The Hamas massacre of Oct 7, 2023, and its aftermath, medical crimes, and the Lancet commission report on medicine, Nazism, and the Holocaust

BACKGROUND

The report of the Lancet Commission on medicine, Nazism, and the Holocaust, released in November 2023, calls for this history to be required for all health professions education, to foster morally courageous health professionals who speak up when necessary.

MAIN BODY

The report was released a month after Hamas' October 7 invasion of Israel, with the accompanying massacre of over 1200 people, taking of civilian hostages, and gender-based violence. These acts constitute crimes against humanity including genocide. Post-October 7, war in Gaza resulted, with a legitimate objective of Israel defending itself within international law. The authors discuss an accompanying Statement to the report condemning Hamas crimes and denouncing the perpetrators' use of their own civilians as human shields, including in healthcare facilities, and with the Hamas attack unleashing immense and ongoing suffering in Israel and beyond. With some exceptions, the medical literature shows a marked absence of condemnation of Hamas atrocities and includes unsubstantiated criticisms of Israel's military. A significant surge in global antisemitism including on university campuses since October 7, 2023, has occurred; and health professionals, according to the Commission, have a special responsibility to fight antisemitism and discrimination of all kinds. In this context, the authors discuss the controversy and criticism regarding diversity, equity, and inclusion education programs ("DEI") including such programs failing to protect Jews on campuses, especially as the U.S. President Biden's "The U.S. National Strategy to Counter Antisemitism," released in May 2023, calls for the inclusion of issues of antisemitism and religious discrimination within all DEI education programs. The authors support an evidence-based approach to the Hamas massacre, its aftermath and its relevance to health professionals both within medicine and their global citizenship, including refuting the international community accusations and anti-Israel libel.

CONCLUSIONS

The report of the Lancet Commission on medicine, Nazism, and the Holocaust has striking relevance to the Hamas massacre of October 7, 2023 and its aftermath. This is further conveyed in an accompanying Statement, that describes the report's implications for contemporary medicine, including: 1) provision of skills required to detect and prevent crimes against humanity and genocide; (2) care for victims of atrocities; (3) upholding the healing ethos central to the practice of medicine; and (4) fostering history-informed morally courageous health professionals who speak up when necessary.

Assessment of a digital intervention program with Holocaust survivors

OBJECTIVE

This study evaluated a digital intervention program with aging Holocaust survivors. Participants received a tablet device and were coupled with a volunteer who assisted them to use the tablet. The study aimed to assess which characteristics of the Holocaust survivors are linked with more frequent use of digital communication at the end of the program.

METHODS

Information was collected by telephone interviews with 91 survivors before and 54 after participating in the program. We combined this data with digital usage data from the tablets. Regression models examined the characteristics of Holocaust survivors that were related to higher frequency of using digital communication technologies during the intervention.

RESULTS

The Holocaust survivors expressed high satisfaction with the program. They increased their frequency of using digital communication technologies-text correspondence and video chats with friends and family. Regressions showed that Holocaust survivors who reported increased digital communication were characterized at the start of the intervention by having fewer post-traumatic stress symptoms, higher levels of flourishing (reflecting a more meaningful life and higher well-being), being lonelier, and were also more satisfied with the program at follow-up.

CONCLUSION

The pilot program benefited the aging Holocaust survivors. Further programs should be developed to increase the digital communication of vulnerable older populations, such as trauma survivors.

A biography of Dr Carl Bodon: Pioneer of intracardiac injection of adrenaline

This biographical essay will provide historical insights about Dr Carl Bodon who performed one of the first successful intracardiac injections of adrenaline to a patient and made important contributions to the understanding of cardiac diseases and women's health. Dr Bodon's biography reveals the story of a medical doctor who lived during tumultuous times between two world wars and ultimately died in the Holocaust. His story sheds light on forgotten contributors to the medical field and its practices.

[HE GAVE EVERYTHING HE HAD: DR. SHLOMO GURFINKEL - A LAST DESCENDANT]

INTRODUCTION

Holocaust survivors gave a significant contribution to Israel's fighting forces and to the victory in the War of Independence. Many of them lost their lives in the battlefields. Many doctors who were survivors took an active part in the war, and afterwards in the building of the base of public medicine in the country. The "Last Descendants" were those Holocaust survivors who remained the last remnant of their nuclear family (parents, brothers, sisters, sons and daughters), who immigrated to Israel, joined the army and fell in battle, thus ending forever their family legacy. One of them was Dr. Shlomo Gurfinkel. During World War II he was a member of the Jewish underground and served as a doctor in Vilna's ghetto and in the ranks of the partisans. In the War of Independence, he was a doctor in a "Haganah" battalion and lost his life in the battles in Jerusalem. By telling his personal story, we intend to throw light on the heroic actions of those Holocaust survivors, amongst them medical personnel, who came to Israel and joined the fighting forces, including those who were "last descendants".

