The best scenario, they said, is that our three ships–one carrying 5,500 tons of humanitarian aid and two carrying the passengers–will reach Gaza and accomplish our mission. Another scenario would be that the Turkish government might cave to pressure from Israel, the United States and Germany, and prevent the boats from even leaving Istanbul. This happened in 2011, when the Greek government buckled under pressure and ten boats were stalled in Greece. With our boats docked in Istanbul today, we fear that Turkish President Erdogan, who recently suffered a crushing blow in local elections, is vulnerable to any economic blackmail the Western powers might be threatening.

Another possibility is that the ships take off but the Israelis illegally hijack us in international waters, confiscate our boats and supplies, arrest and imprison us, and eventually deport us.

This happened on several other voyages to Gaza, one of them with deadly consequences. In 2010, a flotilla of six boats was stopped by the Israeli military in international waters. They boarded the biggest boat, the Mavi Marmara. According to a UN report, the Israelis opened fire with live rounds from a helicopter hovering above the ship and from commando boats along the side of the ship. In a horrific display of force, nine passengers were killed, and one more later succumbed to his wounds.

To try to prevent another nightmare like that, potential passengers on this flotilla have to undergo rigorous training. We watched a video of what we might face—from extremely potent tear gas to ear-splitting concussion grenades—and we were  told that the Israeli commandos will  be armed with weapons with live rounds. Then we divided up into small groups to discuss how best to react, non-violently, to such an attack. Do we sit, stand, or lie down? Do we link arms? Do we put our hands up in the air to show we are unarmed?

 Photo credit: Medea Benjamin

The most frightening part of the training was a simulation replete with deafening booms of gunfire and exploding percussion grenades and masked soldiers screaming at us, hitting us with simulated  rifles, dragging us across the floor, and arresting us. It was indeed sobering to get a glimpse of what might await us. Equally sobering are Israeli media reports indicating that the Israeli military has begun “security preparations,” including preparations for taking over the flotilla.

That’s why everyone who has signed up for this mission deserves tremendous credit. The largest group of passengers are from Turkey, and many are affiliated with the humanitarian group, IHH, an enormous Turkish NGO with 82 offices throughout the country. It has consultative status at the UN and does charity work in 115 countries. Through IHH, millions of supporters donated money to buy and stock the ships. Israel, however, has designated this very respected charity as a terrorist group.

The next largest group comes from Malaysia, some of them affiliated with another very large humanitarian group called MyCARE. MyCARE, known for helping out in emergency situations such as floods and other natural disasters, has contributed millions of dollars in emergency aid to Gaza over the years.

From the U.S., there are about 35 participants. Leading the group, and key to the international coalition, is 77-year-old retired U.S. Army colonel and State Department diplomat Ann Wright. After quitting the State Department in protest over the U.S. invasion of Iraq, Wright has put her diplomatic skills to good use in helping to pull together a motley group of internationals. Her co-organizer from the U.S. is Huwaida Arraf, a Palestinian American attorney who is a co-founder of the International Solidarity Movement and who ran for congress in 2022. Arraf  was key to organizing the very first flotillas that started in 2008. So far, there have been about 15 attempts to get to Gaza by boat, only five of them successful.

The incredible breadth of participants is evident in our nightly meetings, where you can hear clusters of groups chatting away in Arabic, Spanish, Portuguese, Malay, French, Italian, and English in diverse accents from Australian to Welsh. The ages range from students in their 20s to an 86-year-old Argentine medical doctor.

What brings us together is our outrage that the world community is allowing this genocide in Gaza to happen, and a burning desire to do more than we have been doing to stop people from being murdered, maimed and starved. The aid we are bringing is enormous–it is the equivalent of over 100 trucks—but that is not the only purpose of this trip. “This is an aid mission to bring food to hungry people,” said Huwaida Arraf, “but Palestinians do not want to live on charity. So we are also challenging Israeli policies that make them dependent on aid. We are trying to break the siege.”

Israel’s vicious attacks on the people of Gaza, its blocking of aid deliveries and its targeting of relief organizations have fueled a massive humanitarian crisis. 
The killing of seven World Central Kitchen workers by Israeli forces on April 1 highlighted the dangerous environment in which relief agencies operate, which has forced many of them to shut down their operations.

The U.S. government is building a temporary port for aid that is supposed to be finished in early May, but this is the same government that provides weapons and diplomatic cover for the Israelis. And while President Biden expresses concern for the suffering Palestinians, he has suspended aid to UNRWA, the main UN agency responsible for helping them, after Israel made unsubstantiated claims that 12 of its 13,000 employees in Gaza participated in the October 7 attacks.

Given the urgency and danger this moment presents, the Freedom Flotilla Coalition is entering rough and uncharted waters. We are calling on countries around the world to pressure Israel to allow us “free and safe passage” to Gaza. In the U.S., we are asking for help from our Congress, but having just approved another $26 billion to Israel, it is doubtful that we can count on their support.

And even if our governments did pressure Israel, would Israel pay attention? Their defiance of international law and world opinion during the past seven months indicates otherwise. But still, we will push forward. The people of Gaza are the wind in our sails. Freedom for Palestine is our North Star. We are determined to reach Gaza with food, medicines and, most of all, our solidarity and love.

They said of the just-realeased Integrated Food Security Phase Classification (IPC) assessment, “This is unprecedented. No IPC analysis has ever recorded such levels of food insecurity anywhere in the world.” [Emphasis added.]

They continued, “Life-threatening levels of acute malnutrition have risen at an alarming rate since the last report, and we are already witnessing with horror the death of children due to starvation. Hunger cannot be used as a weapon of war. What we are seeing is not a natural hazard but a manmade disaster, and it is our moral duty to stop it.”

Borell said in Brussels, “In Gaza we are no longer on the brink of famine, we are in a state of famine, affecting thousands of people.” He added, “This is unacceptable. Starvation is used as a weapon of war. Israel is provoking famine.”

Sometimes a telling detail outweighs a statistic. Something like 25,000 babies have been born in Gaza since the Israeli campaign began.

According to reporters on the scene, many of their mothers are too malnourished to produce milk for them. Imagine the anguish and the guilt.

There is no powdered milk in the market. Most of the available water is full of bacteria, which kills newborns by giving them diarrhea and dehydrating them. One mother said that her two-month-old is like a two-week-old because of malnutrition.

