Oct 30, 2023

A child receives medical attention at Al Shifa Hospital in Gaza on October 17th.

Mohammad Abu Elsebah/picture-alliance/dpa/AP Images

“We Have Lost the Ability to Provide True Care”

Three doctors describe coping with fatal shortages and agonizing choices in Gaza’s overwhelmed hospitals.

As evening fell in Gaza on October 30th, the Palestinian Health Ministry announced that the Turkish-Palestinian Friendship Hospital had been “severely damaged” in an Israeli airstrike that had destroyed water pipes, electrical infrastructure, and oxygen tank lines. In preceding days, similar strikes have hit areas near Gaza’s Shifa, Al Quds, and Indonesian hospitals, which are sheltering thousands of patients and tens of thousands of displaced people.

For the medical workers attempting to keep these hospitals operational, airstrikes are only one of many concerns. Since Israel’s October 7th decision to cut off the besieged enclave’s access to food, water, electricity, and medical supplies, reports from the region have captured harrowing scenes: amputations performed without anesthesia, ice cream trucks turned into makeshift morgues, premature infants kept alive in incubators that rely on quickly dwindling reserves of fuel. Indeed, according to the health ministry, the shortages have been so severe that, combined with the bombings, they have led to the closure of one-third of Gaza’s hospitals and two-thirds of its healthcare clinics. “The health system here is in its last throes,” one Palestinian doctor told Time. “If the electricity goes, that’s it. It just becomes a mass grave.”

Amid this desperate situation, Palestinian doctors are nevertheless working around the clock to save as many patients as possible. The toll of those injured in Gaza is currently estimated at more than 21,000. As the number of people grievously wounded in bombardments climbs and resources run out, medical workers face increasingly unbearable choices. Dr. Yousef Al-Akkad, the director of the European Gaza Hospital, describes a capacity shortage so dire that “we have been forced to prioritize: to assess which patient might benefit most from each bed.” Dr. Hammam Alloh speaks of a similar situation at the Aqsa Martyrs and Shifa Hospitals, where a severe lack of equipment and medicine has forced doctors to “prioritize patients who are younger, healthier.” Al-Akkad describes the agony of these impossible calls: “It’s disgusting. It’s such a hard decision to make.”

While testifying to the grimness of the current situation, these dispatches also speak to how Israel’s 16-year blockade of Gaza has long forced the enclave’s hospitals to function in suboptimal conditions, without essential supplies. Previous rounds of Israeli bombings had already taken a toll on the quality of care. “We have lived through seven wars,” says Dr. Reda Abu Assi in his dispatch from Al Naser Hospital. “In each war, the medical services we were able to provide to patients deteriorated.” Given the cumulative nature of Gaza’s present healthcare crisis, doctors emphasize that providing quality services in the area will require not just an end to the siege, but also the achievement of Palestinian freedom. As Al-Akkad says, “I think we need a free Palestine to be able to live peacefully.”

“Yesterday, I had to stop the resuscitation of a patient . . . because if she made it back to life, we had no ventilator to offer her.”

I became a doctor to treat people in Gaza. I had to leave for 14 years to get the degrees and certification necessary to become a nephrologist [a kidney specialist]—a specialty I chose because there was a need for it. When I returned, I was shocked by the lack of resources available to me for treating my patients. Even before this war, those of us providing medical care in Gaza were operating in far-from-optimal conditions. We regularly suffered from a dearth of vital medications, essential labs, and instruments critical to our work. In my field, this meant we had trouble administering dialysis to patients; we were also frequently unable to obtain immunosuppressants and antifungal medications, as well as medications used to treat bone disease, anemia, and advanced kidney disease. Patients undergoing dialysis usually receive medicinal injections [to stimulate the bone marrow to produce red blood cells], but when we were unable to access that medication, which was often, we had to administer blood transfusions instead.

Since the war, things have become increasingly dire. We are dialyzing more and more patients—including those who’ve come [to us in the center of the Gaza Strip] from the north, some of whom have suffered kidney injuries from the bombardments. We are cutting the duration of dialysis sessions in half. Many medications are completely unavailable. Doctors make decisions based on hunches because we don’t always have access to labs. Yesterday, I had to stop the resuscitation of a patient who went into cardiac arrest in the dialysis unit, because if she made it back to life, we had no ventilator to offer her. We have to prioritize patients who are younger, healthier. We have lost the ability to provide true care.

This is not the medicine I thought I would be practicing. I always wanted to progress in my field—to learn more, to teach more. In Gaza, I haven’t been able to do that. I hope to raise my kids to be ambitious—not to think about war, missiles, rockets. Every day, I see a fear in their eyes that I can’t do much about. It’s very painful. If you have kids, you know how horrible it is not to be able to comfort them, to ensure they are alright, to make them hope for anything beyond living one more day. We want to live freely like other people—to grow scientifically and economically, to walk in the street without fearing bombardments, to make plans. We want to be able to learn, think, grow, travel, dream—to feel like we are really human. Not to think only about meeting our basic needs. This is what life has always been about for us, and now—I want the world to know—we are being eradicated en masse. This is not what life should look like.

— Dr. Hammam Alloh, nephrologist at Aqsa Martyrs and Shifa Hospitals, as told to Maya Rosen, October 26th

[Note: On November 11th, Dr. Hammam Alloh was killed in an Israeli airstrike.]

“Soon there were even more patients, so we opened a third [ICU] department, then a fourth, a fifth, a sixth . . . every single bed is occupied.”

