Aid As Domination: The Logic of Exclusionary Inclusion in Humanitarian Zionism

Aid As Domination: The Logic of Exclusionary Inclusion in Humanitarian Zionism

By Layth Malhis, Fatima Mohammadi, Tarek Meah

Volume 27, no. 3, Public Health

Artwork by Abdullah Al Muharraqi (Barjeel Art Foundation Collection)

The genocide in Gaza, now entering its 30th month, has made clear that the mechanisms meant to protect life through international law do not apply to Palestinian life. Palestinians—fragmented across nation-states and condemned to exclusion since the birth of the State of Israel—have, through their continued existence as a people in their ancestral homeland, exposed the flaw in the system governing the international rules-based order. This flaw, not exclusive to Palestinians, operates through the mechanism of exclusionary inclusion: the visible exclusion through international law of “selected individuals and populations deemed (as yet) unqualified to be part of the national community and territory but, at the same time, spatially incorporated and contained.”1

The logic of exclusionary inclusion is best demonstrated through the Nakba and its aftermath, in which at least 750,000 Palestinians (who accounted for three quarters of the population living between the river and the sea in 1948) were forcibly displaced.2 Following that forced dispossession, the United Nations Relief and Works Agency (UNRWA) was created to manage these new refugees, ensuring their inclusion into international legal frameworks but only as stateless recipients of aid, not as rights-bearing citizens of a nation-state.3 Palestinians were contained in refugee camps and territories—such as the West Bank and Gaza, as well as Syria, Lebanon, and Jordan—with near-impenetrable borders. With the prolonging of this containment came the proliferation of nongovernmental organizations that sought to administer aid but delivered no promise of sovereignty.

Today, this same logic manifests itself in global health responses to Gaza: humanitarian aid flows to sustain life at a minimum, managing Palestinians as permanent humanitarian cases while foreclosing self-determination.4 The legal frameworks governing aid and human rights serve to contain rather than resolve the underlying injustice, ensuring Palestinians remain in a perpetual state of exception—visible enough to warrant minimal protection yet excluded from a full exercise of rights. We explore how this operates through what we term humanitarian Zionism in Gaza: an expansion of the ideology held within Zionism which prioritizes Jewish nationalism and supremacy over the people, land, and resources of historic Palestine.

Humanitarian Zionism

Humanitarian Zionism obfuscates relief giving even as it reconfigures relations of power and subjectivity, preventing Palestinian sovereignty while recoding domination as care. Its logic is deliberate and embedded in the fabric of daily Palestinian life, echoing a longer political project in which intervention displaces and substitutes for self-determination. The colonial project has long recognized that so long as colonized populations are rendered subjects to be managed, measured, experimented upon, sustained, and confined at the threshold of survival, they are structurally incapacitated from organizing and confronting power as a unified front. In the contemporary moment, Zionism and its colonial formation provide a blueprint for genocidal nation-states seeking to foreclose sovereignty, as Palestinians are continually positioned within conditions of enforced dependence on the Israeli state and its military apparatus.5

Following the 1967 occupation of the remainder of historic Palestine, Israel was obligated under the Geneva Convention to facilitate the functioning of society and its social services.6 As a result, Palestinians labored within Israel’s newly occupied territories’ military administration as doctors, nurses, teachers, and municipal employees, sustaining the very people under colonial governance.7 What emerged was a configuration in which Palestinians were structurally incorporated into the administration of social life while remaining subordinated to Israeli authority; in other words, subjects within the system but never agents of power.

This same mechanism persists in the contemporary humanitarian order. International organizations—particularly those headquartered in London, Geneva, Washington, and New York—reproduce this arrangement wherein Palestinians sustain social and civil life yet remain excluded from meaningful decision-making authority.8 It is within this terrain that this article turns to Gaza, where humanitarian Zionism is most starkly expressed through the weaponization of aid delivery.

