Silencing the Messenger: How Power Creates and Entrenches Health Inequities 

By Rupa Marya, MD / Deep Medicine/ Substack

I am a professor of medicine at the University of California, San Francisco, where I have been working for more than 20 years to address the health impacts of racism in medicine and society at large. For six weeks, I was in almost daily contact with Dr Ghassan Abu Sitta, a Palestinian British surgeon who was communicating about Israel’s destruction of Gaza’s healthcare system  from the operating room of Al-Shifa hospital as it unfolded. He also gave testimony of this at the Hague to the International Court of Justice, which is pursuing the concern about Israel’s genocide against the Palestinian people. 

As my life’s work advancing health justice demands, I spoke up to bring attention to the extent of what was happening to Israel’s coordinated and catastrophic destruction of Gaza’s healthcare system. I never expected that my advocacy to stop bombing hospitals and my criticism of Israel for those actions would elicit harassing racist attacks against me. Much to my dismay, my own institution participated in the online harassment. 

On Jan. 2, I wrote a social media post inquiring into how Zionism as an ideology of supremacy in medicine impacts health and healthcare access for people of color. California State Senator Scott Wiener reposted it, misrepresenting my views as antisemitic and naming me and my employer as UCSF. An account associated with the Canary Mission shared it, sending their trolls after me. 

Canary Mission is an organization with ties to Israel that runs campaigns to harass and destroy the careers of students and faculty in the U.S. who criticize Zionism or Israel. It is funded by U.S. foundations and has been supported by the Helen Diller Family Foundation, the largest donor to UCSF. This is the second time I have been targeted by a pro-Israeli group in the past 100 days. The first time was in November, when I received hate mail through my UCSF account that included phrases like “kill yourself you retarded grifting n*gger,” “Jew baiting c*nt,” and “White people are the greatest people on Earth. You know this.” I reported these threats to UCSF leadership. 

Despite their awareness of this harassment, on Jan, 6, UCSF picked up where Wiener left off and launched a  coordinated post across multiple social medicine platforms, parroting Wiener’s misrepresentation of my words and framing my inquiry as antisemitic. My supervisor, Department Chair Bob Wachter, and Vice Chancellor Catherine Lucey coordinated UCSF’s post at the same moment, which precipitated more hateful online attacks against me. While UCSF didn’t name me, the inference was clear, as was the intention — to silence and discredit me. 

Many people across social media identified me and either called for me to be fired or denounced UCSF’s action as a racist attack on a faculty of color who is committed to health equity. A speaking engagement was canceled due to this flurry of online activity, which is a challenge as the main breadwinner for my family. Wiener then thanked UCSF for amplifying his dangerous rhetoric. These connections between a state senator, a public university, their largest donor and an Israeli entity are alarming for their impact in a public educational institution. 

I write here and now to clarify my position for my community, to whom I am accountable and who deserve to understand my views. We are in a moment where substantive critique of the Israeli government and the Zionist ideology upon which it was founded is being cast as antisemitic. When I say Zionist ideology, I am referring to the ideology of supremacy, apartheid, and ethnonationalism we see in practice in Israel—not an identity nor Jewish people generally. 

When I speak about its impact in medicine, I situate this inquiry with other systems of supremacy and their well-documented effects on bodies. I share these thoughts with deep love of humanity, the web of life and the Earth herself. I share them with humility, understanding where my words have contributed to misunderstanding and taking accountability to clarify for the purpose of our collective evolution of thought and to avoid devolution into hateful rhetoric or manipulative attempts to silence scholars of color.

When I wrote “Zionist doctors,” I used a phrase that triggered a trauma response in many Jewish people and for this I apologize. In my attempt to protect the identities of physicians who have said and done horrific things, I regrettably used a phrase that invited comparisons to a Soviet-era racist trope about Jewish doctors. I can see how that phrasing was hurtful, and to offer clarification, I will name some of these physicians and their actions. 

I should have characterized these doctors as “some doctors who espouse Zionist ideologies.” For clarity, not all doctors who espouse Zionist ideologies have done and said these things. And I repudiate all insinuations that I was referring to the many Jewish doctors who are deeply committed to the service of all, many of whom I am grateful to count among my valued colleagues and friends. But I will offer examples of people who do espouse these ideologies and who prompt me to question to what extent this ideology of supremacy operates in U.S. health systems, and how it may impact the health outcomes for marginalized people, particularly brown, Black and Indigenous people.