The Gaza Strip has been under Israeli siege since 2007. This means that for the past 16 years, doctors have lacked the drugs and medical supplies necessary for our work. For instance, we’ve had a lot of trouble getting new radiology equipment like MRI machines and CT scanners. And when these machines are out of order, we’ve sometimes had to wait over a year for a replacement part. I am the director of the European Gaza Hospital, which is one of the biggest hospitals in the Gaza Strip. At one point, we had no CT scanner for more than eight months because we lacked a simple replacement part.

Such delays are avoidable. It is easy to get these parts from Europe to Jordan within, say, 48 hours. And then it takes only a few more days to get them from Jordan to the West Bank. But to get them from the West Bank to Gaza takes months and months, because the Israeli authorities do not allow such replacement parts and equipment to enter. So even if I had the money, it would take me a year or two to receive any new radiology equipment. We have the same problem with generators. Whenever there is not enough electricity in Gaza, we run the hospital on a generator, but when a generator breaks, we struggle to get replacement parts. And then there is the fact that even before the war, fuel was not always available, and when it was, it was expensive. For these reasons, we have always struggled to provide good and safe medical services.

These problems multiplied after October 7th, when our electricity and water were shut off. In such circumstances, we have hardly managed to run the hospital, let alone run it as we would like. For instance, we have been forced to use water from a local well, which is not safe at all.

In the past weeks we have received tens, hundreds, thousands of injured patients. We have also received dead bodies, and if you imagine what happens when a house is bombed, you can understand why some of the bodies come to us in parts. The patients, too, come with many injuries, sometimes needing as many as four specialists to treat them simultaneously. For example, if a patient comes in with head trauma, chest trauma, and orthopedic injuries—broken arms or legs—the orthopedic surgeon, the general surgeon, the vascular surgeon, and the neurosurgeon will all be working on them at once. So each patient ends up requiring a great deal of time and resources. But we increasingly lack the necessary resources to handle such cases. We desperately need fuel, water, electricity, and equipment—such as screws and nails to set the spinal cord—as well as all the drugs necessary for surgery. Meanwhile, we have a long waitlist of patients who need surgery, especially orthopedic surgery and neurosurgery. These patients need to go to Egypt or somewhere else to be able to find treatment, but the authorities have not allowed that yet.

In addition to the thousands of patients we have received since the war started, there are also thousands who fled their homes who are now inside the hospital because they think that the hospital is safe. This really makes things difficult because they are inside the rooms, inside the corridors, roaming the hospital. They need water, they need food, they need electricity, and this puts a lot of pressure on the medical services.

The most important shortage we face is one of ICU beds. Even before the war, we had only 12 ICU beds in the European Gaza Hospital because such beds are expensive and require a lot of equipment. But once we started receiving so many seriously injured people, we opened another department so that we could increase the bed occupancy in the ICU. Soon there were even more such patients, so we opened a third department, then a fourth, a fifth, a sixth. Now we have 54 ICU beds, which we have never had before—and every single bed is occupied.

The ICU situation has become so dire that we have been forced to prioritize: to assess which patient might benefit most from each bed. Now, when a patient is seriously injured and we think that they have no chance to live, we unfortunately have to leave them to die so that another injured person can occupy that ICU bed. There are likewise patients who, in normal circumstances, we would resuscitate, but now we don’t because we don’t have enough beds. It’s disgusting. It’s such a hard decision to make.

What I want for Gaza is simply freedom. We have been under occupation for 75 years. It is time to end this conflict. Everybody talks about two states living side by side peacefully and freely, but unfortunately, nobody feels pressure to make it happen. We want to live in peace, and we want a good future for our children. I think we need a free Palestine to be able to live peacefully.

— Dr. Yousef Al-Akkad, director of the European Gaza Hospital, as told to Maya Rosen, October 27th

“The fuel for generators will be gone soon. Most of our patients are connected to devices that need this electricity.”

We have lived through seven wars. In each war, we lost co-workers with whom we had memories. In each war, the medical services we were able to provide to patients deteriorated.

Since this war began, our situation has become even more difficult. When Al Dora Hospital in eastern Gaza was targeted, all of their patients were transferred to our hospital, including patients in pediatric intensive care. With so many patients, we now have shortages of most medications and are trying to reduce the use of IV fluids. We have run out of many life-saving drugs; we live on medical aid from abroad, and if it runs out, we have nothing to offer. We also have a shortage of medical personnel because many of our staff headed south in the hopes of finding safety for their families. We have insufficient electricity as well, and even the fuel for generators will be gone soon. Most of our patients are connected to devices that need this electricity.

I am currently treating a two-month-old patient from Beit Lahia [in the north of Gaza]. He was admitted to the pediatric intensive care unit by members of the community because all of his family was martyred. We cannot discharge him because there is no member of his family left.

Choosing the medical profession is an expression of love for my country. We serve the people of our country in different ways, but it is especially important to serve our children, who have been deprived of all the pleasures of normal life. These children have a right to be cared for, and to lead healthy lives.

For now, we are suffering, and we are fighting, but we do not know how long we can last.

— Dr. Reda Abu Assi, pediatrician and head of the pediatric intensive care unit at Al Naser Hospital, as told to Maya Rosen, October 29th

Dr. Hammam Alloh was a nephrologist at Aqsa Martyrs and Shifa Hospitals.

Dr. Yousef Al-Akkad is the director of the European Gaza Hospital.

Dr. Reda Abu Assi is a pediatrician and the head of the pediatric intensive care unit at Al Naser Hospital.

Maya Rosen is the Israel/Palestine fellow at Jewish Currents.