Gaza: Humanitarian Zionism As a Weapon

Under present conditions in Gaza, the logic of exclusionary inclusion assumes an increasingly grotesque form. Aid no longer merely fails to secure Palestinian sovereignty but actively constrains it, generating the minimal conditions necessary to dilute public and political pressure on Israel to halt its sustained campaign of mass violence against the Palestinian population. To apprehend this dynamic requires an examination of how actors—including the Coordination of Government Activities in the Territories (COGAT), international NGOs, the United States, and Israel itself—mobilize the language and infrastructure of humanitarian intervention to perform political work that exceeds the nominal objective of preserving life. Within this formulation, the military is positioned as the regulator of crisis rather than its producer. A closed circuit emerges in which the same apparatus that engineers deprivation installs itself as the indispensable intermediary through which relief must pass. Humanitarian access is structured through power, not apart from it.

COGAT operates as a mandatory gatekeeper, structuring humanitarian presence through coercive conditionality.9 This became evident when in January 2026, thirty-seven humanitarian organizations were compelled to submit the names of their Palestinian employees or face expulsion from the already besieged and materially devastated Gaza Strip.10 Among these organizations was Médecins Sans Frontières (MSF), which three years into an ongoing genocide operates approximately one-fifth of Gaza’s remaining hospital beds and assists in nearly one-third of all births.11 Organizations such as International Medical Corps, which maintain institutional linkages to Israeli entities, have secured continued access through compliance with these imposed conditions.12

The requirements extended to the submission of detailed personnel data, including passports and identification numbers for both foreign and Palestinian staff, despite evidence that Israeli forces have targeted and killed hundreds of humanitarian workers since October 2023.13 Furthermore, organizations were compelled to formally recognize the “Jewish and democratic character” of the Israeli state and were subjected to ongoing scrutiny for activities deemed to constitute “delegitimization,” including affiliations with boycott movements.14 What emerges is a regime of humanitarian access that renders the provision of care inseparable from the affirmation of the system producing the mass harm that necessitates that care.

This logic is currently articulated within humanitarian institutions themselves. As Dr. James Smith recounts from an internal MSF strategy meeting, planning documents for Gaza did not and perhaps could not entertain the possibility of a horizon in which MSF would no longer be needed. Instead, the discussion centered on expansion: scaling operations, increasing presence, and embedding itself further within Gaza’s medical landscape over the coming years.15 The absence of an exit is revealing. It signals acceptance that humanitarianism, in practice, is not oriented toward its own dissolution through the achievement of sovereignty but toward its own continuity.

The structural incapacity to imagine Palestinian independence as an endpoint is further reflected in accounts from Dr. Ghassan Abu Sittah, who has described offers made to the Palestinian Ministry of Health and other local institutions by Western humanitarian organizations, including the International Medical Corps, to purchase sections of hospitals and land in order to establish parallel, internationally run medical facilities.16 Rather than strengthening Palestinian public health infrastructure, these interventions would fragment and displace it. The hospital becomes a terrain of acquisition.

At the same time, these processes have not gone uncontested. Abu Sittah’s reflections on medical practice in Gaza foreground the clinic as a site of political resistance. Drawing on his experience during the forty-three days following October 7, Abu Sittah argues that the clinic acquires political significance precisely under conditions designed to eliminate it. As hospitals are systematically targeted, infrastructure dismantled, and humanitarian actors constrained, Palestinian medical practitioners continue to organize care in ways that resist full incorporation into this system.17 The clinic thus emerges as one of the few remaining spaces in which fragments of medical sovereignty are asserted and the struggle over life, control, and self-determination is actively waged.

Humanitarian Zionism at Its Most Extreme: The Gaza Humanitarian Foundation

The apotheosis of  humanitarian Zionism is the Gaza Humanitarian Foundation (GHF), a joint Israel–US initiative that sought to replace Gaza’s 400 distribution sites with four militarized, Israeli-controlled distribution points, compelling over two million people to concentrate within designated zones in order to access food and lifesaving supplies.18

The images and videos emerging from GHF sites demonstrate a spectacle of managed desperation. Gates are lifted at designated times, sometimes marked by the sound of a gunshot, while hundreds, if not thousands, of Palestinians are compelled to run toward sporadically positioned aid packages within enclosed, barbed-wire spaces.19 The scene is perfectly constructed to emulate a cattle slaughterhouse.

