When Gaza Is Named, the AMA Generalizes. Its Ukraine Policy Stays Specific.

The viral claim that the American Medical Association has been completely silent about Gaza is wrong. The AMA has spoken about Israel, Gaza, medical neutrality and the protection of health workers.

The harder story is what happens when AMA delegates are asked to name Gaza, Palestine, or a particular detained Palestinian physician.

Across multiple House of Delegates proceedings, the record shows Gaza- and Palestine-specific proposals being broadened, softened or referred amid explicit concerns about political bias, geopolitics and "singling out Gaza." At the same time, the AMA continues to maintain a policy specifically supporting humanitarian and medical aid to Ukraine, and another specifically protecting the Israeli Medical Association from expulsion from the World Medical Association.

That does not prove that every delegate who supported those outcomes was motivated by anti-Palestinian bias. It does something more useful: it creates a documented consistency problem that the AMA should be required to explain.

And one alleged email now circulating on social media makes that institutional question considerably more uncomfortable.

A screenshot presented in an Instagram video by ENT surgeon Dr. Angela Tsai purports to show South Carolina physician Gary A. Delaney responding to a fellow physician’s appeal concerning detained Palestinian doctor Hussam Abu Safiya with the words: "You are annoying. Get a life."

That email has not been independently authenticated by sherafy.com, and we have not found a public confirmation or denial from Delaney, the South Carolina Medical Association or the AMA. It should therefore be treated as an allegation, not as established fact.

But Delaney is not an irrelevant name. The South Carolina Medical Association currently identifies Gary A. Delaney, MD, as chair of its AMA delegation, while the SCMA Members Insurance Trust describes him as a current AMA delegate and former SCMA president.

If the email is authentic, sherafy.com believes Delaney should resign those representative leadership roles.

Not because physicians must share one political view about Israel and Palestine. They do not. Not because disagreement with an advocacy request is unethical by itself. It is not.

But a physician entrusted to represent other physicians before organized medicine should be capable of responding to a colleague asking for help for an imprisoned doctor without contemptuous dismissal. If "You are annoying. Get a life" is an authentic response from the chair of a state AMA delegation to such an appeal, the issue is no longer merely bad manners. It is whether that person should continue speaking on behalf of other physicians.

More importantly, however, one alleged email is not the strongest evidence in this story.

The strongest evidence comes from the AMA itself.

What the AMA’s own record shows

The relevant question is therefore not whether the AMA possesses universal humanitarian principles. It plainly does.

The question is when the AMA believes specificity is acceptable, and why that threshold appears to change depending on which conflict is being named.

First, correct the viral claim: the AMA has spoken about Gaza

Accuracy matters most when an institution is being criticized.

In November 2023, the AMA Board of Trustees issued a statement saying medical neutrality must be observed, physicians and other health professionals must be able to administer care, and humanitarian aid and medical supplies should reach people facing humanitarian crisis.

In 2024, the AMA House of Delegates adopted policy saying the association supported "peace in Israel and Palestine" to protect civilian lives and healthcare personnel and supported healthcare and humanitarian workers in areas of armed conflict. The official 2024 resolutions record confirms that action.

So the claim that the AMA has said literally nothing is incorrect.

But correcting that claim does not clear the AMA. It sharpens the scrutiny.

If the association already recognizes medical neutrality as a universal principle, the question becomes why naming the place where that principle is allegedly being violated repeatedly becomes controversial.

Resolution 615: watch the word "Gaza" disappear

The clearest example came at the AMA’s 2026 Annual Meeting.

Resolution 615 entered the process under the title "Condemnation of Attacks on Healthcare Workers and Facilities in Gaza." According to the AMA’s own annotated Reference Committee F report, the proposed resolution called on the AMA to recognize the deliberate targeting of healthcare workers, medical students and healthcare facilities in Gaza as a violation of medical neutrality and AMA policy. The AMA labels that annotated report a preliminary record pending the eventual official proceedings, but it separately records the House action on Resolution 615 as "adopted as amended."

It also called on the AMA to support efforts to protect, release and provide restitution to detained healthcare workers in Gaza.

The final House action looked different.

There is nothing inherently wrong with universalizing a principle. Medical neutrality should apply everywhere.

But the committee’s explanation matters.

