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Preventing the Preventable; Preserving healthcare services

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Recent address by
Dr. Sarath Gamini De Silva
to the Galle Medical Association

It is indeed my privilege and pleasure to be given this opportunity to address the members of the Galle Medical Association (GMA). I am grateful to the President and the Council of the GMA for inviting me as the guest of honour at the inauguration ceremony of your annual academic sessions.

Coming here today is like getting back to my roots again. I was born and bred in Galle and had my entire primary and secondary education at Richmond College. Between 1982 and 1995 I was associated with the GMA in my capacity, first as a senior lecturer in medicine for two years and then for nine years as a Consultant Physician at the Teaching Hospital, Karapitiya.

I was the President of the Galle Medical Association in 1994.My colleague Prof. Ariyananda and I were the first two senior lecturers in the Dept. of Medicine, with Prof. Hettiarachchi as the head. We knew almost every student in the first few batches by name, taking a personal interest in their welfare, to make sure that they did well as doctors.

The academic and non-academic staff took it up as a personal challenge to prove that the Ruhuna Medical Faculty, though rather hastily established, was second to none in the island. Looking back, we can be happy that all did very well, most of them becoming very competent specialists in various fields, later on, and are providing an exemplary service here and abroad.

We started in the dilapidated buildings at Mahamodera and then moved into modern facilities at Karapitiya, which at that time was still a building site. The long-established Galle Clinical Society later merged with the relatively new Galle Medical Association under the presidency of the late Prof. Tommy Wickremanayake, the Dean of the Medical Faculty, at that time. This wonderful auditorium, named after him, is a tribute to the late Professor’s energy and determination to see that we had the best facilities in the Southern Province. He took me round this building site on several occasions, and I once nearly had an accidental fall trying to mount this stage, only half built at that time. Today I feel quite confident standing here on a firm foundation, a podium graced by many medical luminaries over more than 40 glorious years, in the service of medical education.

The Galle Medical Association has done justice to the ideals and aspirations of its founders. As a life member, I receive regular information of your activities. The Association is meeting amply the academic and non-academic needs of its membership. Your lecture series on beyond medicine; religious and sports activities, musical programmes, leisure trips, etc., would provide much relaxation outside the exhausting routine of medical practice. Your annual academic programme is not second to that of many professional Colleges and Associations based in Colombo or elsewhere in the country. This wide array of activities is indicative of an Association keen on providing an all-round service to its members and their families, as well as to the medical students. My congratulations to all concerned.

Your theme this year, “Preventing the Preventable,” is very timely. With the economic crisis we are experiencing, the age old saying “Prevention is better than cure” is more relevant today than ever before. Certainly, true in the case of prevention of diseases, I am concentrating today on other aspects of healthcare the doctors have overlooked and to a great extent failed to prevent their decline.

Preventing the Preventable; Preserving the Healthcare Services is my concern today.

All the remarkable achievements in the fields of communicable and non-communicable diseases, with world acclaimed health indices, are now being nullified by the economic crisis in which the healthcare services appear to be caught unawares. The shortage of drugs and other equipment, costing more and more with every passing day, has made it near impossible to give proper treatment to needy patients. I will not be surprised to hear of deaths due to lack of treatment in the near future. We already hear allegations, though authorities keep refusing to accept their responsibility, of deaths due to poor quality of drugs hastily imported to overcome shortages in a poorly planned system.

This is compounded by poor household incomes, high transport costs and other difficulties the patients experience in seeking medical care.

While most of the blame for this unfortunate situation falls on poor planning and corruption by the rulers, the medical profession, too, has failed in preventing this calamity. They have contributed by their irrational prescription habits, doing unnecessary investigations and the like, leading to a high cost in the delivery of healthcare. Irrational prescriptions contribute in a big way to multidrug resistance to antibiotics, as well. Poorly regulated private practice by doctors needs an overhaul. Exorbitant fees charged by some specialists are the talking point in the society. I need not bore you with details which should be well known to all of you by now.

