My first encounter with Israel’s role in genocide happened while caring for patients, not in Palestine but in California.
Compared to traumatization of ordinary people in Israel or deaths and injuries in Gaza now, that experience may seem small. But as possible Israeli genocide causes concerns worldwide, including South Africa’s case against Israel in the International Court of Justice, Israel’s actions outside Palestine, often as an enforcer of U.S. policies, deserve more attention than they have received so far.
My experience happened while doing medical work with refugees. During the 1980s and 1990s, I directed a University of California internal medicine residency program. We faced an epidemic of dramatic physical symptoms among patients arriving from the wars in Central America. Symptoms included severe chest pain, abdominal pain, pelvic pain, and neurological problems such as dizziness, loss of consciousness, weakness, headaches, and visual and hearing problems. Although some of the patients came from El Salvador, Honduras, and Nicaragua, most were Mayan refugees who journeyed from the highlands of Guatemala, through Mexico, to California.
Extensive evaluations revealed that these symptoms did not develop from physical causes. Instead, the bodily distress came from horrifying traumas, including torture, rape, watching the murders of parents and children, and being forced to dig graves for friends, family, and themselves before they escaped.
In vivid detail, they described Israel’s role in Guatemala’s genocide. They mentioned Uzi submachine guns and Galil rifles made in Israel and described how Guatemalan and Israeli military personnel used the arms during massacres. Despite our efforts, we knew that most patients never would outgrow such memories. Human rights organizations named the atrocities of the Guatemalan government, but not the U.S. or Israeli governments’ supporting roles, as genocide.
As a doctor, I experienced work with these patients as very rewarding and very stressful, although obviously less stressful than the traumas that the patients themselves reported. I confess that I developed symptoms of “secondary” post-traumatic stress disorder–nightmares, flashbacks, cold sweats, and more–linked to the patients’ witnessing genocide and Israel’s role in it. Several medical colleagues also developed secondary PTSD. Over time, my PTSD reactivates whenever Israel gets involved in aggressive military action, both within and outside Palestine, for instance during the current war.
Later, our work in global public health revealed impacts of Israel in multiple Latin American countries. Israel acted as a surrogate for the United States, especially when direct U.S. military intervention was politically not feasible.
For instance, Israeli personnel helped coordinate U.S.-backed interventions against Nicaragua, which colleagues and I witnessed through our medical work there. During the so-called Iran-Contra affair, Israel sold U.S. weapons to Iran, generating funds for the counter-revolutionary (“contra”) forces in Nicaragua. Israel also sent weapons confiscated from the Palestinian Liberation Organization directly to the contras based in Honduras.
Arriving for a health conference that we helped organize in Nicaragua, colleagues and I barely escaped the bombing of the international airport by contra forces receiving Israeli equipment and assistance. We also survived our medical work during contra attacks supported by Israel near the border with Honduras, while others were injured or killed.
Israel assisted U.S.-backed dictatorships in El Salvador, Honduras, Colombia, Chile, Argentina, Brazil, Paraguay (with a plan to relocate Palestinians there), Bolivia, and Haiti. In our work to help health workers and other people imprisoned and tortured in these countries over time, Israeli arms and counter-insurgency personnel kept reappearing.
In Africa, Israel has played similar roles. Israel aided the apartheid government in South Africa and its military in Angola. Israel’s support strengthened the military regime after Patrice Lumumba’s assassination in the Congo. Israeli arms facilitated genocide in Rwanda. According to our African medical colleagues, this history informs South Africa’s current legal case that focuses on the question of Israeli genocide in Palestine.
The Israeli military-industrial complex also supports the militarization of the Mexico-U.S. border. An Israeli corporation, Elbit Systems, is an important contractor in constructing surveillance towers and other security infrastructure, for instance on the Tohono O’odham Nation’s reservation, which straddles the border. The startling similarities between Gaza and the Mexico-U.S. border, sometimes called “Gaza in Arizona,” draw concern partly due to the dangerous health effects of U.S. immigration policies.
After George Floyd’s death, investigative journalists reported that the dangerous “knee to the neck” restraint technique was the same as used by Israeli police and military forces in Palestine. Israeli companies and government agencies sold or donated educational programs on these methods to U.S. police, in Minneapolis and elsewhere. As a physician, I spent many intense hours trying to care for victims of police brutality but didn’t understand the knee to the neck technique. Israel’s role in the worldwidepublic health crisis of police brutality receives less attention than it should.
Some simple facts illustrate Israeli and U.S. economic interests in militarism. U.S. annual arms sales in 2022 totaled $100 to $200 billion, the most by far of any nation. Using the low estimate, with a population of 336 million, that equals about $300 per person. For Israel, population nearly 9.7 million, arms sales in 2022 amounted to $12.5 billion, or about $1,300 per person. Israel remains the largest recipient of U.S. foreign financial aid, most of which goes for Israel’s military uses and returns to the United States for arms purchases.
Links among the arms trade, militarism, and Zionism deepened after Britain’s Balfour declaration during World War I, when Jewish and non-Jewish financiers provided their capital to collaborate in Britain’s attempts to wrest Palestine from the Ottoman Empire. While treating our traumatized patients from Guatemala, I learned that the arms trade developed long before the Holocaust. Israeli collaborations involved Guatemalan, Nicaraguan, and Cuban dictatorships, the so-called Jewish mafia in Miami, and Zionist paramilitary forces in Palestine, such as Haganah and Irgun, whose stated purposes morphed between self-defense and capital accumulation. The Uzi submachine gun that terrified our patients proved quite profitable through sales to dictatorial regimes in Latin America and Africa.
Israelis whose actions are dangerous to health deserve compassion. Cognitive dissonance and moral injury can become unhealthy for those who act in these ways. As health workers, we have seen these patterns often, for instance in the heroic actions of Israeli colleagues rescuing leftist Jews threatened by the same dictatorships that Israel was assisting in Chile and Argentina.
Over time, I’ve felt that a search for understanding the Israel/Palestine problem, especially as it relates to public health, resembles the search depicted in Joseph Conrad’s short racist novel, Heart of Darkness, or in its movie sequel, Apocalypse Now. A protagonist, let’s say me, sails slowly up a river deep in the jungle, trying to find an evil anti-hero, and eventually realizes that he has found himself.
Israel’s unhealthy behaviors, such as killing children, are only possible because of us U.S. taxpayers. Over $10 million per day of U.S. military aid generated by taxes goes to Israel. Investments in Israel by institutions like universities and unions actually are much smaller than the support we provide through our taxes.
So reaching the heart of darkness convinced me and my family to take some drastic but pretty safe actions. First, with more than 20 thousand others (that number has increased markedly during the invasion of Gaza), we refuse to pay the half of our income taxes that support militarism, including Israel’s. We also redirect our modest savings and retirement accounts away from organizations that invest in militarism generally and Israel in particular. Such resistance is safe, legal, and–if done by large enough numbers–transformative.
We who are responsible for such tragedies can help achieve a more just and healthy planet if we choose to stop our consent to paying for militarism and genocide.
Howard Waitzkin is a distinguished professor emeritus of health sciences and sociology at the University of New Mexico and professor emeritus of internal medicine and social sciences at the University of California, Irvine. He practices internal medicine and primary care part-time in rural areas.