“I will not use my medical knowledge to violate human rights and civil liberties, even under threat.” This is a line in The Physician’s Pledge adopted by the World Medical Association in 1948, which guides the work of doctors around the globe.

Unfortunately, as the practice of torture persists across the world, too often medical workers are at risk of becoming complicit. One country that has come under the spotlight recently regarding medical complicity in torture has been Israel.

For years, human rights organisations have reported “widespread and systematic” use of torture by Israeli security forces and prison authorities. The Israeli NGO Public Committee against Torture (PCATI) has filed over 1,400 torture complaints against Israeli authorities since 2001.

Since October 7, allegations of ill-treatment and torture of Palestinians in Israeli detention have sharply increased. According to media reports, at least 40 Palestinians have died in Israeli military detention and 16 in prison over the past eight months. These numbers represent a substantial increase when compared to the average of four deaths per year from 1967 to 2019.

Medical complicity in deaths or ill-treatment of detainees would leave a dark stain on the medical profession in Israel. We therefore call on the Israeli authorities and medical institutions and associations to investigate any allegations of complicity of doctors and other medical staff in torture and ill-treatment.

A history of medical complicity

Reports that Israeli medical workers may have been complicit in the ill-treatment of detained Palestinians since October 7 should not come as a surprise. Human rights organisations have detailed such practices in past years.

In 2007, the Public Committee against Torture in Israel (PCATI) published testimonies alleging that in between torture sessions victims were seen by doctors who neither documented nor reported the torture.

In 2009, an appeal was sent on behalf of more than 700 doctors from 43 countries asking the World Medical Association (WMA) to take action against the Israeli Medical Association based on evidence of medical complicity in torture compiled by several reputable international human rights organisations including the PCATl. The WMA did not take any action and refused even to acknowledge the submission.

In 2011, Physicians for Human Rights Israel (PHRI) documented prison doctors’ implicit involvement in ill-treatment by returning victims to perpetrators after perfunctory care, sharing medical information with perpetrators and failing to document and report torture and ill-treatment. Despite demands made to the Israeli Medical Association to investigate the accused doctors, no examination of medical files nor interviews with the victims were conducted.

In 2016, the Palestinian human rights organisation, Addameer, released a report, decrying Israel’s policy of deliberate medical negligence towards Palestinians in detention. It detailed cases of Palestinians being denied treatment in prison and doctors failing to include physical signs of torture and ill-treatment in the medical files.

The same year, the UN Committee against Torture also raised concerns about prison doctors failing to report injuries indicative of abuse. It also recommended that they be placed under the supervision of the Ministry of Health.

However, that has not happened. Medical staff working in Israeli prisons are still not overseen by the health ministry or any other medical body and are not members of the national medical association. Given that they report to the prison authority rather than a health authority, they are at risk of compromising their patients’ health care to preserve their loyalty to their superiors.

Post-October 7 deterioration

Human rights organisations in both Israel and the occupied Palestinian territories have noted a spike in the cases of torture, ill-treatment and death in detention since October 7. Some have indicated that this is a deliberate policy of the Israeli authorities.

On October 11, the Israeli Minister of Health called for hospitals to refuse treatment to Palestinians from Gaza. Since then, Palestinians in Israeli prisons have reported medical appointments being cancelled and medical care being denied to them.

International standards stipulate a medical examination on entry to prison. However, PHRI found that this has not been systemically implemented for Palestinians arriving at Israeli detention centres since October 7. Thus, medical teams are not identifying persons with medical needs, nor are they documenting ill-treatment or torture taking place during the arrest process.

The Israeli authorities have set up new military detention facilities in the Negev desert for arrested people from Gaza. One of them is located in the Sde Teiman military base. This site has been dubbed the “Israeli Guantanamo” with media coverage detailing horrific conditions based on whistleblower testimony.

Israel has suspended access to prisons for the International Committee of the Red Cross (ICRC) since October 7 and no visits are allowed in Sde Teiman from lawyers or family. Thus, external oversight of the detention centres is currently non-existent.

In April, a doctor working at Sde Teiman sent a letter to the Israeli ministers of defence and health as well as the attorney general stating that the facilities’ operations “do not comply with a single section among those dealing with health in the Incarceration of Unlawful Combatants Law”. According to that person, all patients are handcuffed by all four limbs and blindfolded at all times, including when receiving treatment, and must therefore use diapers.

Medical personnel treating these patients without opposing the conditions under which they are being kept are at risk of medical complicity in torture, thereby not only violating the patients’ human rights but also their own professional ethics which include the fundamental duty to respect human dignity and always act in the best interests of the patient.

Urgent action needed

Over the past few months calls on the Israeli authorities and international institutions to take action have multiplied.

In March, Palestinian rights groups filed an urgent appeal to 11 UN Special Working Groups and Special Rapporteurs urging them to take action on torture and ill-treatment of Palestinians by Israeli forces. Among vast evidence of the use of torture, they also reported instances of medical doctors and nurses “disregarding and ignoring the needs of the prisoners” and “ordering the prison guards to further attack and assault a prisoner”.

In April, when this article was written, more than 600 health workers from around the world called for the closure of the Sde Teiman detention centre. We joined this call then and continue to demand the closure of the facility.

We urge all health professionals to put patients first, do no harm, and document and report harm done by others.

We call on professional associations to support members who express concerns that they may become complicit in torture.

We call on Israeli authorities to give lawyers, civil society organisations and the ICRC unhindered access to places of detention.

We call on the international community to insist on such access, on investigations into alleged cases of torture and medical complicity, and on accountability for perpetrators.

Israeli health professionals are at risk of becoming and may already be complicit in torture and ill-treatment of detained Palestinians. This needs to stop. Non-compliance with the Physician’s Pledge is a slippery slope. It can have grave consequences for patients and leave a lasting stain on the medical profession.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.