Al Jazeera video: “2-month-old baby dies from hunger in Gaza | Al Jazeera Newsfeed”

The IPC review [pdf] found that 100% of the Palestinians in Gaza face food insecurity as a result of Israel’s war strategy. But matters have gone beyond the level of food insecurity in some parts of the Gaza Strip, for instance in the north.

The report says, “Famine is now projected and imminent in the North Gaza and Gaza Governorates and is expected to become manifest from mid-March 2024 to May 2024.”

We’re in mid-March. Something like 300,000 people remain in these two governorates.

People there are now suffering acute malnutrition.

Acute malnutrition, WHO explains, shows up in four broad ways: “wasting, stunting, underweight, and micronutrient deficiencies.” These conditions make people horrifyingly skinny, reducing their limbs to the dimension of sticks. Physicians measure limbs according to mid-upper arm circumference (MUAC), which tells them about the degree of Global Acute Malnutrition (GAM).

In Gaza’s children from a half-year old to 4.9 years in age, 1% were considered to be suffering from Global Acute Malnutrition according to their MUAC in September, 2023. By January it had risen to 6-9%. By February, just last month, it was 12%-16%. It has been just about doubling. So by the end of March you’re looking at at least 24%-26% of infants and toddlers and young children suffering from Global Acute Malnutrition so severely that their upper-arm circumference is tiny. But what if the numbers aren’t just doubling? The IPC provides a helpful graph of Israeli cruelty:

We don’t have the raw data to nail it down, but we probably aren’t seeing more than 2 deaths per 10,000 per day yet from malnutrition, according to the IPC. But that would be 60 people starving to death per day in north Gaza, or 1,800 a month.

The Israelis only let in half as many aid trucks in February as they had in January. That is a recipe for an exponential, not just serial increase in hunger. We could be going to half or more of north Gaza’s children suffering this extreme malnutrition. Of course, it isn’t just children, but children are half the Palestinian population in the Gaza Strip.

The IPC expects a big spike in deaths from starvation beginning as early as now through May.

The worst level of malnutrition is Phase 5, which has two stages, famine and catastrophe.

The report found that fully 70% of the population of north Gaza is now in Phase 5-Catastrophe. That is 200,000 people.

An Israeli ground offensive in Rafah will push more 500,000 people into Phase 5-Catastrophe. If just 2 per 10,000 of them died daily of starvation as a result, that would be 100 per day or 3,000 a month, on top of the ones in the north. That is nearly 5,000 people a month dead of malnutrition, and that is if it stays at the rate of 2 per 10,000 per day. It won’t.

The IPC concludes, “The persistent attacks on hospitals, health posts, ambulances, water services, civilian telecoms services, and IDP sites must cease. Attacks against health care workers must cease. Civilians and civilian infrastructure must be protected, as required under International Humanitarian Law. (Already stipulated in the December 2023 FRC report.”

The authors note that the only proven way to avert famine is to deliver food to those threatened by it. Moreover, they point out that unless people are in fair health, they can’t take in the nutrition, so health care has to be restored as well.

Jake Johnson

( Commondreams.org ) – Patients on Medicare Advantage spoke out against the privatized plans this week as part of a coordinated campaign to shed light on the program’s care denials, treatment delays, and overbilling—and to pressure U.S. President Joe Biden to rein in the insurance giants raking in huge profits from such abuses.

“These corporations do nothing to increase positive outcomes in medical care. So don’t fall for their bullshit,” Jenn Coffey, a retired EMT from New Hampshire, said during a livestream hosted by People’s Action on Wednesday night.

The stream featured testimony from several patients who have experienced the kinds of delays and denials for which Medicare Advantage is notorious.

Rick Timmins of Puget Sound Advocates for Retirement Action said it took five months and “multiple calls and emails” for his insurance company to approve his referral to a dermatologist for a suspicious lump on his earlobe that turned out to be malignant melanoma. The delay stemmed from a byzantine process known as prior authorization, whereby doctors are required to prove a treatment is necessary before an insurer will cover it.

By the time his referral to a specialist was approved, Timmins said, the previously tiny lump “had tripled in size” and was “quite painful.”

Coffey, for her part, ended up on a UnitedHealth Medicare Advantage plan after she was diagnosed with breast cancer in 2013. She later developed two rare diseases—including complex regional pain syndrome—and required expensive treatments that her Medicare Advantage plan refused to cover.

“If Medicare Advantage has it their way, they’re going to deny me care and delay me care until I’m dead,” Coffey, a healthcare advocate, said in a video published Thursday by the advocacy group Be A Hero as part of a social media day of action against the for-profit plans.

Image by Steve Buissinne from Pixabay

“They only make money when they don’t have to spend it on you,” said Coffey.

Once enrolled in a Medicare Advantage plan, patients often find it difficult to get out.

“They like to tell you: ‘Medicare Advantage numbers are so high, can’t you tell people love it?'” said Coffey, alluding to the fact that more than half of all eligible Medicare beneficiaries are now enrolled in a Medicare Advantage plan. “No, we don’t. We’re stuck. It’s the Hotel California: You can check in, but you can’t get the hell out.”

Next month, the Biden administration is expected to finalize 2025 payment rates for Medicare Advantage, which is funded by the federal government. Medicare Advantage plans frequently overbill the government by making patients appear sicker than they are.

An analysis released last year by Physicians for a National Health Program estimated that Medicare Advantage plans are overcharging U.S. taxpayers by as much as $140 billion per year—an amount that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare’s prescription drug program.

Patients and advocacy groups are calling on Biden to “not fork over more money for insurance companies like UnitedHealthcare,” as Coffey put it during Wednesday’s livestream.

A petition sponsored by Social Security Works urges Biden to “reclaim Medicare” from Medicare Advantage providers, which “have delayed and denied care to millions of Americans in order to turn a massive profit.”

“Medicare Advantage isn’t really Medicare, and it isn’t an advantage to the seniors and people with disabilities who rely on the program,” reads the petition, which has over 22,800 signatures as of this writing. “In the 25 years that it has existed, it’s clear that Medicare Advantage is riddled with the same problems as the rest of private insurance: Opaque bureaucracy and extraordinary fees. Seniors who enroll in these for-profit plans are being price-gouged by massive corporations.”

The Biden administration has proposed a 3.7% payment increase for Medicare Advantage in 2025—a change that insurers have portrayed as a cut. But Social Security Works noted in response to the industry’s complaints that “MA companies are not hurting for profits.”

