A Pediatrician’s Two Weeks Inside a Hospital in Gaza

Dr. Seema Jilani is currently a senior technical adviser at the International Rescue Committee, where she leads their emergency health responses globally. In December, she went to Al-Aqsa Hospital in central Gaza to aid the humanitarian effort there. More than twenty-six thousand Palestinians have been killed by Israel’s military campaign in Gaza, which began after Hamas’s terrorist attack on October 7th. Since that time, Gaza’s health-care system has been on the brink of collapse, and Israel has refused to allow sufficient food and medicine into the territory. I recently spoke by phone with Jilani, who has practiced medicine across the world, including in numerous conflict zones, about her experiences in Gaza. Our conversation, edited for length and clarity, is below.

Where have you worked before you ended up in Gaza?

I have been in and out of Gaza and the West Bank for the past nineteen years. I was previously in Gaza in 2005, prior to Israeli disengagement, and then again in 2015, right after the 2014 war. And also again several times in and out of the West Bank. I have worked in Afghanistan, Iraq, Lebanon, Egypt, Turkey, Pakistan. And I have worked on refugee rescue boats off the coast of Libya.

When you’re working in Iraq, or Pakistan, or Afghanistan, who are you working with, and in what capacity are you working there?

A variety of N.G.O.s, some that are tiny and made up predominantly of volunteers. I was working with the International Committee of the Red Cross in Lebanon when I lived there. I usually am working in a pediatric capacity as a clinician. In Turkey, I was teaching refugee and migrant medical students how to advocate for their patients.

So when did your most recent stint in Gaza begin, and how did you get into the territory?

We departed from Cairo on Christmas Day. The International Rescue Committee, in partnership with Medical Aid for Palestinians (MAP), deployed an emergency medical team to provide emergency and lifesaving medical care. That was facilitated in part by the U.N. Office for the Coordination of Humanitarian Affairs. We were a team of surgeons, a high-risk obstetrician, an emergency-care doctor, an anesthetist, and myself, as well as other I.R.C. folks.

So you arrive at the hospital after Christmas. What did you see, and how did you begin your work?

We worked alongside the Palestinian physicians and nurses there, and we really think it’s important to work alongside them and learn from them. We were in one of the last enduring emergency rooms in central Gaza. Within the two weeks that I was there, I saw it go from a semi-functional hospital to a barely or nonfunctional hospital as a result of increasing violence in surrounding areas and, eventually, evacuation notices started coming through.

In the first few hours of my work, I treated an approximately one-year-old boy. His right arm and right leg had been blown off by a bomb, and flesh was still hanging off the foot. He had a bloodstained diaper, which remained, but there was no leg below. I treated the baby while he lay on the ground. There were no stretchers available because all the beds had already been taken, considering that many people were also trying to use the hospital as a shelter or safe space for their families. Next to him there was a man who was on his last breaths. He had been actively dying for the last twenty-four hours, and flies were already on him. All the while, a woman was brought in and was declared dead on arrival. This one-year-old had blood pouring into his chest cavity. He needed a chest tube so he wouldn’t asphyxiate on his own blood. But there were neither chest tubes nor blood-pressure cuffs that were available in pediatric sizes. No morphine had been given in the chaos, and it wasn’t even available. This patient in America would’ve immediately gone to the O.R., but instead the orthopedic surgeon bandaged the stumps up and said he couldn’t take him to the operating theatre right now because there were more pressing emergencies. And I tried to imagine what was more pressing than a one-year-old with no hand and no legs who was choking on his own blood. So that, to me, was symbolic of the impossible choices inflicted on the doctors of Gaza, and how truly cataclysmic that situation is.

Who’s making decisions at the hospital? Are you being told you should do “X,” and someone else should do “Y”? Or it’s just people rushing into rooms, and you are improvising?

So I worked predominantly in the emergency room. I also did work in the pediatric wards. We worked with our MAP colleagues that would help with translation, and then also helped navigate the group work that we would engage in the emergency room. In all honesty, because of the mass casualties, no system is built to withstand that, and so it was truly chaos. So if it’s coming across as chaos, it’s because it was. Because people would come in by any means they could, whether carried on makeshift stretchers, if you’re lucky, or by an ambulance that was overflowing with people, via donkeys. There were bombings happening close by, so you would see the effects of that. So we would work, like I said, alongside the doctors that were able to make it. Many doctors were not able to make it to work because they themselves had been forcibly displaced several times as well.

How many hours per day are you working during these two weeks?

Only during daylight hours, due to security. So 9 A.M. to 3 P.M.

Why only that?

We didn’t feel comfortable. We were staying at a guest house, and we did not feel comfortable with the safety and security measures after dark.

At the hospital, you’re saying?

Both at the hospital and in transit while driving to and from.

Did you feel in some ways that your presence was making a difference in the over-all way in which the hospital functioned? Or was there a sort of sense that you were always so far behind that it was futile?

It’s such a nuanced question. I really appreciate it. I did feel that we were making a difference, and I think the best way I can illustrate that is when Palestinian doctors would look at us as foreign doctors and say, “We’re not forgotten. It’s evidence that they haven’t forgotten us on the outside.” The other way I thought we made a difference was by triaging patients to make room, simply making space in the emergency room, for more patients to come in. So we would be able to see patients and allow the ones who were less urgent to move out of the hospital, so that we could make room for oncoming mass casualties. Doctors sometimes were unable to come. They’re valiantly, bravely looking for shelter for their own families, and showing up to work with a stethoscope the next day, but if they couldn’t make it to work, we were there to fill in some gaps. All that said, it is a completely overwhelming situation in terms of the severity, scale, and magnitude of injuries we were seeing. And no system is designed to withstand that.

You said that things became worse during the two weeks that you were there. Can you describe what changed between the time that you arrived and the time that you left?

Each day became more and more tense, with more and more people piling into surrounding areas looking for safe shelter. I remember I was counselling new mothers on breastfeeding, and I looked out of the ward, and there were plumes of smoke rising in the air and bombs narrowing in on the hospital, and it felt very surreal. One day, a bullet went through the I.C.U. The next day, the road to the hospital had been deemed unsafe for us to use. And then the Israeli military dropped leaflets, designating areas surrounding the hospital as a red zone. Given the history of recent attacks on medical staff and facilities in Gaza, our team was unable to return, and people began evacuating the area in panic.

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