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‘It’s a Death Zone’: How Israel Destroyed Gaza’s Healthcare

Medics tortured and executed, operations without anaesthetic, patients dying from starvation. Gaza's medical workers speak to Tribune about Israel's apocalyptic war on healthcare.

The aftermath of an Israeli strike on the maternity hospital inside the Nasser Medical Complex in Khan Yunis, Gaza. (Ahmad Hasaballah/Getty Images)

‘It’s a death zone,’ said Athanasios Gargavanis, a trauma surgeon for the World Health Organisation, upon reaching the now defunct emergency department of Nasser medical complex. There were dead bodies in corridors, no tap water at all and no electricity beyond a small backup generator. At least eight patients had died due to a lack of oxygen.

This was the grim outcome of Israel’s brutal siege on the barely functioning hospital in the Southern Gaza city of Khan Yunis. Two weeks earlier, 14-year-old Ru’a Atef Qadeeh was shot dead by Israeli snipers in front of the Hospital gate while desperately trying to fetch water from a nearby location. A further twenty-one Palestinians in the vicinity of the besieged hospital were killed by Israeli snipers in the days that followed.

During a raid on the hospital, medical staff were interrogated, and more than seventy healthcare workers were reportedly detained by Israeli forces. ‘I have lived three days of hell, along with my patients’, said one surgeon. ‘What happened to doctors, patients and internally displaced people here is unbelievable, even in your worst nightmares.’

Doctor Ahmed Moghrabi, who was forced to leave Nasser Hospital in the middle of the night with his family, described families being chased by Israeli military dogs as they evacuated. In an interview with Al Jazeera, he detailed how the Israeli military abducted his head nurse, demanding that he take off his clothes. ‘At midnight, it was cold… He was screaming because they used to beat him.’

Gaza Medic Voices, an organisation set up by international medics to provide first-hand accounts from Gaza, shared the following testimony from a nurse at the time: ‘They tied our hands behind our backs, on our knees, our heads on the floors…thirteen hours without food, water, or the bathroom even.’

Far from being an isolated incident, Doctor Rebecca Inglis, an intensive care doctor and co-founder of Gaza Medic Voices, says that the attacks on healthcare workers are systemic. ‘The use of violence and degrading treatment against doctors, nurses and paramedics are recurring themes in the testimonies we have collected.’ Inglis says detainees are being denied family contact, medical care and legal counsel. ‘There is a complete lack of transparency regarding their whereabouts. This is in flagrant violation of international humanitarian law.’

She describes horrific examples of torture and doctors being ‘specifically targeted’ by Israeli forces. ‘They were forced to strip. There were a variety of forms of humiliation. They were getting hit in the face, there were dogs involved, there was electricity involved absolutely horrendous things were happening,’ she says. 

Inglis says she has been in contact with a colleague who was held in detention alongside the head of Al-Shifa Hospital, Doctor Mohammad Abu Silmiyeh, who was abducted while supporting the transfer of ambulances and buses of patients from the hospital to southern Gaza. ‘He described all of [Abu Silmiyeh’s] limbs having been broken. They forced him to crawl on the ground with a chain around his neck and eat food off the floor in front of people like a dog. Naked.’

Since last Monday, Al-Shifa has once again been targeted by Israeli forces, and the same tactics are being used. IDF soldiers reportedly undressed the male medical staff and left them in the cold for hours. Many were arrested and taken to an unknown place. Soldiers assaulted medical staff and left them without food or water during the month of Ramadan when they were fasting.

Preliminary reports indicate that at least 200 Palestinians have been killed since last Monday’s assault on the hospital, many of whom were extrajudicially executed. Survivors from the hospital siege and its vicinity have been sharing horrific testimonies indicating that the Israeli military conducted executions and killings against Palestinians, including some being run over by tank treads. One survivor said Israeli forces detained him and another eight Palestinians at Al Shifa for around three hours before they shot and killed all the group, including his father, brother, and a 67-year-old man. Another witness said he saw Israeli forces taking around ten Palestinians into the hospital’s morgue area before he heard heavy gunfire and saw the Israelis leaving without any Palestinians.

