Gaza's Healthcare Crisis: From Healing to Horror

Learning points for tomorrow’s doctors and a call for action

By Rahma Hegy

References to death and violence which some readers may find distressing

Gauze, the fabric used to dress wounds of all sizes and types, derives its name from the Palestinian city of Gaza, where it is believed to have originated. Gaza has long served as a symbol of healing, but today, it stands as a symbol of genocide.

33,899 killed, including 13,800 children and 8,400 women. Over 8,000 people are missing, 76,664 are injured, and 2,000,000 have been displaced. Furthermore, 301 healthcare facilities lie partially or fully destroyed, with 349 healthcare professionals killed and 520 injured, as per statistics predating the aftermath of the last siege and attack on Al-Shifa Hospital.

These are not just numbers; they represent lives filled with hope, ambition, faith, creativity, resilience, and love. Each individual lost is a testament to a failure of humanity. Amidst this destruction, the deliberate targeting of the healthcare system is particularly atrocious. Dr. Ghassan, a world-renowned British-Palestinian plastic surgeon recently elected as Rector for the University of Glasgow, witnessed the Al-Ahli Hospital massacre, where over 500 innocent civilians, including doctors, nurses, patients, and children, were killed by an Israeli airstrike. In an interview, he reported: “The destruction of the health system has been the main thrust of the military strategy […] The wounded, due to being unable to receive adequate treatment, will eventually succumb to their wounds.” This is further emphasised by the complete and merciless obliteration of Al-Shifa Hospital, in northern Gaza, as of the 1st of April 2024. It has led to over 300 people being killed. It stands as the epitome of the worst attack on a place of healing, turned into a place of death, surrounded by human remains and horror – an indelible stain on humanity.

The World Health Organization rightly asserts, “The world cannot stand silent while these hospitals, which should be safe havens, are transformed into scenes of death, devastation, and despair”. Sadly, those in the world who can stop this have been silent and inactive. The international framework for human rights has been crumbling, as leading nations ignore Israel's appalling actions, while individuals who advocate for human rights and dignity are met with repression and hostility.

Additionally, the siege on Gaza by Israel has deprived its inhabitants of food, water, electricity, fuel, and medicines. Patients and healthcare workers contend not only with bombs and bullets but also with unsanitary water, exacerbating diseases and leading to the acquisition of further illnesses. The lack of electricity and fuel has caused incubators and ventilators to shut down, resulting in numerous deaths and horrifying scenes of neonates’ decaying bodies. Furthermore, the scarcity of medical supplies and electricity has forced doctors to perform surgeries on the floor without anaesthesia or sterilised equipment. 52,000 pregnant women have been deprived of antenatal and postnatal care and been subjected to caesarean sections without anaesthesia.

Thousands of children have had one or more limbs amputated - forced to a lifetime of surgeries and disabilities. Save the Children reports that more than 10 children a day lose a limb in Gaza. A new acronym had to be created: “WCNSF - Wounded child with no surviving family.”

An International Rescue Committee’s Paediatrician, Dr. Seema Jilani, recounts her experience in Gaza: "I took care of an approximately 1-year-old patient who had sustained a traumatic amputation of his right arm and right leg and was bleeding into his chest…I never thought as a paediatrician that I would be at all useful in a war, but I was treating war-wounded children and pronouncing them dead at rates I had not done before. One day in our code resuscitation room, four out of the five patients we were actively bringing back from the brink of death were under the age of 15. My fear is around the generation of new amputees, and children who have been traumatically burned or left to live with a disability, who will now face adolescence and adulthood without the support they need. The children of Gaza deserve better".

Dr. Mohamed Ziara, from Al-Aqsa Martyrs Hospital, recalls his colleagues' sentiments at the start of the war: “We rather wish for death than to be injured like that because in this situation, even the injury is so horrific.” This sentiment reflects the cruel reality of Gaza's healthcare system under siege.

Healthcare is a fundamental right for all, a cornerstone of human dignity. It is unacceptable for anyone to endure the kind of devastation, despair, and systematic destruction of healthcare infrastructure witnessed in Gaza.

