The war in Gaza rages on with no end in sight, but in Gaza, British-Palestinian surgeon Dr. Ghassan Abu Sitta urges the world to start thinking about “the day after,” especially with Gaza’s healthcare system, because the war continues when the bombs end.
On Sunday, Steve Sosebee of Palestine Children’s Relief Fund (PCRF) held a webinar with Dr. Ghassan Abu Sitta, a plastic and reconstructive surgeon in Gaza. On the other side of the world, physicians in the West listened intently, many asking how to help the staggering number of wounded Palestinians (23,000+), nearly half of which are children per Dr. Abu Sitta.
As Dr. Abu Sitta spoke from Al Ahli hospital, nearby, Gaza’s largest hospital, al-Shifa, was under its third day of bombardment, with patients and staff going without food the entire time, per Gaza’s Ministry of Health. Abu Sitta was back and forth between Al Ahli and al-Shifa until al-Shifa’s besiegment by Israeli forces caused it to “basically collapse.” At times, bombing disrupted the call quality, yet he remained steadfast as he described the horrors healthcare providers face as they care for severely wounded patients without basic supplies – all while under fire by Israeli snipers.
Since then, late Tuesday night/early Wednesday morning, ground forces invaded the beleaguered hospital, searching for an alleged Hamas base. Hamas denied running operations from al-Shifa, calling Israel’s claims that weapons were found “a continuation of the lies and cheap propaganda through which (Israel) is trying to give justification for its crime aimed at destroying the health sector in Gaza.”
Even before the ground force invasion of al-Shifa, Abu Sitta said the situation was dire. “The scale of the destruction; the number of patients is overwhelming,” he said. He described a grim situation: hundreds of wounded patients and only three surgeons and two operating rooms.
“We don’t have access to a blood bank; the blood bank has been destroyed.” At Shifa hospital, remaining patients and staff were hiding in the corridors because it is “completely surrounded by Israeli snipers who are firing into the windows.” He reported that the IOF “killed a couple of young doctors and fired missiles into a couple of buildings” earlier. The hospital’s oxygen pipes were hit, resulting in the deaths of multiple oxygen-dependent patients in the intensive care of al-Shifa.
Since Sunday’s call with Dr. Abu Sitta, as of Thursday (11/16/2023), he reports that surgery is no longer possible at Al Ahli hospital.
Israel’s war crimes that include targeting medical personnel, ambulances, blood banks, and hospitals have succeeded in a “systemic uprooting of the health system” that will have implications for decades to come. With dwindling resources and exhausted staff, healthcare providers in Gaza are forced to focus on acute care and crisis stabilization as patients die due to lack of basic supplies. Dr. Abu Sitta is realistic about what’s needed in the future when many will need further surgeries unavailable now, urging his international colleagues to start planning for “the day after.”
The longterm effects of the healthcare system’s collapse will be felt by all. Currently, preventative or chronic illness care isn’t readily available. Expectant mothers have no safe place to deliver their babies, and multiple babies in incubators are at imminent risk of death. Without sufficient aid, the death toll from the war will continue to rise as “many patients may be left to die while the system tries to recuperate.” Virtually everything has been destroyed, including the ophthalmology hospital, cancer hospital, and “all core pediatric hospitals.”
Abu Sitta is treating “traditional blast injuries” as well as wounds resistant to multiple drugs and never-before-seen injuries he attributed to “new weapons that get tested on Gaza.” Delays in treatment make the longterm effects “devastating,” requiring more surgeries and more complex reconstruction, resulting in more residual disability.
Gaza’s children of war will require multiple surgeries throughout their childhood and into adulthood. “A whole generation has been permanently damaged and disabled,” he implored, as he described doing a double amputation on a six-year-old the day prior while one room over, his colleagues worked on a child with an abdominal wound and no surviving family. That child is now being cared for by the family in the bed next to him.
Abu Sitta likened the working conditions in Gaza to something out of World War I, recounting how earlier in the day he had to do “major dressing changes on children” with no pain medication. “There’s no ketamine, no morphine, not even Tramadol. We’ve been reduced to this kind of brutalisation,” he said.
The same day, he also had to perform a surgery he hadn’t done in 15 years because there was no one else to do it. “We have a field hospital in the compound where the missile landed. We’re just basically making do,” he explained. “We have no CT scans, no neurosurgeons. There are three of us: myself, an orthopedic surgeon and one general surgeon.”