“In 2022 alone, seven healthcare companies that comprise 70% of the MA market brought in over $1 trillion in total revenue and over $69 billion in profits, and spent $26.2 billion on stock buybacks,” the group observed. “These same companies claim that if the government doesn’t increase their already bloated payment rates, they will have no choice but to slash benefits for patients. This is false, and should be seen for what it is—MA plans holding patients hostage to extort the government for profits.”

In an op-ed for STAT last month, former insurance industry insider Wendell Potter—who is now an outspoken critic of private insurers—and John A. Burns School of Medicine professor professor Philip Verhoef wrote that “private plans have no business administering Medicare benefits.”

“Traditional Medicare is already more efficient than its private counterpart, in large part because the approval process is much simpler and there aren’t the same incentives to upcode,” the pair wrote. “Traditional Medicare spends far less of its funds on administrative overhead, and overall it spends less money per patient than Medicare Advantage while providing far superior access to doctors, hospitals, and treatments.”

“Medicare Advantage isn’t working for any group: the government, patients, taxpayers, and now even investors,” they added. “It’s time to turn to what we already know works. We need to support and strengthen traditional Medicare.”

Imagine this: since March 2023, 16 million Americans — yes, that’s right, 16 million — have lost healthcare coverage, including four million children, as states redefine eligibility for Medicaid for the first time in three years. Worse yet, the nation is only halfway through the largest purge ever of Medicaid as the expansion and extension of healthcare to millions, brought on by the Covid-19 pandemic, have ended, leaving some families no longer eligible, while others need to reapply through a new process in their state.

This thrusting of tens of millions of Americans out of the national healthcare system at a moment when healthcare outfits, pharmaceutical companies, and health insurance corporations are making record profits has been termed “the great unwinding.” And it couldn’t be more cruelly ironic. After all, states have the power and authority to expand healthcare to all their residents; the federal government could similarly extend the declaration of a public health emergency that would let so many of us keep distinctly life-protecting access to healthcare. Yet millions have instead been pushed violently and rapidly from such life-saving care.

Some states are feeling the impact especially strongly. In Georgia, for instance, more than 149,000 children lost their pandemic Medicaid enrollment in just six months. Perhaps unsurprisingly, Texas is the epicenter of Medicaid’s unwinding. There, more than two million Americans have been removed from the state’s Medicaid program since federal pandemic-era coverage protections were lifted last April. As Axios reported, new state data indicates “that’s the most of any state and nearly equivalent to all of Houston — Texas’ most populous city, with 2.3 million residents — losing coverage in less than a year.” In fact, 61% of enrollees in Texas have lost Medicaid since last April.

Death by Poverty and the Lack of Healthcare

In my home state, policy analysts predict that more than 1.1 million New Yorkers will be pushed off Medicaid roles in this same unwinding. Fortunately, people are organizing in response, calling for the right to healthcare, living wages, the abolition of poverty, and more. 

On Saturday, March 2nd, I stood next to Becca Forsyth of Elmira, New York, at the Poor People’s Campaign’s Mass Poor People and Low Wage Workers Statehouse Assembly in Albany, New York. Becca was one of dozens of low-income people who testified at simultaneous assemblies held in 31 state capitals and Washington, D.C. These assemblies launched 40 weeks of the mobilizing and organizing of poor and low-income eligible voters in the lead-up to the 2024 elections, while challenging those running for office, as well as elected officials, to confront poverty as the fourth-leading cause of death in America. Becca was not the only speaker to touch on the crisis of healthcare (and its connection to poverty and death), but her words stuck with me:

“Just since December 19th, I have lost more than a dozen people I loved dearly. In 74 days, I’ve watched as people I’ve known most of my life were literally squeezed to death by poverty and the catastrophic impact it has on our entire lives. People like Missy, a 47-year-old woman who was found lying beside the railroad tracks, dead… Or Gary, who died at the hands of the police while in a hospital for a mental breakdown. Or Loretta, a friend who was a friend before I even knew what the word friend meant, who is no longer with us because my community won’t spend money on substance-use treatment. Chemung County leads this state in way too many negative ways. We rank 59 out of the 62 counties in New York for health outcomes. We have outrageous homelessness, food insecurity, premature death rates, and lead poisoning. Our chances for getting out of poverty are extinguished before we even have a chance!”

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Just two days before I stood with Becca in Albany, the state capital, demanding the right to thrive and not just barely survive, I rallied with healthcare workers and community members at SUNY Downstate Hospital. With the support of New York Governor Kathy Hochul, SUNY Chancellor John King recently announced that his outfit may close SUNY Downstate Medical Center in Brooklyn, New York, one of the few remaining public-safety-net hospitals in the state.

At that rally, community members, hospital workers, local politicians, and faith leaders shared information about the crucial role that hospital has played in the community. It served as a Covid refuge where thousands of lives were saved in the heat of the pandemic, as a critically safe birthing place for Black moms (crucial given the maternal health outcomes for so many women of color), as the only kidney transplant hospital in Brooklyn, and as one of the only remaining teaching hospitals in the area after the closure of such facilities, particularly in impoverished neighborhoods, across Brooklyn and the rest of New York.

Sadly, closing down hospitals or reducing their services in poorer neighborhoods is becoming all too typical of this nation. Big conglomerates are buying up chains of them and making decisions based only on their bottom lines, not the needs of our communities. In fact, more than 600 rural hospitals are now at risk of closing due to financial instability and that’s more than 30% of America’s rural facilities. For half of them, the possibility of closure is immediate, according to a new report from the Center for Healthcare Quality and Payment Reform (CHQPR).

Our Unwinding Health

Such Medicaid cuts and hospital closures are but two manifestations of a far larger attack on American health and healthcare in what’s fast being transformed into a death-dealing nation. They are but harbingers of an even larger “unwinding” of our health as a nation. Before the pandemic and the most recent cuts, 87 million Americans were already uninsured or underinsured. We’re talking about people sharing heart-attack medicine because they can’t afford their own prescriptions, burying their children for lack of healthcare, and relying on emergency rooms rather than preventative care, while going bankrupt in the process.

It’s simple enough. All too many of us are skipping needed care. In 2022, more than one of every four adults (28% of us) reported delaying or going without some combination of medical care, prescription drugs, mental healthcare, or dental care simply because they lacked the ability to pay.

Meanwhile, medical debt is growing all too rapidly. A Census Bureau analysis of such debt found that, in 2021, 15% of all American households owed medical debt — or 20 million people (nearly 1 in 12 adults). Indeed, the SIPP (Survey of Income and Program Participation) survey suggests that, in total, Americans owe at least $220 billion in medical debt, the biggest source of bankruptcy in the nation.

