Three Weeks at Gaza European Hospital: A Medical Mission Journal

Week 1: Critical care, anesthesiology, and a crash course in humanity, in the most dire and desperate environment on Earth.

What has been happening to Gaza is unjust. For a long time, I felt that this situation could be solved without any cost to myself. I don’t believe that anymore. So, I came to Gaza on a mission with a humanitarian, non-political, non-governmental organization, because there was an acute need. As a physician, I took an oath to heal the sick and I felt compelled to do what I could. I knew I was entering a war zone — a society that has been thrown into the most desperate situation on Earth. Only, I found out that it was worse than a war zone. It was an all-out attack, financed by the American public and supported by the American military using American weaponry, on an innocent and educated civilian population.

My wife, Ahlia, who is also a critical care physician and anesthesiologist, signed up first. We knew the risk as we left our three young children back home in the United States. We are civilians and medical personnel. Normally, this status would grant us some assurance of safety and protection by international law. This is not the case in Gaza, where schools, hospitals, aid stations, and other internationally protected functions have come under siege by the Israeli military. While in Gaza, my wife and I slept in different locations, so that if an American bomb were to strike, only one of us would be killed. We found out later that this is something Gazan families routinely do. But you cannot let fear paralyze you from doing the right thing. Just because my wife and I have a 5-year-old, a 3-year-old, and a 9-month-old, doesn’t mean we are exempt from our duty to make the sacrifices necessary to stand for what is right. What kind of message does that send to our children: That it is ok to stand up for what you believe to be right and true, but only when it is easy or convenient? True belief requires sacrifice. Many people don’t believe in anything, and I pity them for going through life aimlessly from one distraction to another. But we cannot hide from the fact that what is happening to the people of Gaza is immoral, no matter how you want to spin it. And once you acknowledge this, I believe you are compelled, morally, to act.

DAY 1: SINAI AND RAFAH BORDER

We packed the trucks in Cairo, Egypt, and headed off to the Rafah Crossing, which is at the border between Egypt and Gaza. I slept through most of the Sinai. It was hardly worth a picture, let alone a suitable place to exile Gazan refugees, as had been not-so-quietly discussed by the Israeli government in previous weeks. As we approached the Rafah Border, I prepared myself to enter a war zone. I was on guard, keeping an alert eye on anyone and anything around us. But as American volunteers, we were welcomed by Gazans at the border with water bottles, snacks, and tea. It was a surreal juxtaposition, and not what I was expecting. Wasn’t the United States of America supplying the weaponry to kill these people? Surely they know there are vocal senators in our United States Congress who profess unabashedly that they would be fine with killing all Palestinians in Gaza? Yet, their greeting to us was overwhelmingly genuine and warm, and our journey from the border to our safe house in Rafah, behind supposed “enemy lines,” was as unthreatening as a Sunday drive down an Appalachian Road. The disparity of this was not lost on me, as the tune of John Denver’s “Take Me Home, Country Roads” played in my head, accompanied by the harsh sounds of Israeli drones and American weaponry not far in the distance.

DAY 2: GAZA EUROPEAN HOSPITAL

As an anesthesiologist and critical care physician, I am mostly confined to the emergency room, operating rooms, and intensive care units. So, it is hard to portray the overall situation in Gaza. What I can tell you is that, as I enter the operating theater or the trauma bay, its gray walls are stained as if they are weeping with dried blood and iodine prep. The injuries suffered by the patients we treat suggests that the situation in Gaza is more accurately described as a specifically coordinated military assault on a defenseless, innocent, and educated civilian population. Ballistic targeting is accurate and specific — femoral artery, brachial artery, long bones — resulting in amputations at the ball and socket joints, eliminating the utility of prosthetics. The prevalence of these cases seems to indicate it is by design: it’s the type of injury that’s meant to dishearten and demoralize, so as to break the human spirit. Burns are severe and extensive, particularly on children. Blasts are almost universally fatal; if the patient survives the trip to the hospital, they likely die shortly thereafter from internal bleeding, infection, or organ failure.

DAY 4: GAZA EUROPEAN HOSPITAL

Our team of international physicians work with the local Gaza emergency room staff, performing primary, secondary, and tertiary assessments, as is common practice in trauma and critical care. We quickly learned that the doctors and nurses here do not perform these assessments on every trauma patient. Today, we had four adults and two children arrive simultaneously. Six traumas coming in at a time is not unusual. The kids who reside in the emergency department smile and give me high fives as I rush to the trauma bay.