The AMA report says testimony was mixed and specifically records concerns about "political bias" and "singling out Gaza." It then says the amendment addressed those concerns by extending the condemnation to all conflict areas and removing the Gaza-specific effort.

That is not an accusation made by activists outside the AMA. It is the AMA’s own written account of its policymaking process.

The obvious question is uncomfortable but unavoidable:

Was the objection to the medical principle, or to applying that principle specifically to Gaza?

The AMA should answer that directly.

In another 2026 resolution, "Israel and Palestine" became "the world"

Resolution 602 provides another example.

The proposed language would have said the AMA supports "peace in Israel and Palestine" in order to protect civilian lives and healthcare personnel.

The final 2026 committee report records the adopted language instead as:

"Our American Medical Association supports peace in the world in order to protect civilian lives and healthcare personnel."

Again, "peace in the world" is not objectionable. It is also considerably less specific than "peace in Israel and Palestine."

The question is why specificity keeps becoming the part that must be removed.

A universal principle is meaningful because it can be applied to particular cases. If the institution becomes most comfortable only after the particular case disappears into universal language, the public is entitled to ask what the universal principle actually requires when a real conflict, government or detained physician has a name.

This pattern did not begin in 2026

The same tension appeared at the 2024 Annual Meeting.

Resolution 603 proposed that the AMA support a ceasefire in Israel and Palestine to protect civilians and healthcare personnel. Resolution 610 proposed opposition to collective punishment, including restrictions on food, water, electricity and healthcare as tools of war, and included language concerning Gaza and U.S. resources.

The AMA did not adopt either proposal as written.

Instead, delegates adopted an alternate resolution supporting "peace in Israel and Palestine", protecting healthcare and humanitarian workers in all armed conflicts, and reaffirming the AMA’s general war-crimes policy. The AMA’s 2024 annotated committee report records the debate.

That report is especially revealing because proponents explicitly pointed to the AMA’s own treatment of Ukraine. They noted that the AMA had published an article calling for a ceasefire there.

Opponents, meanwhile, argued that the Israel-Palestine issue was beyond the AMA’s proper purview, that the association should not engage in geopolitical issues, and that doing so could divide the membership and distract from core concerns.

Those arguments are legitimate subjects for debate.

But they collide with a basic factual problem: the AMA has engaged in geopolitical specificity elsewhere.

The Ukraine comparison is not rhetorical. It is written into AMA policy.

The strongest comparison is not a speech, social-media post or accusation of hypocrisy.

It is a current AMA policy called "Humanitarian and Medical Aid Support to Ukraine," D-65.984.

That policy does not say "all people affected by conflict."

It specifically directs the AMA to advocate for continuous support of organizations providing humanitarian missions and medical care to Ukrainian refugees in Ukraine, neighboring countries and the United States. It also specifically addresses war trauma and mental-health needs among Ukrainian refugees.

The policy was last modified in 2024 and remains in the AMA Policy Finder.

Now compare it with Resolution 616 from 2026.

Resolution 616 was titled "Humanitarian and Medical Aid Support to Palestine." It proposed that the AMA:

• support efforts to contribute funds for the humanitarian crisis in Gaza;
• advocate for organizations providing humanitarian missions and medical care to Palestinian refugees; and
• advocate for early mental-health measures addressing war-related trauma among Palestinian refugees.

Those provisions are strikingly similar in structure to the existing Ukraine policy.

The AMA’s own committee report says several people who testified recommended generalizing humanitarian principles to all populations affected by armed conflict rather than adopting conflict-specific resolutions.

Then comes the sentence the AMA needs to explain:

"Since current Policy D-65.984, ‘Humanitarian and Medical Aid Support to Ukraine,’ is not under consideration at this time…"

Resolution 616 was referred for a report back rather than adopted.

Referral is not rejection, and it would be inaccurate to present it as one. The AMA may ultimately produce broader policy that encompasses Palestinians and others affected by war.

But the present record remains stark:

When Palestine-specific aid was proposed, the committee favored moving toward universalized policy. The existing Ukraine-specific policy remained untouched.

If conflict-specific humanitarian policy is undesirable as a matter of principle, why is the Ukraine policy still conflict-specific?

If conflict-specific policy is sometimes appropriate, what makes Ukraine appropriate and Palestine different?

Those are not rhetorical tricks. They are questions created by the AMA’s own policy book.

