Spain: health institutional complicity in the ongoing Palestinian Genocide. Gaza: complicidad institucional sanitaria de España. ENG ESP

ENGLISH

The Spanish health system: experience regarding Palestine.

AUTHORS:

Fernández Lozano  I, Hamdan Nassar T; Pérez-Palomares s, Álvarez CS, Rodríguez Sendín JJ, Pérez-Fernández M, Gérvas J (corresponding author jjgervas@gmail.com)

 

ABSTRACT

A People’s Tribunal convened in Madrid on 28-29 November 2025 examined allegations of institutional complicity in the ongoing Palestinian Genocide by Spanish institutions. The Tribunal’s section dedicated to the healthcare system highlights the persistent silence of major professional health associations. Material complicity was further identified in the case of TEVA, a leading Israeli pharmaceutical firm. Additionally, Spain’s limited efforts to evacuate wounded Gazans and its endorsement of an Israeli amendment at the 2024 WHO Assembly were criticized. The People’s Tribunal concluded that such systematic silence, action in public-private alliances and inaction constitute complicity with the Palestinian’ Genocide.

 

MAIN TEXT

Spain

Spain is an European Union country located in southwestern Europe, whose capital is Madrid. Spain is a high-income country (gross domestic product per capita EUR 30,500) home to just under 50 million people. The population is urbanized and diverse, with markedly differentiated regions and nearly a fifth of residents born outside Spain.

Governance is highly decentralized, with the central government taking on a regulatory and strategic – rather than operational or management – role (e.g. regional health authorities have jurisdiction over operational planning, resource allocation, and purchasing and provision decisions).

Spain has the highest life expectancy in the European Union, at 83.2 years (Madrid Region, 85.2). Indicators for both population health and health system performance are very favourable, thanks in large part to a high-quality, universally accessible health system based on a primary health care model (salaried family physicians working in public health centers with “patients lists”). Healthcare is free, there are no co-payments for healthcare in primary and hospital settings. Co-payments for medications are very low in primary care, and they are free in hospitals.

Spain has low rates of preventable mortality. Cancer screening and vaccination rates are generally above the European Union averages. Spain’s low rates of hospital admissions for congestive heart failure and diabetes reflect some well-functioning primary care and integrated care systems in the country.

At the same time, public health also faces major challenges, including an ageing population and health-care workforce; the intensifying effects of the climate crisis; the accelerating cost-of-living crisis, especially in relation to housing; the ever-present threat of health emergencies; and persistent inequalities rooted in the social determinants of health.

While Spain’s health expenditure – at EUR 2,771 per capita – falls below the European Union average, the health system provides universal health coverage. Public expenditure is the primary source of financing, but levels of out-of-pocket spending (21 %, mainly for dental care) are higher than the European Union average (15 %) [1,2].

 

People's Tribunal on Complicity with the Palestinian Genocide in the Spanish State

The People's Tribunal on Complicity with the Palestinian Genocide within the Spanish State is a tribunal of conscience, composed of figures from the legal, academic, cultural and human rights fields, convened by the University Network for Palestine (RUxP) and civil society organizations with the aim of examining, from the perspective of international law and public ethics, the conduct of state and non-state actors in their links to the occupation, apartheid and genocide of the Palestinian people.

The Tribunal does not simply intend to convict-acquit, but above all, to convince Spanish public opinion with evidence demonstrating Spain's involvement, intent, and systematic actions that enable the genocide of the Palestinian people in Gaza, where Spanish actors (or those with criminal responsibility in Spain) are knowingly acting in favor of the Zionist state of Israel and profiting from the genocide itself. It is not Israel that is being tried, but Spain.

The necessary complicity and cooperation has been documented about:

• The Spanish government and state institution.

• The Armed Banking System, for financing the production of all types of weapons used in Gaza and the West Bank.

• Universities, for initiating and maintaining contracts, agreements and research projects, including dual-use technology.

• Companies, for continuing to trade with companies based in occupied territories, thereby violating international law.

• Health organizations and professional associations, for ignoring all the ethical codes of the profession through active and stubborn silence in the face of barbarism and destruction of life.

• Culture, sport and the media, for contributing to the narrative that the state that has most often violated international law is not a criminal state but just one that has the right to normal relations with other states.

The Court met in Madrid on November 28 and 29, 2025. In its verdict (“Madrid Declaration”) on the healthcare system, it declared that:

“In the healthcare sector, it has been documented that, despite repeated statements by healthcare personnel and public health experts about the atrocities committed against the civilian population in Gaza, the vast majority of academies, associations and scientific societies in medicine, nursing and pharmacy, as well as professional health organizations, have remained silent and completely ignored the obligations imposed by their ethicals codes. In material terms, complicity with genocide in the medical field is best exemplified by the pharmaceutical giant TEVA” [3].