We as a profession should not allow ourselves to be exploited by the profit-oriented private healthcare services and the pharmaceutical industry. The patients are compelled to pay a heavy price for our shortcomings in this regard. Thus, by our inaction in dealing with such, we have failed to prevent the gradual deterioration of the respect the society has for the profession.

Has the medical profession knowingly or unknowingly colluded with the misdeeds of the politicians? As an example, I wish the institutions, like the drug regulatory authority, NMRA, did more to prevent corruption and irregularities in the procurement of drugs. They have remained mostly silent knowing very well how their decisions regarding the registration of drugs are overruled or circumvented by politicians and administrators with ulterior motives.

Functioning of the Sri Lanka Medical Council is being looked down upon by many in the profession itself. The amendments to the Act governing the SLMC has been proposed over many years to broad base its membership to include non-medical professionals and make it more effective in its primary duties of regularizing medical practice, maintaining discipline in the profession and maintaining good standards of medical education. Politicians have so far failed to enact them. With poor standards of medical education, due to shortages in staff and other facilities in hastily established new medical schools, SLMC has been largely silent on these aspects. At present it appears that the medical trade unions and indirectly the political influence are hampering its proper functioning. As a result the SLMC remains mainly a body for holding the ERPM for foreign medical graduates and registering the medical practitioners. Our professional associations should be more involved in its affairs and add their voice for reforms.

I have been a member of the SLMC for 10 years in the past. But your chief guest as its immediate past president, who was removed from the post in a most unprofessional way by the politicians, with perhaps the connivance of our own colleagues, will be in a better position to address these issues. That action initiated by our own professional colleagues has now established a precedent for the Health Minister to have a bigger say in the SLMC affairs, seriously undermining its autonomy.

In my address to the Colombo Medical Congress a year ago, I stressed how our Professional Colleges and Associations kept a blind eye without getting involved and having their say in the administration of the health service. Even when there was an uprising asking for a system change, the medical profession remained largely silent without adding their voice. This was in stark contrast to the legal profession who stood up with the people asking for justice. By remaining ‘respectable’, confining ourselves to academic activity only, we have allowed our efforts at improving services to the public and training postgraduates to become meaningless. As a result, we are now spending tax payers’ money for training specialists for service abroad. With an unprecedented exodus of locally trained doctors and other healthcare staff, we are helping richer countries to serve their citizens better. The world-acclaimed health indices we have achieved by hard work over the years are becoming irrelevant with rampant malnutrition and other maladies affecting a significant proportion of the people.

Even the few medical men who dared to warn the authorities publicly on impending childhood malnutrition in their area had to face disciplinary action. The services of an alumnus of the Ruhuna medical faculty have been terminated as a result. Unfortunately, there is hardly any protest heard from the trade unions or other medical organizations against such action, at a time when elsewhere numerous unlawful activities and rampant corruption remain unpunished.

As much as the people are asking for all 225 in the Parliament to be thrown out, there are loud whispers in the society that the medical profession, too, is corrupt exploiting the people in various ways. There is no use in our grumbling about any shortcomings of doctors and incidents of medical negligence being highlighted in mass media regularly. Naturally, the good work done by the doctors will not be talked about with praise as that is the minimum the society expects from us.

It is high time our annual conferences and other meetings had a regular session or symposia on various aspects of the doctor in society, discussing our own faults and ways of rectifying them. All Colleges, especially those dealing with clinical disciplines coming into direct contact with the public daily, should communicate regularly with their members on these issues. They should also keep a close watch on the activities of health-related institutions like the SLMC and the NMRA already referred to, and intervene where necessary, without waiting till it is too late.

Thus, prevention in broader terms involves not only prevention of diseases but also prevention of other irregularities in the administration of health and questionable practices of our own colleagues that have a direct bearing on the health of the people. The medical profession, despite its many shortcomings, is still respected and influential. Our strong voice will be heard by the rulers, medical administrators and the general public.With these thoughts let me conclude by wishing you all a very successful and enjoyable annual sessions. I wish you all a very good evening.