The Sun Also Rises: Tracing the evolution of humanistic values in anatomy pedagogy and research, including cadaveric acquisition practices

Anatomy has always been at the intersection of the socio-cultural and political landscape, where new ideas constantly replace older wisdom. From ancient Egyptians through the Greeks, and then the Romans, finally culminating into the European Renaissance-all the significant eras of human civilisation have left their insignia and distinct marks on the evolution of anatomical practices. Despite its utility as a tool for anatomy pedagogy and research that has proven its worth over millennia, cadaveric dissection has particularly been subject to political and social vicissitudes. A major debate about anatomical dissection lay with the ethical considerations, or its lack thereof, while acquiring corpses for demonstration in the dissection halls. From antiquity, anatomical dissection-often synonymous with medical studies-had typically been carried out on the dead bodies of executed criminals with certain laws, such as the Murder Act of 1752, facilitating such uses. Gradually, the uses of unclaimed bodies, resourced primarily from the impoverished sections of society, were also introduced. However, these body acquisition protocols often missed the crucial element of humanism and ethical considerations, while knowledge augmentation was taken as sufficient reasoning. Unfortunately, a gross disregard towards humanistic values promulgated heinous and illegal practices in acquiring corpses, including grave robbery and even murders like in the case of Burke and Hare murders of 1828. Follow-up legislation, such as the Anatomy Act of 1832, and comparable laws in other European nations were passed to curb the vile. What distils from such a historical discourse on humane values in anatomy dissection, or medical science in general, is that the growth and integration of humanism in anatomy have never been linear, but there were intermittent and, yet, significant disruptions in its timeline. For example, there were serious human rights violations in anatomical practices during the Third Reich in Germany that perpetrated the holocaust. The medical community has kept evolving and introducing new moral values and principles while using such egregious events as lessons, ultimately resulting in the Declaration of Helsinki in 1964. This article revisits the heterogeneous journey of integrating humanistic values in anatomy practice. Such humanistic traits that, like medical science, have also developed over centuries through the inputs of physicians, researchers, and philosophers-from Greece to modernity with an important stopgap at the Renaissance-are a fascinating lore that deserves to be re-envisioned through the lens of contemporary values and ethos. In parallel to human medicine, humanistic values continue to influence veterinary medicine, a welcome development, as our society condemns animal cruelty in any form. There are lessons to be learned from this historical journey of how humanism shaped many of the concepts that anatomists use now. Finally, and most importantly, it might prevent the medical community from repeating the same mistakes by cautioning against the traps that are there, and in a convoluted world where morality as such is eroding from our social fabric, will always be there. Such historical account acts as a righteous, ethical, and contextual compass to guide the existing and upcoming anatomists in discerning between light and dark, right and wrong, and roads-to be or not to be-taken.

Irma Weinberg's 1928 paper "on the problem of the determination of heredity prognosis: The risk in the cousins of schizophrenics"

Irma Weinberg, a German-Jewish Neuropsychiatrist/Physician, authored the fourth report from the German Research Institute for Psychiatry in Munich examining the risk for dementia praecox (DP) in particular relatives of DP probands, here first-cousins. She examined 977 cousins of 54 DP probands and found a best-estimate risk of 1.4%. She conducted within-study analyses, showing a much higher risk for DP in the siblings than cousins of DP probands. She studied DP-related personalities showing a familial link between these conditions and risk for DP. She demonstrated that the risk for DP in cousins was impacted substantially by the distribution, in ancestors, of psychosis and personality abnormalities. After completing work on this article, Weinberg worked in private practice in Frankfurt, emigrating to the Netherlands in 1934, where she worked at a Jewish psychiatric hospital. In 1943, German occupiers evacuated the hospital, transporting the patients and staff, either directly to Auschwitz or, like Weinberg, to the Westerbork transit camp. On September 4, 1944, Dr. Weinberg was transported to Theresienstadt and soon thereafter to Auschwitz, where she was murdered at the age of 53. Her history raises painful questions about the relationship between genetic studies of psychiatric illness in prewar Germany and the Holocaust.

