Palestinian women react at the site of an Israeli strike on a house, amid the Israel-Hamas conflict, in Nuseirat in the central Gaza Strip December 1, 2024. Photo: REUTERS/Ramadan Abed

As a doctor who spent a lifetime of work in epidemiology and environmental medicine, I have extensive experience thinking about how external factors drive public health outcomes — preventable disease and premature death.

I have studied the negative public health impacts of asbestos, pesticides, unsafe driving, cigarettes, and more — and made recommendations aimed at reducing these dangers.

Much of this work occurred in the West Bank and Gaza Strip. That experience has much to say about the catastrophe we have witnessed in Israel and Gaza, and which we risk reoccurring, if we do not address the intergenerational indoctrination and incitement in the Palestinian world.

As an environmental epidemiologist with significant work studying genocide and incitement, I see indoctrination in genocidal ideology as a form of hazardous exposure with toxic effects on all age groups — but with specifically dangerous impacts on the young. Exposure to such indoctrination and incitement can be likened to frequent or prolonged exposures to toxins such as lead, asbestos, and tobacco smoke. The impacts are both immediate and long-lasting. We should act accordingly.

October 7th

It’s critical that we see the Hamas massacres on October 7th and the resulting war in Gaza not just as a geostrategic milestone, but also as an incident in environmental medicine with impacts on both Israeli and Palestinian lives.

The barbaric attacks on Israel were systematic. For one day, Hamas waged total war — raping, murdering, and kidnapping — and setting out to make Israel’s Gaza envelope communities uninhabitable, which many still are, more than a year later.

Israel has responded by defending itself and seeking to defeat Hamas militarily. Because Hamas has placed itself within and often underneath the civilian population, this has required a brutal and grinding kind of warfare, combined with internal displacement of Gaza’s population, especially in its north.

For Gaza, this has been an epidemiological catastrophe. Whatever Gaza once was, it no longer is.

While some in the public health and humanitarian community blame Israel for this destruction, that would be a mistake.

The predicate for all of the public health losses was the ideology that made Israel’s military action inevitable.

Poisoned Minds, Not Poisoned Wells

In a disease model, we must look for the risks and causes of the disease, not merely the symptoms, if we are to heal the patient. The same is true in epidemiology: We must identify the content and effect of toxic exposure in a community. The legendary epidemiologic discovery came in 1854, when John Snow deduced that a cholera epidemic in London could be linked to a single water pump on Broad Street.

In this case, we are not looking for a contaminated well. We are looking for contaminated minds — the contaminant is the ideology of Hamas.

Hamas and its enablers have indoctrinated all Gazans in this ideology, from cradle to grave. Many of the thousands who came across the border to murder, rape, and loot on October 7 were not only uniformed and trained Hamas terrorists, but ordinary Gazans who joined in on the genocidal massacre.

They were motivated to commit murder and rape by what they were taught at home, at school, at mosques, in the streets, and on social media. If they had no formal training to kill, they didn’t need any.

It is rare that a society becomes so sick to the core that mass murder becomes a socially acceptable norm. Hamas terrorists bragged to their parents. They were greeted as conquering heroes and were eligible for large cash awards and free apartments. This is a culture in which genocidal massacre is celebrated.

Critics of Israel’s offensive into Gaza say it will only create more supporters for Hamas. That is absurd. Gaza already is dominated by intergenerational indoctrination of an extreme version of jihadist Islam.

It is critical that we recall Gregory Stanton’s seminal “Ten Stages of Genocide,” which speaks to this issue specifically. Genocide follows a distinct pattern, from classification of the enemy to symbolization of the enemy, to discrimination, dehumanization, organization, polarization, preparation, persecution, extermination, and finally, denial.

Just as Palestinian society has been shaped by genocidal motifs of demonization, delegitimization, and glorification of terror, it is also destined to serve the cause of genocide. This was not inevitable. There are many traditional and religious societies in the Arab world similar to Palestinian Arabs which do not engage in any of the kind of genocidal or pre-genocidal steps of Hamas.

More than Hamas

If the problem is man-made, then the solution will be man-made. First, let us dispense with the fiction that destroying Hamas’ hardware, its fortifications above ground, and its tunnels underground is sufficient.

If Israel exits Gaza only having killed Hamas operatives and destroying Hamas infrastructure, it will have achieved very little of lasting value. It must take on the hard work of removing genocide indoctrination and incitement.

Like any epidemiological matter of any consequence, this will take many years.

Many public health epidemics and mass exposures in the past such as typhoid, cholera, exposure to asbestos, and lead took many years to prevent or control, and required a generational commitment of the entire medical and policymaker community.

De-Nazification as a model

There is, however, a model for this process, and it comes from America and its allies as they sought to de-Nazify Germany and pacify Japan after World War II. These efforts were comprehensive and driven by military dominance.

In Germany, the process included the Nuremberg trials, which did much to expose the world — and Germany — to the horrors of the Nazi genocide program. But it wasn’t enough.

The process was not perfect. Many former Nazis avoided punishment; some innocent Germans were unfairly accused. The Allied forces confiscated all media — including school textbooks — that would contribute to Nazism or militarism. Art extolling Nazism was similarly banned and shunted aside. This was not a libertarian exercise.

But it succeeded. Germany had, at that point, emerged from roughly a century of bellicose militarism and deep antisemitism. It had started two world wars and carried out an industrial-scale program of genocide. Few believed it could ever be anything but a source of human misery in the heart of Europe.

The Germany of today — peaceful, global, and prosperous — would have seemed to be a mirage. In fact, General Dwight Eisenhower, Allied commander in Europe, predicted the de-Nazification of Germany would take 50 years.

In Japan, too, the efforts were monumental. Japan had been a militant and bellicose society, with deep racial animus towards its neighbors and the West, for several centuries. Not only were its military and military industries disbanded, but outward signs of patriotism were banned in public life, including schools.

Massive other changes, including the introduction of a parliamentary democracy, the political rights of women, and basic free speech rights, were enshrined in its new constitution. Again, as in Germany, textbooks were censored and control over schools was strictly regulated.

Elihu D. Richter is a retired head of the Unit of Occupational and Environmental Medicine at the Hebrew University School of Public Health and is the founder of the Jerusalem Center for Genocide Prevention.