Within these sites, testimonies repeatedly indicate that contractors and armed personnel exercise the authority to shoot at will—on impulse, at perception, in the moment—transforming spaces of ostensible relief into sites of arbitrary violence.20 This is humanitarian Zionism in its most unvarnished form: under conditions of manufactured starvation, the Palestinian subject is reduced to a desperate figure whose access to sustenance is mediated through humiliation, coercion, and exposure to death. For many Palestinians, navigating these sites is experienced as degradation so profound that death itself is imagined as more merciful than the process required to access food.

The Sphere Association, which sets minimum humanitarian standards, explicitly determined that GHF “does not adhere to core humanitarian standards.” Yet the framework persists, with continued entanglements involving United Nations (UN) actors and institutions.21 Accusations have been leveled against UN agencies that, even in the face of overwhelming evidence, have entertained or moved toward collaboration with GHF.22

For agencies driven by an institutional imperative to deliver aid at any cost, the condition becomes clear: aid must be delivered through the very apparatus producing mass suffering. Humanitarianism does not stand outside violence but is folded into it. To provide aid becomes to operate within the auspices of a settler-colonial regime in which feeding the starving is inseparable from the system that engineered their starvation.

The humanitarian apparatus can thus claim compliance with international law—aid flows, food is distributed—while structuring distribution itself as an instrument of elimination. The GHF performs humanitarian legibility for international audiences. Israel claims facilitation. The United States claims funding. The structure, however, ensures that the provision of aid functions as a mechanism of population control while foreclosing sovereignty: the Palestinians are recognized as a people (inclusion), but one without a state (exclusion).

Organizing Implications

The global health community’s silence on the Gaza genocide has been devastating yet structurally determined, for this is the world that produced the subaltern. Medical journals publish on “conflict health” without naming genocide.23 International health institutions perform neutrality while hospitals are destroyed, rendering them nonfunctional, and Palestinian colleagues are murdered, disappeared, detained, coerced into abdicating their liberatory practice, or raped to death in Israeli dungeons.24 Bioethics frameworks analyze “resource allocation” under siege without interrogating the siege itself.25 Even the World Health Organization (WHO) includes Israel in its Europe region while excluding Palestine, literalizing yet another manifestation of the exclusionary inclusion structuring Palestinian life. As Danya Qato and Bram Wispelwey and colleagues insist, public health cannot be disentangled from the structures of settler colonialism that precede and organize all determinants of health.26

The denial of Palestinian agency extends into what can be understood as a crisis of statistical sovereignty. During the genocide, but really since Palestinian medical committees were formulated in the 1970s, Palestinian death counts—produced by the Gaza Ministry of Health—were systematically discredited, dismissed as partisan, or reduced to suspicion through their through their association with whatever group that is public enemy number one at the time (today it is Hamas), while the data produced by international organizations was, and continues to be, elevated as neutral, credible, and authoritative.27 What is at stake is the control over who is permitted to count the dead, to narrate loss, to mobilize next steps, and to define Palestinian reality itself. As Qato reminds us, data is never neutral but structured by power, ownership, and purpose. In denying Palestinians authority over their own dead, global health institutions participate in a broader epistemic violence that renders Palestinian death both visible and dismissible.28

As Mary Turfah demonstrates, the humanitarian medic is often positioned as the “neutral observer” precisely because Palestinian voices have been systematically eliminated. Journalists are killed, institutions destroyed, narratives discredited. This produces a racialized hierarchy of credibility in which foreign, often Western, medical professionals are authorized to speak, while Palestinians themselves are denied narrative authority over their own suffering.29

This mediation and dismissal of the Palestinian at the bedside is constitutive of contemporary medical ethics. Palestinian deaths are analyzed, quantified, and endlessly debated, yet never grieved within the same moral register. This arrangement produces a form of medical complicity that, in its everyday operations, shapes institutional power, professional conduct, and the trajectory of global health itself. The exclusion of Palestinians from ethical subjecthood structures the conditions under which medicine operates as an extension of governance. Medical research partnerships normalize occupation as background, treating apartheid as context rather than disqualification. Academic conferences hosted within Israeli institutions function as sites of normalization, positioning these institutions as legitimate producers of knowledge while Palestinian universities are bombed, scholars killed, and students immobilized. At the same time, capital derived from weapons manufacturing and surveillance technologies flows into medical and research infrastructures, embedding the machinery of violence within systems that claim to alleviate its effects.

