The author is an emergency pediatrician and associate professor in the Faculty of Medicine and Health Sciences at McGill University. He is involved in the collective Caring for Social Justice and wrote the award-winning book No more aboriginal children torn away. To end Canadian medical colonialism (Lux publisher).
June 29 marked the sixth anniversary of the “Framework on Parental Accompaniment” launched by Évacuations aéromédicales du Québec (EVAQ) to end the practice of non-accompaniment that for decades had prohibited a parent from accompanying their child during an emergency transfer on the EVAQ hospital plane. I was the spokesperson for the #TiensMaMain campaign, launched on January 24, 2018, to denounce the transfer each year of hundreds of sick or injured unaccompanied children living in rural and isolated areas to pediatric hospitals in Montreal or Quebec City. In my two testimonies to the Viens Commission, I explained how the non-accompaniment rule disproportionately affected Indigenous communities in northern Quebec, particularly the Cree (Eeyou) and the Inuit.
Following the success of the #HoldMyHand campaign, a new family-centered care policy was implemented in the summer of 2018. At the same time, award-winning Israeli journalist Amira Hass reported in Haaretz that had caught my attention: After several months and at least two missed appointments, and following the intervention of Physicians for Human Rights in Israel, a Gazan mother, Hanan al-Khoudari, was finally allowed by Israel to accompany Louay, her three-year-old child suffering from an aggressive sarcoma, for chemotherapy and other treatments in the West Bank, at An-Najah National University Hospital in Nablus. Until then, her requests to accompany her toddler had been denied on “security” grounds.
A year later, Israeli journalists Gideon Levy and Alex Levac reported on the stories of children from the Gaza Strip admitted to the pediatric cancer ward of An-Najah hospital, the vast majority without their parents. In reporting the story of Miral Abu Amsha, a 10-year-old girl being treated for leukemia, the journalists echoed the issues raised in the #HoldMyHand campaign, including the hell her parents went through “not being by her side, not holding her, not caressing her, not caring for her in her suffering.” The journalists described the atmosphere of helplessness and helplessness in the children’s rooms as unbearable: in their words, “a portrait of the essence of Israeli evil.”
These cases are not anecdotal. They are the product of Israel’s permit regime, already described as “arbitrary” by the World Health Organization, which reported in a 2023 report that, for the period 2019-2021, 32% of children with an approved permit to leave the Gaza Strip, even to the West Bank, did not have a parent authorized to accompany them, meaning they had to travel with another adult or could not access necessary health care. In most cases, delays or denials of permits are not explained, indicating a lack of transparency and due process.
“Medical Apartheid”
According to Save the Children, permit applications for nearly 400 children from Gaza who were due to travel to the West Bank for urgent health care in the first six months of 2023 have been either ignored or denied. The NGO says children have even died from diseases such as leukemia and congenital heart defects in 2022 because they were not given exit permits in time to undergo life-saving surgery or access urgent medication.
Behind these injustices lies the Israeli siege imposed on Gaza since 2007, which severely restricts the entry of medical supplies and medicines into the area, preventing the Gazan health system from providing necessary care to its population and, as I have previously noted in these pages, from keeping the “social body” alive and healthy. Long before the most recent war in Gaza, Save the Children warned that “Gaza’s health system remains on the brink of collapse after 16 years of blockade” imposed by Israel and that, “along with the recurring escalation of violence, this poses a constant threat to the lives of children in Gaza.”
This situation in Palestine is described by many as “medical apartheid.” In an article published in the journal Global Public Health In April 2023, researchers at the School of Public Health at Drexel University (in Philadelphia), Yazid Barhoush and Joseph J. Amon, explain that “historical underinvestment in health, ongoing economic dependency and attacks on health workers, facilities and transportation, permit requirements, and restrictions on freedom of movement for residents of the occupied Palestinian territory […] result in a system that can be considered a form of medical apartheid that is detrimental to Arab and non-Jewish citizens of the occupied Palestinian territory.”
An injustice rooted over time
Today, here, EVAQ allows any child to be accompanied by a parent during an aeromedical evacuation. The new cohorts of pediatric residents have never had to provide care to a child transferred alone because of the practice of non-accompaniment, which many of us had normalized for decades. It should never be normal to inflict trauma—physical, emotional, or psychological—on children.
During the #TiensMaMain campaign, we never stopped demanding the abolition of the draconian rule of non-accompaniment for all children in Quebec. The campaign therefore helped improve the situation of all populations concerned, Indigenous or not, even if we insisted on the children most affected, namely the Cree and Inuit children of northern Quebec. In fact, throughout this campaign, our message remained focused on this injustice rooted over time in the history of medical colonialism, a concept that I use in my book to designate “a culture or ideology rooted in systemic anti-Indigenous racism and using medical practices and policies to establish, maintain and/or advance a genocidal colonial project”, particularly in Canada.
Analyzing these health inequalities helps us understand the structures that underlie them and recognize settler colonialism—both Canadian and Israeli—as a structural determinant of health, as developed in July 2023 by the leadership collective of the Palestine Program for Health and Human Rights at Harvard University. The collective describes settler colonialism as “an enduring structure rather than a past event” where this “system of power serves as a fundamental and ongoing configuration that determines the social and political mechanisms that impose themselves on human health.”
Throughout the #HoldMyHand campaign, I have been personally inspired by a concept popularized by the late American trade unionist, feminist, and Black freedom activist Fannie Lou Hamer: “No one is free until we are all free.” Her words came to mind recently while reading an interview about the liberating role of medicine between medical student Mary Turfah and surgeon Ghassan Abu-Sittah published by Mondoweisswhich highlights how the Palestinian people’s struggle is rooted in solidarity with indigenous and southern peoples. Towards the end of the interview, Turfah expresses her dismay when she hears people say that “Gazans are defending their humanity.” Instead, she says, Gazans are “defending the humanity of the entire world.”