Lifelong effects of prenatal and early postnatal stress on the hippocampus, amygdala, and psychological states of Holocaust survivors

This study focuses on hippocampal and amygdala volume, seed-based connectivity, and psychological traits of Holocaust survivors who experienced stress during prenatal and early postnatal development. We investigated people who lived in Central Europe during the Holocaust and who, as Jews, were in imminent danger. The group who experienced stress during their prenatal development and early postnatal (PreP) period (n = 11) were compared with a group who experienced Holocaust-related stress later in their lives: in late childhood, adolescence, and early adulthood (ChA) (n = 21). The results of volumetry analysis showed significantly lower volumes of both hippocampi and the right amygdala in the PreP group. Seed-based connectivity analysis revealed increased connectivity from the seed in the right amygdala to the middle and posterior cingulate cortex, caudate, and inferior left frontal operculum in the PreP group. Psychological testing found higher levels of traumatic stress symptoms (TCS-40) and lower levels of well-being (SOS-10) in the PreP group than in the ChA group. The results of our study demonstrate that extreme stress experienced during prenatal and early postnatal life has a profound lifelong impact on the hippocampus and amygdala and on several psychological characteristics.

Preexisting social ties among Auschwitz prisoners support Holocaust survival

Survivor testimonies link survival in deadly POW camps, Gulags, and Nazi concentration camps to the formation of close friendships with other prisoners. To provide evidence free of survival bias on the importance of social ties for surviving the Holocaust, we study individual histories of 30 thousand Jewish prisoners who entered the Auschwitz-Birkenau concentration camp on transports from the Theresienstadt ghetto. We ask whether the availability of potential friends among fellow prisoners on a transport influenced the chances of surviving the Holocaust. Relying on multiple proxies of preexisting social networks and varying social-linkage composition of transports, we uncover a significant survival advantage to entering Auschwitz with a larger group of potential friends.

The Limits of Professional Identity: A Lesson From My Grandfather

My grandfather was a prominent Jewish physician in Nazi Germany who escaped the Holocaust with his family but nevertheless came to a tragic end. As I, an American family physician, learned more about him, I was surprised by how much I identified with him. I was struck by how his success in his career had not been matched in other areas of his life, leaving him little to fall back on when his professional status was taken away. My grandfather's story has given me insights about him, my family, and myself and has taught me important lessons about the balance between professional and personal life.

Eponyms that honor Jewish dermatologists: A celebration and a remembrance, Part one: Jewish physicians who practiced before 1933

This multipart feature celebrates the Jewish contribution to dermatology over the past 200 years, as reflected by medical eponyms that honor the names of Jewish physicians. Many of these physicians practiced in Germany and Austria after the emancipation of Jews in Europe. Part one discusses 17 physicians who practiced medicine before the Nazi takeover of Germany during 1933. Examples of such eponyms from this period include the Auspitz phenomenon, Henoch-Schonlein purpura, Kaposi's sarcoma, Koebner phenomenon, Koplik spots, Lassar paste, ital Neisseria gonorrhoeae, and Unna boot. One of these physicians, Paul Ehrlich (1854-1915), became the first Jew to be awarded the Noble Prize in Medicine or Physiology, an honor he received in 1908 and shared with his fellow Jew, Ilya Ilyich Mechnikov (1845-1916). Parts two and three of this project will present the names of 30 more Jewish physicians honored by medical eponyms and who practiced medicine during the Holocaust era and its aftermath, including those physicians who perished at the hands of the Nazis.

From the Library of the Late Irving I. Gottesman: Memories and Treasures/Twin Research Reviews: Twin Study of Callous-Unemotional Traits; Depressive Symptoms in Prospective Chinese Twin Mothers; Twins With Sagittal Suture Craniosynostosis; Creative Expressiveness and Educational Achievement/Media Reports: Male-Female Twin Holocaust Survivors; Nontuplets Born in Mali; Indian Twins Marry Same Man; Twins Born From Longest-Frozen Embryos; Infant Twin Abduction; Twins Born in Different Years

The experience of going through the personal library of our late esteemed twin research colleague, Dr Irving I. Gottesman, is described. I came away with fond memories and unexpected treasures. This essay is followed by brief reviews of timely research on factors affecting callous-unemotional traits, depressive symptoms in prospective Chinese twin mothers, twins with sagittal suture craniosynostosis, and creative expressiveness and educational achievement. Media reports on informative topics of interest to researchers and the general public include male-female twin Holocaust survivors, nontuplets born in Mali, Indian twins who married the same man, twins born from the longest frozen embryos, an infant twin abduction and twins born in different years.

