Bilal Irfan is a global health justice advocate, bioethicist and researcher. A graduate of the University of Michigan, he completed his Master of Science in Bioethics at Harvard Medical School in May 2025. He independently conducts research on a wide variety of health issues with public health experts, clinicians and researchers from around the world. The views expressed in this piece do not necessarily represent the views, decisions or policies of the institutions with which he is or has been affiliated.
Irfan has published extensively on the healthcare consequences of the Gaza genocide, producing dozens of peer-reviewed papers in collaboration with Palestinian physicians, nurses and medical students across East Jerusalem, the West Bank and Gaza. His published research spans orthopedic trauma, craniofacial and ear, nose and throat injuries, maternal and neonatal health, infectious disease, Alzheimer’s disease and dementia care, the ethics of medical documentation under bombardment, pediatric medical evacuations and the political determinants of health system destruction.
Among his most cited works is a Lancet correspondence, “Will there be a future for newborns in Gaza?” (2024). His paper “People-Centered Accountability amid the Gaza Genocide,” published in Health and Human Rights (2025), examines the roles of Doctors Against Genocide, Healthcare Workers Watch and the Freedom Flotilla Coalition in enforcing the right to health under international law. He has also published on the political economy of Gaza’s health system destruction in the International Journal of Health Planning and Management (2026) and has co-authored work on the ethics of journalism and healthcare in conflict zones published in the WHO’s Eastern Mediterranean Health Journal.
Irfan has participated directly in medical missions to Palestine and Pakistan and continues to engage with health systems across the Eastern Mediterranean region and South Asia. He is among a small number of researchers who have continued to document the medical realities of the Gaza genocide in real time, maintaining contact with healthcare workers on the ground through the destruction of the health infrastructure they are embedded in.
The World Socialist Web Site spoke with Bilal Irfan, amid an accelerating regional catastrophe that has transformed the Middle East since our previous interviews in November 2024 and June 2025. This interview, conducted on April 26, 2026, was edited for brevity and clarity.
Benjamin Mateus (BM): Last time we spoke it was May 2025, a little more than one year ago. The world has been transformed. We have a full-scale US-Israeli war on Iran, Lebanon under bombardment, the Gaza death toll now confirmed at approximately 72,500—I think it is higher, but that is a conservative figure—and the West Bank now under accelerating attack and annexation. What are you hearing from physicians and healthcare workers you remain in contact with on the ground?
Bilal Irfan (BI): People are still being killed almost every week. There are people being massacred. And what we’ve seen now—from on-the-ground reports as well as international media—is that the so-called yellow line, which was supposed to encompass approximately 53 percent of Gaza, has been steadily and incrementally expanding in some sectors.
It’s not marked clearly. A lot of people who thought their houses were quite far away from the supposed line find themselves incrementally closer to it. So, some people are not sending their children out in the streets—often not even to school—because of the risk of being shot. We now see so many testimonies from Israeli soldiers about shooting unarmed people crossing arbitrary, often undelineated lines.
Sometimes the existence of such lines is justified by the Israeli military as stemming from an operational necessity. In fact, delineating such a line on the ground, often through destroying homes and physical infrastructure, is even sometimes pervasively presented in humanitarian terms to minimize civilian casualties. This can serve to further entrench the annexation of those lands. There are some parallels to what has been done with the apartheid wall in the occupied West Bank, which the International Court of Justice ruled illegal, and which has slowly absorbed more settlement blocks and further bifurcated and cut off Palestinians from their own land.
Operation Epic Fury and Iran
BM: The US and Israel launched Operation Epic Fury against Iran on February 28. What was your immediate reaction, and what were you hearing from contacts in that region?
BI: In some ways it was shocking, and in some ways it wasn’t. We know that the United States and Israel have a long history of conducting illegal invasions and attacking countries in violation of international law. There was no authorization by the UN to utilize such force. And some commentators have even noted how it is a breach of even some of the norms of modern armed conflict—going after heads of state, attacking the civilian and political and military leadership of a country, assassinating them. That is not to say it hasn’t been done previously; it’s become somewhat routine. That’s part of what Israel and the United States have normalized. Israel has attempted to assassinate diplomats in other countries in the middle of negotiations. Right after the Omani foreign minister was speaking about a potential breakthrough in negotiations between Iran and the United States, we see the US and Israel launch this illegal assault.
