As a doctor who spent a lifetime of work in epidemiology and environmental medicine, I have extensive experience thinking about how external factors drive public health outcomes – preventable disease and premature death.

I have studied and recommended reductions in pesticide use, the deployment of speed cameras, and removal of lead from contaminated flour mills, and household exposure to tobacco smoke in children among other areas of focus.

Much of this work occurred in the West Bank and Gaza. That experience has much to say about the catastrophe we have witnessed in Israel and Gaza, and which we risk reoccurring, if we do not address the intergenerational incitement and murderous intent in the Palestinian world.

As an epidemiologist with significant work studying genocide and incitement, I see indoctrination in genocidal ideology as a form of hazardous exposure with toxic effects on all age groups, but with specifically dangerous impacts on the young. Exposure to such incitement can be likened to frequent and high-dosage exposure to poisons like lead, PCBs, asbestos, and tobacco smoke. The impacts are both immediate and long-lasting. We should act accordingly.

October 7 as An Epidemiological Event

It’s critical that we see the Hamas attacks of October 7 and the resulting war in Gaza not just as a geostrategic milestone event but also as an incident in environmental medicine with impacts on both Israeli and Palestinian lives.

The barbaric attacks on Israel were systematic. For one day, Hamas waged total war, raping, murdering and kidnapping, and setting out to make Israel’s Gaza envelope communities uninhabitable, which many now are.

Israel has responded by defending itself and seeking to defeat Hamas militarily. For Gaza, this has been an epidemiological catastrophe. Whatever Gaza once was, it no longer is – and more destruction is surely coming if Hamas does not surrender.

While some in the public health and humanitarian community blame Israel for this destruction, that would be a mistake.

The predicate for all of the public health losses –of life, medical infrastructure, safe water, homes – was the ideology which made Israel’s military action inevitable.

Not Poisoned Wells, but Poisoned Minds

In a disease model, we must look for the disease, not the symptoms of the disease, if we are to heal the patient. The same is true in epidemiology: We must identify the content and effect of toxic exposure. The most famous such epidemiological discovery came in 1854, when John Snow deduced that a cholera epidemic in London could be linked to a single water pump on Broad Street.

In this case, we are not looking for a contaminated well. We are looking for contaminated minds: The contaminant is the ideology of Hamas. Hamas and its enablers have indoctrinated all Gazans in this ideology, from cradle to grave. Many of the thousands who came across the border to murder, rape and loot on October 7 were not only uniformed and trained Hamas terrorists, but ordinary Gazans who joined in on the genocidal massacre.

They were motivated to commit murder and rape by what they were taught at home, at school, at mosques, in the streets and on social media. If they had no formal training to kill, they didn’t need any.

It is rare that a society becomes so sick to the core that mass murder becomes a socially acceptable norm. Hamas terrorists bragged to their parents. They were greeted as conquering heroes and were eligible for large cash awards and free apartments. This is a culture in which genocidal massacre is celebrated.

Critics of Israel’s offensive into Gaza say it will only create more supporters for Hamas. That is absurd. Gaza already is dominated by intergenerational indoctrination of an extreme version of jihadist Islam.

It is critical that we recall Gregory Stanton’s seminal “Ten Stages of Genocide” speaks to this issue specifically. Genocide follows a distinct pattern, from classification of the enemy to symbolization of the enemy, to discrimination, dehumanization, organization, polarization, preparation, persecution, extermination and finally, denial.

Just as Palestinian society has been shaped by an ideology of genocide, it is also not destined to serve the cause of genocide. This was not inevitable. There are many traditional and religious societies in the Arab world similar to Palestinian Arabs which do not engage in any of the kind of genocidal or pre-genocidal steps of Hamas. 

Destroying Hamas is Not Enough

If the problem is man-made, then the solution will be man-made. First, let us dispense with the fiction that destroying Hamas’s hardware, its fortifications above ground, and its tunnels underground is sufficient.

If Israel exits Gaza only having killed Hamas operatives and destroying Hamas infrastructure, it will have achieved very little of lasting value. It must take on the hard work of removing genocide-indoctrination and incitement.

Like any epidemiological matter of any consequence, this will take many years. Most public health scourges of the previous two centuries – typhoid, cholera, H1N1 flu, HIV/AIDS – took many years, considerable resources and a generational commitment of the entire medical and policymaker community.

There is, however, a model for this process, and it comes from America and its allies as they sought to denazify Germany and to pacify Japan after World War II. These efforts were comprehensive and driven by military dominance.

In Germany, the process included the Nuremberg trials, which did much to expose the world – and Germany – to the truths of the Nazi genocide program. But it wasn’t enough.

The process was not perfect. Many former Nazis avoided punishment; some innocent Germans were unfairly accused. The Allied forces confiscated all media – including school textbooks – that would contribute to Nazism or militarism. Art extolling Nazism was similarly banned and shunted aside. This was not a libertarian exercise.

But it succeeded. Germany had, at that point, emerged from roughly a century of bellicose militarism and deep antisemitism. It had started two world wars and an industrial-scale program of genocide. Few believed it could ever be anything but a source of human misery in the heart of Europe.

The Germany of today – peaceful, global and prosperous – would have seemed to be a mirage. In fact, General Eisenhower predicted the deNazification of Germany would take 50 years.

In Japan, too, the efforts were monumental. Japan had been a militant and bellicose society, with deep racial animus towards its neighbors and the West, for several centuries. Not only were its military and military industries disbanded, but outward signs of patriotism were banned in public life, including schools.