Dehumanization and mass violence: A study of mental state language in Nazi propaganda (1927–1945)

Dehumanization is frequently cited as a precursor to mass violence, but quantitative support for this notion is scarce. The present work provides such support by examining the dehumanization of Jews in Nazi propaganda. Our linguistic analysis suggests that Jews were progressively denied the capacity for fundamentally human mental experiences leading up to the Holocaust. Given that the recognition of another’s mental experience promotes moral concern, these results are consistent with the theory that dehumanization facilitates violence by disengaging moral concern. However, after the onset of the Holocaust, our results suggest that Jews were attributed a greater capacity for agentic mental states. We speculate this may reflect a process of demonization in which Nazi propagandists portrayed the Jews as highly capable of planning and intentionality while nonetheless possessing a subhuman moral character. These suggestive results paint a nuanced portrait of the temporal dynamics of dehumanization during the Holocaust and provide impetus for further empirical scrutiny of dehumanization in ecologically valid contexts.

Max Wolf: A New York city physician rescued from the Holocaust by Albert Goring

Dr. Max Wolf and his wife Margareta were native Austrians. Dr. Wolf was educated in Austria and enjoyed a successful practice of his speciality in Vienna. One of his patients was Albert Goring, the brother of the infamous Nazi, Hermann Goring. This relationship would have a notable effect in Dr. Wolf and his wife escaping the eventual Holocaust after the "Anschluss". Leaving Vienna Dr. Wolf and his wife eventually arrived in New York and began a new life becoming a prominent physician in America.

Starvation Genocide: Myocardial Infarction in the Lodz Ghetto

Medical records discovered after the liberation of ghettos in Nazi-occupied Europe are unique documents that report on the suffering of inmates, on ravaging infectious diseases, and on starvation-related organ degeneration and the resulting mortality. We offer a pathogenetic explanation for the scarcity of acute myocardial infarction in the Lodz Ghetto, Poland, 1941-1944.

Medicine during the Nazi period and the Holocaust: what are the implications? An interview with Volker Roelcke

In this interview, Volker Roelcke explains and analyzes historical evidence refuting erroneous assumptions about medical atrocities committed by physicians during the Nazi era, provides insight into the implications of medicine during the Nazi period and the Holocaust for medicine and bioethics today, analyzes the history of the term "genocide," and suggests formats for future teaching, among other topics.

[Long-term medical complications of Holocaust trauma]

Holocaust survivors are currently confronted with the problems inherent to ageing such as illness, frailty, dependency and isolation. A study was carried out to assess the long-term medical consequences of the Holocaust trauma.

Transgenerational Transmission of Trauma across Three Generations of Alevi Kurds

Background: Thus far, most researchers on genocide and transgenerational transmissions have focused on the National Socialist Holocaust as the most abhorrent example of this severe human rights violation. Few data have been published on other ethnic or religious groups affected by genocidal actions in this context. Methodology: Using a mixed-method approach integrating qualitative interviews with standardized instruments (SCID and PDS), this study examines how individual and collective trauma have been handed down across three generations in an Alevi Kurd community whose members (have) suffered genocidal perpetrations over a longer time period (a “genocidal environment”). Qualitative, open-ended interviews with members of three generations answering questions yielded information on (a) how their lives are shaped by the genocidal experiences from the previous generation and related victim experiences, (b) how the genocidal events were communicated in family narratives, and (c) coping strategies used. The first generation is the generation which directly suffered the genocidal actions. The second generation consists of children of those parents who survived the genocidal actions. Together with their family (children, partner, relatives), this generation suffered forced displacement. Members of the third generation were born in the diaspora where they also grew up. Results: Participants reported traumatic memories, presented in examples in this publication. The most severe traumatic memories included the Dersim massacre in 1937–1938 in Turkey, with 70,000–80,000 victims killed, and the enforced resettlement in western Turkey. A content analysis revealed that the transgenerational transmission of trauma continued across three generations. SCID and PDS data indicated high rates of distress in all generations. Conclusions: Genocidal environments such as that of the Kurdish Alevis lead to transgenerational transmission mediated by complex factors.

Assessing the Impact of Holocaust Education on Adolescents' Civic Values: Experimental Evidence from Arkansas

BACKGROUND

American adults overwhelmingly agree that the Holocaust should be taught in schools, yet few studies investigate the potential benefits of Holocaust education.

OBJECTIVES

We evaluate the impact of a Holocaust education conference on knowledge of the Holocaust and several civic outcomes, including "upstander" efficacy (willingness to intervene on behalf of others), likelihood of exercising civil disobedience, empathy for the suffering of others, and tolerance of others with different values and lifestyles.