We’ve also seen the goalposts shift as to what the US is allegedly seeking to achieve. What members of the American government were talking about in January versus February versus after they launched this war has changed, in some ways because previous plans were realized to be unrealistic and unachievable after seeing the aftermath of US military attacks and Iran’s retaliation. One of the most difficult things in terms of understanding the situation on the ground is the lack of telecommunications access with Iranian healthcare providers. What we hear are fragmented reports, often from the Iranian diaspora in the UK or the US who have relatives there and relationships with people in health institutions who can pass something along.
What is clear is that some of what is occurring right now is a continuation of the long-proven intent of attacking healthcare infrastructure—i.e. decimating a health system to make life unlivable. Some of the same language used during the genocide in Gaza is being used here, as well as calls to “liberate” a people from an “oppressive” government. We won’t know the full extent of the devastation until perhaps a lot later. In Iran, as of late March 2026, over 200 medical and humanitarian centers had been reportedly attacked, including at least 13 hospitals put out of service.
BM: By most measures the operation has not achieved any of its stated goals. The regime has survived. The Strait of Hormuz remains closed. US intelligence has said that approximately one-third of Iran’s missile arsenal has been destroyed—meaning they still retain substantial capacity. For someone who studies health policy, the threats being made against a country of 90 million people, attacking infrastructure, water desalination plants, electrical grids, how does this compare to Gaza?
BI: We see the consequences of widespread attacks against civilian infrastructure in the case of Gaza. And in many respects, Iran was already vulnerable. The economic sanctions, even with exemptions for healthcare and essential needs, have resulted in soaring prices for essential drugs, and often result in overcompliance by third parties and banks. Sanctions have also been associated with reduced life expectancy in Iran. Lancet Global Health published a study just days ago on the different causes of death and life expectancy in Iran, based on data from before the current war.
When you couple that pre-existing fragility with what we’ve now seen, obliterated health systems, attacked hospitals, attacked universities, part of the goal is also to make it more difficult to collect data. That’s what they’ve done quite successfully in Gaza: cast a wide net of claiming the data is inaccurate or false, partly because they’ve devastated the healthcare infrastructure and killed the people who would be the data collectors. They’re trying to do some of the same things in Iran. We are watching the checks and balances of any semblance of international human rights law evaporate right in front of our eyes.
A crime against peace: The historical context
BM: WSWS International Editorial Board Chairman David North recently spoke at Nuremberg, drawing an explicit parallel to the standards established at the Nuremberg trials, calling this attack a “crime against peace.” He argued the US goal is to reestablish control over Iran and the entire Middle East, and that every policy since the 1979 revolution—from sanctions to the Soleimani assassination to the bombardment—has been directed at reversing the strategic defeat the US suffered when the Shah fell. Does that analysis resonate with you?
BI: Obviously there are war crimes being committed, but it is not just about Iran. This can be seen in the broader context of US military action in the region. In Afghanistan, they prosecuted a two-decade-long war; still, the Afghan Taliban came back to power. In Iraq they removed Saddam Hussein but, in its wake, left civil unrest and political turmoil that resulted in further US military involvement. The US was just recently withdrawing some of its last military personnel in Syria, itself partly a consequence of the Iraq war and the rise of ISIS thereafter. With interventions in Yemen, Libya, Egypt and the Gulf states—sometimes through military force, sometimes through propping up US-backed leaders that fall in line with pro-genocide interests, sometimes through supporting governments that host the military bases used to conduct these war crimes—the US has still not been able to achieve a complete hegemony such that Israeli military-led war crimes and crimes against humanity go completely unchecked. The government of Iran presents a specific threat to aspects of that imperialist project.
Many Americans are clearly dissatisfied with this war and the US’s broader entanglement with pro-genocide forces rather than investing in healthcare domestically. Poll after poll shows this. Many people are fed up with the attempts to distract away from pressing needs domestically by committing war crimes and human rights abuses abroad. Much of the propaganda is falling apart.
BM: Popular opposition to these wars is clearly widespread—but the history of the last several years suggests that neither elections nor polling have translated that opposition into a political force capable of stopping them. The Democratic Party, which presented itself as the alternative to Trump, supported the genocide in Gaza and has offered no opposition to the war on Iran.