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UN COP28: What to know about the climate summit in Dubai

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At Expo City Dubai, world leaders will reevaluate their implementation of the UNFCCC (pic Aljazeera)

World leaders, government representatives and delegates are set to gather for the annual United Nations climate change summit, known as the Conference of the Parties or COP28  in Dubai, the United Arab Emirates (UAE).

Reining in fossil fuels and carbon emissions are expected to be topping the agenda of the 13-day summit (November 30 to December 12). International funding to help countries adapt to climate change will also be hotly debated as developing countries have been demanding more contributions from the industrialised nations.

An ambitious loss and damages fund agreed last year to support poorer nations to help manage the negative effects of climate change has yet to be put into place. World leaders agreed to the fund after COP27 last year, but they have failed to reach consensus on the most important questions of all – which states will pay into it and how much.

Countries will also face the first review of their progress towards the Paris Agreement,  a landmark international treaty on limiting carbon emissions that was signed at the COP21, almost eight years ago.

Although the UAE was the first Middle Eastern country to ratify the agreement, people are deeply divided over hosting the summit in a nation that has been termed as part of the problem for its reliance on fossil fuels, which account for more than 75 percent of global greenhouse gas emissions. Some are now also criticising the inclusion of oil and gas-linked representatives in such summits at all.

As the debate around COP28 and its impact continues, here’s what to know about this year’s conference and what makes it significant.

What, when, where is COP28?

COP is the primary decision-making body of The United Nations Framework Convention on Climate Change (UNFCCC), established in 1992.

Representatives of 197 countries who have signed or are “parties” to the UNFCCC will participate primarily through debates and negotiations.

COP28 will begin on November 30 and continue for almost two weeks, while the exact schedule for each day will be published a night prior. Pre-sessions for the conference began on November 24.

The conference will be held at Expo City in Dubai, UAE.

INTERACTIVE_COP_GLOBAL_CARBON_EMISSIONS_NOV27_2023-1701095237
(Al Jazeera)

Why is COP28 important?

The COP28 will take place in the backdrop of devastating floods and heatwaves, fierce wildfires and the Earth’s hottest summer on record this year.

The event is considered an opportunity for countries to better rein in climate change by devising improved targets and measures through tools such as finance, technology and capacity-building.

The conference comes weeks after a UN report said greenhouse gases in the atmosphere hit a record high in 2022. Based on countries’ current climate plans, the report says, global carbon emissions by 2030 will be cut by only two percent compared with 2019 levels, far short of the 43 percent fall needed to limit warming to 1.5 degrees Celsius since pre-industrial levels.

Although the 1.5 degree Celsius target became binding in the 2015 Paris Agreement, the goal was first adopted after COP16, more than a decade ago.

A report from the World Meteorological Organization in May also found that with current trends, the world may temporarily breach the 1.5 degrees Celsius target in 2027.

As states scramble to catch up before climate change risks spike further, they will not be immune to crises around the world.

“For years parties have been struggling to agree to a fossil fuel phase-out, and the challenge to reach an agreement was made worse by the fiscal crises precipitated by the pandemic and energy crisis following the war in Ukraine,” said Olivia Rumble, director of Climate Legal in South Africa.

What is the agenda and theme for COP28 in Dubai?

A primary objective of COP each year is to review and calibrate the implementation of the UNFCCC terms, Paris Agreement,  and Kyoto Protocol, a binding treaty agreed in 1997 for industrialised nations to reduce greenhouse gas emissions.

This year, member states will negotiate while facing their first Global Stocktake (GST) – a scorecard analysing countries’ progress towards the Paris Agreement – so they can adapt their next climate action plans which are due in 2025.

“Countries will be hard-pressed to make concessions to agree on the principal reasons for historic failures and what they believe needs to be done going forward to make meaningful progress on the agreement’s goals,” said Rumble.

Parties will also seek to operationalise the loss and damages fund after developing nations proposed in September that developed countries should disperse at least $100bn to them by 2030.