What emerges aligns with a broader transformation identified by Ghassan Abu Sittah: a historical moment in which global capital dispenses with the language of liberal accommodation and operates through layered forms of violence—military, political, epistemic, and linguistic.30 Within public health, this shift materializes through the management of populations rendered disposable, where differential life expectancy, exposure to disease, and access to care become instruments for regulating surplus life. In this configuration, medicine ceases to function as a neutral or benevolent domain; it becomes a site through which hierarchies of humanity are reproduced and enforced.

Scientists, health workers, academics, and researchers therefore confront a structural choice that exceeds individual ethics: remain embedded within systems that sustain mass death, or participate in the construction of alternative infrastructures of care and knowledge. The movement to boycott, divest from, and sanction Israeli institutions must be understood beyond the register of refusal. It functions as a radical call for institutional reconstitution.31 It demands the development of alternative forms of governance within public health that are detached from the imperatives of global capital and settler-colonial control. This entails rethinking medicine itself: from a field organized around management, extraction, and technical intervention, toward one grounded in collective survival, political accountability, and health sovereignty. Within such a framework, care is inseparable from liberation, and the organization of health systems becomes a question of power rather than delivery.

The inclusion of Palestinians as objects of humanitarian concern while denying them political subjecthood, ethical standing, and narrative authority constitutes the operating logic of humanitarian Zionism. Health under occupation cannot be addressed through improved coordination or more refined frameworks of neutrality, as neutrality serves to protect Israel’s standing on the international stage. It remains imperative that the destitute and the wretched attain sovereignty as a condition of liberation.32 What is required is a transformation at the level of structure: the dismantling of systems that produce illness, premature death, and dependency as modalities of rule, and the creation of public health institutions grounded in sovereignty, dignity, and collective life—in other words, the dismantling of the Zionist settler state in Palestine.

—

Layth Malhis is a graduate student at Georgetown University’s Center for Contemporary Arab Studies, where he studies settler colonialism and Palestinian health. His research develops the concept of dehealthification to describe the systematic dismantling and weaponization of healthcare systems in Palestine as a colonial strategy. His work has appeared in The New Arab, Al-Shabaka, and the Institute for Palestine Studies. He will begin his PhD in History at the University of Toronto in the fall. @laythco_

Fatima Mohammadi (J.D.) is the co-founder of and researcher with the Limb and Life Research Collective, focusing on prosthetics and orthotics within Gaza’s rehabilitation care systems. With a background in law, humanitarian delivery, and community education, she brings an interdisciplinary approach to examining healthcare access and disability rights in occupied and besieged territories. She also leads grassroots efforts centered on liberatory education at the local and national level. @alhadafkc @resistanttotheSQ

Tarek Meah (MSc) is a PhD student in the Science, Technology & Society program at MIT. His current focus is on re/habilitation in settings afflicted by violence. He is also a writer/researcher for Limb & Life – a collective of academics, activists, and clinicians dedicated to rebuilding Gaza’s rehabilitation sector. He received his MSc in Built Environment from the Bartlett, University College London and his BA in Public Health Studies from the Johns Hopkins University. @tkxmh