And of course, as I’ve written before, this is all connected to another reality: that life expectancy is down for everyone, while the poor can expect to die, on average, 12 to 13 years earlier than rich people. Worse yet, the death-rate gap between rich and poor in this country has risen by a staggering 570% since 1980. As the Washington Post reported, “America is increasingly a country of haves and have-nots, measured not just by bank accounts and property values but also by vital signs and grave markers. Dying prematurely has become the most telling measure of the nation’s growing inequality.”

Poor Health

In the face of all of this, you might wonder how things could get any worse. Recently, Congress announced potential cuts to another crucial food and health program for the poor. The Special Supplemental Nutrition Program for Women, Infants, and Children (known as WIC) is at risk of a $1 billion shortfall, essentially guaranteeing harmful cuts to that lifeline for low-income families and children. If Congress refuses to fully fund the program, current funding levels simply won’t cover all eligible participants.

In fact, the $1 billion shortfall now slated to occur equals 1.5 months of benefits for all program beneficiaries or six months of benefits for all pregnant women and infants participating in WIC. House Republicans are currently refusing to approve the budget for this vital program that helps mothers and children up to age five access staples like fruit, vegetables, and infant formula, and connects them to healthcare resources.

In a statement to NBC News, Agriculture Secretary Tom Vilsack called WIC, “one of the most consequential, evidence-based public health programs available.” He implored Congress to fully fund the program, which provides “life-changing benefits and services” to its participants.

And Vilsack is anything but wrong when he speaks of the importance of that pro-poor, pro-health program. An abundance of research suggests the critical role that WIC plays in “supporting maternal health and child development. WIC participation during pregnancy is associated with lower risk of preterm birth, lower risk of low birth weight, and lower risk of infant mortality.” Children on WIC are more likely to consume a healthier diet, and this impact only grows the longer a child stays in the program, which also has a significant reach. As the Department of Agriculture reports, “Nearly 40 percent of America’s infants participate in WIC, which is available only to pregnant women, new mothers, infants, and children who meet income guidelines and are determined to be at nutritional risk by a health professional.”

So Much More Is Needed

But as such programs are cut to the bone and more people experience a plethora of problems already plaguing the health of the nation, many are likely to give up entirely, assuming there’s nothing to be done and that it’s just too costly to address inequality and poor health. As someone who has been organizing among the poor for more than 30 years, however, I want to suggest that, as a nation, this just can’t be as “good” as it gets.

Across the span of my lifetime, there have been debates about how to address the larger health crisis in American society. When I was in high school, there was already debate about the effectiveness of establishing a national healthcare program, as President Bill Clinton and Hillary Clinton campaigned on expanding healthcare and actually proposed a new plan for it in 1993. At the time, I remember hearing criticism of the Canadian system of nationalized healthcare. People there, it was said, experienced long lines, way too much paperwork, and a lack of options for patients.

Today, considering the way our healthcare system is unwinding, I could almost laugh (however grimly) at what it would mean to have that Canadian system of years past. All too sadly, however, that country has followed the United States in cutting and privatizing its healthcare system.

Many consider the Affordable Care Act (ACA) one of the most important policies adopted under the presidency of Barack Obama, given that more than 20 million people gained health coverage through it and the ACA’s policies made it easier for eligible people to enroll in Medicaid. In particular, the ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,783 in 2024) and helped states with matching federal dollars expand Medicaid to more of their residents. Yet the ACA didn’t go nearly far enough. To date, 40 states and Washington, D.C., have adopted Medicaid expansion, while 10 states have not. Even in states with Medicaid expansion, too many of us are still not covered. And now we’re witnessing one of the greatest attacks on health and healthcare in decades (and just imagine what we’re likely to face if Donald Trump becomes our next president and/or the MAGA Republicans take Congress).

What this nation truly needs is a complete overhaul of its healthcare system. As a start, Medicaid needs to be expanded, extended, and built into a single-payer, universal healthcare plan. Workers need the right to living-wage jobs with generous benefits, including guaranteed paid family sick leave. Social welfare programs like the Supplemental Nutrition Assistance Program, WIC, and the Child Tax Credit need to be strengthened so that the abundance of this society is experienced by everyone. Household and medical debt would have to be cancelled, while drug-recovery programs would need to be fully funded. And parks and recreation centers, as well as grocery stores with quality, affordable food, would have to proliferate, starting in poor communities.

It’s not enough to protest the unwinding of pandemic Medicaid programs. Even that classic protest chant — “They say cut back, we say fight back!” — doesn’t go far enough. Instead, the 135 million poor and low-income Americans, and for that matter, the rest of us, must make healthcare and so much more into basic human rights.

Let me end then not with words of mine but with Becca Forsyth’s challenge to Americans in her Poor People’s Campaign testimony that day in Albany. “We must stop this raging storm of policy violence that is killing our friends and neighbors,” she said movingly. “It doesn’t have to be this way! We can wield our votes as powerful demands. The time for sitting on the sidelines is over. We have to move forward together like our lives depend on it… the lives of our children! Because they do!!”

How right she is!

Copyright 2024 Liz Theoharis

Via Tomdispatch.com

( Tomdispatch.com) – Amid ongoing emergencies, including a would-be autocrat on his way to possibly regaining the American presidency and Israel’s war on Gaza (not to mention the flare-ups of global climate change), the U.S. has slipped quietly toward an assault on civil liberties as an answer to plummeting mental health. From coast to coast, state lawmakers of both parties are reaching for coercive treatment and involuntary commitment to address spiraling substance use and overdose crises — an approach that will only escalate despair and multiply otherwise preventable deaths while helping to choke the life out of America.

In December, we wrote about how loneliness has become a public-health crisis, according to the Surgeon General, and the ways in which it drives widespread substance use. We reach for substances to ease feelings of isolation and anguish — and when the two of us say “we,” we mean not just some hypothetical collective but the authors of this article. One of us, Sean, is a doctor living in long-term recovery from a substance-use disorder and the other, Mattea, is a writer who uses drugs.

And we’re anything but unique. Disconnection and loneliness aren’t just the maladies of a relatively few Americans, but the condition of the majority of us. Vast numbers of people are reaching for some tonic or other to manage difficult feelings, whether it’s weed, wine, work, television, or any mood- or mind-altering substance. These days, there’s scarcely a family in this country that’s been unscathed by problematic drug use.