Additionally, this year’s presidency has set four themes to be at the forefront of the summit:

  • Fast-tracking the energy transition:  revolves around renewable energy, and food and agricultural systems.
  • Fixing climate finance: aims to prioritise the Global South in adaptation finance and help vulnerable communities rebuild after climate disasters, among other targets.
  • Nature, people, lives, and livelihoods: geared towards food systems, nature-based solutions, and protecting against extreme weather events and biodiversity loss.
  • Inclusivity, in climate management: includes youth involvement and improved communication between different sectors and agencies.

However, focusing on specific themes such as financing strategies must also be accompanied by a revamping of global structures to be effective across the world.

While this year’s climate financing agenda aims to better support developing nations with emergency funding, such mechanisms currently lack effective needs analysis and involve the inefficient distribution of funds. High debts imposed on such countries through global financing structures also reduce their ability to invest in the maintenance of climate projects.

“Renewable energy and energy efficiency will mean little to African countries without significant reforms to the global financial architecture to make these targets achievable. This includes revising risk ratings and perception of investment risk in Africa,” said Rumble.

INTERACTIVE_COP_GOALS_SEP27_2023-1701095241
(Al Jazeera)

Who will and will not attend COP28 in Dubai?

More than 140 heads of state, senior government leaders and at least 70,000 participants are expected to attend COP28.

Some of the notable figures who have confirmed their attendance so far include:

  • Britain’s King Charles III, who will also deliver an address at the opening ceremony
  • Rishi Sunak, prime minister of the United Kingdom
  • Pope Francis of the Catholic Church
  • Humza Yousaf, first minister of Scotland
  • Indian Prime Minister Narendra Modi.

US President Joe Biden is not expected to attend but the country will be represented by top officials such as Special Presidential Envoy for Climate John Kerry.

The summit will be divided into a “blue zone” with sessions for UN-accredited participants such as state representatives only, and a “green zone” with events and exhibits for registered participants from the public and civil society.

What are the controversies around COP28?

Many environmentalists and other analysts have raised concerns about COP28’s choice of president.

Sultan al-Jaber, CEO of the Abu Dhabi National Oil Co, has been tasked with changing the world’s climate course while the company he heads is one of the world’s largest oil producers. The UAE is the world’s seventh-largest liquid fuel producer.

In May, al-Jaber faced criticism for referring to the need to phase out “fossil fuel emissions” — using techniques such as carbon capture — instead of phasing out fossil fuels themselves.

Others have questioned the UNFCCC for involving the fossil fuel industry in its discussions and failing to generate sufficient progress towards the 1.5-degree goal.

In September, more than 200 civil society organisations, including Amnesty International, wrote an open letter to the UAE government to follow certain demands in the lead-up to COP28. On top of calling for labour reforms, and abandoning plans to step up oil and gas production, the letter demanded that the UAE refrain from surveilling COP28 attendees.

The country has said it will allow environmental activists to “assemble peacefully” for protest acts during the summit.

(Aljazeera)

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Budget, Taxation Turmoil and Policy Blunders – Part II

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Last week, we delved into a significant event in New Zealand, where a group of affluent individuals expressed a willingness to voluntarily pay more taxes, only to have the tax authority reject their offer. This incident prompts questions about the fairness of the current tax system, particularly in relation to the lower tax rates paid by the wealthiest citizens. Drawing parallels with Sri Lanka, the discussion advocates for the implementation of mandatory Tax Identification Numbers (TINs) in developing economies, underlining the necessity for a more equitable tax system.

We observed a unique situation in Sri Lanka where, despite per capita GDP growth, the tax-to-GDP ratio has been on a decline. The introduction of some naïve tax policies, such as the abolition of mandatory PAYE Tax, the increase in tax and VAT allowances, in 2019/2020, were also discussed.

The projection for Sri Lanka’s tax revenue as a percentage of GDP is expected to rise from 7.3% in 2022 to 12.1% in 2024, with the World Bank emphasizing the importance of maintaining tax revenues above 15% of GDP for economic growth. Projections for Sri Lanka’s GDP per Capita indicate a gradual increase over the next few years, reaching around US$4098.00 in 2025.