Notes

  1. Richard Carter-White and Claudio Minca, A Spatial Theory of the Camp: Geopolitics, Biopolitics and the Immunitarian State (Cheltenham: Edward Elgar Publishing, 2025), 15.
  2. Nur-eldeen Masalha, Expulsion of the Palestinians: The Concept of “Transfer” in Zionist Political Thought, 1882–1948 (Washington, DC: Institute for Palestine Studies, 1992).
  3. See Randa Farah, “UNRWA: Through the Eyes of Its Refugee Employees in Jordan,” Refugee Survey Quarterly 28, no. 2–3 (2009): 389–411.
  4. Yipeng Ge and Layth Malhis, “How Humanitarianism in Gaza Entrenches Palestinian Oppression,” Unfiltered, December 16, 2025.
  5. Layth Malhis, “De-Healthification: Israel’s Engineered Collapse of Palestinian Life,” Al-Shabaka: The Palestinian Policy Network, January 11, 2026, https://al-shabaka.org/briefs/de-healthification-israels-engineered-collapse-of-palestinian-life/.
  6. The law of occupation imposes on the occupying power a duty to ensure the minimum conditions necessary for the functioning of civil life, including the maintenance of public order and civil life (Hague Regulations of 1907, Art. 43); the provision of food and medical supplies (Fourth Geneva Convention, Art. 55; Additional Protocol I, Art. 69); the maintenance of medical and hospital services and public health (Fourth Geneva Convention, Art. 56; Additional Protocol I, Art. 69); the facilitation of relief schemes where the population is inadequately supplied (Fourth Geneva Convention, Arts. 59–63; Additional Protocol I, Art. 70); and the continued operation of essential social institutions, including those devoted to the care and education of children, alongside the preservation of the existing legal and institutional order (Fourth Geneva Convention, Arts. 50, 64).
  7. Union of Palestinian Medical Relief Committees, An Overview of Health Conditions and Services in the Israeli Occupied Territories (Jerusalem: Union of Palestinian Medical Relief Committees, August 1987).
  8. Mohammad Salaymeh, “Permission to Narrate a Humanitarian Crisis,” Public Health Is Political, October 12, 2025, https://publichealthispolitical.com/permission-to-narrate-a-humanitarian-crisis/.
  9. Refugees International, “Siege and Starvation: How Israel Obstructs Aid to Gaza,” March 7, 2024, https://www.refugeesinternational.org/reports-briefs/siege-and-starvation-how-israel-obstructs-aid-to-gaza/.
  10. See Muaddi, Qassam, and Tareq S. Hajjaj. “Israeli Ban on 37 Aid Organizations Expected to Have Devastating Impacts Across Palestine.” Mondoweiss, January 13, 2026, https://mondoweiss.net/2026/01/israeli-ban-on-37-aid-organizations-expected-to-have-devastating-impacts-across-palestine/, and Eve Ottenberg, “By Suspending 37 Aid Orgs Is Israel Pushing Toward a Final Expulsion?” Responsible Statecraft, January 9, 2026, https://responsiblestatecraft.org/aid-organizations-gaza/.
  11. “Israel Bans Doctors Without Borders, Dozens of Other NGOs in Gaza,” NPR, December 30, 2025, https://www.npr.org/2025/12/30/g-s1-103986/israel-gaza-aid-ngos.
  12. “IDF Clears 24 Aid Groups for Gaza, Bans Some NGOs,” The Jerusalem Post, accessed March 10, 2026, https://www.jpost.com/israel-news/defense-news/article-882010.
  13. United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), “UNRWA Situation Report #215 on the Humanitarian Crisis in the Gaza Strip and the Occupied West Bank, including East Jerusalem,” March 31, 2026, https://www.unrwa.org/resources/reports/unrwa-situation-report-215-humanitarian-crisis-gaza-strip-and-occupied-west-bank.
  14. Jeremy Sharon and AFP, “Israel Bars 37 Nonprofits from Gaza and West Bank for Not Abiding by New Guidelines,” The Times of Israel, December 30, 2025, https://www.timesofisrael.com/israel-bars-37-nonprofits-from-gaza-west-bank-for-not-abiding-by-new-guidelines/.
  15. James Smith, interview by Layth Hanbali and Layth Malhis, “Gaza and the Crisis of Humanitarianism: An Interview with Dr. James Smith,” Palestine Blog, March 30, 2026, https://www.palestine-studies.org/en/node/1658847.
