In medicine, silence is never neutral—it has consequences. Doctors exist on the side of life, against death and suffering; that is the premise our profession is built on. Yet history shows the profession has often been timid, at times aligning with power rather than justice. Atrocities such as genocide and state repression are not inevitable; they persist through inaction and a lack of moral courage.

Within days of October 7, 2023, Gaza’s healthcare system was rapidly devastated—hospitals destroyed, physicians killed or detained. These are direct assaults on the core principles of medicine, yet the U.S. physician community’s response has moved along a spectrum from silence to open intimidation. Physicians who spoke up faced suspension, censure, or job loss—one pediatrician was stripped of a national leadership role for urging her own academy to address the deaths of Gaza’s children. Even trainees were not spared: medical students’ names quietly circulated among the same program directors reviewing their residency applications. Editors faced similar pressure—Scientific American retracted a Palestinian-solidarity piece despite finding no factual errors—and when Gaza is written about at all, the silence often persists in another form: framing that never asks why its health system collapsed in the first place.

This silence—and the intimidation that enforces it—demands scrutiny not only in Gaza but in Pakistan. The two are geographically distinct, and in Pakistan the perpetrator is the state itself rather than a foreign power, yet the muted, conflicted response from the medical community remains strikingly similar. Many Pakistani physician social media groups have reached the same conclusion: that Pakistan itself is too political or divisive a subject to raise. APPNA, the leading U.S.-based physician organization of Pakistani descent, met the November 2024 Islamabad killings with an equivocal “both-sides” statement that diluted accountability and bordered on victim-blaming—prioritizing performative neutrality over moral clarity rather than condemning force against unarmed protesters. Now, as its annual convention season returns, APPNA remains mired in........

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