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Dispatch from Gaza: In Al Shifa, doctors can't keep up with the wounded

In Cast Lead, some 5,300 Palestinians were injured. This time around, the number is almost twice that – with no end in sight.  

Hebron-born oncologist Haitham Al Amleh had never seen Gaza. Like most Palestinians from the West Bank, he had been barred from traveling here by an Israeli-imposed permit system that has made movement between the West Bank and this teeming strip all-but-impossible for Palestinians.

On Friday, 30-year-old Al Amleh entered Gaza for the first time with a delegation of 30 West Bank and Jerusalem-based doctors. Denied entry via the Israeli-controlled Erez crossing, they travelled to Egypt and entered through Rafah, where they had to wait out several hours of Israeli airstrikes which also stranded dozens of Palestinian families attempting to exit the strip.

“When we arrived to Al Shifa, there was only one oncologist tending to all the cancer cases,” says Al Amleh, whose delegation is hunkered down at the facility along with other staff, long-term patients, and hundreds of displaced residents from Gaza’s eastern border with Israel.

A Palestinian man watches on as a child breathes through a medical ventilator. (photo: Activestills.org)

A Palestinian man watches on as a child breathes through a medical ventilator (photo: Activestills.org)

Al Amleh points out that in addition to the strain Gaza’s medical facilities face from a now month-long Israeli military operation, doctors are struggling to cope with complicated medical conditions, such as cancer, that require specialized care.

On Sunday alone, Al Amleh estimates that he saw close to 100 patients. “In many cases,” he says, “we lack the proper equipment and medicines to treat them” – a reality that the United Nations Office for the Coordination of Humanitarian Affairs has traced to the eight-year Israeli siege. He adds that the most dangerous cases are awaiting transfer to specialized facilities outside Gaza, including Jerusalem’s Augusta Victoria Hospital, where Al Amleh works.

But the transfers require Israel’s permission, which can take too long to obtain. The Israeli military announced on July 20 that it had opened a field hospital for injured Palestinian civilians, but reporters who were invited to tour the facility on August 1 found it empty.

For those who can’t make it to specialized hospitals like Augusta Victoria, Al Shifa remains their only option. But these days, the place feels more like a frontline field hospital than a long-term care facility. Several times a day, paramedics race in through the front entrance, shuttling the wounded. Triage takes place in crowded receiving rooms, where the scene is often chaotic.

According to figures cited by Gaza’s Ministry of Health spokesperson, Ashraf al-Qidra, as of Sunday evening the number of injuries from Israeli attacks had topped 9,300, a quarter of them “critical.” In the 22-day air and ground assault known as Cast Lead, total injuries were estimated at 5,300.

Qidra points to recent reports that Israel has been using so-called DIME weapons – dense inert metal explosives – on civilian areas, which have, in turn, led to a sharp increase in severe injuries. According to Norwegian doctor Mads Gilbert, who volunteered at Al Shifa during the current operation and Cast Lead, such weapons cause “horrendous injuries where arms and legs were cut off as though a huge ax had chopped off their limbs with a direct immense force.” The weapons, according to Palestinian human rights watchdog Al-Haq, are illegal under international humanitarian law.

Health ministry spokesperson Ashraf al-Qidra briefs reporters outside Al Shifa Hospital on August 3, 2014.  (photo: Samer Badawi)

Health ministry spokesperson Ashraf al-Qidra briefs reporters outside Al Shifa Hospital on August 3, 2014. (photo: Samer Badawi)

There is good reason for that, says Qidra. “Many of our patients – including severe burn victims – arrive with complicated wounds that require specialized care from teams of doctors, as well as proper equipment and medications.” According to OCHA, though, Gaza’s hospitals were running dangerously low on medicines even before Israel’s latest air and ground attacks began. And treatment options have been limited by too-few – and mostly dilapidated – equipment.

Given these limitations, says Qidra, transferring patients to hospitals outside Gaza is essential “to reduce the demand on doctors, medications, and beds.” He says that, so far, Al Shifa has managed to transfer some 250 patients to Jerusalem’s Makassed Hospital, but the ratio of patients to doctors is still too high.

To help bridge the gap, aid organizations have helped bring in volunteer doctors to support their Palestinian counterparts. Paris-based Pal-Med Europe sponsored Moroccan doctor Zouhair Lahna, who has been in Gaza for 20 days, witnessing the worst of Israel’s ground operation.

Lahna, 48, volunteered in Gaza following Cast Lead, which began on December 27, 2008. He says the situation now is more difficult, with many of the injured suffering severe shrapnel wounds from tank shelling along Gaza’s eastern border. That, in part helps to explain the much higher numbers of wounded.