Sri Lanka compared

According to a map available on the Internet, depicting global comparison of Tax-to-GDP ratio, Sri Lanka is bracketed with several economically challenged African nations as well as Afghanistan and Bangladesh within its region. Notably, it ranks lower than many neighbouring countries including India, Nepal, Bhutan, Pakistan, and Indonesia etc.

On the contrary, countries with higher income levels, such as US, UK, Australia and any European countries, demonstrate considerably elevated tax-to-GDP ratios, ranging from 20% to 30%, and, in some cases such as UK France, the Netherlands, New Zealand and Denmark, reaching as high as 40% to 45%.

Figure 1 plots countries based on their GDP per capita and tax revenue as a percentage of GDP. Countries with income levels like Sri Lanka (ranging between US $2,000-4,000) are highlighted within the circle. Sri Lanka’s tax-to-GDP ratio falls significantly below the average. For instance, Morocco and Georgia, with GDP per capita figures of US $2,931 and US $3,529, respectively—comparable to Sri Lanka’s GDP per capita of US $3,369—both countries collect 24 percent of GDP as tax revenue, whereas Sri Lanka collects only 11 percent.

The tax revenue as a percentage of GDP for middle-income countries has shown a relatively stable trend over the years. The values range from around 10.7% in 2005 to an expected 11.4% in 2024 (Forecast).

Sri Lanka’s tax revenue as a percentage of GDP has experienced fluctuations during the period. Notable peaks are observed in 2006, 2007, and reaching up to 14.6% in 2015 and was par with the Middle-Income countries, followed by a decline again from 2019. The values have varied, with a dip to 7.8% in 2021, indicating a substantial decrease. Projections for 2022 and 2023 show a gradual increase, with the budget for 2024 aiming at a significant rise to 12.1%. (See Figure 2).

Hence, the tax revenue for Sri Lanka, while exhibiting fluctuations, generally appears to be on a recovery path after a notable decline in recent years. The budgeted figure for 2024 suggests an ambitious target, aiming for a substantial increase in tax revenue as a percentage of GDP.

Not only arbitrage but

also corruption

In countries like the United States, income tax stands out as the primary revenue source. This is facilitated by nearly zero import duties, typically set at 5 percent or less, and the absence of a value-added tax (VAT). In contrast, Europe relies heavily on a value-added tax, often around 20 percent, but does not impose import duties. In Sri Lanka, despite the relatively high import duties borne by the average citizen, the government only receives a fraction of this revenue. This is a result of the diversion of substantial sums to domestic protectionists through the practice of tax arbitrage, coupled with instances of tax avoidance (commonly referred to as tax minimization) and evasion, often involving manipulations and collusion.

Tax arbitrage involves exploiting differences in tax policies or rates across different jurisdictions to gain a financial advantage. In the context of domestic protectionists, individuals or entities within a country capitalize on tax differences among regions. This strategy often involves the strategic use of tax regulations or loopholes to minimize or entirely avoid tax liability. Notably, corruption plays a crucial role in this dynamic. Given the prevalent culture of corruption, extending from the top echelons of the state to even lower-level positions in Sri Lanka, these tactics can be readily implemented by astute business individuals, both on a large and small scale.

Not only anomaly but

also corruption

A noteworthy aberration in Sri Lanka’s tax structure is its disproportionate reliance on taxes related to international trade for tax revenue in comparison to its income level. Global patterns indicate that the proportion of taxes on imports as a share of total tax revenue tends to decrease as income levels rise. For instance, a study by Loewy, titled ‘Taxation: 21st Century Issues and Challenges’, revealed that trade taxes contribute to approximately 25% of total tax revenue in low-income countries, 12% in lower-middle-income countries, 9% in upper-middle-income countries, and less than one percent in high-income countries.

Contrary to these trends, in Sri Lanka’s case, taxes imposed solely on imports constitute nearly 20% of the government’s total tax revenue—a significantly high figure for a lower-middle-income country (Figure 3). The country’s substantial reliance on international trade for tax income has proven to be a risky proposition for the government. While restricting imports is essential to address the trade deficit, it comes at the cost of reduced government revenue and an exacerbated budget deficit. Conversely, increasing imports would boost government revenue but intensify the trade deficit. Consequently, a strategic shift away from trade-related taxes becomes crucial for the government to generate revenue without destabilizing the country’s macroeconomic environment.

