“Basically what we have to do is choose between saving the life of someone who is dying today in front of us, at the risk of someone who will die tomorrow.”
This is how Amber Alayyan, pediatrician and deputy director of Middle East Programs at Doctors Without Borders Paris (MSF) describes it. the critical situation in Gaza hospitals in the midst of the war, who this Sunday turned six months old.
Half a year after the start of the conflict in the Palestinian territory, which was unleashed after the attack by the Islamist group Hamas on Israel on October 7, 2023 and which left more than 1,200 people dead, the humanitarian balance in the Strip is critical: More than 33,000 people, mostly women and children, have died and the injured exceed 75,000.
The enormous number of injuries and the attacks on medical centers in Gaza have led the health system to collapse. EL TIEMPO learned of the testimonies of pediatrician Alayyan and Marie-Aure Perrault Revial, Emergency Coordinator in Gaza in December 2023 and last March; who described what doctors see today in the Strip and the critical situation of the Palestinian population.
This is what life is like today in Gaza hospitals
Alayyan has been closely following the situation in Gaza and the Occupied West Bank for five years and assures that Although before the war the health system in the Palestinian enclave was not perfect, it was quite solid and improved every day. “We saw great advances in reconstructive surgery, antimicrobial stewardship, care for women and children, whether through pediatrics or maternal care, and even oncology care,” she says.
But the situation changed on October 7, when Israel launched its operation against Hamas in Gaza in response to the militants' air, sea and land attack. Six months later, 84 percent of the Strip's medical facilities have been destroyed or damaged, according to data released this week by the World Bank.
Al Shifa Hospital, the largest health center in the Palestinian territory, for example, was the focus of a weeks-long Israeli military operation that left a trail of destruction. Other hospitals such as Al Aqsa or Nasser have also been affected by the bombings.
We are trying to be creative by setting up installations with plastic strips or in what used to be chicken farms
“Collectively, we have lost count of the number of primary healthcare facilities that have been forced to evacuate since December. We are trying to be creative by setting up installations with plastic strips or in what used to be chicken farms,” says Perrault Revial.
According to Dr. Alayyan, who currently coordinates some of MSF's activities in the Palestinian enclave, 99 percent of people arriving at hospitals in Gaza have injuries from explosives, since most of them were in their buildings or tents when the bombs hit, leaving them under the rubble.
This means that, upon reaching the hospitals, many have crush injuries to the chest or require amputation of legs and arms. Other times, he says, patients suffer burns from fires that break out in bombed buildings.
“If you look at the hospital system before, for example, we wouldn't have to carry out these amputations because we would have had a system that worked. We would have had reconstructive surgery. Immediate life-saving surgery would have been possible, and those limbs could have been saved. But now we are doing everything we can to save lives at the moment,” he says.
Alayyan assures that only 12 semi-functional hospitals remain in Gaza and says that in many of them surgeries must be done on the floor of the emergency rooms due to lack of space. This is because, in addition to caring for hundreds of patients at the same time, The rooms of medical centers are also full of displaced people seeking shelter for themselves and their families.
As a result, the pediatrician says, the wounds patients suffer in war are beginning to rot. And since hospital microbiology centers no longer function, the infections that Gazans acquire cannot even be analyzed and treated.
Patients with chronic illnesses also do not receive care in the Strip. Either due to the lack of medicines or because many are not able to approach medical centers for fear of dying if the health structure becomes a focus of war. Given the lack of medicines or space, in addition, Doctors face the decision every day of who to save.
“This means that doctors have to choose between sedating a patient so they can intubate and save their life, or treating a seizure because the same medication is needed. The whole system has collapsed,” he says.
The problem is that no health system in the world can cope with the volume of injuries and the types of injuries
In the case of children, Alayyan assures that minors arrive at hospitals with wounds from bullets fired from drones. They also register an alarming increase in infectious diseases, outbreaks of hepatitis or Shigella (intestinal infection caused by bacteria).
“The problem is that no health system in the world can cope with the volume of injuries and the types of injuries and medical conditions that we see every day in Gaza,” he says.
Alayyan also mentions that the women's health care system has been destroyed, with only one hospital left that provides care for pregnant and laboring women, and Lack of space has led to them having to recover from vaginal births or cesarean sections within an hour.
“As soon as they can walk they have to go out (…) We cannot do our job correctly under the current circumstances. “This is like nothing we have ever seen,” she adds.
'Prices have multiplied by up to 10'
But perhaps what worries them most, says the deputy director of MSF, is the acute malnutrition experienced in Gaza. According to the UN, more than a quarter of the inhabitants of Gaza “face catastrophic levels of deprivation and lack of food” and international indices ensure that Famine in the north of the enclave is imminent in 2024.
“Gaza has had, as a result of the siege for many years, problems with iron deficiency anemia or micronutrient deficiencies. But now because of this war in just six months, we have seen malnutrition rates have skyrocketed. We have seen women who are forced to feed their children with dates squeezed in a handkerchief to be able to introduce some type of sugary substance into their bodies,” he says.
Lack of food has also led many women to be unable to produce milk on their own, putting babies at risk of malnutrition. Women who cannot breastfeed typically turn to formula, but Gaza has no drinking water, so formula is not an option for babies either.
“Visually, there is a little more food in the southern markets, but prices have multiplied by up to 10. A carton of eggs used to cost between 1 and 4 dollars and now it can cost 40 US dollars, and most of it is often rotten, as long border checks mean fresh food spoils by the time it enters Gaza. And in the north, there is simply no (food),” says Perrault.
Thus, MSF staff say, Doctors who previously worked as specialists in intensive care units have begun training to treat malnourished patientswhich poses special challenges and difficulties.
The truth is that, in the midst of this panorama, the impact on the mental health of medical personnel in Gaza is significant: these are teams that have been working day after day for six months straight, while many of them have also lost their homes or families.
“The significant challenges we face continue to result in teams fearing for their lives or the lives of their families when they come to work… In medical personnel who have to deal with mental health trauma, which they have never seen before, while going through the same trauma themselves, and who have to train in a new discipline (malnutrition) after having worked for six months all day in the most terrible conditions and having to set criteria to choose who gets assistive devices: an adult who has lost both legs, or a child who has lost both parents,” concludes Perrault, while calling for a ceasefire that will allow urgent intervention in the crisis experienced by the Gazan population and medical personnel.
ANGIE NATALY RUIZ HURTADO – INTERNATIONAL EDITORIAL – EL TIEMPO
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