Since the outbreak of the new round of Palestinian-Israeli conflict, one-third of hospitals in the Gaza Strip have been forced to close due to damage or lack of fuel, according to the United Nations Humanitarian Office. The latest data from the Gaza health department shows that as of November 1, 132 medical personnel have been killed and 25 ambulances destroyed in Israeli air strikes. In addition to providing medical services to more than 20,000 injured people, the remaining hospitals that are still functioning also accommodate tens of thousands of displaced refugees.
However, it has been difficult for international aid to enter Gaza. According to reports, only a 10-member medical team was allowed to enter the enclave through the Rafah crossing on the border between Egypt and Gaza on October 27. Several international medical teams have been stranded in Cairo, Egypt for three weeks, still waiting for approval from Egypt and Israel to enter Gaza.
Mads Gilbert, a Norwegian surgeon and professor of emergency medicine at the University of Tromso, is one of them. “I desperately want to go to Gaza to support my brothers and sisters.” On October 29, Gilbert said in an interview with China News Weekly.
Gilbert is 76 years old. Since 2000, he has traveled to Gaza almost every year for teaching, research or first-aid treatment. He is known as “one of the medical experts who knows Gaza best.” “Every time an attack happens, I sit on edge at home in Norway. I know I have to go, not because the Palestinians are incapable of treating patients – they are well educated and have extensive wartime medical experience – but because It’s because of the importance of unity. They said, you are here, we no longer feel alone.” Gilbert wrote in “Gaza Nights”, a book recording his experiences of the 2014 war.
Since 2006, Gilbert has witnessed four Israeli attacks on Gaza, but he said, “Never has it been as severe as this one.”
Gilbert and his medical team from the Norwegian Aid Committee have been exchanging information with local medical staff in Gaza “almost every hour.” According to Gilbert, there was a total shortage of fuel, water, and medical equipment, and the situation in the hospital had reached an intolerable level. The number of injured far exceeds the treatment capacity of each hospital, and only the injured with a high chance of survival can go to the operating table.
Recently, Israel accused Hamas of setting up command centers and erecting weapons and equipment in and around hospitals. Hamas denies this. Gilbert told the media that if there was a Hamas command center in the hospital, “I would not work there.” “I support neither Hamas nor Fatah. I do not support anyone targeting civilians,” Gilbert said.
The following is Gilbert’s account (text abridged).
“Never has it been so severe as this time.”
I am now at the Palestinian Hospital in Cairo, which is also the headquarters of the Palestinian Red Crescent Society. The pyramids are not far from here. Sitting in this dusty room, I felt as if I were sitting on an island, with history flowing past me.
I feel frustrated. If there is anything in human nature that we should cultivate, celebrate and promote, I think it is compassion and solidarity. These are things that the Israeli military, which prides itself on being the “most moral”, does not possess. They are blocking Gaza, first a brutal 17-year siege, and then the last three weeks of a total blockade. They have cut off Gazans from electricity, water, food, medicine, forced bakeries, hospitals, schools to close. They have cut off humanity. Everything society needs. They bombed almost non-stop and refused entry to Gaza to those of us who wanted to help.
So far, more than 8,000 civilians have been killed in the attacks, including more than 3,300 children, 25 journalists, and more than 100 medical workers. At first I felt helpless and extremely angry. Later I stopped complaining and tried to concentrate on my work. I write articles, give interviews, and speak out for my colleagues and the Palestinian people in Gaza. I talk to journalists from all over the world, India, Brazil, South Africa, Norway, the United States, the United Kingdom, etc. Accepting interviews and delivering information is the most effective thing I can do at the moment.
I feel like I have to stay strong and sharp. My colleagues in Gaza and I exchanged information almost every hour. Until Israel shut down the Palestinian mobile network a while ago, there was a communication interruption of nearly 48 hours. My colleagues told me that the situation in the hospital had reached a point where it was completely unbearable. They are short of fuel, and once the generator shuts down because there is no fuel, various machines and equipment can no longer work. They are short of water and medical supplies. They have run out of antibiotics, anesthetics, and disinfectants. Disposable surgical equipment is also in short supply. They also lacked space, lacked food for patients and doctors themselves, and lacked wages. They have had no income since the beginning of Israel’s full siege of Gaza.