The AMA has also shown that it can name an aggressor

Another possible defense is that a medical association should not identify governments, aggressors or military conduct because doing so risks politicizing medicine.

The AMA’s own Ukraine record makes that explanation difficult to sustain as a general rule.

In an April 2022 column published on the AMA website, then-AMA President Gerald Harmon described Russia’s invasion as an "unprovoked attack by the Russian military" and referred repeatedly to "Russia’s aggression." He wrote that the AMA was outraged by the Russian military’s assault and joined the World Medical Association and other partners in calling for an immediate ceasefire and an end to attacks on healthcare workers and facilities.

The point is not that the AMA was wrong to speak clearly about Ukraine.

The point is that it did speak clearly.

That record rules out the claim that geographic specificity or naming a belligerent is inherently outside the AMA’s conception of its medical mission.

The institution has already decided that there are circumstances in which medicine, humanitarian protection and explicit geopolitical language can coexist.

The unresolved question is what standard determines those circumstances.

Meanwhile, an Israel-specific AMA policy remains in place

The asymmetry becomes harder to ignore when Resolution 617 is added to the record.

For years, AMA Policy D-250.990 has said:

"Our AMA will oppose any efforts to expel the Israeli Medical Association from the World Medical Association."

In 2026, the Resident and Fellow Section brought Resolution 617, proposing that the AMA rescind that country-specific policy and replace it with a general rule: decisions about applications, discipline or termination of WMA constituent members should be based on the prevailing evidence at the time.

The full House did not adopt that proposal.

The Reference Committee F report says testimony was largely opposed to rescinding the Israeli Medical Association policy. One concern was that withdrawing the explicit support could be interpreted as endorsing exclusion of the Israeli association because of the Israeli government’s conduct, conflicting with AMA policy against censuring a medical association for government actions.

That is a substantive argument and it should be represented fairly.

But it creates another consistency question.

If the AMA can preserve a policy naming the Israeli Medical Association because the specific institutional circumstances warrant it, why does specificity become a problem when a resolution names Gaza or Palestine?

There may be a coherent answer.

The AMA should provide it.

Put the name back into the policy: Dr. Hussam Abu Safiya

Institutional language becomes easier to generalize when the people affected become abstractions.

Dr. Hussam Abu Safiya is not an abstraction.

He was director of Kamal Adwan Hospital in northern Gaza and has been detained by Israel since December 27, 2024.

The central facts need to be stated carefully.

Israel has alleged that Abu Safiya has links to Hamas and has investigated him on that basis. Those allegations are serious. They also have not, according to the latest public reporting reviewed for this article, resulted in a formal criminal charge or criminal trial.

In July 2026, the Associated Press reported that Abu Safiya remained detained without charge, while Israeli authorities maintained that he was being investigated for alleged Hamas ties. His lawyers and Physicians for Human Rights Israel alleged serious deterioration in his condition and mistreatment; the Israel Prison Service denied allegations of abuse and said detainees were treated according to applicable legal and health standards.

The distinction matters.

This article does not need to declare Abu Safiya innocent, nor should it pretend allegations against him do not exist.

The relevant question for organized medicine is more basic: what does medical neutrality require when a physician has been detained for an extended period without formal charge or trial?

The World Medical Association has already answered that question much more specifically than the AMA has.

In November 2025, the WMA called on Israel to guarantee due process and fair-trial rights for Abu Safiya and said that, in the absence of charges and due process, he and similarly situated health workers should be released immediately and unconditionally.

In July 2026, the WMA renewed its appeal directly to Israeli Prime Minister Benjamin Netanyahu, saying Abu Safiya had remained detained without formal charge and expressing grave concern over reports about his health and treatment. The WMA also said its prior appeals had received no response.

On October 6, as the World Medical Association prepared to convene in Rotterdam, Doctors Without Borders again urged WMA members to press for the release of detained Palestinian medical workers. MSF is an advocacy and humanitarian organization, so its allegations should not be treated as neutral adjudicated findings. But its intervention makes the present timing impossible to dismiss as merely historical.

The question for the AMA is therefore remarkably simple:

Does the AMA’s adopted policy supporting efforts to protect and release detained noncombatant healthcare workers in all areas of conflict apply to Dr. Hussam Abu Safiya?

If the answer is yes, what has the AMA done under that policy?

