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The writer is a consultant plastic and reconstructive surgeon and former vice-president of the Royal College of Surgeons of England who travelled to Gaza with the IDEALS charity
Earlier this month I was operating on a 17-year-old girl who had been orphaned during an air strike in Gaza. Under theatre drapes improvised from surgical gowns, and with knife blades gripped dangerously in forceps for lack of sterilised handles, I tried in vain to excise the tissues riddled with shrapnel damage. I knew that in these conditions, infection was highly likely; we duly amputated her leg a few days later.
My fortnight as a volunteer surgeon at the European Gaza Hospital near Khan Younis, in effect the last working health facility in south Gaza, was like nothing I had ever experienced before. I first visited the occupied strip 10 years ago during Operation Protective Edge — Israel’s military conflict with Hamas in 2014 — teaching and training local colleagues in reconstructive surgery techniques. Back then I was astonished at my patients’ brutal wounds, but nothing could have prepared me for the scale of humanitarian collapse in Gaza today.
The hospital I once knew was unrecognisable, hidden behind a huge throng of people who had come to seek sanctuary in the compound. The corridors, and stairwells were filled with families taking refuge; children of all ages ran through the dimly lit passages. The Emergency Department was a scene of barely-organised chaos which would erupt with new patients after every shelling.
Despite the efforts of dedicated local colleagues, there was a devastating deterioration in surgical provision. Most aspects of ‘aseptic technique’ — the sterile method of surgery and wound care first described by Florence Nightingale in the Crimean war — had been abandoned for lack of appropriate equipment. It was astonishing to me that the backbone of safe surgery, which had been practised during every conflict from the First World War trenches to Afghanistan, had utterly disintegrated.
Without proper sterilisation, patients will not survive, regardless of how skilled the surgeon. And even if effective surgery had been possible, the hospital could barely provide aftercare given the minimal ICU facilities and shortage of experienced clinicians to manage follow-up. As a result, wound infection is universal and severe.
The numbers of dead across Gaza, currently estimated at over 29,000, are shocking enough. But the scale of life-changing injuries from burns to embedded shrapnel and lost limbs is utterly staggering. I came to understand why families without shelter cluster together when they are under attack, so they can live or die together. The loss of hospital staff from death and injury has only deepened the healthcare crisis.
Amid the carnage and misery, the dwindling number of remaining staff have learnt psychological survival strategies. Over a small cup of coffee brewed on a naked flame on the floor of the operating theatre, one surgeon told me how he had taught himself to face only the medical problem in front of him, distancing himself from the patient’s devastating back-story.
In many ways I felt helpless, but the presence of foreign medics did at least reassure local staff that they were less likely to come under IDF attack. Despite having worked in conflict zones in the past, I have never experienced such sustained bombardment. I became more anxious and sleepless as my fortnight at the hospital progressed but the people of Gaza have endured this for more than four months.
Since leaving, I have thought hard about what we can do to contain this catastrophe. Medical personnel and equipment are desperately needed. Existing supply lines are woefully inadequate, and lives are lost each day these resources are withheld. Can our governments not cut through the red tape obstructing life-saving deliveries?
On one of my last days at the hospital, I met my friend Moe, a young Palestinian doctor who I have worked with for a decade. He has been displaced six times since October, but he took the risk of visiting me from Rafah. “They have taken away everything Dr Tim, and most of all, they have taken my dignity,” he told me as we embraced. When I asked how he kept going, kept treating patients, he looked at me with sadness. “We have to live,” he said. “We have to go on”.