I have heard the word Zionism used by my American Jewish friends to signify the right of  Jewish people to have a safe place to live without fear of discrimination. I agree wholeheartedly with this assertion–specifically for Jewish people who have experienced terrible, long histories of discrimination and trauma, and also generally, for all people. 

What I take issue with is Zionism in practice as set forth by the State of Israel, which since its inception in 1948 has enacted the violent oppression of Palestinian people, land theft, and depopulation of Palestinian villages. I take issue with the brutal occupation, the settlements, the racism, the abduction of children, apartheid society and medical apartheid that Israel has created. I oppose Israel burning farms, poisoning Palestinian wells, pouring cement into Palestinian agricultural wells and destroying ancestral olive orchards. I am deeply troubled by over 100 days of unmitigated violence in Gaza that has killed an estimated 23,000 people, almost 400 of them my colleagues in healthcare. I am concerned about Israel’s starvation of the residents of Gaza.

Zionism in practice is not some aberration from some ideologically pure intention. It falls very much in line with what the founders and leaders of Zionism intended, which is documented and laid out by the founders of Israel. Zionism as a political movement started in the early 1880s in Eastern Europe, predating Theodor Herzl and the First Zionist Conference (1897) and the 20th century calls for the creation of a Zionist state in Palestine. Founding Zionist thinker Ze’ev Jabotinsky clarified that Zionism was a settler colonial project that required “the transformation of ‘Palestine’ into the ‘Land of Israel.’” As Israel’s first Prime Minister Ben-Gurion stated,  “If I were an Arab leader, I would never sign an agreement with Israel. It is normal; we have taken their country. It is true God promised it to us, but how could that interest them? Our God is not theirs. There has been Anti-Semitism, the Nazis, Hitler, Auschwitz, but was that their fault? They see but one thing: we have come and we have stolen their country. Why would they accept that?”

Albert Einstein rejected the offer to become Israel’s first president, specifically because of the system of supremacy he saw that Israel in practice would require. He argued for a secularism with equal rights for all, saying said in a 1938 speech: “I should much rather see reasonable agreement with the Arabs on the basis of living together in peace than the creation of a Jewish state … My awareness of the essential nature of Judaism resists the idea of a Jewish state with borders, an army, and a measure of temporal power … I am afraid of the inner damage Judaism will sustain.”

When I name Zionism as a system of supremacy, I am referring to what many Jewish and Israeli people commonly understand as the practice of Zionism in Israel. As the young Israeli intellectual Hayim Kastim wrote before he was tragically killed by Hamas on Oct. 7: 

Zionism, as enacted by the state of Israel and currently understood by the vast majority of Israelis, is based on ethnonational principles. According to this view, Jews living in Israel must receive more privileges and be entitled to more rights than non-Jews living in the state.

This view is reflected in Israeli law. In July 2018, Israel legislated the “Basic Law: Israel as the Nation-State of the Jewish People.” The purpose of this law was to officially establish that Israel is the homeland for Jews. The bill contains no mention of Palestinian national identity and does not even use the words “democracy” or “equality.”

For the doctors who espouse Zionist ideologies across the U.S, I am concerned by the racism that has been expressed, which are documented on the site, Raven Mission. Physicians are using dehumanizing language against Palestinians, Muslims and Arabs, at the same time that the world has been watching horrific images of violence live-streamed to our phones, showing children in Gaza under rubble and healthcare workers kidnapped and murdered. On X, ER physician at Boston Medical Center, James Feldman wrote “there are no innocents,” referring to people in Gaza. This phrase was just reiterated by Israeli MP Nissim Vaturi, who is currently advocating that Israel burn Gaza to the ground. This rhetoric gives justification for killing all civilians, which is collective punishment and a violation of International Law. 

At UCSF, physician Matt Cooperberg, who is the Helen Diller Family Chair in Urology, “liked” social media posts such as “REMOVE Palestinians FROM [sic] the map” and this quote by former Israeli prime minister Golda Meir, “We are able to forgive the arabs [cq]for killing our children. We are unable to forgive the arabs [cq] for forcing us to kill their children.” Cooperberg “liked” another post that stated Muslims are “Fucking Morons. Emotionally immature racists. Idiots. Irrational men.” 

Cooperberg’s endowed chair comes from the Helen Diller Family Foundation, UCSF’s largest donor, which to date has gifted some $1.15 billion dollars to the health campus. In 2018, due to a mistake on a tax form, the Helen Diller Family Foundation was exposed as a funder of the Canary Mission. The Foundation attempted to erase its connection after this exposure. Looking at UCSF’s behavior since Oct. 7, faculty, students and staff have questions and deep concerns. Patients and community groups do as well. 