 

Spanish health organizations and associations and Palestine

We have studied the complicity and normalization of the genocide of the Palestinian people within the healthcare sector through a joint effort between the University Network for Palestine and Health Workers for Palestine Spain (HW4PS), based on the research conducted by the latter organization since the beginning of the genocide.

The results are summarized in three main areas.

The first is the symbolic support for the genocide within the healthcare sector; that is, the normalizing silence surrounding the genocide that has prevailed in healthcare associations and professional bodies. This silence is especially scandalous coming from a sector that, regulated by stricter codes of ethics than any other, is focused precisely on contributing to the preservation of human life. It is not a matter of sympathy or solidarity, but an obligation, an ethical matter, since doctors have the obligation to put health, life and human dignity above any political or institutional interests.

The second area concerns the lack of sufficient action in a specific area where the healthcare sector could have made a crucial contribution to alleviate suffering: the transfer and care of sick and wounded people from Gaza to Spain.

The third point concerns the material relations within the healthcare ecosystem between Spain and the Zionist state of Israel: commercial relations in the healthcare sector, with an emphasis on the pharmaceutical sector, research projects, the "transfers of value" (payments) received by doctors from the Israeli pharmaceutical company Teva, which has a significant presence in the sale of generic drugs in Spain.

Cases of complicity, collaboration, silence, or normalization are contrasted—as is only fair—with cases in which individuals, civil society organizations, or institutions have reacted by denouncing or taking action against the genocide and other violations of international law perpetrated by the Zioniast of Israel.

 

Spain's support for the Zionist state of Israel at the World Health Assembly.

The bombing of Al-Ahli Al-Arabi Al-Mamadani Hospital in Gaza City on October 17, 2023, in which 471 people were killed and 342 wounded, symbolically marked the moment when the “war” against the Palestinian people (if it ever was one) began to be a genocide.

Since then, the Zionist state has completely disregarded the Fourth Geneva Convention (which establishes the protection, during wars, of hospitals and the particularly vulnerable populations they house: the wounded, the sick, pregnant women, and children) through systematic and deliberate attacks on healthcare infrastructure and professionals, including attacks on ambulances and paramedics, and the murder, imprisonment, and torture of healthcare professionals and their families.

As a key determinant of social health and an expression of solidarity among people, the healthcare sector is one of the main targets, if not the main target, of any genocidal project. Today, the Palestinian healthcare system is completely collapsed.

On a positive note: the commitment and professionalism of Gaza's healthcare workers who, despite unimaginable material constraints, continue to provide essential care for the sick and wounded.

This brutality has been justified in the eyes of the public, to a large extent, thanks to the support and legitimization that the narrative of the “militarization of hospitals, health centers and ambulances” received on May 31, 2024 at the 77th World Health Assembly of the World Health Organization (WHO), through the introduction by the Zionist state of Israel of an amendment to the final resolution. Verbatim: “Calls for the immediate and unconditional release of all hostages held in Gaza, including children, women and older persons, and condemns the use, by armed groups, of health facilities, including hospitals and ambulances, that endangers the civilian population” [4].

According to Israeli media: “Israeli amendment surprisingly passes World Health Assembly. The amendment, which calls for release of the hostages and condemns Gazan terror groups for militarizing hospitals, roiled the group of Arab countries. The amendment received a wide range of support—from traditional allies, like the United States, United Kingdom and Germany, to countries that often oppose Israel in international forums, such as Iceland, Spain and the Philippines” [5]. And: “The amendment put forth by the Israeli delegation condemned Hamas’s use of health facilities, including ambulances and hospitals for terror purposes, while putting the civilian population at risk” [6].

Spain voted, through its representative, the Minister of Health, who was in turn proposed, shortly afterwards (November), by WHO-Europe (in which the Zionist state of Israel participates) as a member of the WHO Executive Board (a position confirmed in May 2025, at the new World Health Assembly of the WHO).

The 2025 WHO World Health Assembly concluded in June 2025 without any changes being made to Israel's 2024 amendment. 

There is no reliable evidence whatsoever of the alleged militarization of the Gazan healthcare system, nor have the infamous "tunnels" ever been discovered under the hospitals.

As a positive contrast : the complaint filed by the Healthcare Workers with Palestine Platform, Valencia [7], and HW4PS [8].

 

Silence is complicity, and action is obligation.

