In October, a video from Gaza began to circulate that horrified the world. An injured teenager was depicted in the video, lying unconscious in his hospital bed. He is unable to move his arms in agony as flames engulf him.
Shaban al-Dalou was being treated for injuries sustained when he survived another Israeli bombing when a bomb dropped by the Israeli army detonated on the courtyard of Al-Aqsa Martyrs Hospital in Deir el-Balah, which set off the fire that shocked him in front of us.
The video of al-Dalou’s death – likened by many observers to atrocity-defining images like the Pulitzer Prize-winning 1972 photograph of nine-year-old Phan Thị Kim Phúc being burned by US napalm in Vietnam – is far from an isolated nightmare.
Over the past 15 months, thousands of brutal killings have occurred in Gaza, frequently as a result of US weapons being given to Israel by the US government. These deaths are symptomatic of an Israeli strategy of total war and overwhelming horror inflicted on an entire people, not just individual tragedies or unintended consequences. This reality, and how we must respond to it, is nowhere clearer than at the ruins of Gaza’s hospitals.
MK-84 bombs and Gaza’s hospitals
A recent peer-reviewed , study, of which one of us is a co-author, examined patterns in Israel’s bombing of the Gaza Strip during the first 40 days after October 7, 2023. It specifically analyses Israeli use of US-supplied Mark-84 bombs (MK-84s) around hospitals, which by international law and basic ethical imperatives, are afforded special protections against acts of war.
MK-84s are 2, 000-pound (900kg) air-dropped explosives – otherwise known as “bunker busters” – designed to destroy infrastructure and kill human beings within hundreds of metres of where they land. They are weapons of indiscriminate destruction and annihilation, not “targeted strikes” against discrete targets.
Israel dropped MK-84s within blast range of more than 80% of hospitals in Gaza in the first 40 days of the conflict, according to the study, which included a bomb that was dropped 14.7 meters (48 feet) from a hospital, effectively a direct hit.
Numerous hospitals had multiples of these massive bombs encircled. Two hospitals had more than 20 MK-84 bomb craters within 800 metres (the upper end of the MK-84’s infrastructural damage and serious injury blast range) of their facilities, another hospital had seven bomb craters within 360 metres (MK-84’s lethal range) of its patient wards. Thirty-eight MK-84s were detonated within the range of hospitals inside Israel-defined evacuation zones.
During this initial period of Israel’s acute destruction of Gaza, international , controversy , raged for weeks over , the claim that Israel had bombed even a single hospital. Israel’s government and media have repeatedly denied, in violation of internationally recognized humanitarian law, that Israel would attack hospitals. Simultaneously,  , enablers , of Israeli violence that, shamefully, included senior US physicians and bioethicists, began publishing , supposed justifications , for any such possible action.
More than 1, 000 Palestinian health workers had already been killed by Israeli attacks in December 2024. Unequivocal evidence demonstrates that the Israeli military has repeatedly targeted almost all hospitals in Gaza with US-made weapons. What was once said to reflect an outrageous and libellous accusation is now regarded as a fundamental element of Israeli military behavior.
In May, in an implied recognition of this reality after eight months of watching Israel use , thousands of US-supplied bombs to destroy heavily populated areas of Gaza and kill countless civilians, the Biden administration placed a hold on shipment of MK-84s to Israel, sending , 500-pound (227kg) bombs , instead. Last week, the Trump administration , announced it is resuming shipment of MK-84s to Israel without any conditions.
A new paradigm: Horrorism
Such obscene acts of horror are the subject of a definition called “horrorism,” according to philosopher Adriana Cavarero’s work. She uses the term to describe an impersonal violation that is rooted in massacres and disfiguration, such as those we were seeing every day in Gaza, as well as disfiguration.
The idea of horrorism requires that we approach violence with the victim rather than the perpetrator, as is frequently done in conflicts. The victim is the only one with the authority to determine the definition and value of violence. Children, like the thousands of Palestinian children who have been killed, mutilated, and killed by Israeli soldiers and US weapons over the past 15 months, are the most prominent supporters of the defenceless victim in Cavarero.
The hope for horrorism as an ethical paradigm is that by displacing preoccupation with “terrorists” and reframing violence through the lens of the most vulnerable, or those most in need of care, we might end the endless-by-design “war on terror” that reproduces , horror upon horror , for the world’s most dispossessed people, who, unsurprisingly, continue to revolt. In this paradigm, the human effects of violence, not intentions or justifications for it, are all that matter.