RESEARCH DESIGN

We recruit two cohorts of students from three local high schools and randomize access to the Arkansas Holocaust Education Conference, where students have the chance to hear from a Holocaust survivor and to participate in breakout sessions led by Holocaust experts.

RESULTS

We find evidence that the conference increased participants' upstander efficacy, but fail to reject the null hypothesis that the conference would increase participants' knowledge or other civic attitudes.

Starvation Genocide in Occupied Eastern Europe 1939-1945: Food Confiscation by and for the Nazis

The genocide effected by the Nazi regime during World War II, intended for the local population in Eastern Europe, took the form of allocation of daily food rations: 100% for the Germans; 70% for the Poles; 30% for Greeks; 20% for Jews. Hermann Göring, the Reichsmarschall of the Nazi Empire created a blueprint for full alimentation of the occupying German forces through theft of land and food of the Soviet Union thus forcing its "racially inferior" population to starve, adopted on 29 April 1941. In the weeks leading to the German invasion of the Soviet Union in June 1941, the Reich Minister for Food, Richard Darré, and his State Secretary, Herbert Backe, developed the "Hunger Plan", which led to death by starvation of at least seven million Soviet civilians, Jews and gentiles. This article reviews responsibility for the formulation and implementation of this form of genocide.

Unnatural Resources: The Colonial Logic of the Holmesburg Prison Experiments

This article focuses on medical trials performed by Dr. Albert Kligman on the inmates of Philadelphia's Holmesburg Prison between 1951 and 1974, which have been widely criticized as exploitative. I seek to investigate the mechanics behind the "ethical blind spot" that enabled the American medical community to laud Kligman for his efforts while simultaneously condemning the medical atrocities of the Holocaust and supporting the development of the Nuremberg Code. I argue that this nonrecognition hinges on a colonial logic by which certain populations are produced as waste, both rhetorically and materially. Drawing on the incarcerated men's accounts included in Allen Hornblum's books on the subject, I trace the process by which human beings come to be reclassified as natural resources and their exploitation recast as industrious cultivation.

From scientific exploitation to individual memorialization: Evolving attitudes towards research on Nazi victims' bodies

During the Third Reich, state-sponsored violence was linked to scientific research on many levels. Prisoners were used as involuntary subjects for medical experiments, and body parts from victims were used in anatomy and neuropathology on a massive scale. In many cases, such specimens remained in scientific collections and were used until long after the war. International bioethics, for a long time, had little to say on the issue. Since the late 1980s, with a renewed interest in the Holocaust and other Nazi crimes, a consensus has increasingly taken hold that research on human tissues and body parts from the Nazi era is inadmissible, and that such specimens should be removed from scientific collections and buried. The question of what to do with scientific data obtained from these sources has not received adequate attention, however, and remains unsolved. This paper traces the history of debates about the ethical implications of using human tissue or body parts from the Nazi period for scientific purposes, primarily in the fields of anatomy and neuropathology. It also examines how this issue, from after the war until today, influenced the establishment of legal and bioethical norms on the use of human remains from morally tainted sources, with a particular emphasis on Germany and Austria. It is argued that the use of such specimens and of data derived from them is unethical not only because of potential harms to posthumous rights of the victims, but also because such use constitutes a moral harm to society at large.

From bioethics to biopolitics: "Playing the Nazi card" in public health ethics-the case of Israel

While bioethicist Arthur Caplan claims that "The Nazi analogy is equivalent to dropping a nuclear bomb in ethical battles about science and medicine", we claim that such total exclusion of this analogy is equally problematic. Our analysis builds on Roberto Esposito's conceptualization of immunitas and communitas as key elements of biopolitics. Within public health theories and practices there is an inherent tension between exclusion (immunitas) and inclusion (communitas) forces. Taking the immunitas logic to the extreme, as National Socialist medicine did in the name of securing the German race, is a constant danger that needs to be taken seriously into consideration when discussing public health policies. The tension between the silencing of the Holocaust in bioethical debates on one side, and the persistent use of National Socialist medicine metaphors, on the other hand, is the focus of this paper. By delving into the meanings and the implications of this two-edged discourse, we argue that comparing post-war bioethics with pre-war medical practices from a biopolitical perspective has the potential to depict a more nuanced account of continuities and discontinuities in bioethics.

Teaching Health Professions Students About the Holocaust

The legacy of health professionals' roles in the Holocaust is fundamental to understanding modern health care ethics, but teaching it is difficult. The University of Colorado Center for Bioethics and Humanities has developed a program that addresses 4 main pedagogical challenges of this content. This article identifies 3 core lessons and proposes 5 specific learning objectives related to health professionals' involvement in the Holocaust for any health professional training program.

