Providing Medical Care During An Ongoing Genocide: A Doctor’s Account From Missions In Gaza

A Letter And A Will

After the initial bombing started in Gaza, I saw organizations posting applications for mission trips into Gaza. It seemed risky, but signing up certainly wasn’t and I hadn’t put much thought into it at that point. The real challenge began when I received the phone call offering me a spot to go. I had donated money, but I felt so helpless as many of us did and still do.

The notice of my acceptance was incredibly inconvenient given that I only had 2-3 weeks’ notice. I would have to reschedule all of my patients that had been booked for surgery. Moving them would be a big challenge given that patients often plan their lives around surgery. But I realized that the need was more pressing in Gaza. What was my inconvenience compared to what was happening there? So I moved forward, leaving the rest unto Allah .

Once I had decided to move forward, I made sure my assets had beneficiaries listed. I  then wrote a letter to my wife and kids entitled, “In the Event of my Timely Death.” Death has been written for me already and it is never untimely. It comes exactly when it should—whether you’re in a fortified bunker or in the middle of Gaza during a genocide. These aspects comforted me along with the reward provided that Allah would accept. Soon thereafter, I departed to Cairo and entered through the Rafah Crossing.

Providing Care Under A Crippled Medical System

I had stayed at the European Gaza Hospital for two weeks and at that point, there was yet no major incursion into Rafah. Some hospitals had been attacked in Gaza, but thankfully ours was still functioning.

We had three orthopedic surgeons in our group and we did around forty surgeries collectively. The local team worked with us on a rotating basis. We had other specialties present as well in our group of 20 or so doctors.

The types of injuries were quite complex—ones that would be challenging to treat even in the U.S. at a tertiary medical center. There were large soft tissue defects that accompanied the injuries. These would require multiple surgeries and eventual coverage with tissue transfer (flaps, skin grafts, etc.) done by plastic surgery. During this trip, the resources were somewhat limited, but we were able to operate and do a significant number of cases across our whole team.

There were two types of patients that we had seen. First those with acute injuries that had just happened (gunshot wounds, drone strikes, bombings, etc.). Second,  a much larger group with chronic injuries that never healed properly (eg. fracture nonunions, infections, malalignment, etc.) from weeks to months before we arrived. We also saw diseases that were unrelated to the war such as congenital abnormalities and tumors.

The medical system was significantly burdened as a result of a loss of manpower as physicians/nurses and other medical personnel had to look after their families. The pathology department was nonexistent. This meant that any tissue that needed analysis was placed into a container and instructions were given to cross into Egypt under a medical exemption for a diagnosis. The medical system was crippled, but it still provided care—albeit in a limited capacity. This, unfortunately, worsened substantially during my second trip—five months later in July.

My Second Medical Mission – Shuhada Al-Aqsa Hospital

Shuhada Al-Aqsa Hospital

The European Gaza Hospital had been evacuated and was too damaged to be reopened by the time I got back into Gaza. I had seen pictures of it from the locals and it was completely empty. When I had gone in February, there were 30,000 people living in and around the hospital. The hallways were filled with patients and families in makeshift tents that were made from bedsheets. The stairways had entire families living on the landing where it changed direction between the floors.

Now, I was at Shuhada Al-Aqsa Hospital which was much smaller comparatively and was located in Deir-al-Balah. It was one of two hospitals that was providing care for the nearly 1.2 million people in the southern part of the Gaza Strip. It was in a “safe zone”, but still managed to get bombed in its courtyard once when I was there, and three other times soon after I left. There was a stark contrast between my experience across these two hospitals over the five months I had been away.

After reaching Al-Aqsa Hospital, I noticed that they were only doing emergent surgical procedures. The lack of surgical drapes and gowns in the hospital brought the operating room to a halt. The hospital was well staffed from a physician standpoint due to consolidation from the closure of other hospitals. Unless someone was on the verge of dying from a brain injury or had a penetrating abdominal injury, no surgery was being performed – not even for problems that were not truly elective and needed surgery on a semi-urgent basis. This was causing excess patient morbidity and even mortality.