You have described the US prosecuting wars in Afghanistan, Iraq, Syria, Yemen, Libya and now Iran, and failing strategically in every theater. Yet the policy not only continues but escalates. If the stated objectives—regime change, regional hegemony, the disarmament of adversaries—are not being achieved, what does the continuation of this policy regardless of its failures tell us about what is driving it? Is this a question of strategic miscalculation and political will, or does the compulsion to wage these wars reflect something more fundamental about the system that produces them?
BI: Part of it speaks to the priorities of some members of the American government. Instead of investing in healthcare and strengthening our education system domestically and working on the affordability agenda, many politicians seem to think committing war crimes abroad is more important. There are obviously lobbying groups that specifically work on advocating for a pro-genocide foreign policy.
BM: I think what we are witnessing reflects something deeper than the policy choices of any particular administration. These wars are an expression of a capitalist system in profound crisis—one that turns to military violence abroad precisely when it cannot resolve the contradictions accumulating at home. The attack on democratic rights domestically and the wars abroad are not just parallel phenomena; they are expressions of the same process. The working class in the United States, facing the destruction of its living standards, its healthcare, its education, is being asked to pay for wars that serve the interests of a financial and military oligarchy—the same oligarchy that exploits it at home.
With respect to the current war, we probably should go back to 1953 and the CIA-orchestrated overthrow of Iran’s democratically elected prime minister, Mohammad Mosaddegh, who had nationalized Iranian oil; that coup reinstated the Shah. For 26 years the Shah’s regime, sustained by American support and his secret police, the SAVAK, tortured and killed thousands, until a strike by Iranian oil workers broke it in 1979. Given that history, meaning the continuity of the political developments that manifested in the revolution and thereafter, how do Iranians understand what is being done to them now, and how cynical is the claim that this war is being fought for their liberation?
BI: Iranians, like all people, are not a monolith. There are so many different ethnic and religious groups that are residents or citizens of Iran. There are Persians/Farsi, Kurds, Balochs, Azeris, Lurs, Mazandaranis, Gilakis, Arabs, Assyrians, Armenians, among several other groups who have their own lived experiences. Of course, there are people deeply dissatisfied with many policies of the Iranian government, the same way there is widespread dissatisfaction with policies of the American government. There are tens of millions of Americans who would love to see a change of government, to stop its human rights abuses domestically, to stop the assault and intimidation of unarmed protesters, to stop some of the illegal deportations. But they may not support a foreign country coming in and bombing American hospitals or slaughtering American schoolchildren in the name of liberating them. Much of this also holds true in the case of Iran.
It is also important to remember that many of the domestic conditions, including inflation and high prices, are shaped by and a direct consequence of US-led sanctions, which have openly been touted as a tool to make life unlivable for residents. Many US lawmakers, policymakers and think tank figures openly state they know sanctions are hurting civilians. Studies have documented this for years. All of it is thus part of a strategy aimed at weakening the functioning of life in Iran and fomenting domestic unrest.
Reza Pahlavi and the colonial pretender project
BM: Reza Pahlavi, the former Shah’s son, an exile in the United States since he was 18, is now trying to position himself as a possible future leader of Iran. He spoke at CPAC in Texas, urging Trump not to make a deal with Iran. European leaders like German Chancellor Friedrich Merz and pro-Israel outlets have championed him. Trump has been more cautious, calling him “a nice guy.” What do you have to say about the Pahlavi project?
BI: The revolution did not happen out of thin air. The Shah engaged in human rights abuses against his own population and enacted many crackdowns on civil liberties, which is precisely why there was such widespread support for the revolution when it came.
We do have to be careful to not give too much attention to pretenders to thrones who have unclear paths to play a meaningful role in governance, especially anyone who supports or defends war crimes and genocide. Governing tens of millions of people while actively supporting bombing campaigns that hurt them may make it difficult to make an eventual return to a position of power. We need to be mindful of the propaganda project of imperialists and pro-genocide media: Even giving airtime and credence to certain people’s ideas can lend a form of legitimacy in some cases.
