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In just two weeks, the brutality of the Israel-Hamas conflict has shocked the world. But one of its most heartbreaking aspects — the destruction of the already struggling health care system in Gaza — is part of a decades-long pattern during war both in the region and around the world.

Leonard Rubenstein is a distinguished professor of practice at the Johns Hopkins Bloomberg School of Public Health and author of “Perilous Medicine: The Struggle to Protect Health Care From the Violence of War.” On this episode of the “First Opinion Podcast,” we spoke about health care in war, the Geneva Conventions, and why it’s so difficult to hold those who break international law accountable.

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Gaza’s health care system was in dire straits even before the most recent conflict began, Rubenstein said. Now, after an Israeli blockade of resources including food, water, and electricity, facilities in Gaza are short on urgently needed supplies. People who need medical attention are scared to go to hospitals, worrying that they could be hit intentionally or accidentally. “There’s a lot of evidence, and it shouldn’t surprise anyone, that when hospitals are attacked, people are afraid to go there. They’re afraid that they’re targeted,” he said. And traumatic injuries are not the only medical problems that need treatment: People continue to have other health care needs, like cancer or diabetes, and thousands of Gazans are pregnant.

Despite what he’s observed in Gaza, Syria, Ukraine, and elsewhere around the world, he continues to push for adherence to international law.

“Fighting for human rights and fighting for protection of health care means you’re against very powerful forces, and many times they don’t want to comply for a whole lot of reasons — because they don’t care, or because it’s too hard or inconvenient. … You just have to keep pushing,” he told me.

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This conversation was based on Rubenstein’s recent First Opinion essay, “Why Gaza health care facilities and workers have suffered so much violence.”

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