Despite repeated statements from healthcare personnel and public health experts regarding the atrocities committed against the civilian population in Gaza, most academies, associations, and scientific societies of medicine, nursing, pharmacy, psychology, dentistry, physiotherapy, etc., and professional health organizations that claim to be committed to social justice have remained silent, at least until well into the genocide, completely ignoring the obligations imposed on them by their ethical codes.

The silence of other professional healthcare associations is striking, even more so than that of medical associations.

In any case, in general, the statements and declarations have employed the "art" of writing about Gaza (and Palestine) without mentioning:

1) the harm (apartheid and genocide),

2) the cause (the Zionist state of Israel),

3) the root causes (Zionism and "Western" colonialism),

and without taking any decisive action, such as suspending ties with Israeli healthcare associations and expelling them from international organizations.

Since the beginning of the current phase of the genocide, Spain has hosted at least three medical congresses with Israeli participation (including the one held in Zaragoza, co-organized with the Zionist state of Israel, as it should have been held in Tel Aviv) [9]. One of these congresses even had the Israeli pharmaceutical giant TEVA as a "platinum sponsor"[10]. According to the abstracts of the presentations, no mention is made of the state of health of the Gazan population years after the start of the genocide.

Only from the summer of 2025 onwards did the condemnation of the International Humanitarian Law violations that had been occurring for months become widespread,

t. As a positive contrast, the early declarations in 2023 and 2024, of FoCAP (Catalan Forum of Primary Care), Spanish Association of Pediatrics, Spanish Society of Family Medicine (SEMFYC), Ethic`s group of the Catalan Society of Family and Community Medicine, Spanish Society of Public Health (SESPAS), etc. and the manifests and actions, in mid-to-late 2025, of Toledo Medical Association, Spanish Medical Association, Spanish Society of Palliative Care, and Medical Associations of Ourense and Barcelona.

 

Teva and other experiences

Complicity with genocide in the medical field, in its commercial dimension, finds its prime example in the pharmaceutical giant Teva.

Teva is a corrupt and corrupting company, forced to pay since 2000 more than $10 billion for its criminal activity [11].

Although its main activity is in the field of generic drugs, its flagship branded products are Austedo (deutetrabenazine) for Huntington's disease, chorea, and tardive dyskinesia; Ajovy (fremanezumab) for migraines; Copaxone (glatiramer) for multiple sclerosis; Uzedy (risperidone) for schizophrenia; and Azilect (rasagiline) for Parkinson's disease. In primary care in Spain, its "best sellers" are three generic drugs: omeprazole, atorvastatin, and pantoprazole [12].

The Israeli company declared €2,010,412 in "transfers of value" (payments to doctors and their associations) in Spain in 2023, according to its transparency report. Nearly one million euros of this amount corresponds to payments to professionals to promote its products [13].

Teva has a major factory in Zaragoza, which also coordinates all aspects of clinical trials for medicines worldwide. TEVA operates 58 manufacturing facilities worldwide. Its plant in Zaragoza accounts the 5,91% of Teva’s global pharmaceutical production and supplies approximately 40% of generic drugs used within the Spanish health system [14].

Teva is directly involved in the genocide in Gaza [15], for example, by funding a project to help in "the recovery" of the mental health of Israeli soldiers upon their home return.

Another case illustrating the connection and alliances between Israeli health industries and Spanish health system concerns patient management software. Israeli health technology companies Assuta Medical Centers Ltd and Ewawe Ltd participate in CONNECARE which is an EU-funded consortium that develop integrated systems for chronic patient care in collaboration with European, including Spanish, partners. Likewise, the pan-European DAPHNE initiative for lifestyle monitoring and preventive health is co-led by Spanish firm Treelogic and Israel’s Nevet Ltd (Maccabi Group), together with IBM Israel and other Spanish technology partners.

The complicit silence regarding Palestine ultimately backfires on the "silent" ones, as "local" Zionists operate under the cloak of tolerance towards the Zionist state of Israel. The case of Pablo Simón, a rural doctor from Granada and member of HW4PS, clearly demonstrates this. He was anonymously denounced by Zionists seeking to censor dignity, in this case to prevent him from not prescribing Teva medications, which generate profits that sustain apartheid and Palestinian genocide.

The denunciation had no punishment for Pablo Simon , but it illustrates how the Zionist state of Israel poses a danger to humanity [16].

As a positive contrast , given Teva's role as a source of income for the Zionist state of Israel, apartheid, and the Palestinian genocide, there have been boycott campaigns against Teva products by Yala Nafarroa con Palestina and HW4PS, protests by hospital professionals in the Basque Country and Madrid, and decisions by the public healthcare systems in Asturias and Navarrea to terminate their contracts with Teva.