Not surprisingly, under the circumstances, many elected officials feel increasing pressure to do something about this crisis — even as people who use drugs are widely considered to be social outcasts. In 2021, a survey of thousands of U.S.-based web users found that 7 in 10 Americans believed that most people view individuals who use drugs as non-community members. It matters little that the impulse to use such substances is driven by an urge to ease emotional pain or that the extremes of substance use are seen as a disease. As a society, we generally consider people who use drugs as rejects and look down on them. Curiously enough, however, such social stigma is not static. It waxes and wanes with the political currents of the moment.

“Stigma has risen its ugly head in almost every generation’s attempts to manage better these kinds of issues,” says Nancy Campbell, a historian at Rensselaer Polytechnic Institute and the author of OD: Naloxone and the Politics of Overdose. Campbell reports that she finds herself a target of what she calls “secondary stigma” in which others question why she even bothers to spend her time researching drug use.

Perhaps one reason to study such issues is to ensure that someone is paying attention when lawmakers of virtually every political stripe seek to answer a mental health crisis by forcing people into institutionalized treatment. Notably, such “treatment” can increase the odds of accidental death. Allow us to explain.

“Treatment” Can Be a Death Sentence

Across the country, the involuntary detainment and institutional commitment of people with mental illness — including those with a substance use disorder — is on the rise. Deploying the language of “helping” those in need, policymakers are reaching not for a band-aid but a club, with scant or even contradictory evidence that such an approach will benefit those who are in pain.

“The process can involve being strip-searched, restrained, secluded, having drugs forced on you, losing your credibility,” said UCLA professor of social welfare David Cohen in a 2020 statement about his research on involuntary commitment. He co-authored a study that found its use rose nationwide in the decade before the pandemic hit, even as there was a striking lack of transparency regarding when or how such coercion was used.

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Today, many states are expanding laws that authorize mandatory treatment for people experiencing mental-health crises, including addiction. According to the Action Lab at the Center for Health Policy and Law, 38 states currently authorize involuntary commitment for substance use. None of them require evidence-based treatment in all involuntary commitment settings and 16 of them allow facilities to engage in treatments of their choice without the individual’s consent. Nearly every state that ranked among the highest in overdose rates nationally has an involuntary commitment law in place.

In September, the California legislature passed a bill that grants police, mental healthcare providers, and crisis teams the power to detain people with “severe” substance use disorder. The Los Angeles County Board of Supervisors subsequently voted to postpone implementation of the law, with Board Chair Lindsey Hogarth noting the risk of civil rights violations as a reason for the delay. In October, Pennsylvania state legislators introduced a bill that would permit the involuntary commitment of people who have been revived following an overdose. While many mental health advocates acknowledge the good intentions of legislators, the potential for harm is incalculable.

New research shows that people who attended abstinence-based treatment programs were at least as likely, if not more likely, to die of a fatal overdose than people who had no treatment at all. By contrast, those who had access to medications like methadone or buprenorphine for opioid-use disorder were less likely to die. Those medications, however, are not considered “abstinence” and so are not uniformly provided in treatment settings. Though there is extensive evidence of the effectiveness of medications for opioid use disorder, abstinence still remains widely regarded as the morally upright and best path, even if it makes you more likely to die. The reason for the elevated risk of mortality following abstinence-based treatment is no mystery: abstinence reduces the body’s tolerance. If a person who has been abstinent resumes use, the ingestion of a typical dose is more likely to overwhelm his or her bodily system and so lead to death.

Disturbingly, both The Atlantic and the Wall Street Journal recently ran columns favoring mandatory treatment, with the Journal citing as evidence a 1960s study in which individuals fared well after 18 months of mandated residential treatment that included education and job training — a standard of care that’s virtually nonexistent today. The Atlantic referenced a study of 141 men mandated for treatment in the late 1990s whose outcomes were comparable to individuals who entered treatment voluntarily; the study’s own authors had, however, cautioned against generalizing the findings to other populations due to its limited scope — and since then, the potent opioid fentanyl has entered the drug supply and raised the risk of a fatal overdose following a period of abstinence.

Meanwhile, as policymakers turn to coerced treatment, consider this an irony of the first order: there are far too few treatment options for people who actually want help. “There is no place in this country where there is enough voluntary treatment. So why would you create involuntary commitment, involuntary treatment?” asks Campbell. The reason, she suggests, is the inclination of lawmakers not just to do something about an ongoing deadly crisis, but in no way to appear “soft on drugs.”

Just to put the strange world of drug treatment in context, imagine elected officials wanting to seem tough on constituents who have cancer or heart disease. The idea, of course, is ludicrous. But 7 in 10 Americans think society at large views addiction as “at least somewhat shameful” and people who use drugs as significantly responsible (that is, to blame) for their substance use. No surprise, then, that politicians would find it expedient to punish people who use drugs, even if such punishment only layers on still more shame, with research indicating that shame, in turn, exacerbates the pain and social isolation that drives people to use drugs in the first place. As Dr. Lewis Nelson, who directs programs in emergency medicine and toxicology at Rutgers New Jersey Medical School, pointed out to USA Today, the science of addiction and recovery is frequently overlooked because it’s inconsistent with ingrained social ideas about substance use.

“I Still Don’t Need Saving”

Punishing people for substance use worsens the pain and isolation that make drugs so appealing. So rather than punishment — and in our world today this will undoubtedly sound crazy — what if we treated people who use drugs as full and complete human beings like everyone else? Like, say, people with high blood pressure? What if we acknowledged that those who use drugs need the very same things that all people need, including love, support, and human connection, as well as stable employment and an affordable place to live?

Research on this, it turns out, suggests that human connection is particularly good medicine for the emotional pain that so often underlies substance use and addiction. Stronger social bonds — namely, having people to confide in and rely on — are associated with a positive recovery from a substance use disorder, while the absence of such social ties elevates the risk of further problematic drug use. Put another way, perhaps you won’t be surprised to learn that a powerful means of healing widespread mental distress is to connect with one another.

When people in distress have friends, attendant family, and healthcare providers who are genuinely there for them no matter what, their own self-perception improves. In other words, we help one another simply by being nonjudgmentally available.

Jordan Scott is a peer advocate for Recovery Link, which offers free digital peer support to people in Texas and Pennsylvania. She identifies as a person who uses drugs. “I felt like the message got reinforced that there was something wrong with me, that there was something broken with me,” she told us. “Anything that isn’t abstinence, or anything that doesn’t include total abstinence as a goal, is constantly positioned as less than.”

