By Anna Lekas Miller
With Israel’s Operation Protective Edge now approaching its 16th day, there have been more than 600 casualties and over 3,000 injuries in Gaza, and more than 100,000 Palestinians displaced within the strip. Without any means of leaving the territory, many feel that no matter where they go, it is impossible to escape the shelling.
Even under ordinary circumstances, Gazans live under an Israel-imposed blockade that not only restricts their movement — costing them travel, employment, and education opportunities — but also controls what can enter the region, restricting essential items such as construction materials and medical supplies. This is exacerbated in times of crisis, particularly within the health sector.
A former nurse and current program director for Medical Aid for Palestinians (MAP) about how doctors in Gaza are coping with the current assault.
How are medical professionals in Gaza impacted under ordinary circumstances given Israel’s siege?
Fikr Shaltoot: The Gaza Strip has been suffering for a long time under the blockade. The health sector is one of the most affected areas, particularly in hospitals. Under normal circumstances, our medical team works under difficult circumstances, with severe shortages of drug items, consumables, and spare parts for necessary equipment.
How have Israel’s air raids and ground invasion exacerbated these conditions?
During this aggression, the situation has become much, much worse. The team is trying to save the lives of injured people who arrive at the hospital almost every minute, all the while coping with severe medical shortages.
Can you give me an example of how doctors are coping with these shortages?
I was talking to one of the doctors the other day, and he told me that for operating on someone’s small intestine, they need a size two stitch, but since this size was not available, they used a size four.
When they do things like this, they are never sure what the impact will be on the patient, or whether they will suffer from complications afterwards. Another thing that is frequently missing is solutions, including saline, one of the most essential items that any hospital patient will need. It is simply not available.
What are some of the other challenges facing doctors?
Doctors and nurses have to cope with a huge number of patients arriving every day, many of whom are in critical condition. Many have lost limbs, and have the kinds of injuries that are not easy to tolerate looking a, much less operating on.
The numbers arriving at the hospital are enormous. On Sunday, al-Shifa hospital, the main hospital in Gaza City, received 400 injuries from the eastern Gaza and Shujaiyeh in 24 hours.
Very few of the patients have been discharged, and some have been staying at hospitals because they are unable to go back to their homes.
The al-Aqsa hospital was struck by Israeli fire on Monday. Can you tell me about this?
The al-Aqsa hospital serves the middle of the Gaza Strip and is the only hospital in the area. The Israeli missiles hit the second and third floors on Monday, striking the surgical department and the patient waiting room. One of the patients was killed, and another three people died on the spot. Many more were injured, including some of the medical team.
What does this mean for the medical team’s work?
The team doesn’t know when it will be able to get to back to work. How can they work if the hospital is unsafe? There is no safe area in Gaza, but many people go to the hospital because they believe that it is the safest place. Apparently, it is not.
How are doctors coping, with massive amounts of patients, hospitals at their limit, and no sign of an end of violence?
The Ministry of Health has declared a state of emergency. Most medical teams are working 24-hour shifts. They are trying their best to get as little rest as possible and work continuously. Some days they receive up to 100 cases per day and other days, like Sunday, they receive 400. All the time, they have to deal with the shortages.
This is not the first war in Gaza, this is the third in five years, unfortunately. So doctors and nurses have found coping mechanisms. They know what they have on hand and how they can use it. But it is not always the best solution, or the right thing to do. Unfortunately, they don’t have any other options.
Are any patients being treated outside of Gaza?
They tried to refer some of the patients to hospitals outside of the Gaza Strip, but only a very limited number have been successfully referred. The rest of the huge number of injured — more than 3,000 — all these people are being treated in hospitals in the Gaza Strip.
What about humanitarian aid?
Medical workers have been asking international organizations to intervene and explaining the needs of patients to organizations, like MAP and the World Health Organization, who may be able to help. Unfortunately, what they have received is still very little in comparison with the needs on the ground. My background is as a nurse, so I know how difficult it is for a person to be in a hospital, trying to save the lives of injured patients without the proper instruments, medicine or consumables when it would be possible otherwise.
How does humanitarian support come in?
The Kerem Shalom border crossing into Gaza is still open, however it is not operating normally. It depends on the Israelis, and how many hours they keep it in operation per day. Once you buy the drugs, usually it takes a few days before they can make it into Gaza. Doctors need these items within a few hours, not a few days.
What’s more, it should take only a few hours to procure these things. As long as the items are available in the West Bank or Jerusalem they should be able to come through the crossing quickly as it is only an hour drive from there. But the coordination to get supplies into Gaza takes a few days.
How many hospitals are there in the Gaza Strip?
There are 13 hospitals in the Gaza Strip, as well as some other NGO facilities, with around 2,000 beds. The biggest is the al-Shifa hospital, with about 560 beds. There is one relatively big hospital in Khan Younis but otherwise the rest are very small, including the one that was hit on Monday.
Is this assault different than others you have witnessed on Gaza in previous years? If so, how so?
It is different, definitely. War is war, every time, but this is the third war I am witnessing after 2008/09 and 2012. Honestly, I have to say I have been terrified. As anyone in Gaza will tell you, there is no safe place here. This is how everyone in Gaza thinks. In this war, I can say there is lots of targeting of civilians. When they started these strikes, the majority of the airstrikes targeted homes, civilian homes.
They are also targeting NGOs, hospitals, and mosques. People here understand if the target is for security reasons, but they cannot understand if it is a hospital, like al-Wafa. They cannot understand the attack on an NGO where three disabled children died in the rubble. These kinds of things are different to 2012.
Also, the massacre in Shujaiyeh. It looks like the Israeli forces are prepared to kill as many civilians as they want without being worried that anyone will ask why they are killing them. Many of the people killed in Shujaiyeh died while they were trying to find refuge. They were killed in the street. We are in the 21st century, people never thought this could happen, that a whole neighborhood would be exposed to massive attacks, leading to more than 70 deaths and 400 injuries in a few hours. This is completely insane.
So, it is mainly the exacerbated targeting of civilians?
Gaza is so small, isolated, and one of the most densely populated areas in the world. There is nowhere anyone can target in Gaza without impacting on civilians. There are 1.8 million people living in 139 square miles, and half are children under 15 years old. How will any target in such a small area not have an impact on the whole population?
If there is a ceasefire soon, how will people in Gaza still be impacted?
I believe that all the people in Gaza will need immediate psychosocial support after this aggression.
For the medical professionals, even if there is a ceasefire, they will need some time to relax, go home, and see their families. I know that plenty of them working in hospitals are not going to see their children for two weeks. But they will have to continue working. Even if there is a ceasefire tomorrow, it does not mean that the hospitals will be empty. There will still be injuries, many of which will need long-term treatment.
I also believe the medical teams, particularly at al-Aqsa, will need psychological support. They are the ones who have to deal with it everyday, see all of these critical cases, and try to save the lives of people in a very difficult state. Even the bodies that arrive in hospital, the doctors have to make sure that these people are dead. So they are going through a very difficult situation. I am sure these people will need all the support they can get.
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