Despite this, Palestinian healthcare workers persist in showing resilience in the face of relentless displacements and continue in their mission to provide care. Their courage shines despite the threats of being killed or detained, a grim reality faced by their colleagues before them. “When they leave the hospital civilians give them [doctors and nurses] civilian clothing because wearing scrubs is sticking a target sticker on their back. That is how systematically healthcare has been targeted” said Dr Tanya Haj-Hassan, MSF intensive care Paediatrician, to Sky News.

In Gaza, every moment of survival becomes a defiant act of resistance. Healthcare workers stand at the forefront, demonstrating incredible bravery, honour, and dedication. Dr Amira Al-Assouli exemplifies this spirit by fearlessly rushing to aid a colleague who had been shot outside Nasser Hospital in Khan Younis, undeterred by the threat of being targeted herself by the surrounding snipers.

Through their words and actions, Gaza’s healthcare workers remind us never to forget and never to give up.

However, while healthcare workers in Gaza are considered heroes, this label suggests they can single-handedly alleviate suffering, which they cannot.

Marie-Aure Perreaut Revial, MSF Emergency Coordinator recounts: “Our mental health team held art sessions with children. Some drew their families killed during bombings. They drew the legs and arms of their mothers on the ground, beside their bodies. When they told me about this, I thought not only about children but also about the psychologists, holding this trauma whilst going through the same experiences themselves”.

The story of Dr. Samir, injured when the building next door was bombed, resonates deeply. At the sight of his injury his daughter said: “Doctors aren’t supposed to bleed,” yet, in reality, they do.

Despite all the suffering and destruction Healthcare workers in Gaza still teach us life and humanity in a time of darkness. Minutes after being threatened by the Israeli army to evacuate Al-Shifa Hospital (during one of its first attacks) doctors remained steadfast, refused to leave their patients behind, and were seen singing “ سوف نبقى هنا - we will remain here” a song of resistance and hope.

As we stand on the threshold of our medical careers, the scenes unfolding in Gaza offer invaluable lessons to the entire world. The stories of healthcare workers dealing with unimaginable challenges amid conflict serve as a stark reminder of the profound calling, we have chosen to answer.

We must never forget that being a doctor is about more than just diagnosing illnesses and prescribing treatments. It is about being a source of comfort, compassion, and hope in times of despair. It is about advocating tirelessly for the rights and welfare of our patients, especially those who are marginalised and vulnerable. Gaza serves as a reminder of the immense privilege and responsibility we bear as healthcare professionals. Let us carry this awareness with us as we embark on our careers, striving always to uphold the highest ideals of our profession.

Amidst the practical challenges of working within the NHS, it is easy to lose sight of this fundamental truth. Let us recommit ourselves to the vocation we have chosen—a vocation that has the power to save and change lives. It is an obligation upon us to uphold the truth, speak up against injustices, raise awareness about issues affecting our patients and society at large, and do our utmost to ensure justice prevails for all.

To the graduating doctors of the class of 2024: may the courage and resilience exhibited by our colleagues in Gaza serve as a source of inspiration and fortitude as you begin your journey as a doctor.

To everyone: Be the voice of Gaza, and demand freedom and justice for Palestine

If you would like to find out more and for the information used in this article take a look at these resources:

• https://www.aljazeera.com/news/longform/2023/10/9/israel-hamas-war-in-maps-and-charts-live tracker

• WHO EMRO | WHO appalled by latest attack on Indonesian Hospital in Gaza | News | Palestine site

• https://www.aljazeera.com/program/newsfeed/2024/4/1/israel-leaves-al-shifa-hospital-in-ruins and-littered-with-human-remains

• https://www.theguardian.com/world/2023/oct/24/gaza-hospitals-ceasing-to-function-as-water and-fuel-run-out

• https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02835-0/fulltext

• On the ground with a doctor in Gaza | International Rescue Committee (IRC) https://www.hrw.org/news/2023/11/14/gaza-unlawful-israeli-hospital-strikes-worsen-health-crisis

• https://www.mediaite.com/uk/doctor-says-idf-executed-medical-staff-point-blank-in-al-shifa hospital-operation/

• https://www.bbc.co.uk/news/av/world-middle-east-68539701

• The last medics providing healthcare amidst death and destruction in Gaza | MSF