New research published in the journal Addiction draws a contrast between treatment focused exclusively on abstinence and a broader array of wellness strategies, including reducing drug use rather than eliminating it entirely. The study found that reduced use had clinical benefits and that health can distinctly improve even without total abstinence. Director of the National Institute on Drug Abuse Nora Volkow, for instance, supports a nuanced approach that includes many possible paths of recovery along with a shift away from the criminalization of drug-taking to a focus on overall health and wellbeing. And the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services, has identified four dimensions critical to recovery: health, home, purpose, and community.

Most important of all, a person doesn’t necessarily need to be abstinent in order to make gains in all four areas. This makes good sense when you remember that addiction or other problematic substance use is a symptom of underlying pain. Rather than exclusively treating the symptom — the drug use — addressing the underlying loneliness, trauma, or other distress can be a very effective approach. “Family can be a valid pathway to wellness,” Scott pointed out, while adding that her own path went from 12-step meetings like Alcoholics Anonymous to active civic engagement.

For someone else, quality time with his or her kids or even exercising and eating well might be a linchpin for staying mentally healthy. In other words, healing from the pain that underlies substance use disorder can look a lot like healing from any other health challenge.

Yet policymakers continue to call for intensifying the use of coercive treatment. “I think we’re going to see more [involuntary commitment] before we see less of it,” said Campbell, who studies historical patterns in the social response to drug use. There’s nothing new, she noted, in the move to “help” people by institutionalizing them — even if such a move constitutes an erosion of basic civil rights.

“I think most of the time people are genuine in wanting to help,” said Scott, who has been a target of such “help.” The problem, she explained, is the idea that there is a group of people considered “normal” and therefore superior, who think they’re in a position to save other members of society.

“I didn’t need saving. I am a drug user now. I still don’t need saving,” Scott told us. These days she’s focused on being a part of her community through volunteerism while drawing on a support network of people who respect her path.

As for the two of us writing this article, Sean is spending time with his children, staying connected with friends, practicing meditation and yoga, and has for years facilitated a group of physicians in recovery. Mattea has started a new habit of going to the gym with her uncle to ease her loneliness, while also confiding in close friends for support. And all of that truly does make a difference.

Copyright 2024 Sean Fogler and Mattea Kramer

Via Tomdispatch.com

( Commondreams.org ) – The United States health care system—more costly than any on earth—will become ever more so as Wall Street increasingly extracts money from it.

Private equity funds own approximately 9% of all private hospitals and 30% of all proprietary for-profit hospitals, including 34% that serve rural populations. They’ve also bought up nursing homes and doctors’ practices and are investing more year by year. The net impact? Medical costs to the government and to patients have gone up while patients have suffered more adverse medical results, according to two current studies.

The Journal of the American Medical Association (JAMA) recently published a paper which found:

Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line–associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections.

This should not come as a surprise. Private equity firms in general operate as follows: They raise funds from investors to purchase enterprises using as much borrowed money as possible. That debt does not fall on the private equity firm or its investors, however. Instead, all of it is placed on the books of the purchased entity. If a private equity firm borrows money and buys up a nursing home or hospital chain, the debt goes on the books of these healthcare facilities in what is called a leveraged buyout.

To service the debt, the enterprise’s management, directed by their private equity ownership, must reduce costs, and increase its cash flow. The first and easiest way to reduce costs is by reducing the number of staff and by decreasing services. Of course, the quality of care then suffers. Meanwhile, the private equity firm charges the company fees in order to secure its own profits.

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in.

An even larger study of private equity and health was completed this summer and published in the British Medical Journal (BMJ). After reviewing 1,778 studies it concluded that after private equity firms purchased healthcare facilities, health outcomes deteriorated, costs to patients or payers increased, and overall quality declined.

Photo by Towfiqu barbhuiya on Unsplash

One former executive at a private equity firm that owns an assisted-living facility near Boulder, Colorado, candidly described why the firm was refusing to hire and retain high-quality caregivers: “Their position was: We are trying to increase our profitability. Care is an ancillary part of the conversation.”

Medicare Advantage Creates Wall Street Advantages

Congress passed the Medicare Advantage program in 2003. Its proponents claimed it would encourage competition and greater efficiency in the provision of health insurance for seniors. At the time, privatization was all the rage as the Democratic and Republican parties competed to please Wall Street donors. It was argued that Medicare, which was actually much more efficient than private insurance companies, needed the iron fist of profit-making to improve its services. These new private plans were permitted to compete with Medicare Part C (Medigap) supplemental insurance.

In 2007, 19% of Medicare recipients enrolled in Medicare Advantage plans. By 2023 enrollment had risen to 51%. These heavily marketed plans are attractive because many don’t charge additional monthly premiums, and they often include dental, vision, and hearing coverage, which Medicare does not. And in some plans, other perks get thrown in, like gym memberships and preloaded over-the-counter debit cards for use in pharmacies for health items.

How is it possible for Medical Advantage to do all this and still make a profit?

According to a report by the Physicians for a National Health Program, it’s very simple—they overcharge the government, that is we, the taxpayers, “by a minimum of $88 billion per year.” The report says it could be as much as $140 billion.

In addition to inflating their bills to the government, these HMO plans don’t pay doctors outside of their networks, deny or slow needed coverage to patients, and delay legitimate payments. As Dr. Kenneth Williams, CEO of Alliance HealthCare, said of Medicare Advantage plans, “They don’t want to reimburse for anything — deny, deny, deny. They are taking over Medicare and they are taking advantage of elderly patients.”

Enter Hedge Funds

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in. They have bought large quantities of stock in the healthcare companies that are milking the government through their Medicare Advantage programs. They then insist that these healthcare companies initiate stock buybacks, inflating the price of their stock and the financial return to the hedge funds. Stock buybacks are a simple way to transfer corporate money to the largest stock-sellers.

(A stock buyback is when a corporation repurchases its own stock. The stock price invariably goes up because the company’s earnings are spread over a smaller number of shares. Until they were deregulated in 1982, stock buybacks were essentially outlawed because they were considered a form of stock price manipulation.)

United Healthcare, for example, is the largest player in the Medicare Advantage market, accounting for 29% of all enrollments in 2023. It also has handsomely rewarded its hedge fund stock-sellers to the tune of $45 billion in stock buybacks since 2007, with a third of that coming since March 2020. Cigna, another big Medicare Advantage player, just announced a $10 billion stock buyback.

