R, Husseini A, Gordon NH, Awartani F. Imprints on the consciousness: the impact on Palestinian civilians of the Israeli Army invasion of West Bank towns.
Eur J Public Health
Gofin R.
Philo G, Berry M. Bad News from Israel. London: Pluto Press,
McGreal, C. A schoolgirl riddled with bullets. And no one is to blame. Questions remain after Israeli unit commander is cleared of Palestinian pupil's death. Guardian, 21 October, (2004) p 1. URL:,2763,1332219,00.html.
Bird C. To Catch a Tartar: notes from the Caucasus. London: John Murray,