The latest news I got is that there are currently 120 injured people in Al-Quds hospital. In addition, they also have ordinary patients, such as kidney failure patients and 50 premature babies who need to be kept in incubators. Al-Shifa hospital has 580 injured people and 70 patients need to be put on ventilators. I estimate that Shifa Hospital now has 100 to 120 surgeries per day. As far as I know, most doctors now live in hospitals. Because you could be killed in an air raid on your way home, or find your home razed to the ground. They try to work shifts every 10 to 12 hours so they can have a few hours off.
But even so, doctors can only treat patients who have a higher chance of survival and perform operations that can be completed in a shorter time. Some patients were so seriously injured that it took two or three teams of five or six hours to save, but that meant losing the time of four or five patients who could have been saved with minor surgery. So there needs to be a senior doctor to do the priority assessment. If the patient comes to the hospital seriously injured, has no signs of life, and is unable to respond, then he will not be sent to the operating room. If the patient is lying on a stretcher and can respond to the doctor, move to step two. Doctors will find the area of the injury and decide how much treatment is needed. If the patient is only slightly injured, he may not even go to the emergency room. He will have to go to the outpatient clinic to clean and suture the wound. Unfortunately, doctors in Gaza are very experienced in dealing with mass casualties.
I lived through the Israeli bombing of Gaza in 2006, 2009, 2012 and 2014. These attacks were brutal and resulted in large numbers of casualties. Especially in 2014, one night, my hospital in Shifa received 400 patients. I felt like I was in “zombie mode” and kept working like a machine. But never has it been so grim.
First, in the past 17 years, despite the blockade of Gaza, 300 to 400 aid trucks have entered every day. Today, Israel’s comprehensive siege has lasted for three weeks, and the backlog of supplies is approximately 10,000 trucks. Add to that the additional demands brought on by these three weeks of brutal bombing and destruction, and I estimate they needed about twenty thousand truckloads of supplies. However, over the past four days, an average of only 12 aid trucks have entered Gaza per day.
Second, the scale and intensity of the bombing were also unprecedented. I saw drone photos of Gaza, which now looks like Hiroshima in World War II. I’m not comparing it to what the Japanese people suffered after the atomic bombing, but the destruction in Gaza now looks like a nuclear bomb went off.
Third, international forces are not allowed to enter Gaza. The Rafah crossing is still closed, and we cannot enter the Sinai Peninsula, which is a military restricted area, without permission from the Egyptian military, so I am still stranded in Cairo. Only one ICRC team has entered Gaza, a total of 10 people including doctors, nurses and administrative staff, but there are as many as 20,000 injured people in Gaza. In addition, there are no international journalists in Gaza, and the ban on international reporting forces entering Gaza is one of the most significant differences between this attack and previous attacks. Only local reporters are reporting, and at least 25 people have been killed.
“How to survive a bloody experience”
Approximately half of the injured were children. Children are innocent, defenseless and have no political affiliation. Treating injured children can be emotionally stressful, but as healers we cannot let this stress overwhelm us. We have a coping mechanism called focused sensing, which means we block out things that are distracting. I don’t think about whether the child on the hospital bed looks very similar to my grandson, nor do I try to identify whether those high-pitched cries sound like my daughter is crying. We have to pay full attention.
In September 2014, I returned to Norway from Gaza and thought about how to write about that experience. At that time, the hospital in Gaza allowed me to bring the camera into the operating room to record images, provided that it met ethical requirements. I saw a clip on the camera of me treating a child with severe burns. On the screen you can see my green surgical gown, a corner of the operating table, and the child, who is crying. I don’t remember hearing the child cry, but when I saw the photo, I felt his cry pierce my heart, filled with emotions I had built up while working in Gaza. I think I cried for probably 6 hours.
I tell this story to illustrate that as a doctor, whether it is rockets or F-16 fighter jets, I will not let the various sounds of war disturb me. This is a wonderful place of the human brain. But you still have the feeling that they are always there and will eventually find you. How have I survived these bloody experiences over the years, and it seems to me that the best way to deal with these emotions is to talk to people about it. I probably gave thousands of lectures about Palestine, about Gaza. I also write books and do research. Anyway, I kept telling it.
But my colleagues in Gaza and I don’t talk about these things, nor do we talk about the multiple-choice questions we were forced to do during the war. They ask me what the future holds, why no one in the Western world cares, why no one stops Israel. In recent weeks, all they talk about is concern for their families, with many health care workers losing relatives.