If the answer is no, what factual or policy determination excludes him?

The AMA cannot simply outsource the issue to the World Medical Association

The AMA might reasonably argue that international medical issues are principally handled through the WMA.

But the AMA itself describes the WMA as its "primary vehicle for participation in international issues".

That makes the WMA connection more relevant, not less.

The current WMA leadership roster lists three council members representing the American Medical Association: Jack Resneck Jr., Willie Underwood and Bobby Mukkamala. Resneck is the chair of the WMA Council.

The WMA’s 77th General Assembly is scheduled for October 7-10, 2026, in Rotterdam, according to the World Medical Journal’s 2026 meeting information.

So this is not an abstract question about what somebody should have done two years ago.

AMA representatives are participating in the international medical body that has already demanded due process or release for Abu Safiya and other detained physicians.

The public is entitled to know what position those representatives are taking into that meeting.

The alleged Delaney email is not "the AMA’s response" unless evidence establishes that

The viral video that prompted this investigation describes the alleged email as an AMA response.

The evidence currently available does not justify that characterization.

What can be verified is that Gary A. Delaney holds significant organized-medicine roles. The SCMA lists him as a District 12 trustee and chair of its AMA delegation. The SCMA Members Insurance Trust describes him as its chief medical officer and a current AMA delegate.

What cannot yet be independently verified is whether Delaney actually sent the email shown in the reel, whether the screenshot preserves the complete context, or whether any response was made in an official AMA or SCMA capacity.

Those distinctions are not technicalities. They are the difference between investigation and accusation.

The email should be authenticated through the original message, headers, complete thread or direct confirmation from the sender or recipient before it is reported as established fact.

But if it is authentic, the appropriate standard is not complicated.

If Delaney sent it, he should resign his representative roles

The AMA Principles of Medical Ethics state that physicians should provide care with compassion and respect for human dignity and rights, uphold professional standards, act honestly in professional interactions and respect the rights of colleagues and other health professionals.

The AMA’s chapter on professional self-regulation also emphasizes that medicine is permitted to set professional standards in part because it is expected to hold physicians accountable when those standards lapse.

None of that means every rude email is a licensure issue. It is not.

And sherafy.com is not calling for Delaney to lose his medical license on the basis of an alleged insulting email.

The issue is representation.

If Delaney sent "You are annoying. Get a life" to a fellow physician who was asking organized medicine to advocate for an imprisoned colleague, sherafy.com believes he should step down as chair of the SCMA AMA delegation and from any comparable representative leadership role.

He would remain free to disagree with the request. He would remain free to defend Israel’s detention policy. He would remain free to argue that the AMA should not intervene.

What he should not be entitled to demand is the privilege of representing other physicians while treating a colleague’s appeal about another doctor’s prolonged detention with contempt.

Leadership is not a right. It is a position of trust.

If the screenshot is false or materially misleading, Delaney deserves to have that said just as prominently.

If it is authentic, organized medicine should not pretend the only available response is another generic statement about professionalism.

This is a private association with public power

The AMA is not a government agency, and it would be inaccurate to describe the organization as generally "taxpayer-funded."

But it is equally inaccurate to pretend no public money or public infrastructure touches it.

In a 2026 report, the AMA disclosed $2.356 million in government funding received during 2025, principally through three Centers for Disease Control and Prevention projects plus a smaller Substance Abuse and Mental Health Services Administration-related subcontract. The figure appears in the AMA’s Grants & Donations Received by the AMA report.

The AMA also owns Current Procedural Terminology, or CPT, a privately controlled coding system embedded throughout American healthcare administration. The Centers for Medicare & Medicaid Services uses CPT in Medicare, Medicaid and other CMS programs under an AMA license. Importantly, CMS’s published terms describe the federal government’s license as royalty-free, so it would be wrong to imply that CMS simply pays the AMA royalties every time Medicare uses a CPT code.

None of this means taxpayers own the AMA.

It means the AMA occupies a position of substantial public consequence while receiving some government funding and supplying infrastructure deeply integrated into public healthcare programs.

The association also describes itself as the organization that convenes more than 190 state and specialty societies and represents physicians with a unified voice to key healthcare actors.

An institution that seeks that degree of influence should expect correspondingly serious scrutiny.

Private governance does not erase public accountability.