Share of expenses on government servants

Government spending in Sri Lanka was 48% in 2019 to public sector salaries and pensions but now only 44% allocated for 2024 as mentioned before. In the most recent budget presentation, over 35% of government expenditure was directed towards public sector salaries, pensions, and public welfare, emphasising their importance in government spending. In a specific breakdown, it is mentioned that Rs. 92 billion was allocated to pay the salaries of public sector employees in July 2022. Moreover, a historical perspective indicates the significance of government spending on salaries, dating back to 1950. Overall, public sector salaries and pensions play a crucial role in Sri Lanka’s government expenditure, reflecting a substantial commitment to the welfare of government employees.

Another anomaly is too many armed forces

Sri Lanka’s armed forces strength of 317,000 personnel is financially unsustainable because of its considerable annual expenditure of Rs.423 billion (410 in 2023), which is 1.88% of the GDP. Comparisons with other nations, including Australia and the Netherlands, reveal significantly smaller military forces. Sri Lanka’s post-civil war armed forces maintenance highlights the country’s unique revenue-based fiscal consolidation strategy, focusing on tax increases without traditional cost-cutting measures.

Conclusions

This analysis reveals three main anomalies in Sri Lanka’s tax structure, including a decline in taxpayers after significant tax cuts. The essay emphasizes the importance of sustaining tax revenues for economic growth and explores the country’s tax-to-GDP ratio, positioning it against global comparisons (over 15% of GDP). Notably, it highlights the overdependence on international trade taxes, the disproportionate spending on government servants, and the financial challenges posed by the substantial size and expenditure on the armed forces. The narrative suggests a need for strategic reforms to navigate the intricate fiscal landscape.

(The writer, a senior Chartered Accountant and professional banker, is Professor at SLIIT University, Malabe. He is also the author of the “Doing Social Research and Publishing Results”, a Springer publication (Singapore), and “Samaja Gaveshakaya (in Sinhala). The views and opinions expressed in this article are solely those of the author and do not necessarily reflect the official policy or position of the institution he works for.)

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How Hamas built a force to attack Israel on 7 October

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Joint military drills were held between Palestinian armed factions from 2020 onwards (pic BBC)

Five armed Palestinian groups joined Hamas in the deadly 7 October attack on Israel after training together in military-style exercises from 2020 onwards, BBC News analysis shows.

The groups carried out joint drills in Gaza which closely resembled the tactics used during the deadly assault – including at a site less than 1km (0.6 miles) from the barrier with Israel – and posted them on social media.

They practised hostage-taking, raiding compounds and breaching Israel’s defences during these exercises, the last of which was held just 25 days before the attack.

BBC Arabic and BBC Verify have collated evidence which shows how Hamas brought together Gaza’s factions to hone their combat methods – and ultimately execute a raid into Israel which has plunged the region into war.

‘A sign of unity’

On 29 December 2020, Hamas’s overall leader Ismail Haniyeh declared the first of four drills codenamed Strong Pillar a “strong message and a sign of unity” between Gaza’s various armed factions.

As the most powerful of Gaza’s armed groups, Hamas was the dominant force in a coalition which brought together 10 other Palestinian factions in a war games-style exercise overseen by a “joint operation room”.

Prior to 2018, Hamas had formally coordinated with Palestinian Islamic Jihad (PIJ), Gaza’s second largest armed faction and – like Hamas – a proscribed terrorist organisation in the UK and other countries.

Hamas had also fought alongside other groups in previous conflicts, but the 2020 drill was billed in propaganda as evidence a wider array of groups were being unified.

Hamas’s leader said the first drill reflected the “permanent readiness” of the armed factions.

The 2020 exercise was the first of four joint drills held over three years, each of which was documented in polished videos posted on public social media channels.