Earlier this week, the Palestinian Red Crescent reported that Al Amal Hospital was taken out of service after Israeli forces forced hospital crews and the wounded to evacuate and closed its entrances with dirt barriers. The hospital was besieged for more than forty days and shelled several times. The same fate befell Al Quds Hospital in Gaza City, which was taken out of service a few months ago.

Today, there are no functional hospitals in Gaza. Just twelve remain partially functioning and they and the staff who work in them remain under constant attack.

Medics under siege

Before embarking on a medical mission in Rafah last month with Doctors Without Borders (MSF), anaesthesia specialist Doctor Birsen Gaskell was briefed about such dangers. ‘I was told [by MSF] that I might be hit by shelling or be a victim of an explosion,’ she recalls. Birsen was also told multiple times that she could ‘change [her] mind’ and leave the two-week mission even after she’d crossed the border into Rafah. ‘This increased my anxiety levels,’ she says.

Approaching the border, Birsen could hear the explosions and see clouds of smoke just a few kilometres away. When she arrived in Gaza, Birsen says her ‘whole reality changed’. ‘I’d mentally prepared, but when you see it in real life, it’s a lot more intense than you expect.’

‘There is no clean water. There is no sanitation. There is no electricity. There is no schooling kids are everywhere. There is no vaccination. There is no primary health care,’ says Birsen. ‘The order of life as we know it has just completely collapsed’. 

As they endeavour to treat patients in these catastrophic conditions, medics say they feel especially vulnerable to attacks. Birsen had to treat two of her colleagues who’d been attacked in the hospital that they worked in, leaving them severely wounded. ‘They had limb fractures, head injuries one of them had lost an eye,’ says Birsen. The staff were then arrested one for forty-five days, the other one for two months during which time they had received no treatment other than paracetamol tablets. When they reached the hospital, Birsen said that they had ‘severe complications.’ She is unsure if they will survive.

Like Gaskell, Professor Nick Maynard, who travelled to Gaza with Medical Aid for Palestinians in December last year, found things to be ‘inestimably worse’ than he could ever have imagined. A British consultant surgeon, Maynard had made numerous visits to Gaza since 2005, working in all the major hospitals. But, he says, none of that experience could have prepared him for the horrendous scenes he witnessed recently. ‘Some of the horrific things we saw will stay with me till my dying days,’ he tells Tribune.

Maynard saw the most horrific burns in young children often so bad that they had no chance of survival. The intensifying siege meant his team often had no pain relief to give those suffering in pain. And hospitals were so overcrowded that there was nowhere for them to die with dignity. ‘They were literally lying on the floor of the emergency department dying.’

His colleague, British Palestinian surgeon Dr Khaled Dawas recalls one particularly harrowing incident where he and Maynard noticed a 5-year-old child lying on the floor of the emergency ward they were working in. ‘ Both his parents had been killed. He had a horrible hole in his chest from shrapnel. But when we dealt with that, we noticed he had a hole in the back of his head.’

‘There was no triage system at all,’ adds Maynard. ‘No one had seen him. He’d just been dumped there,’ adds Maynard. ‘The first thing we saw was an open chest wound. We just saw bubbles of air coming out.’

As they took him to the recess room, they noticed his sister, just a few years older, was on the floor awake with a fractured leg. ‘I’ll never forget seeing her face when the orthopaedic surgeon had to come and straighten her leg out without any anaesthetic,’ says Dawas. ‘We were all horrified.’

Deliberate Destruction

Under a brutal siege for over sixteen years, operating in Gaza with limited resources has always been a challenge. Israel controls the electricity going into the strip and can therefore cut off the supply when it chooses, leading to frequent power outages in hospitals. It also limits medical supplies reaching Gaza.  At the end of 2021, 40 percent of essential drugs and 19 per cent of medical disposables were reportedly at ‘zero stock’, meaning less than one month’s supply was available at Gaza’s Central Drug Store. Since October 7, these conditions have worsened ‘a thousandfold’, says Maynard. 