A Medical System On The Edge Of Collapse

Despite these shortages, the bombings continued and the medical system was showing signs of a complete collapse. The ER had no functioning CT scanner and patients were being sent to a smaller hospital for the scan only to return for their surgery. There was a large delay as a result and surgery was being put off even in cases where it needed to be done urgently. It was heartbreaking to know that patients were dying not just from the bombs and drones, but also from preventable causes related the the inadequacy of the medical system. There was nothing we could do to change this.

These problems extended to the ER as well since patients were brought in and set on the floor during the bombings. There was a large crowd of patients and bystanders that made it difficult to administer care due to the sheer traffic. We typically triage patients according to the severity of their injuries but this was not possible. Instead, people were tended to in a random disorderly fashion after being incompletely evaluated.

Saveable Limbs And Preventable Deaths

I remember a case regarding a 21-year-old male with a shrapnel injury to his knee. Given that he was breathing and alert, he was tended to minimally but was later discovered to have a vascular injury that was missed. By the time he underwent repair, his leg muscles had died. He needed an amputation above his knee for a completely preventable cause.

There was another case regarding a 4-year-old girl. She had a brain injury that led to a hemorrhage that needed urgent surgical decompression. By the time she underwent surgery, she unfortunately had fixed and dilated pupils with no brainstem reflexes indicating brain death. She was removed from the ventilator and died soon after. Although she may have never had complete neurologic recovery with urgent surgery, her age would have allowed a significantly better prognosis had the intervention been much sooner.

If these were just a small sample of cases I saw in just two weeks, how many others were impacted who could have been saved had the system not collapsed? Even if surgery was done promptly and was successful, infection was another dangerous obstacle to clear for recovery. This was related to poor sterility during surgery (inadequate drapes/gowns) as well as patient malnutrition.

Malnutrition Leads To Wounds Unhealed

Gazans have been deprived over the past ten months in their diet and this reflects on their nutritional state. Healing from complex injuries requires protein which usually comes from meat. Many people haven’t eaten meat for months and their diet often consists of rice alone. Wounds as a result get infected and this leads to re-operations, sepsis (systemic infections), and even death.

Infections usually begin from bacteria that can seed the wound from the initial injury, but they can also happen during the surgery. Since the surgical drapes are very few, the instruments get contaminated during the operation, which increases the likelihood of infection. The burden of this genocide extends to all aspects of the medical system, starting from patients’ arrival at the ER, to when they are undergoing treatment, to when they are healing from their injury or surgery. Even when they successfully heal from their injuries, patients tend to stay in the hospital since they feel it’s the safest place to be.

Destruction Suggestive Of A Post-Apocalyptic Event

The most striking difference outside of the hospital was the extent of the destruction. When I had gone before, Rafah was safe for the most part. The degree of devastation now was suggestive of a post-apocalyptic event such as nuclear war. There was not a single building it seemed that was free from having been bombed, shelled, or riddled with bullet holes. This was in stark contrast to how it looked back in February when I last visited.

People are living in tents with temperatures well into the 90s. Hygiene has suffered tremendously and disease is widespread. Entire multi-generational families are living in these tents, so there’s no privacy. Women are unable to get any relief from the heat while they are fully covered up in religious garb (hijab, niqab, etc.). In addition to the heat-related injuries, we are seeing the polio virus in the sewage around the tents and have had a confirmed case in a 10-month-old child. Gaza has collapsed as a result of this genocide and will need to be rebuilt from the ground up across all sectors of society including the medical system.

What Excuse Will We Have?

As we work towards a ceasefire, it is important to keep our hopes up. Let us also continue putting pressure on the government in order to accomplish this. Our brothers and sisters in Palestine have endured 10 months of genocide and they haven’t given up. They are solely reliant on Allah . Will we give up on them simply because it seems futile? If we had been in their position, would we want the world to give up on us?

When we stand before Allah , what excuse will we have? How will we justify enjoying our lives in the comfort of our homes, while others suffer?  We each have to do something—no matter how small—to help the cause. This help is for now to get a ceasefire, and inshallah, afterward to support the orphans, widows, and injured. There will be plenty of work and we can’t forget them since we are all part of the same body as taught to us by our beloved Prophet Muhammad .

Related:

Podcast [Man2Man]: From The Frontlines Of Gaza | Dr. Jawad Khan And Omar Sabha

Prophetic Lessons From The Muslim Men In Gaza