The BBC has visually identified 10 groups, including PIJ, by their distinctive headbands and emblems training alongside Hamas during the Strong Pillar drills in footage posted on the messaging app Telegram.

Following the 7 October attack, five of the groups went on to post videos claiming to show them taking part in the assault. Three others issued written statements on Telegram claiming to have participated.

The role of these groups has come into sharp focus as pressure builds on Hamas to find dozens of women and children believed to have been taken as captives from Israel into Gaza by other factions on 7 October. Three groups – PIJ, the Mujahideen Brigades and Al-Nasser Salah al-Deen Brigades – claim to have seized Israeli hostages on that day.

Efforts to extend the temporary truce in Gaza were said to be hinging on Hamas locating those hostages. The structure was set up in 2018 to coordinate Gaza’s armed factions under a central command.

Images of Palestinian militants during training

While these groups are drawn from a broad ideological spectrum ranging from hard-line Islamist to relatively secular, all shared a willingness to use violence against Israel.

Hamas statements repeatedly stressed the theme of unity between Gaza’s disparate armed groups. The group suggested they were equal partners in the joint drills, whilst it continued to play a leading role in the plans to attack Israel. Footage from the first drill shows masked commanders in a bunker appearing to conduct the exercise, and begins with a volley of rocket fire.

It cuts to heavily armed fighters overrunning a mocked-up tank marked with an Israeli flag, detaining a crew member and dragging him away as a prisoner, as well as raiding buildings.

We know from videos and harrowing witness statements that both tactics were used to capture soldiers and target civilians on 7 October, when around 1,200 people were killed and an estimated 240 hostages were taken.

Telling the world

The second Strong Pillar drill was held almost exactly one year later.

Ayman Nofal, a commander in the Izzedine al-Qassam Brigades – the official name for Hamas’s armed wing – said the aim of the exercise on 26 December 2021 was to “affirm the unity of the resistance factions”.

He said the drills would “tell the enemy that the walls and engineering measures on the borders of Gaza will not protect them”.

Another Hamas statement said the “joint military manoeuvres” were designed to “simulate the liberation of settlements near Gaza” – which is how the group refers to Israeli communities.

The exercise was repeated on 28 December 2022, and propaganda images of fighters practising clearing buildings and overrunning tanks in what appears to be a replica of a military base were published to mark the event.

Images of Hamas capturing tank crew members

The exercises were reported on in Israel, so it’s inconceivable they were not being closely monitored by the country’s extensive intelligence agencies.

The Israel Defense Forces (IDF) have previously carried out air strikes to disrupt Hamas’s training activities. In April 2023, they bombed the site used for the first Strong Pillar drill.

Weeks before the attacks, female surveillance soldiers near the Gaza border reportedly warned of unusually high drone activity and that Hamas was training to take over observation posts with replicas of their positions.

But, according to reports in the Israeli media, they say they were ignored. Brigadier General Amir Avivi, a former IDF deputy commander in Gaza, told the BBC: “There was a lot of intelligence that they were doing this training – after all, the videos are public, and this was happening just hundreds of metres from the fence (with Israel).”

But he said while the military knew about the drills, they “didn’t see what they were training for”.

The IDF said they “eliminated” Nofal on 17 October 2023, the first senior Hamas military leader to be killed during the conflict.

Images of Hamas taking hostages

Hiding in plain sight

Hamas went to great lengths to make sure the drills were realistic.

In 2022, fighters practised storming a mock Israeli military base built just 2.6km (1.6 miles) from the Erez crossing, a route between Gaza and Israel controlled by the IDF.

BBC Verify has pinpointed the site in the far north of Gaza, just 800m (0.5 miles) from the barrier, by matching geographic features seen in the training footage to aerial images of the area. As of November 2023, the site was still visible on Bing Maps.

The training camp was within 1.6km (1 mile) of an Israeli observation tower and an elevated observation box, elements in a security barrier Israel has spent hundreds of millions of dollars constructing.

Map showing the location of a Hamas training site

The mock base is on land dug several metres below ground level, so it may not have been immediately visible to any nearby Israeli patrols – but the smoke rising from the explosions surely would have been, and the IDF is known to use aerial surveillance.