But we do see aspects of this pattern historically. Over the last two or three hundred years, bringing in or propping up pretenders to a throne has been a part of colonial projects, especially in countries being actively carved up, where dynastic descendants are propped up to legitimize new claims. So, it is not entirely new to Iran. It is just that currently, when monarchies are increasingly less common, many people are not accustomed to seeing it.
BM: And the class interests that would be served by a US-backed restoration are not incidental to that project—they would be its very content: a comprador government subordinate to Washington and Tel Aviv, serving the same imperialist interests the Shah served. The Iranian working class, which has already paid the price of decades of sanctions and now bears the cost of the bombardment, would face a restored order designed to suppress it.
Lebanon: The second front
BM: I’d like to shift to Lebanon, the other front in this war. Israel opened its Lebanese front on March 2. As of the most recent data, 2,659 people have been killed and 8,183 injured, with over 1.2 million people displaced, approximately one-fifth of the country’s total population. What’s happening?
BI: There are several humanitarian groups conducting medical missions. One thing that is different about Lebanon compared to Gaza is that Beirut’s airport is functional to some degree. Some people have been able to come in and out, and Lebanon’s land border with Syria makes refugee flow and humanitarian medical access somewhat easier.
We also must understand Lebanon’s history and the sociopolitical landscape it operates in. Part of the reason Lebanon is treated differently by international media and European governments compared to Gaza is the deeper ties Lebanese institutions, civil society, cultural groups and academic centers have with European and American counterparts. It is also a full member state of the United Nations, Palestine is also recognized as a state under international law but has been under occupation for much of its existence and has never been able to meaningfully exercise full sovereignty over its territories and borders. Lebanon’s colonial history also plays a role, as France has deep ties to the region.
And we must be frank about the religious dynamic. Israeli leaders and early Zionists, even when they came in as part of a settler colonial project within Mandatory Palestine, were often quite explicit about trying to divide and rule, by elevating certain groups above others and attempting to pit groups against one another. You see the messaging: open calls for ethnic cleansing against Shias in southern Lebanon, while more conciliatory messages are sometimes sent toward Christians or Druze. Israel even sent messaging condemning the attacks on a statue of importance to Christians by its soldiers. One would be hard pressed to find something like that with respect to reprimands for the burning of the Qur’an. This is not to say that Israel does not kill Christians; they have indiscriminately bombed and killed populations in Palestine and Lebanon regardless of faith and have often struck churches. But messaging calling for people of other faiths to expel Shias is part of trying to separate the people of the region from one another to expand the colonial foothold.
It’s also worth noting that while Lebanon and Iran have rightly drawn international attention, Israel has used that shift in focus to continue its human rights violations in Gaza. Many humanitarian medical organizations have been forced to reduce the number of teams they send, which cut down in capacity, due to arbitrary restrictions imposed precisely while much of the world’s media attention is elsewhere.
It is important to also discuss who is bearing the cost of this war in the region. Take the United Arab Emirates (UAE) as an example. South Asian, Southeast Asian and West African migrant workers, living in many cases in systems of severe exploitation through the kafala system, constitute most of the UAE’s population, while Emirati Arabs represent only a small percentage. Much of the country runs on the labor of migrant workers. These workers are now also caught in the crossfire of the UAE’s decision to host imperialist military bases and enable these wars. It is often not the Emirati elites in their palaces, mansions or villas who bear that cost, but rather it is the average worker. That dynamic, where the people who help build a country’s wealth and infrastructure are paying the price of the wars it engages in, runs through many of the themes we’ve discussed.
Gaza, April 2026: The slow suffocation continues
BM: Where do things stand now in Gaza? Research estimates have suggested the true mortality figure may be at least 40 percent higher than the approximately 72,500 confirmed by the Ministry of Health. Life expectancy collapsed by nearly 35 years in the first 12 months of the war, to roughly 40 years of age, equivalent to Gaza in 1900. What does Gaza look like today?
BI: Many people are still being deprived of their education and are unable to leave Gaza. Although we now have fresh graduates from some medical classes in Gaza—a new generation of physicians being born into the healthcare landscape—a lot of talent has been lost. People have been killed en masse. I was talking recently to someone whose research was accepted to be presented at a conference in Europe but can’t attend the talk. The suffocation of life in Gaza continues.
BM: What can you tell us about humanitarian aid and the food situation?