How Should Students Learn About Contemporary Implications of Health Professionals' Roles in the Holocaust?

Foundational documents of modern biomedical ethics, such as the Nuremberg Code, the World Medical Association's declarations of Geneva and Helsinki, and the Belmont Report, trace their origins to health care professionals' complicity in the Holocaust. Rituals of contemporary medical education, such as white coat ceremonies and oath swearing at graduations, are practices that express professional resolve to never again be complicit in genocide or human exploitation. This article considers a historical approach to teaching the Holocaust's contemporary ethical implications for clinicians and their practices.

Teaching Hard Truths About Medicine and the Holocaust

The Holocaust differs from other instances of mass murder in that it was medically sanctioned genocide. Modern health care ethics was born of the Holocaust, and this article describes numerous misconceptions about medicine's key roles in several events prior to and during the Holocaust. This article also illuminates lessons that should be formally integrated into all health professions ethics curricula.

[AGING IN THE SHADOW OF INTERGENERATIONAL TRANSMISSION OF TRAUMA: THE CASE OF OFFSPRING OF HOLOCAUST SURVIVORS]

Can trauma experienced by previous generations shape the aging process of subsequent generations? This fascinating question is relevant to hundreds of thousands of second generation Holocaust survivors, many of whom are middle-aged or older. Therefore, we need to understand in which cases we can find signs of intergenerational transmission, via which mechanisms, under which conditions, and which aspects of functioning and wellbeing are affected. This paper reviews relevant findings from national studies and studies with parent-offspring dyads. From this review, one can conclude that parental exposure to the Holocaust per se is not associated with less favorable aging among offspring, as most Holocaust survivor families are characterized by an impressive resilience extending across generations. Nevertheless, in some cases, second generation Holocaust survivors report increased physical morbidity, perceive aging less favorably, and experience increased filial anxiety. Accumulated evidence points to a series of moderating and mediating variables for these effects. Thus, increased morbidity and difficulties vis-à-vis age-related challenges in offspring are associated with increased parental posttraumatic distress and an intrusive Holocaust-related communication pattern. Several mechanisms link between parental behaviors and offspring aging, amongst them are secondary traumatization symptoms, unhealthy behaviors and avoidance of health-promoting behaviors, and epigenetic modification regulating genes related to the physiological stress response and to other bodily systems. Future studies are needed in order to better understand intergenerational effects among middle-aged and older adult offspring. Additional work will help guide future, interdisciplinary theoretical models and therapeutic interventions aimed at advancing successful aging among adult offspring of Holocaust survivors.

[DISABILITIES IN CHILDREN BORN TO VICTIMS OF MEDICAL EXPERIMENTS]

Between 2001 and 2005 the Claims Conference administered the Fund for Victims of Medical Experiments on behalf of the German Foundation "Remembrance, Responsibility and Future." A small percentage of claimants to the Fund, all of whom were victims of fertility experiments performed predominantly in Auschwitz-Birkenau and Ravensbrück, noted on their applications that their children were born with physical or mental disabilities. All claimants attributed the disabilities to the sterilization, hormone and pharmaceutical experiments that were performed on them. To date there has been no comprehensive research into the extent to which these experiments might have led to physical or mental disabilities in the children of survivors. In order to close this gap, the Claims Conference analyzed 1,363 applications to the Fund for Victims of Medical Experiments, 559 of which were clearly categorized as fertility experiments. Of the 559 claims, approximately 8% noted on the application form that their children were born with disabilities, ranging from congenital problems to fertility issues. This figure is significantly higher than the average 2-3% rate of newborns with disabilities. And the actual percentage of claimants bearing children with disabilities is presumed to be substantially higher, given that the majority of sterilization experiment victims were rendered infertile as a result of the experiments. Most second-generation victims are children of claimants that were subjected to the well-researched sterilization experiments, in particular Dr. Carl Clauberg's intrauterine sterilization experiments and Dr. Horst Schumann's x-ray castration experiments. Another group of female applicants claimed pharmacological experiments causing amenorrhea and subsequently, long-term effects.