Hamas used this site to practise storming buildings, taking hostages at gunpoint and destroying security barriers.

BBC Verify has used publicly available information – including satellite imagery – to locate 14 training sites at nine different locations across Gaza.

They even trained twice at a site less than 1.6 km (1 mile) from the United Nations’ aid agency distribution centre, and which was visible in the background of an official video published by the agency in December 2022.

Map showing 14 training sites in Gaza

Land, sea and air

On 10 September 2023, the so-called joint committee room published images on its dedicated Telegram channel of men in military uniforms carrying out surveillance of military installations along the Gaza barrier.

Two days later, the fourth Strong Pillar military exercise was staged, and by 7 October, all the tactics that would be deployed in the unprecedented attack had been rehearsed.

Fighters were filmed riding in the same type of white Toyota pickup trucks which were seen roaming through southern Israel the following month.

The propaganda video shows gunmen raiding mock buildings and firing at dummy targets inside, as well as training to storm a beach using a boat and underwater divers. Israel has said it repelled attempted Hamas boat landings on its shores on 7 October.

Palestinian fighters training
The fourth and final Strong Pillar drill saw fighters training on raiding buildings (pic BBC)

However, Hamas did not publicise its training with motorcycles and paragliders as part of the Strong Pillar propaganda.

A training video posted by Hamas three days after 7 October shows fences and barriers being demolished to allow motorcycles to pass through, a tactic they used to reach communities in southern Israel. We have not identified similar earlier videos.

Footage of fighters using paragliding equipment was also not published until the 7 October attack was under way.

In a training video shared on the day of the attack, gunmen are seen landing in a mock kibbutz at an airstrip we have located to a site north of Rafah in southern Gaza.

BBC Verify established it was recorded some time before 25 August 2022, and was stored in a computer file titled Eagle Squadron, the name Hamas uses for its aerial division – suggesting the paragliders plan was in the works for over a year.

Images of Hamas using motorcycles

The element of surprise

Before 7 October, Hamas was thought to have about 30,000 fighters in the Gaza Strip, according to reports quoting IDF commanders. It was also thought that Hamas could draw on several thousands of fighters from smaller groups.

Hamas is by far the most powerful of the Palestinian armed groups, even without the support of other factions – suggesting its interest in galvanising the factions was driven by an attempt to secure broad support within Gaza at least as much as bolstering its own numbers.

The IDF has previously estimated 1,500 fighters joined the 7 October raids. The Times of Israel reported earlier this month the IDF now believes the number was closer to 3,000.

Whatever the true number, it means only a relatively small fraction of the total number of armed operatives in Gaza took part. It is not possible to verify precise numbers for how many fighters from smaller groups took part in the attack or the Strong Pillar drills.

While Hamas was building cross-faction support in the build-up to the attack, Hisham Jaber, a former Brigadier General in the Lebanese army who is now a security analyst at the Middle East Centre for Studies and Research, said he believed only Hamas was aware of the ultimate plan, and it was “probable they]asked other factions to join on the day”.

Andreas Krieg, a senior lecturer in security studies at Kings College London, told the BBC: “While there was centralised planning, execution was de-centralised, with each squad operationalising the plan as they saw fit.”

He said he had spoken to people inside Hamas who were surprised by the weakness of Israel’s defences, and assessed militants likely bypassed Israel’s surveillance technology by communicating offline.

Hugh Lovatt, a Middle East analyst at the European Council on Foreign Relations, said Israel would have been aware of the joint training drills but “reached the wrong conclusion”, assessing they amounted to the “standard” activity of paramilitary groups in the Palestinian territories, rather than being “indicative of a looming large-scale attack”.

Asked about the issues raised in this article, the Israel Defense Forces said it was “currently focused on eliminating the threat from the terrorist organisation Hamas” and questions about any potential failures “will be looked into in a later stage”.

It could be several years until Israel formally reckons with whether it missed opportunities to prevent the 7 October massacre. The ramifications for its military, intelligence services and government could be seismic.

(BBC)

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