Politico Does Journalism: “We Volunteered at a Gaza Hospital. What We Saw Was Unspeakable.”

“Jesus Christ,” Feroze muttered as we washed the larvae into a bucket, “she’s just a fucking kid.”

The two of us are humanitarian surgeons. Together, in our combined 57 years of volunteering, we’ve worked on more than 40 surgical missions in developing countries on four continents. We’re used to working in disaster and war zones, of being on intimate terms with death and carnage and despair.

None of that prepared us for what we saw in Gaza this spring.

“the world’s most dangerous place to be a child.”

We have always gone where we were most needed. In March, it was obvious that the place was the Gaza Strip.

The two of us had never met before this trip. But we both felt called to serve, so we packed our bags, leaving our lives behind in California and North Carolina.

We landed in Cairo around midnight and met up with the rest of our group of 12: an emergency nurse, a physical therapist, an anesthesiologist, another trauma surgeon, a general surgeon, a neurosurgeon, two cardiac surgeons and two pulmonary and critical care intensivists. All of us had volunteered to work with the World Health Organization through the Palestinian American Medical Association.

who grew up in a Parsi household in Flint, Michigan and worked with a Palestinian-Jewish cooperative in Haifa after graduation from college. Neither one of us is religious. Neither one of us has any political interest in the outcome of the Israeli-Palestinian conflict — other than wanting it to end.

The Rafah Crossing functions like a rural American airport: one baggage scanner, odd procedures and minimal facilities. Scanning the medical and humanitarian supplies from the dozens of aid teams one bag at a time was inefficiency defined. But it was the only reliable way to bring anything into Gaza.

noted on the Senate floor, the process for clearing aid with the Israeli authorities is opaque and inconsistent. “Items that are allowed in one day can be rejected the next….” For this reason, everyone simply brought whatever they could as personal luggage — even surgical equipment — paying exorbitant airline baggage fees instead of bulk shipping rates. Now that Rafah is closed, even this route for resupplying Gaza’s hospitals has been cut off. (Israeli Prime Minister Benjamin Netanyahu, who has shown no signs of backing off, is scheduled to address the U.S. Congress on Monday. He will also meet with Vice President Kamala Harris.)

famous “road of death.”

ineffective process called “deconfliction.” The fact that “deconfliction” is so unreliable explains why “Gaza is the most dangerous place in the world to be an aid worker,” according to the International Rescue Committee. It works something like this: COGAT — the office of Israel’s Defense Ministry that coordinates between the Israeli armed forces and humanitarian organizations — agrees it will not attack traffic on a specific route for a specified period.

This coordination is done through — what else? — a smartphone app. When the road turns green on the app you have 15 minutes to get on and off the specified route, and you can only request deconfliction of a particular route every three hours. After a 40-minute wait, we got the go-ahead and our drivers floored it, dodging foot and donkey traffic all along the road.

all shorter and thinner than they ought to have been. Even over their screams of joy at meeting new foreigners, we could hear Israeli drones humming overhead. We headed to our living quarters — half of our team slept in one room in the adjacent Palestine College of Nursing, while the other half slept in one of the hospital’s outlying patient-care areas — and spent our first night sleeping under continuous, room-shaking bombardment.

For our entire time there, we lived in constant fear that Israel would invade the hospital. Thankfully we never saw a single combatant, Israeli or Palestinian.

had been destroyed, while the remaining partially functioning hospitals operated at 359 percent of their actual bed capacity. The World Health Organization describes them as “partially operational.”

city of 419,000 people in southern Gaza. Now it functions as the only trauma center for well over 1.5 million people, an impossible task even under the best of circumstances. It is likely the safest and best-resourced city block in the entire Gaza Strip — and yet its horrors defy description.

We first noticed the overcrowding: 1,500 people were admitted to a 220-bed hospital. Rooms meant to hold four patients typically had 10 to 12, and patients were housed in every possible space: the radiology department, the common areas, everywhere. Next, we noticed the 15,000 people sheltering on the hospital grounds and inside the hospital — lining and even blocking the hallways, throughout the wards, in the bathrooms and closets, on the stairs, even in the sterile processing and food preparation facilities and the operating rooms themselves. The hospital itself was a displaced persons camp.

It’s what we imagine the first weeks of a zombie apocalypse would look — and smell — like.

left infants to die in a pediatric intensive care unit.

Gunshot wounds to the head are an entirely different matter.

We started seeing a series of children, preteens mostly, who’d been shot in the head. They’d go on to slowly die, only to be replaced by new victims who’d also been shot in the head, and who would also go on to slowly die. Their families told us one of two stories: the children were playing inside when they were shot by Israeli forces, or they were playing in the street when they were shot by Israeli forces. 