These questions run deep due to UCSF’s long support of a doctor who espouses Zionist ideologies and has done real harm to Black and brown people in California. As a faculty member at UCSF, disgraced dermatologist Howard Maibach exposed and injected over 2,600 imprisoned Black and brown people with chemicals in experiments that echoed the experiments put on trial at the Doctors’ Trial just a few years before he went to medical school in Pennsylvania. There he studied under Albert Kligman, who taught him how to exploit Black people for medical experimentation, documented extensively in the horror nonfiction book, Acres of Skin.  Maibach also advanced notions of racial differences in skin, furthering racist ideas from the pseudoscience of eugenics. Race is a social construct that enshrines supremacism. It is not a biological reality.

Most of Maibach’s experiments were conducted without informed consent, and while UCSF issued an apology, Maibach is still employed by the University of California. His family supports the Friends of the IDF, and he is represented by Alan Dershowitz, who also argued for the bombing of hospitals in Gaza. Dershowitz attempted to prevent me from speaking at the AMA’s first National Health Equity Grand Rounds, where scholar Harriet Washington, who studies medical experimentation on Black people, highlighted Maibach’s racist practices. In the wake of George Floyd’s murder, UCSF faculty, trainees and students of color brought Maibach’s story to light, and many have expressed their horror that they have to continue to sit in the same room as this man during Dermatology Grand Rounds. But the problem is not just one man. It is a system that allows someone with these values and actions to continue to be present in our learning and practicing community.

The horror of faculty of color exposed to this harm comes in big and little moments. Recently a South Asian physician at UCSF introduced the idea of putting forth a ceasefire statement through the Antiracism Task Force in the Division of Hospital Medicine, where I work. The idea moved forward until Abraham “Avromi” Kanal started echoing talking points circulating among  people who espouse Zionist ideologies. In response to the proposal for a ceasefire statement, Kanal wrote to an email thread of some 40 people, “I fear that imposing ceasefire at this moment — even with the possibility of every living hostage returned —  disproportionately empowers Hamas and incentivizes kidnapping for ransom.” When I expressed my concerns about this expression of anti-Arab hate, I received no response from the Division leadership. 

Physicians should advocate in every circumstance to preserve human life, especially the lives of children and our colleagues in healthcare. We took an oath to do no harm. In Gaza, children, whole families and healthcare workers have been catastrophically impacted by Israeli attacks that have targeted schools, refugee camps and hospitals. Several SWANA (South West Asian and North African) and South Asian physicians texted me after reading Kanal’s statement to say they do not feel safe in his presence, because he was indirectly advocating for the ongoing slaughter of Arabs in Gaza.

The current conflict has prompted physicians to reveal concerning perspectives that directly impact the lives of Black and brown people. In November 2023, a group of 100 Israeli doctors called for the bombing of all hospitals in Gaza, claiming they were military holdouts, a claim that was echoed by Israel’s defense lawyers at the International Court of Justice but has been disproved by extensive investigation. Bombing hospitals is a violation of International Humanitarian law. However, shortly after the Israeli doctors’ letter circulated, the legitimacy of this international law was questioned and described as morally debatable by ethicist Matthew Wynia in his widely condemned JAMA article, which states that “health professionals of goodwill and equally strong commitments to human rights” could disagree about bombing hospitals. 

This article was published close to the time when the American Medical Association’s House of Delegates silenced SWANA and other minority delegates from bringing forward the discussion of a Ceasefire Resolution. This move stood in stark contrast to the AMA’s call to condemn Russia’s attacks on Ukrainian healthcare systems in 2022. Are Palestinian lives to be valued less than the lives of Ukrainians? As healthcare workers of conscience, we must ask these questions and ensure all people have the right and access to lifesaving care and have equal, lifesaving protections under international law.

What has ensued since November when the Israeli doctors’ statement was issued is Israel’s wholesale destruction of Gaza’s entire healthcare infrastructure, an unprecedented act of collective punishment, tantamount to genocide, for which Israel is on trial at the International Court of Justice. And through this destruction, we have seen the categorical silence of U.S. medical institutions and active silencing of people within these institutions who speak up about this destruction. The ICJ’s ruling against Israel’s violence should serve as a call to action for all healthcare institutions; as healthcare providers we have taken an oath to protect human life — that means everyone. We must examine the complicity of these institutions’ silence. And we must investigate the impact of silencing U.S. doctors who speak out about this violence when U.S. weapons are killing Palestinian doctors.

