A Chicago Doctor Decries the Suffering of Medical Professionals and Patients in Gaza

The dismantling of health care in the strip has left workers traumatized, hospitals in ruins and conditions ripe for outbreaks of disease

A Chicago Doctor Decries the Suffering of Medical Professionals and Patients in Gaza
British doctors working in Gaza attend a memorial ceremony for the victims of Israeli attacks, including their colleagues, in London. (Rasid Necati Aslim/Anadolu via Getty Images)

Being a Palestinian doctor has been an incredibly difficult thing over the last few months. Although I was born and raised in the great city of Chicago, to me Gaza is home. My aunts, uncles and cousins reside in Gaza — as does my heart. I’ve lived in Chicago for my entire life but have also returned to the motherland, Gaza City, to visit my family. For a while now, I have had a trip to Gaza planned for the summer of 2024. It would make 11 years since my last visit, and mark a culmination of all my schooling and training over that time. I’ve graduated from university and medical school, and shortly will be graduating from medical residency training where I am currently completing my chief year in obstetrics and gynecology. Summer 2024’s trip to Gaza would have been a way for me to treat myself after over a decade of hard work and to celebrate alongside my family. But given the circumstances, this trip no longer looks like I imagined it.

I am from Gaza and my family remains in Gaza; I am a doctor and I have a strong desire to work as a doctor in Gaza. And yet I can do nothing right now as people in my homeland are slaughtered. The disconnect — the desire to do more but not being able to, while watching Palestinian doctors working until their literal last breath — has caused me a lot of grief.

Gaza has, or rather had, 36 hospitals throughout the strip. The land area of 140 square miles is not enough for the 2.3 million people who live there, and neither are the 36 hospitals. To put things in perspective, Chicago has a population of 2.7 million people, and there are 103 hospitals and primary care facilities that serve the city. At base line, with no war, Gaza’s health care structure is overwhelmed and overworked. Even at base line, Gaza lives under nonstop siege, with its limited supplies and hospitals unable to function to the capacity that they should.

The first few weeks of the war saw the majority of Gaza’s hospitals become nonfunctional, the number of available beds collapse and the capacity to treat trauma cases or perform complex surgery confined to one hospital. Among the medical facilities that are out of service are Gaza’s only pediatric cancer center — Al-Rantisi Hospital — and Gaza’s only mental health facility. A child who has cancer or a young adult who has schizophrenia have nowhere to go to receive crucial specialized care.

The hospitals that do function are running in an extremely limited capacity and with minimal resources, overworked staff and high patient numbers. Hallways are filled with people seeking health care and others seeking refuge. One hospital bed is often occupied by two or three children at a time, to ensure that children are not being treated while lying on the cold floor. Patients awaiting triage lie in the hallways or corridors of the hospital, rather than sitting in a nice, bland but comfortable waiting room like they would if they were taken care of in America.

Doctors in Gaza have taken on more than just the job of being physicians. They have become family to orphaned children who are the sole survivors in their entire family — a tragic state of affairs now ubiquitously referred to by international aid organizations with the acronym WCNSF, or Wounded Child No Surviving Family or, in Arabic, simply “mafi ahl.” No family. The professionals providing medical care have also become cooks, making bread in the hospital hallways for themselves and staff. They’ve become historians and journalists, documenting tragedy after tragedy, advocating for basic human rights and health care needs. They’re doing this all while taking care of more patients than is safe for any doctor to take on.

Here in the United States, we have work hours restrictions. Physicians are not supposed to work more than 80 hours a week. If they do, they are violating medical education guidelines. It is illegal to work more than 30 hours as a single shift. Regardless of how much or how little you work, you are entitled to 10 hours off between shifts. This is necessary to ensure that the physician gets enough rest to operate in accordance with professional standards. This mandatory respite is not happening with physicians in Gaza. Physicians have spent weeks on end working at the hospital, with just three to four hours in between shifts, working 36 to 40 hours straight, and sleeping on chairs or on the floor in storage closets so that they can be readily available if needed. They have gone weeks without a single day’s break.