These repurchases are also extremely lucrative for United Healthcare’s top executives, who receive most of their compensation through stock incentives. CEO Andrew Witty, for example, hauled in $20.9 million in 2022 compensation, of which $16.4 million came from stock and stock option awards.

Those of us fighting for Medicare for All have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks.

A look at the pharmaceutical industry shows where all this is heading. Between 2012 and 2021, fourteen of the largest publicly traded pharmaceutical companies spent $747 billion on stock buybacks and dividends, more than the $660 billion they spent on research and development, according to a report by economists William Lazonick and Öner Tulum. Little wonder that drug prices are astronomically high in the U.S.

And so, the gravy train is loaded and rolling, delivering our tax dollars via Medicare Advantage reimbursements to companies like United Healthcare and Big Pharma, which pass it on to Wall Street private equity firms and hedge funds.

It’s Not Just Healthcare

In researching my book, Wall Street’s War on Workers, we found that private equity firms and hedge funds are undermining the working class through leveraged buyouts and stock buybacks. When private equity moves in, mass layoffs (just like healthcare staff cuts and shortages) almost always follow so that the companies can service their debt and private equity can extract profits. When hedge funds insist on stock repurchases, mass layoffs are used to free up cash in order to buy back their shares. As a result, between 1996 and today, we estimate that more than 30 million workers have gone through mass layoffs.

Meanwhile, stock buybacks have metastasized throughout the economy. In 1982, before deregulation, only about 2% of all corporate profits went to stock buybacks. Today, it is nearly 70%.

Those of us fighting for Medicare for All, therefore, have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks. Every fight to stop a mass layoff is a fight against the same Wall Street forces that are attacking Medicare and trying to privatize it. Creating a sane healthcare system, therefore, will depend on building a massive common movement to free our economy from Wall Street’s wealth extraction.

To take the wind out of Medicare Advantage and Wall Street’s rapacious sail through our healthcare system, we don’t need more studies. It’s time to outlaw leveraged buyouts and stock buybacks.

To ensure you have good coverage for both current and unforeseeable health needs this open enrollment period, you should choose traditional Medicare.

Diane Archer

( Common Dreams ) – During this Medicare Open Enrollment period, ask yourself these seven questions. And, please know that you can always call the Medicare Rights Center at 1-800-333-4114 or your SHIP—State Health Insurance Assistance Program—for free, unbiased advice on any of your Medicare questions.

1. Q. What’s the biggest difference between traditional Medicare and a Medicare Advantage plan? To ensure you have good coverage for both current and unforeseeable health needs, you should enroll in traditional Medicare. In traditional Medicare, you and your doctor decide the care you need, with no prior approval. And, you have easy access to care from almost all doctors and hospitals in the United States with no incentive to stint on your care. In a Medicare Advantage plan, a corporate insurance company decides when you get care, often requiring you to get its approval first. Medicare Advantage plans also restrict access to physicians and too often second-guess your treating physicians, denying you needed care inappropriately. The less care the Medicare Advantage plan provides, the more the insurance company profits. You will pay more upfront in traditional Medicare if you don’t have Medicaid and need to buy supplemental coverage, but you are likely to spend a lot less out of pocket when you need costly care. Regardless of whether you stay in traditional Medicare or enroll in Medicare Advantage, you still need to pay your Part B premium.
2. Q. Should I trust an insurance agent’s advice about my Medicare options? No. Unfortunately, insurance agents are paid more to steer you away from traditional Medicare and into a Medicare Advantage plan, even if it does not meet your needs. While some insurance agents might be good, you can’t know whom to trust. Keep in mind that while Medicare Advantage plans tell you that they offer you extra benefits, you still need to pay your Part B premium, and extra benefits are often very limited and come with high out-of-pocket costs; be aware that many Medicare Advantage plans won’t cover as much necessary medical and hospital care as traditional Medicare. For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a SHIP.
3. Q. Why can’t I rely on my friends or the government’s star-rating system to pick a good Medicare Advantage plan? Unlike traditional Medicare, which gives you easy access to the physicians and hospitals you use from everywhere in the U.S. and allows for continuity of care, you can’t count on a Medicare Advantage plan to cover your care from the healthcare providers listed in their network or to cover the medically necessary care that traditional Medicare covers. Even if your friends say they are happy with their Medicare Advantage plan right now, they are gambling with their healthcare. The government’s five-star rating system does not consider that some Medicare Advantage plans engage in widespread inappropriate delays and denials of care, and other Medicare Advantage plans engage in different bad acts that can endanger your health. So, while you should never sign up for a Medicare Advantage plan with a one, two, or three-star rating, Medicare Advantage plans with four and five-star ratings can have very high denial and delay rates.


Image by Coombesy from Pixabay

4. Q. If I’m enrolled in a Medicare Advantage plan, can I count on seeing the physicians listed in the network and lower costs? Unfortunately, provider networks in Medicare Advantage plans can change at any time and your out-of-pocket costs can be as high as $8,300 this year for in-network care alone. You can study the MA plan literature, and you can know your total out-of-pocket costs for in-network care. But, you cannot know whether the MA plan will refuse to cover the care you need or delay needed care for an extended period. This year alone, dozens of health systems have canceled their Medicare Advantage contracts, further restricting access to care for their patients in MA, because MA plans make it hard for them to give people needed care.
5. Q. Doesn’t the government make sure that Medicare Advantage plans deliver the same benefits as traditional Medicare? No. The government cannot protect you from Medicare Advantage bad actors. The insurers offering Medicare Advantage plans can decide you don’t need care when you clearly do, and there’s no one stopping them; they are largely unaccountable for their bad acts. In the last few years there have been multiple government and independent reports on insurance company bad acts in Medicare Advantage plans.
6. Q. If I join a Medicare Advantage plan, can I disenroll and switch to traditional Medicare? You can switch to traditional Medicare each annual open enrollment period. However, depending upon your situation, where you live, your income, your age, and more, you might not be able to get supplemental coverage to pick up your out-of-pocket costs and protect you from high costs. What’s worse, you could incur thousands of dollars in out-of-pocket costs in Medicare Advantage.
7. Q. If I have traditional Medicare and Medicaid, what should I do? If you have both Medicare and Medicaid, traditional Medicare covers virtually all your out-of-pocket costs. You will get much easier access to physicians and inpatient services in traditional Medicare than in a Medicare Advantage plan if you need costly healthcare services or have a complex condition.