BI: It may not be an IPC Level Five famine in every sector, but there is still substantial food insecurity, and people will carry long-term health consequences because of it. And it is important to remember that the people of Gaza are not monoliths; some live closer to humanitarian aid distribution points, some have more money or relatives, some have more successful fundraising campaigns. The way aid is distributed is very complex and so the health and nutritional status can differ from person to person, family to family, location to location.
With regards to medical supplies (e.g., orthopedic implants, essential surgical tools, basic analgesics), some of it is still in flux of what is or is not being allowed in. And with cancer care specifically: the Turkish Friendship Hospital in Northern Gaza, which provided oncology services, was completely decimated and turned into an Israeli military base. Even the patients who need to evacuate face enormous barriers. It is one thing to keep the corridor open for people to return voluntarily; it is another to force patients back into a place that is largely unlivable when they come out for medical reasons and continue to have recurring healthcare needs.
On maternal and neonatal care: The Al-Helou Maternity Hospital has been providing some care, and there has been some neonatal care at Al-Aqsa Martyrs’ Hospital. But it is quite limited. I’ve spoken to neonatologists and pediatric critical care intensivists who went to Gaza and have expressed being limited in what they’re able to do because you simply don’t have the basic supplies. Patients who do manage to leave—to Jordan, Egypt, Europe, the US, Gulf countries—often face a process requiring Ministry of Health approval, confirmation that care is unavailable in Gaza, a hospital willing to host them, a team of physicians, nurses, lab technicians and other healthcare workers willing to treat them, social workers, an NGO to cover expenses including sometimes years of a child’s education. That is part of the constraint in evacuation when thousands need it, though of course Israel maintains control over who gets in and out and approves such a small amount, and who gets to accompany minors. A lot of family separation happens here. The essential frame must be autonomy: If people want to return, keep that option open; if people need to settle abroad to continue their care, that option must also remain open.
The West Bank: Ethnic cleansing hiding in plain sight
BM: The West Bank has largely disappeared from the headlines, but the numbers are stark. Approximately 1,152 Palestinians killed since October 7, 2023, including 239 children. More than 11,885 injuries. Settler attacks and demolitions at record levels. The OHCHR has raised serious concerns about ethnic cleansing. What’s happening on the ground?
BI: The ethnic cleansing of these people is not a future prospect or something on the horizon; it is happening in front of our eyes. We often hear the phrase said that “this may constitute ethnic cleansing”—as if there is uncertainty. There is no uncertainty. It is ongoing. In many ways it is an ongoing Nakba, as slow-moving, continuous dispossession continues. We see village after village, every month: people displaced, attacked, killed, children shot.
Life has become increasingly restrictive. I know many people who are staying within the parameters of their own city because movement from one part of Area A to another—as checkpoints have increased, sometimes with ad hoc settler checkpoints erected—is extremely difficult. East Jerusalem continues to be cut off from the rest of the occupied West Bank. During Ramadan we saw the Al-Aqsa Mosque largely closed even through the Eid prayers, one of the few times a relatively larger group of people are granted permits to access it. All this changes not just the demographic nature of the territory but the day-to-day reality of life. And increasingly, the discourse of the Iran war and security measures is being used to make more facts on the ground. That’s part of the settlement policy.
Harvard graduate workers’ strike
BM: This week, some 4,000 Harvard graduate workers walked off the job in an indefinite strike. Teaching fellows earning between $18 and $21 an hour at a university with a $53 billion endowment, many qualifying for state food assistance. Harvard responded with an offer of a 2.5 percent annual raise against the documented need for a 74 percent increase just to reach basic pay parity. As a recent Harvard graduate, what does this strike mean to you?
BI: I’ve seen something similar before at the University of Michigan a couple of years ago with a graduate student strike that impacted operations for months. In some ways it’s part of the same pattern: the way these institutions treat their workers, the lack of support, the willingness to police, brutalize and investigate their own students, to invite private contractors to surveil them.
In some ways it is no surprise. When institutions are invested in genocide, when many of the people on their boards benefit materially and socially from genocide, when some staff, leadership or faculty members teach their own children to commit genocide and are themselves committed to the settler colonial project, it is no surprise that many of them then turn around and attack the workers and students most opposed to those policies.
