To: Dr. Claire Shannon: President, Royal College of Anaesthetists. ceo@rcoa.ac.uk, info@rcoa.ac.uk
Dr. Daniele Bryden: Dean, Faculty of Intensive Care Medicine. contact@ficm.ac.uk
Dr. Lorraine de Gray: Dean, Faculty of Pain Medicine. contact@fpm.ac.uk, m.philbin@fpm.org.uk

Subject: Joint Petition to Anaesthesia, ICM and Pain – Urgent Call to Action on the Gaza Crisis

Dear Doctors,

We write to you as concerned members of the Royal College of Anaesthetists, Faculty of Intensive Care Medicine and Pain Medicine regarding the unprecedented catastrophe in Gaza. As frontline healthcare professionals committed to the protection of life, the ethics of medical neutrality, and the dignity of all patients, we feel a moral and professional duty to speak out with urgency and resolve.

As of May 2025, the World Health Organization and United Nations report the near-total collapse of Gaza’s healthcare system. Ninety-four percent of hospitals have been damaged or destroyed, and over 71,000 children under five are projected to suffer acute malnutrition. At least 57 children have already died of starvation since the intensification of the blockade in March. Emergency, surgical, and intensive care services have been devastated. Gaza’s only burns unit has been destroyed. The Nasser Medical Complex, a major referral hospital, lost 18 critical care beds following an airstrike.

Across Gaza, healthcare teams are performing emergency surgeries, amputations, caesarean sections and other procedures without anaesthesia, electricity, oxygen, or sterile instruments. Trauma systems have collapsed, blood products are unavailable, and the prehospital response is overwhelmed. These are not isolated failures - they are the predictable outcome of a deliberate blockade, the obstruction of humanitarian aid, and repeated attacks on healthcare facilities and personnel. As anaesthetists, we are particularly alarmed as the collapse of surgical services and critical care has had catastrophic consequences for trauma, obstetrics and paediatric care.

These acts constitute clear violations of international humanitarian law, the Geneva Conventions, and the ethical obligations that underpin our profession. They undermine every principle we uphold - to preserve life, relieve suffering, and provide care impartially and without fear.

While the Royal College of Physicians, Nursing, General Practitioners, Paediatrics, Surgeons and Emergency Medicine have all made public statements, and written to the UK Foreign Secretary condemning attacks on hospitals and calling for a ceasefire, our colleges have remained silent. This silence stands in stark contrast to its rightly swift and unequivocal response to the Russia-Ukraine war. This disparity has not gone unnoticed, and has caused significant distress among members, a number of whom have deployed to Gaza over the last 20 months.

The RCoA’s only formal output, a generic wellbeing resource page titled “Middle East Crisis Resources” was a limited response. It reframes moral distress as a matter of individual wellbeing, without acknowledging the atrocities underlying that distress or addressing the professional implications of sustained attacks on healthcare. At previous council meetings, the College have suggested that issuing statements has little material effect. This reasoning raises deep concerns about the culture within the College leadership, especially given the RCoA’s Global Partnerships Strategy of “advocating alongside global health ministries, educational bodies and associations across the world… need for improved anaesthesia services and provision of anaesthesia as part of the wider surgical team…” The logic of disengagement in the face of one of the most extreme attacks on healthcare in recent history is difficult to reconcile with the College’s stated values.

We understand that there may be institutional hesitancy due to pressures from external lobbies. The College is however, accountable to its members and to the values we uphold. As anaesthetists, we cannot be silent in the face of mass suffering, and neither should our College.

We therefore respectfully call on the RCoA, FICM and FPM to:

• Publicly and unequivocally condemn the use of starvation, siege, and the targeting of healthcare infrastructure and workers, and call for an immediate and lasting ceasefire.
• Publicly support and align with United Nations Security Council Resolution 2728, adopted in March 2024, which calls for an immediate and lasting ceasefire, unimpeded humanitarian access, and the protection of civilians and healthcare personnel.
• Collaborate across colleges and international organisations to advocate for the restoration of emergency, surgical, and intensive care services in Gaza, and the protection of healthcare systems in conflict zones.
• Support legal accountability for those responsible for the obstruction of care, the targeting of ambulances, hospitals, and healthcare workers, and the violation of medical neutrality.
• Provide a platform for members to advocate, educate, and act, and issue clear ethical guidance for clinicians responding to humanitarian crises of this scale.

The College must now take responsibility for the reputational damage caused by its sustained silence. It should acknowledge the delay in responding to one of the most severe assaults on healthcare in modern history. Without such reflection, the perception may deepen that the College does not represent or advocate for those on the frontlines of a humanitarian disaster, or its members.

Sincerely,

The Undersigned UK Anaesthetists

May 2025