When one doctor asked what supplies they’d need to bring, Abu Sitta responded “everything,” imploring that by the time aid would be allowed to arrive, “there will be nothing.”
From canulas to bandages to medications and staff, “everything you can imagine has been consumed by over 23,000 wounded over 37 days with no real resupply. There’s been a couple hundred trucks that came in, but they were just a drop in the ocean; they didn’t make a difference.” He requested that doctors “make a daily list of every insignificant item you take for granted” so they could arrive prepared with consumables, revealing that Israeli forces hit a storage building at al-Shifa earlier, likely decimating what little supplies remained.
Jordanian aid has been of some benefit to those in close proximity, but it’s “not large enough to make a dent and movement is really restricted now.” He relayed that the director of the Jordanian field hospital was unable to get pain medication for his own niece.
Israeli forces make movement near impossible, even targeting ambulances. “There are quad copters with new drones that fire at people, so you no longer need snipers to shoot the ambulances. They will fire at ambulances and as people try to get out.”
Dr. Tarek Khalefi of Canada mentioned an aid group wanted to get preterm babies to hospitals in Egypt, but were unsure of the logistics, noting safety concerns. Abu Sitta rejected the idea Israel would allow even babies to be escorted to safety, reiterating that al-Shifa hospital has Israeli snipers “firing into the windows at anything that moves.” He reported Israeli forces were on the premises at the time of the call, but it was unknown exactly where, and pointedly restated how Israeli forces bombed the oxygen pipes.
“At the moment, Israelis have not shown any kind of humanitarian inclination. The kind of brutalism that’s happening defies any kind of logic,” as he urged the international community to begin preparing to help Gaza rebuild in the aftermath, urging that aid to Gaza needs to be ready to “hit the ground running.”
While Israel claims they offered fuel to al-Shifa but Hamas refused it, the director of al-Shifa says this isn’t true: “The IDF contacted me to supply the hospital with 300 liters of fuel, which is barely enough for 15 to 30 minutes. We did not refuse to receive the fuel; he asked for it to be delivered through the Red Cross instead of me going to the army myself to take it.”
“The whole aim of what’s happening now is to make Gaza uninhabitable so that those who have not left during the war and as a result will leave soon after. That’s the aim of this brutalization, to empty Gaza of its population or a big part of its population and leave the rest destitute and fending for survival. We need those on the outside to be thinking about the second phase of this war, which is the war of ethnic cleansing by making Gaza into an uninhabitable place,” Abu Sitta implored.
The whole aim of what’s happening now is to make Gaza uninhabitable so that those who have not left during the war and as a result will leave soon after. That’s the aim of this brutalization, to empty Gaza of its population or a big part of its population and leave the rest destitute and fending for survival.Dr. ghassan abu sitta
Abu Sitta said there will be thousands and thousands of patients that need complex reconstruction and nerve and/or bone grafts. “This is a society that has been destroyed that will need primary healthcare – good primary healthcare – because of what its undergone,” pointing out that providing that healthcare will be challenging due to unmet basic needs like nutrition and housing.
“These people will now spend the winter out in the open,” he explained, discounting the possibility of getting enough prefabricated homes to house all of the displaced Gazans. People will be sheltering in close quarters in schools or other buildings, creating “all of the catastrophes you can imagine” in regards to “infectious diseases and dermatological infections.”
The close quarters, however, have only increased the ever present sense of community. “When you lived in a kind of individualist, capitalist society long enough, you forget what community living looks like,” he reflected. “But people share mattresses, their food, and their space with each other. It’s awe-insiring they rise up in their humanity at a time when they’re being so brutalized,” he said of the Palestinian people’s resilience.
“This is a continuance of what our parents went through in 1948,” he said, referencing the Nakba. “The people who are being killed, driven out of their homes, are the children and grandchildren of those who survived the same kind of elimination,” he continued, speaking to the intergenerational trauma of a decades-long ethnic cleansing.
He commended the millions who have taken the streets to march for Palestine, urging people to “keep this outrage and channel it positively,” and saying that on the ground, Gaza’s healthcare heroes would do their best with whatever they have.
“Every nightmare has to come to an end,” he said. His parting words were a sobering revelation of the point he’d been driving home for almost an hour: “Wars don’t stop when the bombs end.”