Abdullah, a Palestinian nurse, spent nine months wearing the same pair of shoes. Jokingly, during a daily chat to distract from the anxiety of war with the Doctors Without Borders (MSF) team, he told this to Diego Guerrero, a Colombian who worked with him for six weeks in emergencies at the Al-Aqsa hospital in the centre of the Gaza Strip. After the outbreak of the Palestinian-Israeli conflict on 7 October, Abdullah lost everything, except for that pair of broken tennis shoes that he never took off. On the last day of his mission before returning to his country, Guerrero gave him his own. Thanks to those shoes, he has been able to maintain constant contact with his companion and it has been the excuse to find out if he is still alive. He sounds affected when he tells it, he looks melancholic. His gaze seems to repeat in a spiral the heartbreaking images that he faced for 45 days in the middle of the war.
Under a tiny, salty stream of water, Guerrero began his daily routine. After a quick, equally tiny breakfast, he put on his white MSF vest. In a car with huge United Nations badges, the team of seven international doctors set off for Al-Aqsa Hospital, one of just three hospitals – there were 17 before – that are still standing in the city. Suddenly, without time to think, Guerrero got to work. He always started and finished the day surrounded by wounded and corpses. “On a day of bombings, 400 wounded or more than a hundred dead could arrive. The emergency room at that hospital was very small, so it was apocalyptic, you never knew for sure how many patients you had,” he recalls. At around four in the afternoon, the day came to an end, he returned home and hung up his vest, already covered in blood and dust.
Guerrero was no stranger to critical medical situations, but he says there is nothing like what he faced in Gaza. The previous year, the 32-year-old doctor and graduate of the National University lived in Iraq, where he spent six months attending emergencies in Tal Afar, in the north, on the border with Syria. Before working for MSF, he was part of the health personnel who attended to the Covid-19 emergency at the Kennedy hospital, one of the points in Bogotá where the pandemic care was most critical.
He thought that this experience, combined with the Colombian context of armed conflict in which he grew up, would prepare him for the most adverse scenarios. Today, without a shadow of a doubt, he says he was wrong. “Until before I left Colombia, the war scenario there was the most violent I had ever seen. But when I arrived in Palestine, the level of violence was different. The anguish, the uncertainty, the fear… the level of death is one I never imagined,” he says.
In his emergency room he received all kinds of wounded. He treated people from gunshot wounds, shrapnel and debris, to those mutilated and burned by bombs. Most of his patients were children and young people. “There is a generation of amputees growing up in Gaza. A generation full of pain and hatred around this tragedy,” he reflects. According to Unicef, in these nine months of war more than 1,000 children have lost one or both legs.
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―Does reality match the videos on social media?
―It’s worse. The emotional burden during the entire mission is too much. The memories I have most in my mind are those of orphaned and mutilated children.
“I did everything I could”
The floor, the windows and the walls shake, and Guerrero continues working. Although he says he never got used to the explosions, the anxiety of the siege quickly turned into the anguish of not having the necessary tools to do his job. After the blockade of Rafah in April, and added to the “endless bureaucracy imposed by the Israeli authorities,” the NGO has not been able to bring humanitarian aid into the Gaza Strip, which has made medical work in the area difficult. For Guerrero, if the shortage continues, in a few weeks the MSF operation will be unsustainable. In the meantime, and without the option of stopping, the team in Al-Aqsa has managed as best it can. For example, they no longer do dressings at six-day intervals, but at three. He denies the rumour that they have had to operate without anesthesia, although he clarifies that they do not have ideal medicines for all needs.
“Since May 7, we have not been able to bring in medical supplies or equipment, so we are using up our reserves and are reaching the limit. If there is not a ceasefire soon, if there is not a true humanitarian truce that allows the free entry and movement of humanitarian workers, many organizations will have to stop their services,” he stressed. Currently, the humanitarian organization is considering building its own field hospital in the center of Gaza. Guerrero says that this would only be possible if there is political will to allow it.