I work as an obstetrician and gynecologist in Chicago, and am working 24-hour shifts approximately six times a month. By hour 20, I am exhausted beyond words. I feel nauseated, overheated and fatigued, and will only speak when spoken to. My call shifts aren’t predictable: Some nights I might deliver six babies and see a few consults in the emergency department. Other times, I deliver one baby and complete an emergency surgery. But never in my wildest imagination can I conceive of taking care of family members and friends, or admitting and assessing seven to eight patients an hour — all of which doctors in Gaza are doing regularly.

The physicians in Gaza are resilient beyond words. They are also suffering from their own chronic stress and trauma. Many videos taken by freelance journalists have shown physicians discovering that their family members have been killed when they are brought into a trauma bay. When they pull aside the garments used to wrap around the patients for their trip to the hospital, they soon realize it is their own family, covered in shrapnel, barely identifiable from the damage of the attacks. Regularly, doctors announce their family dead upon arrival, mourn their death for a few minutes, and then must return to work. There is no more time to mourn, since there are hundreds of patients in desperate need waiting to be seen.

If, God forbid, a friend or family member came to the hospital here in Chicago after having suffered a major accident or tragedy, I would not be allowed to take care of them. Protocols like this exist so that emotions don’t cloud our medical judgment. There are usually other physicians in the hospital that I can hand off the care to, and if not, I can always call someone in. In my current work as a physician, I struggle when patients die who are complete strangers to me, people whom I took care of for just a few hours or a day at most. I need time to decompress and disconnect. If I were in Gaza, I would have none of these luxuries.

In the U.S., doctors are well compensated for the often difficult work we do. The doctors in Gaza are all working without having received a paycheck since the beginning of October. Truly, their empathy and desire to take care of people is what drives them. Since the war started, over 300 (and counting) health care workers have been killed. Some of them are killed upon returning home after having spent 40 or 50 consecutive days in the hospital, when they are back with their family again. An Israeli airstrike wipes out their house, and they and their family are instantly killed. Other health care workers are killed while on the clock, as the Israeli military continues their aggression toward hospitals, as seen at Al-Shifa Hospital and Al-Awda Hospital.

Paramedics are working around the clock to transport the injured to the hospital. They, like physicians, are doing far more than just their jobs. Paramedics are consoling patients, holding them, risking their own lives to save the lives of their patients. Videos of a paramedic soothing a baby in his lap and wiping her bleeding forehead while he drives the ambulance, while in the back the other medic is taking care of four or five patients at a time, are becoming a common sight. Paramedics and first responders are getting killed by Israeli strikes while doing paramedic work, as reported by rights organizations and the media.

The IDF has openly attacked hospitals, completely incapacitating several, including Nasser Hospital, Al-Aqsa Hospital, the Indonesian Hospital and the Turkish-Palestinian Friendship Hospital, to name a few. Israel also attacked and bulldozed tents outside Kamal Adwan and, according to CNN, arrested many health care workers there and took them to an unknown location. Northern Gaza is currently reliant on seven remaining, partially functioning hospitals, according to a World Health Organization report published on Jan. 24.

The attack on Al-Shifa Hospital, in particular, has reverberated around the world. Nearly every Gazan has some sort of connection to Al-Shifa Hospital, myself included. My family lives just a few blocks away from the hospital. When I tell people where my family is from, I refer to Al-Shifa Hospital in al-Rimal neighborhood as a way to contextualize the geography. Due to the hospital’s popularity throughout the entire Gaza Strip, and even beyond, people understand exactly where I’m from.

When I visited Gaza as a teenager, my mama wanted me to be inspired by the hospital in the motherland and she took me to see how Al-Shifa functioned. Al-Shifa is Gaza’s largest medical complex with special units and highly trained medical professionals, unlike any other hospital in the entire Gaza Strip. I knew I wanted to be a physician by this time, but wasn’t sure what kind or in what capacity. Used to all the bells and whistles of American hospitals, I was unimpressed. The hospital looked old, there weren’t many new machines and supplies were rationed due to the siege on Gaza. But having finished medical school and reached the end of my training years, I reflect on that visit and imagine myself working at Al-Shifa one day. Although not as fancy as the U.S. hospitals that I’ve worked or trained at, it has a deeper meaning to me because it is a hospital in my homeland, deeply embedded in my roots, and would allow me to pay it forward to my people.