Now, at the end of the day, I have a “debrief time” with my two daughters, my sister. I’ll tell them if everything is okay with my day. I had not been able to do this in previous wars, and there were times when my daughters were terrified because they had no news from me.
Many others are separated from their families. A friend of mine returned to the Holy City Hospital in the north after sending his wife and 7 children to the south. Just today, Israel threatened to bomb the hospital. Twice, in 2009 and 2014, Israeli generals, through the Norwegian Ministry of Foreign Affairs, asked me and another Norwegian doctor to leave Shifa Hospital because they said they were going to bomb the hospital because it had a Hamas command center there. We refused to leave the hospital and nothing happened. In the past 20 years, I have entered Al-Quds Hospital and Shifa Hospital countless times, and I was allowed to take photos inside. I have never seen the so-called “command center” of Hamas. I think this is one of a series of Israeli lies.
My friend asked me, “Dr. Maz, if we die, please consider Muhammad your son.” This was their eighth child, now in Cairo. I said yes and introduced him to my daughters, who said they would consider him a brother.
“Why I’m a political doctor”
Gaza’s health care system was in dire straits even before the bombing began. The blockade that began in 2006 has brought huge problems to Gaza’s medical structure, supply system and management system. I have written relevant reports to the United Nations.
First, medical staff in Gaza’s public hospitals have long been receiving only a third of their salaries due to disagreements between the Palestinian Authority in Ramallah and Hamas. In order to support their families, doctors will leave public hospitals after lunch and go to private hospitals to see patients.
Secondly, Gaza’s economy has been severely damaged by the long siege, and infrastructure there is very poor. Medical systems require continuous power and water supplies, well-functioning sewage treatment systems, and medical equipment must be regularly maintained and updated. In June of this year, I spent two weeks in Gaza. Walking in the hospital, you can see that there are too many medical equipment that need to be updated, and there are too many wards that need to be cleaned, painted, and upgraded. While Gaza has so many good doctors, they don’t have the tools to do the job they could.
Cancer rates are high in Gaza, especially among women. However, due to political reasons, hospitals in Gaza do not have the equipment to perform radiotherapy. They have to go to Jerusalem for radiotherapy, so every day buses take patients from the Gaza Cancer Center (Turkish Friendship Hospital), through Israeli checkpoints, to Jerusalem’s Augusta Victoria Hospital for treatment, and then in the early evening return. 40% of patients are unable to receive chemotherapy through this time-consuming and expensive route because Israel refuses to grant them a license. The five-year survival rate for female breast cancer patients in Gaza is only 60%; in Norway and Israel, the figure is 95% to 97%. The same is true for patients with myocardial infarction. There are no modern thrombolytics in Gaza that can dissolve coronary clots, they are using drugs that we stopped using 20 years ago. Until recently Gaza did not have the equipment to perform percutaneous coronary intervention, a treatment that unblocks coronary arteries.
The cultivation of medical capabilities is also a problem. Gaza lacks the funds and resources to pay for scholarships for medical students to support their continued postgraduate education. Doctors also rarely have the opportunity to study abroad and communicate with colleagues because every time they leave the country, they need approval from Israel. I have a young student from Gaza, and we spent two years getting her a visa to Norway in order for her to do an internship at Tromso University Hospital in Norway, where I work, but she was only allowed to leave the country for nine months. These are insurmountable obstacles to a well-developed health care system. But now, the bombing has brought everything back to square one.
I think there is an unbreakable relationship between medicine and politics. Health is the primary task of medicine, and the most important goal of public health is to allow more people to live healthy lives. The prerequisites for maintaining health are not doctors and hospitals, but the most basic water and food, a safe residence, a stable job and a good education. Without these prerequisites, it will be useless no matter how many doctors and hospitals you have.
What are the main health concerns in Gaza? It’s the bombing that destroyed hospitals and ambulances, it destroyed water pipes and sewage systems, it’s the lack of water and food, it’s the lack of safety guarantees for 1 million children, all of which are political issues. That’s why I’m a political doctor, not just a doctor. I don’t want to go anywhere and just bandage the wounds of the injured and sweep the blood off the floor without asking how we can prevent these medical problems from occurring.