The real issue is not whether universalism is good. It is whether it is being applied consistently.

There is a respectable argument for universal policy.

Medical neutrality should not depend on nationality. The protection of noncombatant physicians should apply in Ukraine, Gaza, Sudan, Myanmar, Syria and every other conflict. Humanitarian aid should not become a competition among victims.

If that is the AMA’s rule, it is a defensible one.

But a universal rule has to be universal in both directions.

It cannot mean that Palestinian-specific language is generalized because naming one conflict is politically divisive while Ukraine-specific humanitarian policy remains untouched because nobody happened to put it under review.

It cannot mean that "singling out Gaza" is treated as a problem while an Israel-specific institutional protection remains acceptable without a clear explanation of why the situations are materially different.

And it cannot mean that the AMA invokes broad medical-neutrality principles while declining to say whether those principles cover one of the most internationally prominent detained physicians in the world.

The problem is not universality.

The problem is selective universality.

That phrase should not be treated as a verdict about motive. It is a description of the institutional question the AMA’s own records create.

What the evidence proves, and what it does not

A serious criticism should be explicit about its boundaries.

Verified

• The AMA has spoken publicly about Gaza and medical neutrality; claims of complete silence are false.
• In 2026, Resolution 615 entered the process with Gaza-specific language and emerged with language applying to all areas of conflict.
• The committee record explicitly cites concerns about "political bias" and "singling out Gaza."
• A Palestine-specific humanitarian-aid proposal was referred for further work while testimony favored a universal approach.
• The AMA continues to maintain Ukraine-specific humanitarian-aid policy.
• The AMA continues to maintain a policy specifically opposing expulsion of the Israeli Medical Association from the WMA.
• The AMA has previously used explicit country- and aggressor-specific language concerning Russia’s invasion of Ukraine.
• The World Medical Association has repeatedly called for due process or release for Hussam Abu Safiya.
• Gary A. Delaney holds current SCMA roles connected to AMA representation.

Not established by the evidence reviewed

• That every AMA delegate who favored broader language was motivated by hostility toward Palestinians.
• That the AMA as an institution deliberately designed these outcomes to protect Israel.
• That Hussam Abu Safiya is legally innocent of every allegation made by Israeli authorities.
• That the reported allegations of torture or mistreatment have been finally adjudicated.
• That Gary Delaney sent the email attributed to him.
• That, if he sent it, he was speaking officially for the AMA rather than personally.

Those uncertainties do not erase the documented record.

They tell us where responsible criticism should stop and where the AMA’s obligation to answer begins.

Questions the American Medical Association should answer

The AMA does not owe the public a politically convenient answer. It does owe physicians and the public a coherent account of its own standards.

1. Does the AMA’s adopted Resolution 615 apply to Dr. Hussam Abu Safiya?
2. If yes, what action has the AMA taken to support his protection, due process, release or restitution under that policy?
3. Does the AMA support the WMA’s position that detained health professionals should receive prompt fair trials or be released in the absence of formal charges and due process?
4. What position are AMA representatives taking at the October 7-10, 2026 WMA General Assembly concerning detained Palestinian physicians?
5. Why was Gaza-specific language in Resolution 615 replaced after testimony raised concerns about "singling out Gaza"?
6. What rule determines when the AMA uses country-specific policy and when it insists on universal language?
7. Why was Palestine-specific humanitarian-aid policy referred toward broader treatment while D-65.984 remains explicitly Ukraine-specific?
8. Why is a policy specifically concerning the Israeli Medical Association consistent with AMA neutrality while Gaza-specific language prompted objections to geographic specificity?
9. Did Gary A. Delaney send the email attributed to him in the circulating screenshot?
10. If the email is authentic, was Delaney communicating in an AMA or SCMA representative capacity, and do those organizations consider that response compatible with the standards expected of a delegation chair?

These are answerable questions.

If the distinctions are principled, the AMA should be able to articulate the principle.

Medical neutrality only matters when somebody has to apply it

It is easy for an institution to support medical neutrality in the abstract.

The test comes when the physician has a name, the detention has lasted months, the detaining authority has a name, allegations remain unresolved, and taking a specific position may carry institutional consequences.

That is why the story is not simply that the AMA failed to condemn Gaza strongly enough.