Aside from the deaths and injuries that are a direct result of the military airstrikes, there are also trickle-down effects that will kill and maim many people as a result of malnutrition, waterborne illnesses and infections. Skin infections like impetigo, varicella and chicken pox are increasing. Scabies and lice have begun to run rampant. In mid-December, there were already over 19,000 and 17,000 cases of these, respectively, according to a report from the Gaza Ministry of Health. The report also estimated that 150,000 Palestinians in Gaza were suffering from upper respiratory tract infections, without adequate medication or hospital capacity to treat the infections. In the dire living conditions in which the vast majority of Gaza’s population now lives, infections spread rapidly.

With the siege and assault on Gaza, and the lack of humanitarian aid being let into the region, many Gazans are resorting to eating one meal a day. Some men are fasting to allow their wives and children to have food for the day. With limited access to water, people are resorting to drinking brackish water — salty seawater. The consequences of this are far more dangerous than one would initially think. Initially, it leads to urinary frequency as the body attempts to expel the excess salt. But over time, intense abdominal pain, diarrhea, cardiovascular disease and severe kidney dysfunction can be seen. In excess, people die due to dehydration.

The majority of the water for the region comes from local desalination plants, but many have become contaminated as a result of the war. Some water is supplied through Israel, but even that the Israeli authorities withheld for a period of time and only recently restarted. Prior to this war, Gaza’s water infrastructure and sewage system were already on the brink of collapse. With the sheer number of people in the region, the system was regularly overwhelmed. People now stand in line for hours at water distribution sites just to get a few gallons for their family, and ration the water for cooking and drinking. People report not having taken a shower in weeks to save the clean water they have.

Waterborne illnesses will exponentially increase as a result of the runoff and contamination from the corpses that it has been impossible to remove from the rubble. The United Nations and WHO are concerned about widespread cholera infections, which have already started to appear. Cholera is a bacterial diarrheal infection, which can be fatal. Given Gaza’s collapsing health care system and the lack of safe water, there will be a quick spread of disease. Even before October 2023, approximately 97% of Gaza’s water supply was not suitable for drinking (but was used for showering, for example). Water for drinking had to be purchased as bottled water, or in off-grid water tanks. Now, people cannot even attend to basic daily needs like a regular shower or washing their hands frequently because of the lack of access to running water.

Most medical supplies in Gaza have run out. In the U.S., it would be unheard of for a physician to use vinegar to clean a wound. We have sterile water and different kinds of soaps, solutions and antibiotics that are created for this exact reason — to clean and sterilize wounds to prevent infection and to encourage proper healing. Medical supplies in Gaza are so scarce that physicians are making do with whatever they can, trying to be as resourceful as possible. Maggots and bacteria, which thrive in unclean and nonsterile environments, have come to call these wounds home. Multiple patients share one hospital bed, and when all the beds are used, patients lie on the ground. In the U.S., even in a natural disaster or mass shooting, there are hospital beds we can borrow from other units, and we can always transfer patients to nearby hospitals so that they can be taken care of properly.

One of the most needed supplies right now is anesthetics for medical procedures. Priority for anesthetics is given to surgical cases with polytrauma and high-intensity, high-acuity and painful procedures. Women have been undergoing obstetric procedures such as cesarean sections without anesthesia, according to Dr. Mohammad Zaqout, Medical Director of Nasser Hospital. A cesarean section is a major abdominal surgery, approximately 15 centimeters in width and extending through seven different layers of tissue. In the U.S. (as in most of the world), such a surgery without any form of anesthesia is incomprehensible. The procedure is done with a local nerve block that numbs the nerves responsible for all sensation from the chest down. In the hours and days following the surgery, patients are given around-the-clock pain medication to help ameliorate the severe postoperative pain. But there is now no such option for many surgeons, and people giving birth, in Gaza.