There’s also the class dimension, which needs to be named clearly. Supporting genocide often requires a certain privilege, the time and money not to be caught up in meeting day-to-day basic needs. So, when these institutions deny their workers a livable wage, we must understand that in context. And we must be very careful about institutions hailed for supposedly standing up to attacks on academia that are simultaneously exploiting their own workers and students while maintaining the Palestine exception to free speech. Organizations like the Graduate Employees Organization at the University of Michigan have been at the forefront of anti-apartheid and anti-genocide work for many years, precisely because these causes intersect in ways that those who benefit from separation will always try to obscure.
Class struggle and imperialist war as interconnected crises
BM: These strikers are not just demanding living wages; they’re also asking for protection for international students against ICE deportation and defense of academic freedom. Will Lehman, the rank-and-file auto worker and socialist candidate for UAW president, said in his statement supporting the strike that wages, ICE repression, academic freedom and opposition to war are not separate issues, they are all bound up by the same underlying reality, the deepening crisis of capitalism. Does that framing capture what these workers are living through?
BI: There is some degree of resonation. People have been rounded up for their political speech. We have come to see that the First Amendment is not as strong as many people thought it to be. I’ve published on the intersection of these issues—on how support for health violence and attacks on healthcare abroad can reverberate back home in the policies that become normalized here. Because the US and Israel have in many ways successfully normalized killing healthcare workers abroad, we see some of the repercussions in the attacks on science, academia and healthcare domestically in the US. I’ve also recently published a piece on resisting the drums of war against Venezuela, written before US forces moved against Venezuela, though published thereafter.
BM: Think about the people you’ve described in this interview: the Harvard graduate workers walking picket lines for a living wage; the autoworkers in Michigan whose factories could be converted to weapons production; the South Asian and West African migrant laborers in the Gulf hosting the bases that bomb Iran; the healthcare workers in Gaza continuing to operate under bombardment. These people are connected by the same system—their labor sustains it; their bodies pay the price of its wars. What would it take for them to recognize each other as part of the same struggle, and to act on that recognition in a way that the institutions around them have consistently failed to do?
BI: In many ways, there is a need to shift our gaze to see how we can center the lived experiences of people rather than institutions and corporations. I have a piece that relates somewhat to this—“People-Centered Accountability amid the Gaza Genocide,” published in Health and Human Rights. We analyzed three case studies: Doctors Against Genocide, Healthcare Workers Watch and the Freedom Flotilla Coalition. We need people-centered accountability mechanisms—whether through strikes, civil action or creating new institutional forums—because many of the current institutions have failed. Many of them are set up to benefit a select few.
BM: You have mentioned the ICC, the ICJ, UNRWA, civil society coalitions and the Freedom Flotilla Coalition as mechanisms for accountability. Since October 2023 the ICJ’s provisional orders have been openly defied; the ICC prosecutor has been sanctioned and obstructed; UNRWA has been effectively dismantled; the AMA has refused to name what is happening; and multiple flotillas have been seized in international waters. Given the systematic neutralization of every one of these mechanisms, what is your assessment of what remains? And does the pattern of their neutralization—the fact that it is not one institution but every institution simultaneously—require a different conclusion about the kind of political force capable of confronting this?
BI: In short, it calls for us to reckon with the very premise of how states have been erected, who institutions are built to serve and what is the actual international order we live in at this time. A lot of minds may need to come together to chart a path through this.
BM: Any final thoughts you’d like to share?
BI: I think much of what we’ve spoken about today points to the same fundamental conclusion: The destruction of healthcare infrastructure, the suppression of data, the targeting of journalists and physicians—these are not incidental to these wars. They are increasingly weapons of war and direct aims on it. And until the people who are often most impacted by these policies—working people in the Middle East, in the United States, across the world—recognize that their struggles are connected and build the kind of independent political movement capable of confronting the class that profits from all of this, the devastation may likely continue.
BM: I don’t think that movement that you describe can be built through any of the institutions that have already been captured or neutralized—not the ICC, not the UN, not the Democratic Party, not the trade union bureaucracies that have subordinated workers’ opposition to the political interests of the ruling class. It is critical for the working class to organize itself independently and internationally, across the borders that imperialism uses to divide it.
Thank you, Bilal, for your time and for the extraordinary work you continue to do.