The story is more precise and more difficult to dismiss:

The AMA’s own records repeatedly show discomfort with Gaza- and Palestine-specific policy at the same time that the organization maintains Ukraine-specific humanitarian policy, preserves an Israel-specific organizational policy, and has demonstrated elsewhere that it is fully capable of naming a government and military aggressor.

That does not establish motive.

It establishes a discrepancy.

The AMA should explain it.

And if Gary Delaney really responded to a physician’s appeal for an imprisoned colleague with "You are annoying. Get a life," then his case presents the same question at the individual level that the resolutions present at the institutional one:

Are the profession’s stated principles merely language to be affirmed in the abstract, or standards that still mean something when applying them becomes uncomfortable?

For an organization that has spent generations claiming authority over medical professionalism, that should not be a difficult question to answer.

References and Further Reading

AMA primary documents and policy

• Final Report of Reference Committee F, 2026 Annual Meeting — Primary AMA record for Resolutions 602, 615, 616 and 617, including proposed language, House action and summarized testimony concerning Gaza, Palestine, Ukraine and the Israeli Medical Association.
• 2024 Annual Meeting Reference Committee F Annotated Report — Primary record of debate over the Israel-Palestine ceasefire and collective-punishment resolutions, including the explicit Ukraine comparison raised in testimony.
• 2024 Annual Meeting Resolutions — Official resolutions record showing the House action on the 2024 Israel-Palestine proposals.
• AMA Policy D-65.984: Humanitarian and Medical Aid Support to Ukraine — Current conflict-specific AMA policy supporting humanitarian and medical assistance to Ukrainian refugees.
• Statement from the AMA Board of Trustees on Israel and Gaza — Establishes that the AMA has publicly addressed Gaza and medical neutrality, contrary to claims of total silence.
• Targeting civilians and health care in war is unconscionable — 2022 AMA presidential column using explicit Russia- and Ukraine-specific language and calling for an immediate ceasefire.
• AMA’s international involvement — AMA description of the WMA as its primary vehicle for participation in international issues.
• AMA Principles of Medical Ethics — Primary AMA ethics standards concerning compassion, dignity, professionalism and respect for colleagues and other health professionals.
• AMA Code of Medical Ethics: Professional Self-Regulation — AMA guidance on professional accountability, peer review and disciplinary responsibility.
• AMA Grants & Donations Received, year ended December 31, 2025 — Primary AMA disclosure showing $2.356 million in government funding received during 2025.

World Medical Association and Dr. Hussam Abu Safiya

• WMA calls on Israel to ensure fair trial standards for detained Gaza physician — November 2025 WMA demand for due process or, absent charges, release of Abu Safiya and similarly situated health workers.
• WMA July 2026 letter to Israeli Prime Minister Benjamin Netanyahu — Direct WMA appeal describing continued detention without formal charge and requesting due process, humane treatment and release absent formal proceedings.
• WMA leadership and council members — Current roster showing AMA representatives on the WMA Council and Jack Resneck Jr. as Council chair.
• World Medical Journal: 77th WMA General Assembly, Rotterdam — WMA publication confirming the October 7-10, 2026 General Assembly in Rotterdam.
• Associated Press: Lawyer warns detained Palestinian doctor Hussam Abu Safiya is in critical condition — Independent reporting on Abu Safiya’s detention, Israeli allegations, reported health concerns and the Israel Prison Service response.
• MSF appeal ahead of the WMA General Assembly — October 6, 2026 advocacy statement urging WMA members to act on detained Palestinian health workers; useful as evidence of the current pressure campaign, not as neutral proof of contested allegations.

Gary A. Delaney and South Carolina organized medicine

• South Carolina Medical Association leadership — Current SCMA page identifying Gary A. Delaney as a District 12 trustee and chair of the SCMA AMA Delegation.
• SCMA Members Insurance Trust leadership — Current biography identifying Delaney as chief medical officer, former SCMA president and current AMA delegate.

Public-system integration

• CMS license for use of AMA Current Procedural Terminology — Federal terms governing use of AMA-owned CPT in Medicare, Medicaid and other CMS programs.

Editorial currency note: This article reflects records and public information reviewed through October 6, 2026. AMA policy, WMA actions, Dr. Hussam Abu Safiya’s legal status, and any response concerning the Gary Delaney email may change. The article should be updated if new primary records, charges, court rulings, authenticated email records or direct responses become available.