Medical workers in Israel have told the BBC that Palestinian detainees from Gaza are routinely kept shackled to hospital beds, blindfolded, sometimes naked, and forced to wear nappies – a practice one medic said amounted to "torture". A whistle-blower detailed how procedures in one military hospital were "routinely" carried out without painkillers, causing "an unacceptable amount of pain" to detainees. Another whistle-blower said painkillers were used "selectively" and "in a very limited way" during an invasive medical procedure on a Gazan detainee in a public hospital. He also said critically ill patients being held in makeshift military facilities were being denied proper treatment because of a reluctance by public hospitals to transfer and treat them. One detainee, taken from Gaza for questioning by the Israeli army and later released, told the BBC his leg had to be amputated because he was denied treatment for an infected wound. A senior doctor working inside the military hospital at the center of the allegations denied that any amputations were the direct result of conditions there, but described the shackles and other restraints used by guards as "dehumanization". The Israeli army said detainees at the facility were treated "appropriately and carefully". The two whistle-blowers the BBC spoke to were both in positions to assess the medical treatment of detainees. Both asked to remain anonymous because of the sensitivity of the issue among their colleagues. Their accounts are supported by a report, published in February by Physicians for Human Rights in Israel, which said that Israel's civilian and military prisons had become "an apparatus of retribution and revenge" and that detainees' human rights were being violated - in particular their right to health. Concerns over the treatment of sick and injured detainees have centered on a military field hospital, at the Sde Teiman military base in southern Israel. The field hospital was set up by Israel's Health Ministry after the Hamas attacks specifically to treat Gazan detainees, after some public hospitals and staff expressed a reluctance to treat fighters captured on the day of the Hamas attacks. Since then, Israeli forces have rounded up large numbers of people from Gaza and taken them to bases like Sde Teiman for interrogation. Those suspected of fighting for Hamas are sent to Israeli detention centers; many others are released back to Gaza without charge. The army does not publish details of the detainees it is holding. Patients at the Sde Teiman hospital are kept blindfolded and permanently shackled to their beds by all four limbs, according to several medics responsible for treating patients there. They are also made to wear nappies, rather than use a toilet. Israel's army said in response that handcuffing of detainees in the Sde Teiman hospital was "examined individually and daily, and carried out in cases where the security risk requires it". It said that nappies [diapers] were used "only for detainees who have undergone medical procedures for which their movement is limited". But witnesses, including the facility's senior anesthesiologist, Yoel Donchin, say both the use of nappies and handcuffs are universal in the hospital ward. "The army create the patient to be 100% dependent, like a baby," he said. "You are cuffed, you are with diapers, you need water, you need everything – it's dehumanization". Dr Donchin said there was no individual assessment of the need for restraints, and that even those patients who were unable to walk – for example, those with leg amputations – were handcuffed to the bed. He described the practice as "stupid". Two witnesses at the facility in the early weeks of the Gaza war told us that patients there were kept naked under the blankets. One doctor with knowledge of conditions there said prolonged cuffing to beds would cause "huge suffering, horrible suffering", describing it as "torture" and saying patients would start to feel pain after a few hours. Others have spoken of the risk of long-term nerve damage. Footage of Gazan detainees released after interrogation shows injuries and scarring around their wrists and legs. Last month, Israel's daily Haaretz newspaper published allegations made by a doctor at the Sde Teiman site that leg amputations had been carried out on two prisoners, because of cuffing injuries. The allegations were made, the paper said, in a private letter sent by the doctor to government ministers and the attorney-general, in which such amputations were described as "unfortunately a routine event". The BBC has not been able to independently verify this allegation. Dr Donchin said that amputations were not the direct result of cuffing and had involved other factors – such as infection, diabetes or problems with blood vessels. Israeli medical guidelines stipulate that no patient should be restrained unless there is a specific security reason for doing so, and that the minimum level of restraint should be used. The head of the country's Medical Ethics Board, Yossi Walfisch, after a visit to the site, said all patients had a right to be treated without being handcuffed, but that the safety of staff prevailed over other ethical considerations. "Terrorists are given proper medical treatment," he said in a published letter, "with the aim of keeping restraints to a minimum and while maintaining the safety of the treating staff." Many Gazans detained by Israel's army are released without charge after interrogation. Dr Donchin said complaints from medical staff at the Sde Teiman military hospital had led to changes, including a shift to looser handcuffs. He said he insisted on guards removing restraints before any surgical procedure. "It's not pleasant to work there," he