Gaskell was given ‘limited’ anaesthetic to use on patients. ‘The kind of anaesthetic care I was given is sub-optimal; if I did that here [in the UK], I’d be sacked on the spot,’ she says. She describes almost having her patients die on multiple occasions as a result of losing airway (this can occur when the anaesthetist is operating without full monitoring and anaesthetic equipment). ‘The pain management was just not acceptable.’

Medical supplies and facilities, along with basic resources, are extremely limited. Maynard says he has had to use blunt tools to operate on patients, and recalls one occasion where he had no access to running water, meaning he couldn’t scrub up. ‘[Me and my colleague] just had to use alcohol gel on our hands to try to clean them,’ he recalls.

Giving blood transfusion was ‘almost impossible’, says Gaskell, due to there being no blood bank. ‘The only way we could give someone a blood transfusion was if we could send a relative of theirs to the local hospital to give the blood there and bring it back to us,’ she says. ‘This could take two days and not everyone had a relative.’

Medics in Gaza are also contending with severe overcrowding: there are reports that some hospitals in southern Gaza are operating at over 300 percent of their bed capacity.  ‘[Patients] were literally put on the floor in the corner of the emergency room and left to die because there was nowhere else for them to go,’ says Maynard.

According to Birsan, the aim is always to ‘discharge patients as quickly as possible’ to create more space in the hospital. ‘Almost all the patients we tried to discharge had nowhere to go, and we felt extremely bad doing this, because a lot of them still needed a lot of care,’ she says. This included patients who’d had an amputation or were in need of dressing changes for their wounds. ‘They would tell me: “I don’t have any place to go. I don’t know anyone here”. And we would just let them out on the street.’

The overcrowding in medical facilities is contributing to the soaring rates of infectious disease in Gaza. The World Health Organisation has reported at least 369,000 cases of infectious diseases since the war began a staggering increase from before October 7.

Along with infectious disease, medics are now increasingly having to treat malnourished patients. Starvation is being used as a weapon of war, with the Integrated Food Security Phase Classification (IPC) forecasting imminent famine in northern Gaza. Birsan says that during the two weeks she worked in Gaza, three of her patients died of starvation. ‘Most of my patients, especially children, were definitely malnourished’. According to Birsan, MSF couldn’t supply food, but the NGO World Kitchen fed staff and patients once a day. This was just rice, occasionally with some sauce. ‘It was definitely not adequate; not a nutritious meal,’ she says.

The scarcity of food poses additional risks for patients recovering from burns and trauma injuries. ‘They need a lot more calories in order to heal because they need to regenerate skin,’ says Birsen. ‘Maybe more than half of [the people we were treating] actually had old injuries, but they were just not healing well, and we were just treating the complications.’

Another major problem is reaching medical care. Medics say that Israel is directly and systematically attacking ambulances in a clear contravention of international law. In addition to being bombed, ambulances are blocked from accessing areas because it’s too dangerous for them to reach. ‘It means that many people are being brought to hospital by donkey cart or being carried in or wheeled in on wheelbarrows,’ says Dr Rebecca Inglis.

Inglis sees the torture of medical staff as part of a wider, deliberate effort to restrict life-saving care for Palestinians in Gaza. ‘The systematic destruction of the healthcare system in Gaza appears to be a central tenet of the Israeli government’s military strategy,’ she says. ‘In the words of a doctor from Al Shifa when asked why he thought the hospital was being targeted: “Al Shifa Hospital is the heart of Gaza’s healthcare system. You stop the heart, and starve the population, you kill Gaza.”’

Birsen says that leaving Gaza left her with immense guilt. ‘It was very difficult: on the day I left, I was very, very sad,’ she says. Now watching the horror unfold from the UK, Gaskell feels the most important thing she can do is to continue talking about Gaza. ‘I feel morally obliged to speak out,’ she says. ‘It’s our individual responsibility. If we don’t talk about it, we are complicit.’