Again, for free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a SHIP.

(The Conversation) – After more than a month of being subjected to sustained bombing, the besieged people of the Gaza Strip are now confronted with another threat to life: disease.

Overcrowding at shelters, a breakdown of basic sanitation, the rising number of unburied dead and a scarcity of clean drinking water have left the enclave “on the precipice of major disease outbreaks,” according to the World Health Organization.

As an expert in Palestinian public health systems who wrote about the many relationships between war and health for my forthcoming book “How War Kills: The Overlooked Threats to Our Health,” I believe that the looming crisis cannot be underestimated. The easy spread of infectious disease in wartime conditions can be just as devastating as airstrikes to health and mortality – if not more so. Health care services in Gaza – already vulnerable prior to the Israeli bombing campaign – have essentially no capacity to cope with a major outbreak.

Disease already rampant

History has proved time and again that war zones can be a breeding ground for disease. Anywhere impoverished and underresourced people crowd for shelter or access to resources – often in facilities with inadequate living conditions, sanitation services or access to clean water – is prone to the spread of disease. This can be through airborne or droplet transmission, contaminated food or water, living vectors like fleas, mosquitoes or lice, or improperly cleaned and managed wounds.

In any situation of armed conflict or mass displacement, the threat of infectious disease is among the primary concerns of public health professionals. And from the outset of the Israeli bombing campaign, experts have predicted dire health consequences for Gaza.

After all, the Gaza Strip had fragile health and water, sanitation and hygiene sectors long before the Oct. 7, 2023, Hamas attack that killed 1,200 Israelis and prompted the retaliatory airstrikes. The health system of Gaza, one of the most densely populated places in the world, has long been plagued by underfunding and the effects of the blockade imposed by Israel in 2007.

Waterborne illness was already a major cause of child mortality – the result of the contamination of most of Gaza’s water. In early 2023, an estimated 97% of water in the enclave was unfit to drink, and more than 12% of child mortality cases were caused by waterborne ailments, like typhoid fever, cholera and hepatitis A, that are very rare in areas with functional and adequate water systems.

Other forms of infectious disease spread have also been reported in recent years. Gaza had experienced several previous outbreaks of meningitis – an inflammation of the tissues surrounding the brain and spinal cord typically caused by infection – notably in 1997, 2004 and 2013.

In late 2019, a small outbreak of measles – a highly contagious, airborne virus – was reported in Gaza, with almost half of reported cases in unvaccinated people. Despite a relatively high vaccination rate in Gaza generally, these gaps in vaccination and the inability to respond quickly to outbreaks were attributed by the WHO to “the continuous socio-economic decline since 2009, conflict, and closure.”

And the COVID-19 pandemic hit the Gaza Strip hard, exacerbated by the Israeli blockade that prevented or delayed the import of vital personal protective equipment, testing kits and vaccines.

France 24: “Hunger, disease ‘inevitable’ in Gaza as fuel runs out • FRANCE 24 English”

A system overwhelmed

The vulnerability of Gaza’s health care meant that from the outset of the latest conflict, organizations such as the WHO voiced concern that the violence and deprivation could quickly overwhelm the system.

There are several ways war in general, and the conflict in Gaza in particular, accelerates and promotes infectious disease risk.

Almost concurrently with the start of the bombing campaign, Israel imposed siege conditions on Gaza. This prevented the import of fuel needed to run generators for vital infrastructure. Generators are needed because Israel shut off electricity to Gaza.

As fuel has essentially run out in recent days, this has meant no power for desalination plants or for solid waste collection. As a consequence, many people have been forced to consume contaminated water or live in conditions where living carriers of disease, like rodents and insects, thrive.

Even basic cleaning supplies are scarce, and equipment used to sterilize everything from medical equipment to baby bottles is inoperable.

These unhygienic conditions come as hundreds of thousands of Palestinians in Gaza attempt to flee the bombing to the few remaining places left to shelter. This has caused massive overcrowding, which increases the risk of an infectious disease outbreak.

Children especially vulnerable

Already, the WHO has reported worrying trends since mid-October 2023, including more than 44,000 cases of diarrhea in Gaza.

Diarrhea is a particular risk for young children who are prone to profound dehydration. It represents the second-leading cause of death worldwide in children younger than 5 years of age. Half of the diarrhea cases reported in Gaza since the Israeli bombing campaign began have been in children under 5.

Meanwhile, nearly 9,000 cases of scabies – a skin rash caused by mites – have been reported, as have more than 1,000 cases of chickenpox.

More than 70,000 cases of upper respiratory infections have been documented, far higher than what would be expected otherwise. These are just cases that were reported; undoubtedly, more people who were unable to get to a health facility for diagnosis are also sick.

Reports of the spread of chickenpox and upper respiratory infections like influenza and COVID-19 are particularly dangerous considering children’s vaccination schedules are being highly disrupted by conflict. With health services overstretched and the mass movement of families, young children and newborns are likely going without vital, lifesaving inoculations just as winter – the peak season for respiratory infections – arrives.

Upper respiratory infections are also exacerbated by the amount of dust and other pollutants in the air due to the destruction of buildings during bombing.

Then there is the direct impact of the bombing campaign. A lack of antibiotics – due to both the siege and the destruction of health facilities – means physicians are unable to adequately treat thousands of patients with open wounds or in need of medical operations, including amputations.

More death and suffering

Increasingly, doctors are even running out of wound dressings to protect injuries from exposure. Poor infection prevention controls, high casualty rates and high concentrations of toxic heavy metals, among other factors, are leading to reports of antimicrobial resistance, which occurs when bacteria and viruses evolve over time to no longer respond to antibiotics and other antimicrobial medications. This has the potential to lead to health issues long after the bombing stops. Similar trends were also seen in Iraq, where antimicrobial resistance rates remain high despite the peak of bombing campaigns ending many years ago.

And with many bodies laying under rubble, unable to be retrieved, and the necessity of digging multiple mass graves near sites where people are sheltering, there is also increased risk of disease arising from an inability to adequately dispose of the dead.

While the images and photos from Gaza of areas and people that have been bombed are devastating and have caused a massive death toll – at least 12,000 by mid-November, according to Gaza health authorities – the rapid spread of infectious disease has the ability to cause even greater mortality and suffering to a population reeling from weeks of sustained bombing.

Yara M. Asi, Assistant Professor of Global Health Management and Informatics, University of Central Florida

This article is republished from The Conversation under a Creative Commons license. Read the original article.