 

Sick and wounded

Spain has also failed in its duty to assist sick and wounded Gazans who required urgent medical attention (around 16,000), carrying out medical evacuations far below its capacity and even that of other countries like Italy. By the end of August 2025, a year and a half after the start of the genocide, only about 45 patients had been transferred to Spain (an about 200 to Italy). As a positive contrast , some autonomous communities have shown themselves to be very receptive in this regard, such as the Basque Country, which has shown willingness to receive more wounded or sick Gazans. Also on a positive note, Spain has not reached the level of ethical degradation of Germany, which has transferred more donkeys (600) than children (two) from Gaza [17].

 

Import/export

Import/export relations for health and pharmaceutical goods and services between Spain and the Zionist state of Israel resulted in a positive balance for Spain of US$1,300,784,000 in 2024 [18].

Regarding patents linked to Spain and Israel, a total of 53 have been identified in the health sector (in 43 cases the inventor is Israeli and the patent holder is Spanish, and in 17 cases the reverse is true) [19].

R&D&I in the health sector has continued even with the Advisory Opinion of the International Court of Justice (ICJ) in effect. There are 101 health projects with European funding and Spanish and Israeli participation active as of October 1, 2025 (26 projects have a start date after the ICJ's Advisory Opinion of July 2024) [20].

 

Complicity in the face of war crimes, such as genocide, make us criminals

Health Workers for Palestine Spain (HW4PS) has systematically and consistently denounced complicity with genocide within the healthcare sector and repeatedly demanded that the government and healthcare organizations/societies fulfill their obligations a/ to denounce the amendment approved by the WHO World Health Assembly (2024), b/ to evacuate wounded civilians, c/ to boycott Teva products, d/ to demand respect for human rights in Palestine, including the cessation of destruction and the siege of Gaza (and in the Zionist state of Israel itself, with an emphasis on prisons and detention centers), and d/ to sever ties with a state that systematically and openly violates International Law.

We reiterate that any decision other than to denounce and act promptly against a crime can only be described as complicity. We believe that silence, neutrality, insensitivity, and complicity in the face of war crimes, such as genocide, make us criminals.

Assessing the "Western" reaction when compared with the rest of the world, Spain's deplorable stance is far better than that of almost every other country in the world, with perhaps a few exceptions as Ireland and the United Kingdom (and South Africa).

As for the People's Tribunal on Complicity with the Palestinian Genocide within the Spanish State, its research activities are ongoing, as it intends to be a permanent structure of denounce of complicity with the Zionist state of Israel’s international crimes, and to serve as an inspiration for similar initiatives elsewhere.

 

AUTHORS AFFILIATION

Irina Fernández Lozano (lecturer and researcher, department of Sociology II, Universidad Nacional de Educación a Distancia UNED,Spain, University Network for Palestine, RUxP, https://orcid.org/0000-0003-4310-5526), Tamer Hamdan Nassar (student of Medicine, Universidad de Valencia, Spain, University Network for Palestine, RUxP); Sara Pérez-Palomares (lecturer and researcher, Department of Physiatry and Nursing of Zaragoza University, Spain University Network for Palestine, RUxP, https://orcid.org/0000-0002-5770-5146), César S. Álvarez (professor and researcher, Department of Psychology and Sociology of Zaragoza University, Spain, University Network for Palestine, RUxP, https://orcid.org/0000-0001-8274-6217), Juan José Rodríguez Sendín (retired rural doctor, President of the Ethics and Professional Conduct Committee, Toledo Medical Association, Spain ), Mercedes Pérez-Fernández (retired rural doctor, Health Workers for Palestine, Spain (https://orcid.org/0000-0002-9285-1739) ) and Juan Gérvas (retired rural doctor, Health Workers For Palestine, Spain, (https://orcid.org/0000-0002-7802-5457) )

AUTHORS CONTRIBUTION

JG, MPF and CSA had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: IFL, THN, SPP, CSA

Drafting of the manuscript: JG, CSA, SPP, THN, IFL

Critical review of the manuscript for important intellectual content: All authors.

Supervision: JJRS.

DISCLOCURE OF CONFLICT OF INTEREST None declared

FUNDING: None

NOTE: This text is the final version of a paper that was submitted for possible publication to the Indian Journal of Medical Ethics on December 15, 2025. After acknowledging receipt, the journal's next communication was on March 27, 2026: "Decision: Decline submission. Your manuscript was screened internally and the final comments for you are: While the subject you have chosen is important, the manuscript falls short of doing full justice to the subject at hand. In light of the above comments, we regret we are unable to consider it for publication".

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