said. "I know it's against the ethical code to treat someone cuffed in the bed. But what's the alternative? Is it better to let them die? I don't think so." But reports suggest the attitudes of medical staff towards detainees vary widely, in both military and civilian hospitals. A whistle-blower who worked at the Sde Teiman field hospital back in October, shortly after the Hamas attacks on Israel, described cases of patients being given inadequate amounts of painkillers, including anesthetic. He said a doctor once refused his request that an elderly patient be given painkillers while they were opening up a recent, infected amputation wound. "[The patient] started trembling from pain, and so I stop and say 'we can't go on, you need to give him analgesia'," he said. The doctor told him it was too late to administer it. The witness said such procedures were "routinely done without analgesia" resulting in "an unacceptable amount of pain". On another occasion, he was asked by a suspected Hamas fighter to intercede with the surgical team to increase the levels of morphine and anesthetic during repeated surgeries. The message was passed on, but the suspect again regained consciousness during the next operation and was in a lot of pain. The witness said both he and other colleagues felt there was a sense in which it had been a deliberate act of revenge. The army said in response to these allegations that violence against detainees was "absolutely prohibited", and that it regularly briefed its forces on the conduct required of them. Any concrete details of violence or humiliation would be examined, it said. A second whistle-blower said the situation at Sde Teiman was only part of the problem, which extended into public hospitals. The BBC is calling him "Yoni" to protect his identity. In the days that followed the 7 October attacks, he said, hospitals in southern Israel were faced with the challenge of treating both wounded fighters and wounded victims, often in the same emergency departments. Hamas gunmen had just attacked Israeli communities along the border fence with Gaza, killing about 1,200 people and kidnapping some 250 others. "The atmosphere was extremely emotional," Yoni said. "Hospitals were completely overwhelmed, both psychologically and in terms of capacity." "There were instances where I heard staff discuss whether detainees from Gaza should get painkillers. Or ways to perform certain procedures that can turn the treatment into punishment." Conversations like this were not uncommon, he said, even if actual instances appeared very rare. "I have knowledge of one case where painkillers were used selectively, in a very limited way, during a procedure," he told the BBC. "The patient did not receive any explanation of what was going on. So, if you put together [that] someone is undergoing an invasive procedure, which involves even incisions, and doesn't know about that, and is blindfolded, then the line between treatment and assault thins out." We asked the Health Ministry to respond to these allegations, but they directed us to the IDF. Yoni also said that the Sde Teiman field hospital was not equipped to treat severely injured patients, but that some of those held there in the early months of the war had fresh gunshot wounds to the chest and abdomen. He said at least one critically ill man was kept there because of a reluctance by public hospitals to accept his transfer for treatment, adding that doctors at the base were "frustrated" by the situation. Sufian Abu Salah, a 43-year-old taxi driver from Khan Youis, was one of dozens of men detained during raids by Israel's army and taken to a military base for questioning. He said soldiers carried out severe beatings during the journey and also on arrival at the base, where he was denied treatment for a minor wound on his foot, which then became infected. "My leg got infected and turned blue, and as soft as a sponge," he told the BBC. After a week, he said, the guards took him to hospital, beating him on his injured leg on the way. Two operations to clean his wound did not work, he told the BBC. "Afterwards, they took me to a public hospital, where the doctor gave me two options: my leg or my life." He chose his life. After they amputated his leg, he was sent back to the military base, and later released back to Gaza. "This period was mental and physical torture," he said. "I can't describe it. I was detained with two legs and now I have only one. Every now and then, I cry." The IDF did not respond to the specific allegations about Sufian's treatment, but said the claims of violence towards him during his arrest or detention "were unknown and will be examined". In the days after the 7 October attack, Israel's Health Ministry issued a directive that all Gazan detainees should be treated in military or prison hospitals, with the Sde Teiman field hospital created specifically to fill this role. The decision won the backing of many in Israel's medical establishment, with Yossi Walfisch, praising it as the solution to "an ethical dilemma", which would remove responsibility for treating "Hamas terrorists" from the public health system. Others have called for the closure of Sde Teiman, describing the situation there as "an unprecedented low point for the medical profession, and medical ethics." "My fear is that what we're doing in Sde Teiman won't allow a return to the way it was before," one doctor told the BBC. "Because things that looked unreasonable to us before, will look reasonable when this crisis is over." Yoel Donchin, the anaesthesiologist, said medical staff at the field hospital sometimes gathered together to cry over the situation there. "The moment our hospital closes," he said, "we'll celebrate." — BBC