Another reason, says Lahna, is geography. He points to other conflict zones, like Afghanistan, where he’s volunteered with the French-based aid group Medecins Sans Frontieres. The difference here, he says, is that “Afghanistan, for example, has mountains where people can hide. In Gaza, there is nowhere to hide.”

Zouhair Lahna, a Paris-based Moroccan physician, volunteered in Gaza during Cast Lead. He says Israel's current operation is much worse. (photo: Samer Badawi)

Zouhair Lahna, a Paris-based Moroccan physician, volunteered in Gaza during Cast Lead. He says Israel’s current operation is much worse. (photo: Samer Badawi)

When I asked him for a prognosis of what comes next – once the bombing stops – he paused, peered at a row of ambulances on the driveway below, and told me about Ru’a. The six-year-old girl, he recounted, had been rushed in from Shejaiya last week when the shelling there was fiercest. She had “multiple, severe shrapnel wounds,” and Lahna was convinced she wouldn’t make it.

“We operated on her for four or five hours,” he said, but her odds were slim-to-none. When she later fought her way to a stable condition and survived, he and his colleagues coined a phrase – “the miracle of Ru’a.”

“I don’t know how life goes on after all of this,” says Lahna. “But in Gaza, people always find a way.”

Palestinians flock to hospital to wait out assault
The bloody devolution of a ‘ceasefire’
Blaming Palestinians for their own deaths

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    1. Pedro X

      Question. Why are Gaza’s medical capabilities so poor? The answer is simple. Neither the PA nor Hamas have adequately invested in the medical infrastructure or personnel. Both Hamas and PA leaders have siphoned hundreds of millions of dollars out of public coffers. Hamas alone has spent billions of dollars on Hamas’s army and its military complex and weapons. The tunnels cost hundreds of millions of dollars to construct in the past few years.

      During this period Hamas has said that it is too poor to fund healthcare. The PA has access to drugs in Israel and is under no constraint to shipping drugs to Gaza. They do have a problem in Hamas not paying any of the costs of providing medicines.

      Now look at Israel. Although budgeting one out of every 7 shekels towards defense, it still spends 6 out of every 7 shekels on non military costs. Unlike Gaza or the West Bank, Israel while under threat of annihilation and constant threat of attack and attacks built both a first class military force and a first class health care system accessible by all Israelis.

      Israel has a first class medical system because it was a priority of the Israeli people. Gaza has a poor medical system because Gazans have prioritized fighting and terrorizing Israel over Health care.

      Reply to Comment
    2. mt noise

      Might help if they kicked the Hamas honchos out of the basement in the hospital.

      Reply to Comment
      • Reza Lustig

        Yeah, you (an unarmed doctor or nurse) go try telling a bunch of armed guerrillas to “leave.”

        Reply to Comment
        • Avdim

          Reza, you must decide. Are they a bunch of armed guerrillas or are they the loved and Democratically elected leadership?

          You can’t have it both ways.

          Reply to Comment
          • Reza Lustig

            Actually, yes I can, thank you very much. Gazans elected and puts up with Hamas because they are anti-blockade, and because they were less kleptocratic than Fatah, not because they were all peaches and sunflowers.

            Reply to Comment
    3. bar

      Did the author ask one of the doctors if he wishes that Hamas would have avoided launching this war, violating 6 cease fires or prolonging it now that Israel is leaving and thereby provoking more retaliations?

      Did the author ask anybody how much bigger and better this hospital could be if Hamas, Gaza’s government, used its vast resources to build up, supply and support this hospital instead of, say, JUST ONE, of its tunnels?

      Did the author ask anybody there (he could have visited the basement tunnels where Hamas’s leadership is hiding) whether subjecting their people to a war against a vastly superior force while using civilians as cover and civilian building as cover worth the propaganda boost?

      Reply to Comment
      • Reza Lustig

        No, because he’s not going to risk provoking the well-armed guerrillas in his basement when he has patients who got blown half to bits by airstrikes to worry about.

        Reply to Comment
    4. Pedro X

      The Hamas honchos are not only in the basement. A Palestinian reporter reports being interrogated by armed Hamas members in the administration wing of the hospital next to the emergency department. Foreign reporters have reported that Hamas rocket launchings have taken place on the grounds of al-Shifa Hospital. An Italian reporter reports that Hamas rockets hit the al-shifa hospital and killed 10 children.

      Why are the doctors and nurses at al-shifa and other hospitals not speaking out? They are supporting Hamas in its use of human shields because they know it is in Hamas’ interests to have dead Palestinians shown on tv. Their goal is to lie to the international community to demonize Israel no matter the cost to the Gazan population.

      If Gaza doctors and UNWRA personnel came out and clearly pointed out Hamas’ use of hospitals and its responsibility for the causalities, Hamas would have a difficult time in continuing to operate from such places.

      Reply to Comment