As an oncologist, it is difficult to provide cancer care even under normal circumstances. The disease is unforgiving, treatments such as chemotherapy and radiation must be timely, bloodwork is oftentimes checked weekly and scans must be performed regularly to monitor the tumor. To do all of this under the uncertainty and siege of war, without electricity and under the constant risk of death, would be plainly unimaginable. And yet, I am left awed by Gaza’s intrepid doctors, still standing and providing care to patients amid a collapsing health care system.
I am left awed by Gaza’s intrepid doctors, still standing and providing care to patients amidst a collapsing health care system.
The conflict between Israel and Hamas has rendered most of Gaza’s hospitals inoperable. Those still functioning have been reduced to mere community clinics that are unable to provide acute trauma care.
But in the midst of power outages, medicine shortages and military bombardments, Gazan doctors have continued to treat endless throngs of wounded and vulnerable people. Despite real fears about their personal safety and immense limits on their medical capacities due to the lack of basic resources, they have not abandoned their gravely injured patients, many of whom are small children. These physicians are fulfilling the Hippocratic oath daily in the face of daunting odds and are providing a constant light of humanity through medicine.
Gaza’s health care system was starved even before Hamas launched its heinous attack in southern Israel on Oct. 7. Sixteen years of a blockade administered by Israel and Egypt, coupled with a dependence on declining international donations, had left the system chronically strapped for funds and under capacity. Inhabitants of the occupied Palestinian territories lag greatly behind their Israeli counterparts in key health metrics, including average life expectancy, average response time of emergency services, infant mortality, and risk of death from noncommunicable diseases among patients between the ages of 30 and 70.
In oncology, I witness daily how time means life. Delays in diagnosis, surgery, chemotherapy and radiation can greatly alter a patient’s prognosis. In Gaza, prolonged times for receiving travel permits from Israeli authorities to access cancer care in the West Bank (including East Jerusalem) Israel or Jordan has meant poorer outcomes — meaning advanced and terminal cancer — for patients.
Gaza’s health care system was starved even before Hamas launched its heinous attack in southern Israel on October 7
That already teetering health care system has now fallen under the weight of the current conflict. Despite protections enshrined in international law, hospitals have been directly attacked in airstrikes, raided and besieged, resulting most recently in a forced mass evacuation at Al-Shifa Hospital in Gaza City. Just days later, Indonesian Hospital in north Gaza was shelled.
Many physicians and health care workers have taken up residence in the hospitals, subsisting on one meal a day and sleeping in offices or operating rooms. With life-saving measures such as ventilators scarcely available, these doctors are waking to the recurring horror of treating only those critical patients thought to have the best chance of survival and allocating far less, if anything, to the futile cases.
In the face of dire water, fuel and medicine shortages, doctors resort to amputating limbs without anesthesia, using cellphone flashlights for surgeries, and cleaning maggot-filled wounds with vinegar and store-bought washing liquid.
“There is an unprecedented humanitarian crisis unfolding in Gaza and a complete suffocation of resources and materials entering,” Dr. Thaer Ahmed, an emergency medicine physician who has previously been on multiple medical missions to Gaza, told me. He said doctors “are going through a mass casualty event daily. They’re getting an influx of patients every single day, and every subsequent day they have less and less to work with.”
The total mental trauma of these collective experiences will not end when the bombs stop falling. Doctors and nurses have witnessed unimaginable human suffering, provided treatment in impossible conditions and made difficult choices about patients. They have borne this burden while frequently being separated from their own families and while grappling with their own mortality daily. A study looking at the 2014 Israeli offensive in Gaza showed that roughly 90% of doctors and nurses were still reeling from post-traumatic stress disorder (PTSD) even two years later. PTSD has been associated with negative health outcomes, acute depression and burnout.
You think I went to medical school and for my postgraduate degrees for a total of 14 years so I think only about my life and not my patients?
Dr. Hammam Alloh, DAYS BEFORE HIS DEATH
And yet, these doctors persist in their heroism. In late October, Dr. Hammam Alloh spoke with Democracy Now! about his commitment to those in his care. “If I go, who would treat my patients? We are not animals, we have the right to receive proper health care,” he said. “You think I went to medical school and for my postgraduate degrees for a total of 14 years so I think only about my life and not my patients?”
Less than a week after that interview, Alloh died in an Israeli air strike.
The current devastation of Gaza’s health care system will require years of repair. Facilities will have to be rebuilt and patients will have to regain faith that hospitals are not death traps but safe spaces for healing. Already looming are other public health challenges: a nutrition crisis that could affect Gaza’s one million children and the collapse of sanitation and water services that will spawn infections, cholera and other deadly diseases.
But even as the insides of their hospitals turn into morgues and the walls around them become ashes, the doctors of Gaza trod forward with an indestructible hope and love for their people.