(The Israel Defense Forces did not respond to specific questions for this story, but in an emailed statement, it said, “The IDF is committed to mitigating civilian harm during operational activity. In that spirit, the IDF makes great efforts to estimate and consider potential civilian collateral damage in its strikes.”)

acute hepatitis A infection in such overcrowded conditions.

Graffiti in the pediatric wing of Gaza European Hospital. Pearlmutter and Sidhwa quickly learned that their Palestinian health care colleagues were among the most traumatized people in the Strip. | Courtesy of Feroze Sidhwa

500 healthcare workers and 278 aid workers have been killed in Gaza. Among them was Dr. Hammam Alloh, a 36-year-old nephrologist at Shifa Hospital who refused to evacuate when Israel besieged the hospital in October.

After his home was destroyed and his family threatened, European Hospital’s director fled to Egypt, leaving an already overburdened hospital without its longtime leader. This sense of helplessness and disorientation was made worse still by the constant spread of hearsay about kidnappings, troop movements, food shipments, water availability and everything else of importance to survival and safety in a land under siege.

Cut off from the outside world and unable to access reliable information about the forces controlling whether they live or die, eat or starve, stay or run, rumors spread and amplified.

Several staff members told us they were simply waiting to die, and that they hoped Israel would get it over with sooner rather than later.

Images of Tamer from his Facebook feed that show him after he was shot and operated on (left), after he was released from Israeli custody (center) and after he was treated at Gaza European Hospital (right).

one of the highest unemployment rates in the world. When Israel raided Indonesian Hospital last November, he was assisting the orthopedics team in the operating room. He refused to leave his anesthetized patient. He said Israeli soldiers shot him in the leg, breaking his femur. His own orthopedic team cared for him, placing an external fixator to stabilize his shattered leg.

Next, Tamer told us, the Israelis came to his hospital room and took him, where exactly he doesn’t know. He told us he was strapped to a table for 45 days, given a juice box every day — sometimes every other day — and denied medical care for his broken femur. During that time, he told us, he was beaten so badly that his right eye was destroyed. As malnutrition set in, he developed osteomyelitis — infection of the bone itself — in his broken femur. Later, he said, he was unceremoniously dumped naked on the side of a road. With metal sticking out of his infected and broken leg and his right eye hanging out of his skull he crawled for two miles until someone found him and brought him to European Hospital.

detainee abuse and torture at Sde Teiman. In it, the IDF denied mistreating detainees.)

When we met Tamer at the hospital for treatment, all that was left of him was the disfigured outline of a human being, his body crippled by violence, his eye surgically removed and his mind haunted by torture. A man who once healed others was reduced to constantly begging for pain medications, reliant on others for everything — and wondering if his wife and children were even alive.

Nearly all our patients arrived during mass casualty events. Khan Younis, a city in southern Gaza, had been under siege and bombardment since December. By the time we arrived on March 25 the town was inhabited by a combination of displaced persons from the north and locals who had not fled south to Rafah despite Israel’s threats against them. (Israeli forces frequently drop flyers or send texts demanding that Palestinians in Gaza leave their homes or shelters.) Extended families often concentrate themselves in as few buildings as possible. They told us they hoped that gathering in numbers would keep them safe — or at the very least, that dying together was preferable to dying separately.

We noticed that bombing seemed to peak at iftar when families were gathered together to break the fast during Ramadan with whatever food they had available.

We took Israa to the operating room. In the United States or Israel this would have been a 5-minute transition, but in the most functional hospital in Gaza it took more than one hour to get her there — working in such a severely compromised space, there was simply no way to get a trauma patient into surgery quickly. During her surgery, we realigned her broken femur, tibia and ankle in external fixators, explored an injured artery, cut chunks of dead tissue out of the massive wound in her thigh and her burned hands (a procedure known as debridement) and stopped her bleeding. It took three experienced surgeons almost four hours to do all of this. For the next 24 hours we were at her bedside almost continuously, knowing the traumatized and exhausted local staff couldn’t be expected to care for her properly.

After three days in the hospital, Israa, a mother of four, told us how she was injured: Her home was bombed without warning. She saw all her children die in front of her when the ceiling collapsed on top of them. Her relatives confirmed that her entire immediate family was buried under the rubble of their home. We didn’t have the heart to tell Israa that some of her children were probably still alive at that moment, dying unimaginably cruel deaths from dehydration and sepsis while trapped alone in a pitch-black tomb that alternates as an oven during the day and a freezer at night.

One shudders to think how many children have died this way in Gaza.

Two days later, while we waited in the preoperative area, one of the nurses pointed to a slight and clearly sick little girl. “Can you operate on her?” she asked.

“Who is she? We’ve never met her before.”