  16. Mary Turfah, “Health Sovereignty in Palestine: A Conversation Between Mary Turfah and Dr. Ghassan Abu Sittah,” Protean Magazine, April 2, 2026, https://proteanmag.com/2026/04/02/health-sovereignty-in-palestine-a-conversation-between-mary-turfah-and-dr-ghassan-abu-sittah/.
  17. Ghassan Abu Sittah, interview by Psychic Militancy, “Ghassan Abu Sittah: Clinic As Site of Resistance,” YouTube video, January 5, 2026, https://www.youtube.com/watch?v=zb8rB2efVWE, and Mary Turfah, “The Doctor’s Role in Liberation: An Interview with Dr. Ghassan Abu-Sittah,” Mondoweiss, March 5, 2024, https://mondoweiss.net/2024/03/the-doctors-role-in-liberation-an-interview-with-dr-ghassan-abu-sittah/.
  18. See Forensic Architecture, “Aid in Gaza,” Forensic Architecture, accessed April 7, 2026, https://forensic-architecture.org/investigation/aid-in-gaza.
  19. “Starving Palestinians Pepper-Sprayed at GHF Aid Site in Gaza, Video Shows,” Al Jazeera, July 20, 2025, https://www.aljazeera.com/news/2025/7/20/starving-palestinians-pepper-sprayed-at-ghf-aid-site-in-gaza-video-shows.
  20. “Security Contractor Says He Witnessed ‘Barbaric’ and Un-American Tactics at Gaza Aid Sites,” PBS NewsHour, August 1, 2025, https://www.pbs.org/newshour/show/u-s-whistleblower-describes-chaos-and-reckless-force-at-gaza-aid-site.
  21. Amnesty International, “Gaza: Starvation or Gunfire – This Is Not a Humanitarian Response,” July 1, 2025, https://www.amnesty.org/en/latest/news/2025/07/gaza-starvation-or-gunfire-this-is-not-a humanitarian-response/.
  22. Barak Ravid, “Scoop: U.S. Brokers Meeting Between UN and Gaza Humanitarian Foundation,” Axios, August 7, 2025, https://www.axios.com/2025/08/07/un-ghf-gaza-aid-meeting-starvation.
  23. Osama Tanous et al., “Framing Gaza: Medical Journals and the Destruction of Healthcare,” Communication, Culture and Critique 19, no. 1 (2026): 36–48, https://doi.org/10.1093/ccc/tcag013.
  24. Simon Speakman Cordall, “Dying in ‘Hell’: The Fate of Palestinian Medics Jailed by Israel,” Al Jazeera, November 24, 2024, https://www.aljazeera.com/news/2024/11/24/dying-in-hell-palestinian-medics-jailed-by-israel.
  25. Samer Abuzerr, Kate Zinszer, and Hussam Mahmoud, “Healthcare Collapse and Disease Spread: A Qualitative Study of Challenges in Gaza Strip,” BMC Public Health 25 (2025): 589, https://doi.org/10.1186/s12889-025-21817-1.
  26. Danya Qato, “Public Health and the War on Gaza,” Journal of Palestine Studies 49, no. 4 (Summer 2020): 7–27; Bram Wispelwey et al., “Because Its Power Remains Naturalized: Introducing the Settler Colonial Determinants of Health,” Frontiers in Public Health 11 (2023), https://doi.org/10.3389/fpubh.2023.1137428.
  27. No clearer expression of this logic exists than Biden’s early dismissal of Palestinian death tolls, a move that compelled sectors of the pro-Palestine movement to rely on international NGOs as alternative arbiters of truth; yet this recourse, however well-intentioned, ultimately reinscribes the very denial it seeks to contest by displacing Palestinian authority over their own data. Reuters, “Biden Says He Has ‘No Confidence’ in Palestinian Death Count,” October 25, 2023, https://www.reuters.com/world/middle-east/biden-says-he-has-no-confidence-palestinian-death-count-2023-10-26/.
  28. Qato, “Public Health and the War on Gaza,” 15.
  29. Mary Turfah, “Doctors Without Politics,” The Baffler, no. 77 (January 2025), https://thebaffler.com/salvos/doctors-without-politics-turfah.
  30. Ghassan Abu Sittah, “Ghassan Abu Sittah: Clinic As Site of Resistance,” interview by Psychic Militancy.YouTube video, January 5, 2026, https://www.youtube.com/watch?v=zb8rB2efVWE.
  31. Palestinian Campaign for the Academic and Cultural Boycott of Israel, “Call for Academic and Cultural Boycott of Israel,” accessed March 10, 2026, https://bdsmovement.net/pacbi.
  32. Frantz Fanon, Toward the African Revolution (New York: Grove Press, 1967), 76.