Two months after the start of the war in Gaza, Israel's incessant and indiscriminate attacks have reduced the north of the Gaza Strip to rubble and are now hitting the central region and the south with increasing brutality. The suffering of the Palestinians trapped in Gaza can no longer be expressed in words.
With almost all of the 2.2 million residents trapped in the southern Gaza Strip, attacks by Israeli forces on what should be a safe zone prove that nowhere is safe. According to the Health Ministry, around 19,000 people have been killed and more than 50,000 injured in Gaza over the past ten weeks, and the ongoing offensive continues to claim hundreds if not thousands of new victims every day.
Also read: Doctors Without Borders calls for an immediate ceasefire worldwide
Challenges in treating war injured in Gaza
At the Nasser Hospital in Khan Younis in the south of the Gaza Strip, where Doctors Without Borders (MSF) works, scores of dead and injured people have arrived almost daily since the brief ceasefire ended on December 1st. The severity of the injuries and the large number of patients are pushing Gaza's health system to the point of collapse in this region of Gaza, too, after it collapsed in the north, where only one hospital remains, albeit partially, in place, according to the World Health Organization Operation.
“The emergency room at Nasser Hospital is completely overcrowded and new patients are being treated in the ward. Doctors climb over the bodies of dead children to treat other children who will die anyway,” complains Chris Hook, head of the MSF medical team in Gaza. “More and more temporary structures are being erected, tents are being used as makeshift wards and clinics. Every available building will be filled with beds for patients. More hospital beds are urgently needed.”
Regard: Doctor reports an operation on a child on the hospital floor
The treatment of war wounded is complicated because explosions from explosive weapons and the collapse of buildings result in multiple and simultaneous injuries to many parts of the body. In Gaza, Israel's total siege is making impossible access to vital medicines, including painkillers essential during surgical procedures and the medical tools needed to treat shrapnel and burned bodies.
“The few 'lucky' people who survive suffer lifechanging injuries. Many injured people suffer severe burns and severe fractures that do not heal properly and may require amputations,” explains Hook.
“Many of these patients, even if they are able to return to a somewhat normal life, will suffer from severe chronic pain that also requires comprehensive treatment. “This would be an enormous burden on even the most functional health system, let alone a system under severe pressure like in Gaza,” he concludes.
At AlAqsa Hospital in central Gaza, a team from MSF provided emergency surgery and outpatient care. From December 1 to 11, about one in three patients (640 of 2,058) were declared dead on arrival. On December 6, the number of deaths arriving at AlAqsa Hospital exceeded the number of injured. Healthcare facility staff are striving to maintain effective hygiene protocols and reduce the risk of infection for patients, but at the same time are facing shortages of vital supplies and equipment. Under these conditions, maintaining hygiene protocols is an extremely difficult but essential task, as a growing number of infections can quickly become an additional medical challenge for both patients and already overburdened medical professionals.
What is happening today in the southern Gaza Strip appears to repeat the actions of the Israeli forces in the northern Gaza Strip. A scorched earth policy that leaves no safe space for people, constant attacks and repeated evacuation orders by the Israeli Defense Forces for entire neighborhoods, and the total siege of the Gaza Strip have made it extremely difficult for people to access medical care, with medical personnel to provide it . Since December 1, MSF has had to stop supporting three health clinics in the south and reduce its presence at Nasser Hospital. The ongoing forced displacement of people must end so that the sick and injured receive urgently needed care.
Increase in infections as the health system reaches its limits
While the risk of violent attacks on civilians in Gaza remains, infections due to poorly treated injuries are increasing rapidly, endangering lives.
“The risk of infection is incredibly high due to the conditions people have to live in and the fact that it is simply not possible to provide the longterm hospital care that these patients really need,” says Hook.
At the European hospital, a small team of doctors from Doctors Without Borders recently began treating patients who were injured at the start of the war and whose wounds are now infected due to a lack of medical care.
In the south, only a few primary health facilities are open, including the AlShaboura clinic supported by Doctors Without Borders. This means there are few treatments for infectious diseases such as respiratory infections, diarrhea, chickenpox, lice and scabies, which spread uncontrollably in crowded shelters and increase the risk to displaced Palestinians.
Terrible living conditions and widespread hunger
Another urgent need is shelter for displaced people, as the new displaced add to the already high number of people living in desperate conditions. “If you walk the streets south of Khan Younis and near Rafah, you can see the shelters expanding as more people arrive,” says Hook.
“The general conditions for most of these people are terrible: they live in makeshift structures made of a few pieces of beatenup wood covered with plastic sheeting, with no insulation from the earth or concrete floor. They struggle to find enough water to meet their hygiene needs,” adds Hook. The fragile shelters are now in constant danger as they are damaged by strong winds and heavy rain.
As more people arrive in the South, it becomes harder to find food, and what little food is available is too expensive for people to buy.
During a sevenday ceasefire in November, the arrival of patients with violent injuries at Nasser Hospital was briefly halted. Instead, the health facility was overcrowded with diabetics and other patients with chronic illnesses who were unable to access the medical care they needed during the fighting. This changed again when hostilities resumed on December 1st. This time with even greater intensity. We do not know what happened to these chronically ill patients after the facilities were overwhelmed by the mass arrival of war wounded, nor how they will survive.
On December 17, the maternity ward at Nasser Hospital was targeted by attacks. One patient was killed in this attack and other patients were injured. Attacks on health services must stop now.