Yet UCSF is trying to isolate and marginalize me. Medicine residents are complaining that leadership will not allow me to speak in antiracism forums because they characterize me as “controversial.” But I am not some outlier of medicine. I am a part of its history of correction. Judging by the sheer numbers of medical students who reach out to me from around the country to ask for mentorship, to work alongside me, and who come to UCSF specifically because of my work, I am part of a movement bringing forward ideas that are a postcard from the future, that were gifted to me by the loving relationships of the communities who teach me and who I serve. 

These are ideas that call for radical inquiry into why medicine doesn’t serve all, despite 20 years of investment into so-called “health equity.” These are ideas that look unflinchingly into the violence of our past and the present to map a better world without violence in the future, so that all may be healthy. These are ideas that bring analysis of critical pedagogies into medicine, insisting upon an understanding of how history and power are shaping the health outcomes we see. This is not comfortable work. But it is necessary if we want to see all people thrive and live the lives they truly deserve.

My understanding of health equity and justice comes from decades of being a part of and serving communities in the struggle for our collective liberation. I realize there are not too many physicians in the academy who spend as much time as I have in frontline struggles — listening to families who have lost their loved ones to racist police violence, which continues to grow in the U.S., and standing together with Indigenous people who are resisting a pipeline  through their water, or a real estate development going up on their sacred site. Today, experts with institutional roles in health equity are notably silent about the genocide in Gaza, which speaks volumes about their allegiance to power rather than their commitment to end inequities. I do not learn about health equity from reading books, attending conferences or holding journal clubs. I learn about health equity through building solidarity and living in lockstep with the communities I serve and to whom I belong, through the practice of Deep Medicine.

My understanding of health is shaped by the survivors of genocide working to get their land back in Ohlone territory where I was born and where I work. It is sharpened by La Via Campesina’s peasant farming movement, the legacy of the Black Panther Party, the Waorani’s struggle to hold oil companies responsible for the pollution of the Amazon, the families of Oscar Grant, Mario Woods and Alex Nieto, all killed by Bay Area police, the family at Poor Magazine, disability justice movements and survivors of medical violence, and the Indigenous-led pipeline resistance, which has been the most effective tactic to lower greenhouse gas emissions in North America. My work is shaped by many people who work in service of ending apartheid in Palestine and bringing a future with equal rights for all. 

My data is these people’s stories, their lived experience and their stories of struggle against a system of supremacism that degrades the earth, human relationships and our duties to care for one another and the web of life. My data collection is not through being separate or apart from these struggles. It is from a life lived serving and being a part of them, understanding that all life is sacred and deserves our respect and protection. This life experience has situated my understanding in medicine around the dynamics of history and power, tracing how these forces sediment in the body and give way to patterns of chronic inflammatory disease that disproportionately impact oppressed people. When it comes to any system of supremacy, such as racism, it is critical to investigate how those play out for the safety of our patients, especially when we already know that Black, brown and Indigenous people have worse health outcomes in the U.S. health system. And Palestinian people have worse health outcomes under Israeli occupation, in a system health scholars describe as medical apartheid. 

If the experts in health equity are being actively silenced as European nations line up to condone a genocide where brown people are being killed, this must be accurately described as the latest tactic of white supremacy to exert itself, without opposition. The billionaire donor Bill Ackman, who pushed out Harvard’s president Claudine Gay complained about “racism against white people” as he destroyed the career of an accomplished Black scholar. Harvard health equity experts are also being targeted as “antisemitic” by a law firm that was recently registered as a foreign agent of Israel. 

California Senator Scott Wiener — who launched the online attack against me as “antisemitic” for bringing up my troubling concerns about racism in medicine that I am witnessing and experiencing — is currently pressuring school districts to abandon ethnic studies curriculum across California, using the manufactured charge of antisemitism as the reason. These courses are teaching the histories of Black and brown people who have been impacted by European violence for almost 600 years. The coordinated attacks on academics we are seeing across the country are a racist suppression of speech and academic freedom. It’s an ethnic cleansing of the academy to maintain narrative control of history, so we cannot understand the dynamics of power alive today, in our society and in our bodies. And if we do not understand them, we cannot change them. 

Racism does not require a conspiracy to have an impact. It is embedded into the attitudes and structure of our institutions and our medical system, and it drives the health disparities that were made even more clear with COVID. To change those disparities, we must take on the structures of power that entrench them. We now must turn up the volume and counter all efforts to silence the hard questions in order to transform these structures to make medicine serve all. 

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