[WHY EVERY HEALTH PROFESSIONAL NEEDS TO CONTEMPLATE MEDICINE DURING THE HOLOCAUST]

A growing interest in the realization, understanding and lessons of medicine and physicians' behavior during the Holocaust, is noted in the last two decades. In this incomprehensible time, the dark and enlightened faces of medicine reached an unprecedented (and hopefully will not ever recur) climax. We learn of the criminal conduct of Nazi medicine and Nazi physicians on the one hand, and the noble, faithful to the Hippocratic oath, behavior of some prisoner physicians and nurses on the other hand. The understanding that learning about medicine during and beyond the Holocaust is a unique platform with exceptional impact on professional identity formation for present and future health professionals, is becoming clearer. In the present paper we will briefly delineate the historical background, its place in the professional discourse, describe a seminal conference that took place in Israel in 2017 that also launched the Galilee Declaration, and thoughts for the future. In Israel, Professor Shaul Shasha's initiative to hold a yearly meeting on medicine and health in the Holocaust in the Medical Center for the Galilee in Naharia, for the last 20 years, is central to this important subject. This paper is dedicated to him with profound gratitude.

["WITNESS IN WHITE" SEMINAR TOURS ON MEDICINE AND PHYSICIANS IN THE HOLOCAUST]

The Holocaust represents a seminal event in the annals of medicine. For the first time in history, doctors played a prominent role in the extreme abuse of medical rights, violation of medical obligation to patients, infringement of patient autonomy, forced and unnecessary invasive and damaging procedures for political purposes and the ultimate injustice of involuntary euthanasia. Physicians provided the legitimacy, know-how and momentum that allowed these processes to take place in a symbiotic relationship with the political establishment during the Nazi era. It is critical that modern day physicians be aware of what transpired during this period. For that purpose, we describe a multiyear program bringing Israeli physicians on a learning mission to relevant sites of medical involvement and complicity in Nazi era crimes. These guided educational tours, under the auspices of the Israel Medical Association, originally took place in Poland and more recently, alternately visit Germany and Poland. At all sites, background information on medical practice during the Nazi era is provided, as well as ethical discussions on the merits (positive) or demerits (negative) of physicians who played a role at those particular locations. In addition to site visits, background discussions and lectures are provided to achieve a more comprehensive, deeper and more profound understanding of the issues. Emphasis is placed on learning from examples with relevance to modern day medicine, thus providing the principles from which participants can grow to become more ethical, principled and sensitive physicians as well as individuals. The tour includes formal and emotional ceremonies when relevant at extermination sites where physicians were directly involved, as well as focus groups allowing and encouraging emotional expression and catharsis. The critical role of personal growth during the tour is emphasized with both pre-tour and post-tour meetings providing buffering on both ends. Participants and staff, as well as documented feedback over the years, attest to the utility and profound value of these learning and growth-oriented medical missions.

[TWENTY YEARS OF NAHARIYA CONFERENCES ON MEDICINE AND THE HOLOCAUST]

Since the beginning of the current century, the Galilee Medical Center (formerly Nahariya Hospital) has held "Nahariya conferences on medicine and the Holocaust". It is a unique and ongoing enterprise that tells the wonderful story of Holocaust medicine on the one hand, and the terrible consequences of survivors' health and their offspring on the other. Discussions were held that contributed to intensive research and publications on these issues, as well as to the authorities' recognition of the later stages of Holocaust survivors' illnesses and injuries.

[FAMINE IN JEWISH HISTORY AND THE METABOLIC CONSEQUENCES]

Famine, with its pathological consequences was, apart from climacteric events, used by various dictatorships as a weapon for genocide, This was the case of Nazi Germany using food confiscation from occupied populations, affecting, in particular, the incarcerated Jews, Although food production in the 20th century was sufficient for the global population, World War II lead to a wide range of famine in Europe. The condition resulting from starvation led, in the survivors, to a multi-system Shoah syndrome, with propensity to generational inheritance.

[THE FATE OF THE JEWISH STAFF OF THE MEDICAL INSTITUTE IN THE CITY OF STAVROPOL DURING THE HOLOCAUST]