As firsthand , accounts , and desperate pleas from doctors, nurses, and other health workers providing care in Gaza poignantly illustrate, the resonance of horrorism in hospitals is perhaps more profound and more insistent than in any other context. And doctors, who have privileged access and obligations to the most defenceless – alongside substantial collective economic, cultural, and political power – have a unique position from which to apply horrorism’s lessons to condemn and stop violence.
Horrorism implores us to see and judge violence from the vantage of the hospital – the refuge for the displaced, maimed, and dying. Doctors should therefore be the evangelists of horrorism, with the mandate to not only heal the wounded but also to do everything in their power to end wars that result in disability and death for those who turn to us for care.
Total war and genocide
Another philosopher, Jean-Paul Sartre, described half a century ago as the rise of a new form of “total war” in the postcolonial era that started after World War II, and its central feature is the horror of colonial wars.
In her book,  , Combat Trauma, anthropologist Nadia Abu el-Haj reflects on Sartre’s description of the French and US wars against Vietnam. According to El-Haj, “colonial powers retained their superiority in terms of arms, but they were at a distinct disadvantage in terms of numbers,” as imperial powers attempted to snuff out anticolonial independence movements.
When facing an “enemy” comprised of armed fighters whose dream of freedom is backed by the entire population, colonial armies are “all but helpless” – if they conform to the so-called rules of humane war , and respect for civilian life, that is.
In this scenario, their only chance of destroying the entire population is to put such rules to the side and use them as a means of defeat. In this paradigm, bombing hospitals is no longer to be avoided or prevented by the rule of law or life; it is a strategic necessity.
“Total genocide”, Sartre observed, “reveals itself as the foundation of anti-guerilla strategy”. To a colonial power, genocide appears as “the only possible” response to a “rebellion of a whole people against its oppressors”, resulting in a “total war” that is no longer between two armies.
Instead of being completely war against a largely defenseless people under colonial circumstances, one side is “fought to the end by one side.” According to Sartre, this “genocidal blackmail” was “perpetrated under our eyes every day” and not just a threat to the Vietnamese people. it turned all who did not denounce it into “accomplices”.
Sartre comes to the conclusion that “the group that the Americans are trying to destroy by means of the Vietnamese nation is the whole of humanity” due to the dehumanization this inflicts on the brutalized, the brutalisers, and passive consumers of this horror.
The similarities between Sartre’s analysis of US aggression in Vietnam and its support for Israel’s war are too obvious to ignore. In reality, the conflict was clearly against all Palestinians in Gaza as measured by more than 17, 000 Palestinian dead.
Accountability and reparations
In the days after al-Dalou burned alive, media outlets around the world published stories , about his life and death. His desire to work as a doctor was one of the anecdotes that were featured, which highlights the cruelty of his treatment at a hospital.
It also highlights the US medical profession’s persistent refusal over the past 15 months to use its considerable political influence to oppose flagrantly criminal attacks on hospitals, health workers, and patients by calling for an end to Israel’s supply of weapons for these crimes.
As US-based physicians, we , have , repeatedly , called , upon , our profession , – one that claims to be rooted in a commitment to care, human dignity, and the most vulnerable – to change course and to act boldly against violence in Gaza in accordance with our supposed principles. Since a tentative ceasefire has been reached, it needs to include critical reflection and accountability regarding our blatantly morally and politically wrongdoing violations that the genocide in Gaza has exposed in full.
But we cannot stop at simply rhetoric and moralising self-reflection. We must insist on reparative action, including the release of thousands of Palestinian civilians – including , Dr Hussam Abu Safia , and many other health workers – taken hostage by Israel, the restoration of the entire territory of the Gaza Strip to the Palestinians, and the payment of reparations by Israel, the US, and European nations that have enabled genocide so as to support the full reconstruction of Gaza, including its homes, hospitals, universities, sanitation infrastructure, and schools that now lie in ruins.
We must also demand an end to the Israeli government’s continued violent occupation of Palestinian territory and its embargo on the sale of weapons to it, which has clearly shown itself to be willing and eager to use them against civilian populations in violation of international law.
We have an obligation to forcefully condemn and oppose such crimes if the US government supports Israeli efforts to occupy Gaza, to force its Palestinian residents into exile, and to deny Palestinians their rights to return to their land, as we are currently seeing early indications of. The reality is that the violence against Palestinians has not stopped, and we must not deceive ourselves into thinking that , our ethical obligations , in relation to it have ended.
We must bear the moral responsibility to the memory of those who, like Shabaan al-Dalou, have been killed and to those who must now attempt to live in the shadow of unfathomable horror as we organize with one another to begin the unthinkable but necessary task of atoning for the violence with which our country and its medical system have been – and continue to be – complicit.