Women are facing higher rates of miscarriage and preterm labor due to the extreme stress surrounding them at all times. For babies born early, the hospitals are beyond capacity and are struggling to sustain the lives of the premature babies as they run out of fuel and ventilators. Patients who are not there for trauma from the war or for critical care are asked to leave as soon as possible. Patients who had been admitted to the hospital previously for chronic health problems have been discharged to make room for patients in more critical condition.

Recently, my cousin delivered via cesarean section. She was fortunate to have anesthesia available on her procedure date, but she had expressed concern about not having any for the weeks leading up to her surgery. She had to arrange her own transportation to the hospital and, with the lack of fuel, was only able to arrange for a cart and a donkey to take her. She was in for her surgery at 10 a.m. and was discharged from the hospital by 3 p.m., which would be unheard of in most places around the world. There was no transportation out on the street, so my cousin walked home and fainted en route, due to the pain and blood loss from surgery. Patients who deliver vaginally are asked to leave after a couple of hours, which is also brutal on the body for both mother and baby.

Where are these patients discharged to? Over 1.9 million people in the Gaza Strip have been displaced. Over 80% of homes in Gaza have been either completely or partially destroyed, making them unlivable. So patients leave the hospital to return to schools, mosques, hospitals and tents, where they seek refuge and recovery in overpopulated and unhygienic conditions.

Imagine you’re in Gaza, you’ve just undergone a major surgery and, rather than recover at a hospital, you head to a school-turned-public-shelter on the same day as your procedure, where you are surrounded by hundreds if not thousands of others. Had you been in the U.S., after having completed major surgery, you might stay for a day or two under observation to ensure you’re meeting postoperative milestones like being able to eat, walk and use the restroom, and that your pain is well controlled. Until all of those milestones are met, you do not leave the hospital.

Supplies are running low for critical childhood vaccines and RhoGam injections. Without childhood vaccines, hundreds of thousands of children will be behind on their vaccine schedules, increasing the risk and the rate of preventable infectious diseases such as measles, chickenpox and rubella. RhoGam, a prescription injectable medication for pregnant and recently delivered women, is scarce. This medication is used for mothers with a Rhesus negative blood type, such as A negative or O negative. It helps prevent the mother’s immune system from attacking any fetal blood in her circulation, which can cause serious health problems such as fetal jaundice or, at its worst, fetal death. If not given the injection while pregnant and postpartum, the long-term repercussions include recurrent pregnancy loss and miscarriages.

Antibiotics are so scarce in Gaza that many people are suffering from wound infections, or dying from sepsis. Feminine hygiene products such as pads and tampons are so difficult to find that there are public outcries on Facebook and X (formerly Twitter) to locate them for menstruating women. Women are resorting to using old fabric or cutting strips from the tent canvas, and rates of toxic shock syndrome, which can be fatal, have increased as a result.

As a physician, I took an oath to preserve human life, to “do no harm” and put my patients first. Physicians throughout Gaza have upheld this oath with stunning commitment, truly working around the clock treating patients.

I was horrified to learn that over 100 Israeli physicians signed a letter urging Israel to bomb hospitals in Gaza. And Israel has done so, with over 600 direct attacks on hospitals, according to the WHO. Both of Gaza’s medical schools were attacked. The only mental health facility in the entire region was attacked, making mental health care access difficult for a population with high rates of traumatic stress disorders, depression, anxiety, suicidal thoughts and panic disorders because of the siege.

Respected journalists like Motaz Azaiza, Plestia Alaqad and Wael al-Dahdouh dispatch to the world daily evidence of the war crimes Israel is committing against the Palestinian people, making it increasingly difficult for Israel to deny the atrocities. Independent investigations from The New York Times and The Washington Post demonstrate Israeli aggression against hospitals, a blatant violation of international law.

In defiance of it all, I still hope to work and eventually practice in Gaza. Undeterred by the destruction and broken health care system, I dream of opening a specialized women’s health hospital in Gaza to provide obstetrical and gynecological care for the beautiful women of Palestine.

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