Rockets fired by Palestinian militants from Gaza City toward Israel on October 7, 2023. Image credit: © Mahmud Hams, AFP

Rockets fired by Palestinian militants from Gaza City toward Israel on October 7, 2023. Image credit: © Mahmud Hams, AFP

Close modal

Margaret Thatcher famously stated “crime is crime is crime.” I disagreed with Ms. Thatcher on many issues, but I appreciated the moral clarity of her tautology.

On Friday, October 6, 2023, 50 years and one day after Egypt and Syria staged a surprise attack on Israel (the Yom Kippur War), Hamas terrorists launched an attack on Israel by air (missiles and drones), land (multiple violent breaches of the Israel/Gaza border plus prior infiltration into Israeli communities), and sea. Over the next few hours, Hamas launched over 2,000 missiles at Israel. Concurrently, Hamas gunmen terrorized communities near Gaza, indiscriminately killing civilians and taking dozens of prisoners. On Saturday morning, more than 250 concertgoers were gunned down as they fled. Two days later, Israel was still clearing terrorists from cities. News reports suggest that at least 150 people, mostly civilians, had been taken hostage. Hamas vowed to broadcast the execution of the hostages unless Israel ceases its efforts to destroy Hamas.

As of this writing, more than 1,000 Israelis have been killed by Hamas. To calibrate this number, Israel has a population of 9.4 million people. The United States has a population of 332 million. An equivalent terrorist attack on the United States would have 35,000 deaths. Readers of the ASA Monitor will recall the horror of 9/11 and the numbing dread in the months that followed. About 3,000 people were killed on 9/11. If some infinities are larger than others, then are some depths of hell deeper than others?

Maybe. The terrorists who killed thousands of Americans on 9/11 posed no military threat to the United States. We were terrorized, but our military might was unbowed. In stark contrast, Israel faces a mortal threat from neighboring states that have vowed to destroy it. One of these states, Iran, is developing nuclear weapons. Hamas may not have the military muscle to destroy Israel. However, Hamas terrorism destabilizes the Middle East. The calculus has forced Israel to flex its military muscle, potentially transforming Israel in the eyes of the world as the aggressor, not the victim.

As always with war, the heaviest toll will fall upon the most vulnerable. The Palestinians in Gaza are desperately poor. They are ruled by terrorists drawn from disaffected Palestinians. Hamas became the government of Gaza after a 2006 war with Fatah. A poll in 2021 found that more than 50% of Palestinians in Gaza support Hamas ( That will prove to be a bad choice. The lives of Palestinians will be immeasurably worse following Hamas' terrorist attack. The current poverty and isolation of Gaza stems from the blockade of Gaza by Israel, a blockade created to limit terrorist attacks from Hamas. Israelis rightly expect their government to keep them safe. As Israel seeks to defang Hamas, the 2.2 million Palestinians confined to a mere 140 square miles have nowhere to go. They are now hostages of Hamas as well.

I write about terrorism, war, and violence because the ASA Monitor is written by physicians for physicians. War is more personal for us than for many of our physician colleagues. Anesthesiologists recoil at intraoperative awareness. Steel slicing unanesthetized flesh is the stuff of our nightmares. However, that is an apt description of the deaths of Israelis gunned down by Hamas terrorists, and the deaths of Palestinians killed in Israeli airstrikes.

In 2022, I wrote about the horror of Russia's unprovoked invasion of Ukraine ( That war, just like this war, was a choice by individuals answerable only to themselves. Warlords who seek power through violence are truly evil. As physicians, respected and rewarded by society for our commitment to healing, we have a duty to condemn war and seek peace.

Condemning war means condemning the aggressor. Russia invaded Ukraine without provocation. Hamas launched a massive terrorist attack against Israel. Both aggressors intentionally targeted the civilian population. I am tired of the “whataboutism” prevalent in the news, social media, and even from the occasional ASA member. Russia claimed Ukraine was a Nazi state. That is false. Hamas claimed its terrorist assault was in response to another Israeli infraction at the Al-Aqsa Mosque on Temple Mount (known as Har ha-Bayit in Hebrew and al-Haram al-Sharif in Arabic). Yes, Israel has taken actions on the Al-Aqsa Mosque that are an affront to Muslims. Yes, there is a need to discuss the causes and consequences of Israel's longstanding blockade of Gaza. However, nothing justifies the terrorism unleashed on Israel by Hamas.

How should we respond? In this article, I have provided a table of charitable organizations, both for Israel and for Gaza. People are people. I urge readers to help those whose lives have been upended by the senseless violence unleashed by the terrorist assault on Israel.

Lacking answers to questions that have dogged humanity for millennia, I'll resort to platitudes. Quoting Golda Meir, “Peace will come when the Arabs love their children more than they hate us.” Can we learn to hate less? The attacks by Hamas will evoke hatred for Palestinians. I feel my own outrage as I read the news. The news is filled with more images of horrific bloodshed as Israel seeks to defend itself from further attacks by prosecuting its war to destroy Hamas. That will evoke outrage and hatred toward Israelis. Iran and Hezbollah will stoke outrage and hatred, seeking more violence against Israel. On social media, antisemitism and Islamophobia are rising from their already unacceptable levels.

Can this stop? Can we end the cycle of outrage and violence? Can we love our children more than we hate our enemies?

We were drawn to medicine, and to anesthesiology, by our better angels. We are healers. We value each individual human life. We seek to end pain and suffering. We have other useful skills, including negotiating prowess and scientific literacy. As physicians, and as anesthesiologists, we must be voices for a more compassionate, just, and peaceful world.

Note from Dr. Shafer:

I was unaware that the words of Golda Meir were incendiary, particularly to those of Arabic heritage. The quote is so familiar that I failed to hear the dehumanizing subtext. I should not have quoted Golda Meir in a message intended as a call for compassion. It was my mistake. I apologize to our readers. I have revised the text by striking out the words of Golda Meir.

We have received several thoughtful responses, which currently appear as online comments. Some of these commentaries will appear as letters to the editor in the February and March issues of the ASA Monitor.

Readers may welcome the messages published by Johns Hopkins University ( and the Society for Pediatric Anesthesia (

Is there anything that can be said as we watch the unfolding humanitarian disaster, first in Israel and now in Gaza, following the October 7 attacks? Bertrand Russell was among the most brilliant mathematicians and philosophers of the 20th century. In 1950, Russell was awarded the Nobel Prize in Literature “in recognition of his varied and significant writings in which he champions humanitarian ideals and freedom of thought.” In 1970, Russell wrote, “All who want to see an end to bloodshed in the Middle East must ensure that any settlement does not contain the seeds of future conflict.”

Perhaps our calls for compassion and dialog, as physicians and healers, can lay a foundation for a future without conflict.

Steven L. Shafer, MD, FASA, Editor-in-Chief, ASA Monitor, and Professor Emeritus of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California.

Steven L. Shafer, MD, FASA, Editor-in-Chief, ASA Monitor, and Professor Emeritus of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California.

Close modal