In the first two decades of the 21st century, research on the history of Jewish medicine during the Holocaust expanded. Studies were written on the medical activity in German-occupied areas, particularly the large and medium-sized ghettos in Poland, Lithuania, and Czechoslovakia, in addition to Holland, Hungary, and Germany, and Jewish physicians' activity in the camps. Conspicuously absent is the study of Soviet Jewish medicine and physicians in areas occupied by the Germans in World War II with the German offensive against the Soviet Union, which began on 22 June 1941. This article sheds light on the fate of 36 Jewish physicians and scientists from Stavropol Medical Institute in the North Caucasus during the Holocaust-renowned professors, lecturers in all branches of medicine, of which one third were women of outstanding medical achievements. The description draws on writings by researchers from the Commonwealth, including Stavropol, witness testimonies collected by the Soviet Extraordinary State Commission to investigate Nazi atrocities (1943-1945), and the memoirs of Ludmila Schwartzman, daughter-in-law of Prof. Jacob Schwartzman, renowned cardiologist before the war and senior Medical Institute physician murdered with the rest. The article describes the history of Caucasian Jews and thousands of Jewish refugees who sought shelter in the area, focusing on Stavropol's Jews, including numerous Medical Institute teachers, researchers and their families, either shot to death in forests outside the city or killed in gas vans. Research of the history of Stavropol Medical Institute's Jewish staff both memorializes the Jewish physicians and scientists and opens a window into Jewish physicians' activity in Nazi-occupied Soviet regions. This is a research area in its infancy warranting deeper investigation.

[Holocaust Doctors Survivors and Holocaust's memory]

INTRODUCTION

The Eichmann Trial constituted a turning point in the collective consciousness of Israeli society and its treatment of the Holocaust and of Holocaust survivors. From an anonymous, unfathomable and incomprehensible on a personal level topic, it was personalized into the testimonies and personal stories of survivors who only then been understood and penetrated consciousness. In the design of the memory of medicine during the Holocaust, as part of the design of the Holocaust's memory in general, are unique ethical, medical and social aspects. The purpose of this study was to examine the role of Holocaust surviving doctors in shaping the memory of medicine during the Holocaust.

CONCLUSIONS

The surviving doctors were not silent. They have worked extensively in shaping the memory of medicine during the Holocaust, and they have a crucial role in shaping memory of medicine during the Holocaust in Israeli society.

DISCUSSION

Holocaust surviving doctors delivered their memories in writing and orally, first in medical journals and in front of a physician audience. Gradually their circle of communication channels expanded, especially after the Eichmann trial. The memory of medicine during the Holocaust has always been on the public agenda, even if only several actions were taken. In October 1955, the Holocaust Surviving Doctors' Association was established, but the number of its members was limited and it was active for only seven years. From the 1990s onwards, we have witnessed an increase in organized activity to shape the memory of the Holocaust.

[MY GLORIOUS BROTHERS - JEWISH DOCTORS ON THE RESISTANCE FRONT AGAINST NAZIS AND THEIR COLLABORATORS]

Many Jewish doctors in the Holocaust - in ghettos, concentration and extermination camps and in the forests - displayed courage, valor and sacrifice in the resistance front against the Nazis and their allies. The scope of their actions was broad: active resistance in the underground and rebellion movements or in the lines of partisans in the forests; hiding and saving Jews; smuggling medicines; preparing false medical records; secretly conducting surgery and other treatments; refusing the demands to submit lists of patients and workers, thus sentencing them to death; staying by the sick and the needy in the ghettos, even when they could escape, and many more. All this was done out of truth to their conscience, sometimes even beyond their commitment to the doctor's oath, placing themselves in uncertain situations, in distress, hunger, oppression and humiliation, risking their own lives and those of their families. It is admirable how those degrees of courage, bravery, willpower and sacrifice could develop out of such terrible physical and mental distress. The resistance was an extensive wide-ranging occurrence among the Jewish doctors and not one of just a few individuals. This article presents a number of examples of diverse forms of resistance, of individuals as well as of groups of physicians.

Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study

The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law.

Observations on Osteoporosis in Three Generations of Descendants of Holocaust Survivors

Throughout history, studies on episodes of famine have led to the discovery of metabolic abnormalities and hormonal aberrations as well as an increased incidence of cancer and mental health conditions. Starvation during early life is thought to nfluence the programming of childhood and adult bone metabolism, which may result in poor bone health in later life. This observational case series includes a small group (with no control group) of famine-exposed Holocaust survivors and their descendants. We proposed an investigational mechanism to determine any association between starvation and osteoporosis, both in the individual survivors and in their descendants.

[The Transmission of Trauma and Guilt Feelings Between Generations]

The Transmission of Trauma and Guilt Feelings Between Generations Abstract. After a brief historical outline, the text deals with the emergence of insights into transgenerational transferences and current understandings of mental trauma and various forms of traumatization. At the center lies the question of psychic mechanisms of unconscious transmission in unprocessed traumas. The author inquires into body language and affective communication, beginning in early childhood, and the importance of scenic memory and understanding of nonverbal messages. Different reactions in descendants of survivors of the Holocaust or torture victims and descendants of perpetrators are also taken into consideration. Finally, some conclusions for clinical practice are presented.