Israeli Prime Minister Benjamin Netanyahu has justified the indiscriminate attacks on medical centres, alluding to the fact that members of the Hamas political leadership are hiding under them. However, this has only been confirmed so far. Guerrero, for his part, reiterates that the importance of protecting hospitals goes beyond health care. He says that at the height of the military offensive, the Gazan population takes shelter in these buildings. “There is nowhere to walk, not only because of the number of wounded, but also because of the refugees. We treated patients, they got better, we discharged them, but they had nowhere to go. There are orphaned children who come out of surgery and were the only survivors of their family. How do you explain that to a six-year-old child?” he says.
The health crisis is spreading beyond the most obvious impacts of violence. The absence of basic services, whether drinking water or electricity, has had other effects on the health of Gazans. “People are having diarrhea or pneumonia at home. Going to a hospital involves risks, resources and too much effort, so they either cure themselves or die,” Guerrero reveals.
―How do you deal with so much desolation and so much lack?
―I never got used to it. There is nothing in Gaza. There is no water, no food, no electricity, no fuel, no hospitals. All there is is hunger and need.
The non-future
Of the Mediterranean Sea landscape, surrounded by fine sand and beautiful beaches, nothing remains in Gaza. The surroundings of the sea have been filled with multiple refugee camps who flee to the water when the bombings intensify. They drink from that same water, they bathe in that same water. The few seconds in which a sort of tense calm returns to that land are the nights, where what can be heard are the sounds of the Israeli forces’ surveillance drones or explosions in the distance. When the sun goes down, Gaza is plunged into darkness, because there is no electricity, and the little fuel available is rationed. According to Guerrero, people try to maintain extreme stillness at night and do not move even during night attacks. Sometimes, if there are wounded, they wait for the light to come out or simply die at home.
That is why, in his opinion, the death toll since the conflict began could be higher than the 37,000 reported by the Palestinian Ministry of Health. “If a person dies in hospital or arrives dead, there is no official death registry. There is no Palestinian government center where this can be done accurately. The chaos is total, that is why I think there are many more.” The constant scenes of blood and death have plunged the survivors in Gaza into despair. There are no possibilities of fleeing, and much less resources. Guerrero points out that those who remain in the ruins of the city are poorer families who never had the economic capacity to leave everything and start from scratch. “People tell you: ‘I am going to die, but I don’t know when. I am going to die, just like my father died in a bombing a month ago, or like my uncle died two months ago.” He says that the uneasiness is undeniable.
He doesn’t go very far. He brings up the story of another colleague from the local MSF team. The man was the first to arrive at the hospital and, when he left, he was supposedly sleeping with some friends because he had lost his home in a bombing. However, when he investigated further, he discovered that his colleague lived in his car, which was the only thing he managed to rescue from the rubble. So for all these months he showered at work, changed there, worked his shift and at night returned to his car. Others, with similar stories, lived in tents by the sea and preferred to work long hours and feel useful to their people.
Guerrero highlights this compassion and dedication to his Palestinian colleagues. Faced with hundreds or thousands of orphaned children, facing hunger and fear, solidarity has been the best defense for Gazans who, in addition, have become accustomed for decades to finding extended families in their people’s diaspora. “The culture there is very generous. If your house was bombed, you probably have distant relatives or friends in another city who will always be willing to help you. That keeps a large part of the population alive,” reflects the doctor.
That same generosity, of someone who had nothing, continued until his last moments in Gaza. The farewell was almost harder than the arrival. Guerrero knew that he would never see many of the people he was saying goodbye to again. Once again, dressed in his vest and in the van full of rosettes, he said goodbye to the driver who had been transporting him for weeks. In broken English, the man said goodbye again, picked some small jasmines with white leaves and gave them to him before saying: “I would like to be like these flowers so I can leave here with you and travel to Colombia.”
Back safely in Colombia, Guerrero still has trouble sleeping. Night noises wake him up and remind him of the constant buzzing of drones. He still doesn’t fully understand what he experienced. MSF provides him with therapy and gives him a few weeks of vacation. Afterwards, he can decide whether to return or not.
“I’ll have to make the decision in a few weeks. For now I’m just thinking that I’m safe here, but all the people I worked with, my colleagues, stayed there.”
Precisely, last June 25th, Fadi Al-Wadiya, MSF staff member was killed, allegedly by Israeli forces. His death adds to those of five other MSF staff killed in Gaza since 7 October.
―What reflection does this leave you with?
―The most urgent thing is that a ceasefire is more necessary than ever. The international community must demand a humanitarian truce now.
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