“Debridement,” the nurse said, shrugging and walking away.

That’s how we met Juri, the 9-year-old girl with the horrific injuries.

After washing away the maggots, we positioned her on her right side and got to work. We cut away four pounds of dead flesh, washing her wounds as aggressively as we could. Then we bandaged her up and booked her for another debridement the next day.

He’ll come soon, we assured her.

“You’re lying,” she told us, calmly. “He must be dead.”

As it turns out, Juri’s father wasn’t dead. We found him waiting for her in the pediatric ward of the hospital. He was a loving and gentle man who spent all day every day scouring a land in famine for anything his precious daughter would agree to eat. He told us how Juri was maimed: The family evacuated from Khan Younis to Rafah, as Israel demanded. He and his wife left their seven children with their grandparents while they desperately searched for food and water. They came back to the house bombed and destroyed, their children all severely injured or killed. Juri’s surviving siblings were at another hospital with their mother.

no longer exists in Gaza.

And for Juri, “full recovery” means a lifetime of severe and permanent disability.

famine and disrupted cellular services be damned!

killed their mother along with 10 other members of their family and ripped through their immature and malnourished bodies. Both were being treated at Shifa Hospital in Gaza City when Israel raided the hospital for the second time in March. Medical Aid for Palestinians, a British charity, repeatedly requested that Israel allow MAP to evacuate these two critically ill children from Shifa. Israel repeatedly refused, according to MAP. Perhaps sensing what was to come, the children’s family members somehow got them out of the hospital, onto a donkey cart, and walked south for two days until they came to European Hospital. The siblings arrived with their IVs still in place.

Rafif, a keen and bright-eyed 13-year-old girl, had a chronic ulcer on her amputated right lower leg, an external fixator on what remained of her right leg and malnutrition that was obvious from her sunken face and recessed eyes. Still, she was without major complications. With access to food, proper wound care and future surgical treatment — none of which is guaranteed, but possible — she could survive. But her brother, 15-year-old Rafiq, was so severely malnourished that he could barely speak. The explosion that ripped his sister’s foot off and killed his mother had also sent shrapnel through his abdomen, tearing his intestines apart. He had open wounds on his buttocks that made it impossible for him to lie on his back or sit upright, and a broken left shoulder that had never healed, leaving it frozen. He screamed in pain with any attempt at examination and was constantly terrified.

There were 3,412 acute care hospital beds in Gaza at the beginning of the war, 1.5 beds per 1,000 people, compared to 7.3 per 1,000 people in Ukraine. After the widespread destruction of hospitals in Gaza there are now approximately 1,400 acute care hospital beds for 2.2 million people, more than 88,000 of whom have been seriously injured by military weaponry in the past eight months.

With the medical resources left in Gaza, treating the 88,000 Rafifs and Rafiqs and Juris and Israas would take decades.

Genocide Watch, a nonprofit whose mission is to eliminate mass murder worldwide, noted in his 2017 testimony on Myanmar: “Courts always come after a genocide is over, too late to prevent it.”

We had no illusions that two American physicians could prevent it, either. 

We both believe — passionately —that Americans as a nation can stop what is happening. As a Jewish American, Mark has taken to telling everyone he can that support for what Israel is doing in Gaza has nothing to do with supporting Judaism or Israeli society.

The moment the United States cuts off military aid to Israel the bombs will stop falling and the troops will withdraw. We must decide, once and for all: are we for or against murdering children, doctors and emergency medical personnel? Are we for or against demolishing an entire society? Are we for or against starvation?

Are we for or against peace?

After two weeks, our time in Gaza ended.

But leaving Gaza is impossible to do gracefully.

As we handed Israa’s care off to a team of Canadian orthopedic surgeons, she begged her “American doctors” not to abandon her. We sedated her with ketamine to perform one last dressing change, and then snuck away before she fully regained consciousness, knowing we had no explanation for why she must suffer alone — while we were free to return to our lives and families.

Pearlmutter and Sidhwa walk towards the Rafah Crossing while leaving Gaza, a decision that consumed them with guilt. | Courtesy of Feroze Sidhwa

To this day both of our consciences refuse to let us forget that we chose to leave.

At the Rafah border we encountered — once again — a gaggle of children. With no school to attend they gathered around us, some of them practicing their English. One of them was a 9-year-old boy, Ahmed. He grew up in this desperately poor and besieged territory his entire life, and had almost certainly never met anyone who had ever been outside of the Gaza Strip. He has no past and no present, and if nothing changes, he will have no future.

We both wondered: If nothing changes, where will Ahmed be on October 7, 2033?

Gaza European Hospital and the surrounding territory to be evacuated. European Hospital is now empty, and has been looted by desperate people trying to survive.

SOURCE: POLITICO