The patients look like they are of the same family. One adult female is dead on arrival. I didn’t need to put monitors on her to see that. The little girl looks like she has burn injuries and blast fragmentation in her arm and torso. She was having difficulty breathing and was missing an eye. The local physicians and nurses did not perform a full assessment on her and quickly moved to assist her younger brother, who was missing his left arm below a hastily placed tourniquet. I thought perhaps the local staff were just exhausted—they have been working nonstop for seven months. Returning to the young girl, we intubated her and turned her over to assess her back. The right side of her body was missing. Everything from her posterior ribs to her pelvis to her vertebral bodies, gone. I didn’t bother to ask the staff if they knew about her back injuries based on her initial presentation. They are surprisingly accurate in predicting mortality. Perhaps at this point they have completed enough secondary assessments to know when to protect their eyes from the horrors of American weaponry.

Everyone died except for the boy. He will be crippled for life.

DAY 5: GAZA EUROPEAN HOSPITAL

The children are starving. One child consumed a battery and we had to extract it before the battery acid eroded through his nasopharynx or upper esophagus, which would have been fatal. Children suffer burn, blast, and crush injuries requiring painful treatment without pain medications. In the operating room, flies disrupt the sterile field. Wounds get infected and develop resistance to antibiotics, eventually requiring amputations, leaving innocent children to live a life of disability and deformity. Earlier this week, there was a child who looked about the age of my son in the encampment outside the hospital. He had a four-limb amputation, and I would see him walking on his leg stumps and trying to play with a deflated ball with his arm stumps. But he is gone now. I have been told that he evacuated the area with his family for fear of the impending invasion.

DAY 6: OUTSIDE THE GAZA EUROPEAN HOSPITAL

At night, after the OR cases are completed, I go for walks outside the hospital campus with one of my British colleagues. Outside the hospital walls is where we truly can see Gaza, hear Gaza, smell Gaza, feel Gaza. There’s something very different about the Gazans, even in the face of horrendous, war-imposed devastation. I have seen poverty and despair in many parts of the world. But I have never felt a sense of belonging with people as I do here. I don’t even speak Arabic, though I have become very good with Google Translate. How, I repeatedly wonder, are they able to be so humane under such dire circumstances? Is there some ancient Semitic secret the rest of the world lacks? Certainly there’s an element of Arab warmth and hospitality, but here especially it seems there is something more than that.

Today, we encountered a couple kids on our walk: one, a 14-year-old named Moustafa. My British colleague speaks Arabic fluently, so we talked with Moustafa for a while. Moustafa went from Gaza to Egypt for three months recently, for advanced medical treatment of wounds sustained from American-Israeli weaponry. Once his wounds were healed, he said he felt “strangled” in Egypt. He wanted to come back to Gaza, because “there is no place like Gaza.” He clearly understands and has first-hand experience of the risks that come with being in Gaza. His English is reasonable, so I had my British colleague ask him a few math questions. My guess is that he could probably score around 700 on the math section of his SATs — pretty good for a freshman in high school. I am surprised when Moustafa says he “felt at ease” when he got back to Gaza just 10 days ago. I am even more surprised to learn that the Israeli government makes it very difficult for Gazans to return to Gaza.

“[The Israeli government] doesn’t want us to come back,” Moustafa responded. “They want us to stay in Egypt. There were 160 Gazans there who wanted to return, but only 62 were able to come back.”

The other kid with Moustafa added, “It is a dirty Occupation that tries to [keep us] from the outside world and prevent the world from reaching us.”

Despite the restrictions placed on the Gazans, it appears as though many of them have traveled out of Gaza, particularly professionals who completed their training in other countries, including Italy, Ukraine, Russia, Jordan, Egypt as well as countries in south and east Asia. Most Gazans are multicultural and multilingual. And their desire to return to Gaza has brought back beautiful aspects of many different cultures into Gaza.

I now realize that people like Moustafa are the essence of Gaza: A boy that longs to return to a probable destiny of death, just so he can be reunited with his homeland. A land that gives so much, despite its complete destruction.

The beauty is not in tall buildings and paved roads. The beauty is in the soil, the spirit of Gaza, and the unwavering patience and faith of its people.

DAY 7: GAZA EUROPEAN HOSPITAL

I’ll share with you one case that confuses my understanding of science and modern medicine. Today there was a four-year-old boy who came into the emergency room in severe pain from extensive burn, blast, and crush injuries. He was dying, and there was nothing we could do to save him. He was inconsolably shouting, in excruciating pain. He was clearly scared and breathing erratically and frantically. He had no living family with him, and there was very little we could do to ease his suffering.

I watched as my wife leaned in close and whispered a prayer in his ear. Immediately, it was as though some magical cloak of peace came over him. He died a few hours later, completely calm. I have not seen prayer work that well to treat a dying child in excruciating pain. I suppose that the nature of these Gazans is such that they truly believe in prayer and God.

Week 1 at Gaza European Hospital was April 29-May 5.
Continue reading at “Three Weeks at Gaza European Hospital: A Medical Mission Journal, Week 2.”