Nov. 8, 2000

Physicians for Human Rights USA (PHR) finds that the Israeli Defense Force (IDF) has used live ammunition and rubber bullets excessively and inappropriately to control demonstrators, and that based on the high number of documented injuries to the head and thighs, Israeli soldiers appear to be shooting to inflict harm, rather than solely in self-defense.

PHR sent a medical team to Israel, Gaza and the West Bank from October 20-27, 2000 to investigate claims that Israel Defense Force (IDF) is using excessive force in the current conflict that has pitted Israeli troops and settlers against Palestinian demonstrators and combatants. (full report attached) The team also investigated the disputed death of ‘Issam Judeh Mustafah Hamed, a Palestinian resident of a village near Ramallah, who was found dead near the wreck of his car. PHR’s separate report on the ‘Issam Judeh case, confirming that the cause of his death was a car accident, follows this release. (available at The team also collected information on attacks on ambulances, patients and health professionals.

The three person team was composed of forensic pathologists Robert Kirschner, M.D., University of Chicago Medical School, Nizam Peerwani, M.D., Tarrant County Medical Examiner’s Office, and James C. Cobey, M.D., M.P.H., an orthopaedic surgeon based in Washington, D.C.

SUMMARY OF FINDINGS (also included in attached report)


PHR's analysis of fatal gun shot wounds in Gaza reveals that approximately 50% were to the head. This high proportion of fatal head wounds suggests that given broad rules of engagement, soldiers are specifically aiming at peoples' heads. Since the beginning of the conflict, of the first 1,134 casualties reported in West Bank and Gaza Hospitals, 26% were to the head and neck. Of 339 patients presented to the emergency room through October 22 in Makassed Hospital, East Jerusalem, there were 25 confirmed bullet wounds to the head and neck of admissions. 4 of these injuries were from live ammunition (ammunition fired from handguns, rifles, and machine guns).


The PHR team in its visits to hospitals observed a repetitive pattern of high velocity gunshot wounds to the leg, particularly to the thigh. These wounds cause extreme injury, usually producing complex fractures and extensive muscle, nerve, and vascular injury. The majority of victims of these injuries, according to PHR, will have permanent disability in the affected leg. Witness reports, statements from an IDF spokesman to a member of the PHR team, and information from other human rights organizations, indicate that while, in some instances, the IDF was subject to Palestinian fire, many of those injured in this manner were at most throwing stones, and were not carrying firearms.

The numerous high velocity wounds to the thigh are highly unlikely to be random events, but rather suggest a policy on the part of the IDF that allows individual soldiers to shoot under very broad circumstances. Of the 12 patients that PHR interviewed and examined at Makassed and Shifa hospitals, 10 had gunshot wounds to the thigh or lower leg. All ten of these were either diagnosed as or consistent with high velocity ammunition. In its report, PHR concludes that a response to throwing stones that results in permanent disability, constitutes a gross violation of human rights.


The numerous head and eye injuries related to rubber and rubber coated steel projectiles must be considered to reflect frequent misuse of these weapons, such as firing at a range of less than 40 meters and firing at the upper part of the body. Of 2,299 emergency ward visits in the West Bank and East Jerusalem hospitals from September 29 to October 17, rubber bullets accounted for 40% of the injuries. 21 of 25 gunshot wounds to the head reported through October 22 at Makassed Hospital in East Jerusalem were rubber bullet injuries. Of the 21 rubber bullet injuries to the head, 16 were penetrating.


After reviewing post-mortem photographs, post-mortem and anti-mortem X-rays and CT scans, operating room records and medical records of the 31 Palestinians killed in Gaza between September 30 and October 24, the PHR team found that in 53% of the cases they were shot by high velocity weapons. Live ammunition was responsible for 30% of injuries among the 2,299 casualties previously cited.


Of the 31 Palestinians killed in Gaza between September 30 and October 24, 38% were under the age of 18. Of the first 1,134 injuries reported in the combined West Bank and Gaza data, 2% were under the age of 9, 14% were under the age of 15, and 17% were 16 through 18 years of age.


Medical neutrality, enshrined in international humanitarian law, human rights law, and medical ethics, seeks to protect and limit the injury and death to civilians, combatants, while providing standards for health professionals with respect to their rights and duties during war and peace. There have been repeated violations of medical neutrality during the renewed hostilities. The PHR team studied two damaged ambulances in Gaza; one of which had received a direct hit to the front window and the other was struck on the left-side by 50 caliber armor piercing ammunition that went completely through to the other side and damaged the stretcher inside the vehicle.

IDF officials who were interviewed by PHR admitted that early in the conflict there had been incidents of violations of medical neutrality, but that the orders had been reissued from headquarters to officers to respect the neutrality of ambulances and medical personnel.

The PHR team also personally interviewed a hospital van driver at Shifa hospital who was taking five cancer patients to Israel for outpatient chemotherapy and radiotherapy, who were all turned back at a check point between Israel and Gaza despite their valid permit to enter Israel.


Events on the ground suggest that the IDF are not following their regulations, instead allowing soldiers to fire when they are not acting solely in self-defense. This leniency extends to both non-lethal and lethal weapons. Israel's regulations for the IDF states that the soldier will use weapon in the event of immediate "danger to life," and when it is impossible to effectively defend one's self from the assailant other than by the use of the weapon. Under these regulations, stone throwing or a violent riot can equate to danger to life, justifying the use of firearms. However, the regulations state that weapons are to be used to strike the assailant and not others, and should not cause loss of life to others or grave bodily harm. Also, IDF regulations prohibit open fire towards women and children. As explained by an IDF spokesperson to the PHR team, any soldier in a life-threatening situation may fire his weapon in self-defense if other means of deterrence are not effective. In addition to not following their own standards, the IDF is violating international humanitarian and human rights standards as well.


In its’s report, PHR has issued the following recommendations. PHR calls on Israeli authorities to cease all use of excessive force against the Palestinian population. PHR urges Israeli authorities to adhere to strict rules of engagement that only allow the use of lethal force and live ammunition in truly life threatening situations, and to use its own rules of engagement in the use of rubber and rubber coated bullets. PHR deplores previous attacks on ambulances and medical personnel, and calls on all authorities to ensure safe evacuation, passage and entry of patients and health professionals into hospitals and clinics.

Israeli authorities must investigate and prosecute in Israel those military and civilians responsible for unjustified use of force in the current conflict. In accordance with the Convention on the Rights of the Child, children should be protected by Palestinian authorities to every extent possible. They should be shielded from participation or presence at violent demonstrations. Israeli authorities have a responsibility to ensure that children are not targets of lethal weapons or inappropriate use of force.

Whenever possible, professional forensic death investigations should be conducted by the responsible authorities. Interpretation of wounds and ammunition types by persons without appropriate forensic training can lead to dangerous errors in interpretation of causation of injuries or deaths. Finally, the Palestinian Authority has the responsibility to ensure the safety of all persons within their jurisdiction. They must take measures to ensure that armed individuals do not endanger the lives of other civilians. PHR calls on the Palestinian Authority to make public their rules of engagement and to adhere to international standards regarding the use of lethal and non-lethal force. We call on the Palestinian Authority to investigate and bring to justice all those culpable in the illegal use of force.

Physicians for Human Rights mobilizes the health professions and enlists the general public to protect and promote the human rights of all people. PHR shared the 1997 Nobel Peace Prize for its role as a founding member of the International Campaign to Ban Landmines.