Massive other changes, including the introduction of a parliamentary democracy, the political rights of women and basic free speech rights, were enshrined in its new constitution. Again, as in Germany, textbooks were censored and control over schools was strictly regulated.

Indoctrination

Which brings us to Gaza in particular, and Palestinian nihilism in general. This work must begin first, and with Palestinian children both in Gaza and the West Bank. Hamas, like the Palestinian Authority, values its control over children, as does any culture of indoctrination because it needs a large ever-renewable pool of morally pliable recruits

This was particularly valuable to Stalin’s commissars, Mao’s revolutionaries, Nazi Germany, and the Khmer Rouge in Cambodia. Schools, youth clubs, summer camps and other institutions of child-rearing become instruments of hate. Textbooks signal what children are supposed to think. Other vectors of the genocide-pathology include children’s television, social media, and children’s songs and rhymes.

All of it is shaped and engineered to produce generations who see a specific enemy of the state as subhuman requiring eradication. Again, Stanton’s model applies: In Palestinian textbooks, provided by the Palestinian Authority in both the West Bank and Gaza, the citizens are already being prepared for genocide’s first four steps. The Palestinian textbooks are as bad as ever, according to EU authorities.

Incentivization

Then, our attention must turn to civil society. All systems of genocide incitement create a culture of compliance. Personal space, freedom and autonomy are eliminated. Through coercion, direction, intimidation, and harsh systems of reward and punishment, messages of hate became ordinary thoughts and actions that are criminal and immoral. This is Stanton’s fifth, sixth and seventh stages.

In the case of Gaza, the ideology of Hamas has been enabled by UNRWA (UN Relief and Work Agency) schools, summer camps and a wide variety of social programs, including some tied to health care institutions. UNRWA is staffed by Hamas’s sympathizers and enforcers who amplify hate. UNRWA schools adhere to Jihadist indoctrination, employ Hamas members as commissars to enforce ideological conformity, and create each year a large cadre of students willing to sacrifice themselves in order to kill more Jews. As with Nazi Germany, Hamas has many willing executioners – as we saw on October 7.

The reward-and-punishment system enforced in Gaza and the West Bank includes stipends given to terrorists or their surviving families for attacks – stipends paid for through international aid to Palestinian organizations including the Palestinian Authority.

All those organizations and nations that are willing or unwitting parties to such “pay for slay” programs – Qatar, the United Nations, Canada, the United States, and several European nations and organizations — must confront the epidemiological implications. They are actually hurting the people they aim to help.

Confronting the Foundations

As with the denazification of Germany after World War II, willing parties must take over Gaza’s legal, educational, political, religious, and cultural institutions or reestablish them under new direction and with new governance.

Schools in particular will require substantial reform, with new textbooks and curricula free from Palestinian Authority control or oversight, rigorous programs focused on dignity and respect for the other in line with Muslim teachings focused on charity, kindness and self-improvement (rather than a suicidal ideology of martyrdom on behalf of a political entity).

The process for de-hamasification must begin immediately. Convoys of food, water and other necessary supplies has the perverse effect of resupplying not just Hamas but sustaining its ideological grip over Gaza and causing still more harm to the public. All relief aid that goes into Gaza must be linked to programs to change mindsets. That will require new humanitarian organizations who pledge to end incitement as a part of their public health mission.

Any program of de-hamasification must be undertaken with special awareness of the character of the conservative and religious nature of Palestinian society – it would be foolish to expect a society that is deeply religious and traditional to embrace any of the conventions of a liberal Western secular nation like Germany or see it as a model.

In fact, the most difficult part of de-hamasification will be to decouple Islamic theology and Muslim cultural norms from Hamas and its leadership. But it is possible. For leadership and guidance to promote basic tolerance and moderation, within the texts and the traditions of Islam, we must consult with moderate Islamic theologians and philosophers.

One good example is Wasatia, the movement founded by Professor Mohammad Dajani. The Abraham Accords can serve as the political framework for promoting de-hamasification in Gaza and doing the same in the Palestinian Authority. And the US’s own work in de-Baathification of Iraq may prove instructive.

Some Islamic nations, notably Saudi Arabia, have long sponsored and run counter-indoctrination programs of their own to reverse the effects of exposure to the toxic messages of radical Islamist ideologies. These programs have a solid record of restoring individuals to society. But Saudi efforts are not consistent; the nation’s textbooks continue to promote intolerance and bigotry, especially towards Shia and Sufi Islamic traditions, as well as Christianity and Judaism.

Other models exist. The Carter Center in Atlanta has researched how to counter the indoctrination efforts of ISIS during its rise and years of control over schools in Syria, Iraq and elsewhere. ISIS, like Hamas, concentrated efforts on promoting its genocidal ideology in school curriculum. This curriculum has been studied by public health experts who correctly appreciate its doctrinal character. The effort to remove ISIS ideology in Arab and Muslim nations is ongoing, but clearly is working – and we must include those nations and organizations in the effort to dehamasify Gaza. Their expertise will be critical.

There will be inevitable efforts to revivify Hamas in fresh garb. This must be resisted at every step. It must be stopped not only because of the danger Hamasism represents to Israel, but what it means to Palestinians. Every genocidal regime has been ruined by its own militancy and forced to confront the sources of its pain. This may happen in Gaza one day; but it will only happen if Gaza’s Palestinians are allowed to break free from the industrial level of ideological contamination that Hamas and Iran’s mullahs have been emitting for decades.

Elihu Richter is a retired head of the Unit of Occupational and Environmental Medicine at the Hebrew University School of Public Health and is the founder of the Jerusalem Center for Genocide Prevention.