Dear Secretary Powell,

Since November 2000, Médecins Sans Frontières (MSF) has been providing psychological and medical care in the Palestinian autonomous territories of the West Bank and the Gaza Strip. The programs focus on people living in areas most exposed to violence, including those close to the confrontation spots, particularly Israeli army installations and Israeli settlements.

MSF also supplies clinics and hospitals with drugs and emergency medical supplies. Since the beginning of December 2001, but over the last week in particular, MSF teams have witnessed violence escalating to unprecedented levels and civilians being deliberately denied access to essential medical care. Towns that have been declared military zones, such as Nablus, Bethlehem and Ramallah, are completely cut off from external assistance.

Civilians are unable to reach medical structures and medical organizations are prohibited from accessing these populations. The lack of access also means that many hospitals and clinics are cut off from essential medications and materials resulting in serious shortages in these structures.

In the few instances where access has been possible over the past week in the West Bank, medical activities are carried out under extremely dangerous conditions. Ambulances have been shot at and destroyed; medical centers have been overrun and fired upon; and medical relief personnel and patients have been harassed, threatened and, in some cases, shot at by the IDF (Israeli Defense Forces).

This is occurring even when official permission to carry out medical activities has been negotiated. This past weekend, for example, after receiving authorization from the IDF, our teams were transporting wounded and sick patients from Yatta village to Hebron Hospital.

IDF soldiers ordered our wounded patients out of the ambulance and aggressively threatened them with their weapons. In a separate incident in Yatta, IDF soldiers fired in the direction of our medical team while they were visiting a medical clinic. MSF denounces the serious obstruction of medical activities and harassment of medical personnel as well as the systematic violation of international humanitarian law by the Israeli Defense Forces. Access of the wounded and sick to medical care and respect of international humanitarian law is of fundamental importance and requires your urgent attention during your current Middle East visit.

Yours sincerely, Nicolas de Torrente Executive Director, MSF-USA