On board the Italian ship Vulcano which rescues the wounded in Gaza: «The children arrive like zombies. Treating them also means making them smile again”

Thereit is a “floating” hospital that offers care and protection to those who have seen and experienced first-hand the consequences of a conflict that does not spare children and women. It's about the Italian ship Vulcano moored in the Egyptian port of Al Arish, 20 km from Rafah, which thanks to the doctors from the Navy, the Italian Army and the Air Force, from the Francesca Rava Foundation and some healthcare professionals from Qataris providing aid to the wounded civilians coming from Gaza. The Vulcano mission is part of a series of aid that the Italian Government, in agreement with the main partners in the region and in agreement with Israel, has activated to support the population. Among the other initiatives planned there is also the reception in Italy of around one hundred Palestinian children suffering from serious complications who, accompanied by their families, will receive healthcare at some excellent hospital facilities in our country.

The witness

“Seeing terrified children arrive on the ship, both due to their wounds and fear, severely malnourished, who have lived under the incessant noise of bombs is an experience that leaves its mark on you, even if you are an emergency doctor,” he says. Enrico Ferrazzi former head physician of the Mangiagalli Clinic – Milan Polyclinic among the first doctors from the Francesca Rava Foundation to provide aid on the Vulcano.
«The children arrive on the ship like zombies, petrified by wounds and fear, especially because they see themselves surrounded by soldiers again but then, as soon as they feel safe, despite the physical suffering, they smile again – continues Ferrazzi -. With them, more than with adults, non-verbal communication is very important: they understand the meaning of our gestures, they are comforted by small attentions and they give us lessons in resilience. I still have in my eyes the image of a 12-year-old girl who arrived on the ship in a very serious condition, with lacerations on her abdomen caused by shrapnel from a bomb. When she came out of her critical condition and was able to get up and start walking again, we took her to the deck of the ship and at the mere sight of the sea, the same sea that she had seen who knows how many times, her empty gaze was filled again of life and hope. After 23 years as a clinic director I have met many patients but I am sure I will never forget those eyes.”

The “field hospital” ship

The Vulcano ship is not a hospital ship, it has hospital capacities that were upgraded and reconditioned, within 24 hours, also to treat women and minors. «Thanks to the “Role 2” setup (editor's note of NATO welfare standards) we have created a real “field hospital” on the ship with surgery, intensive and sub-intensive care functions, operating rooms, analysis laboratory, pharmacy, diagnostic unit, radiology and telemedicine, ordinary and intensive hospitalization places using staff doctor recruited by the three armed forces (Navy, Army and Air Force) to which were added the volunteers of the Francesca Rava Foundation (for the obstetric-gynecological, pediatric and plastic surgery areas) and the nurses of the Red Cross – explains the Lt. Col. Valerio Stroppa, Army orthopedist working at the Celio (ed. the Army Military Polyclinic in Rome) —. What we offer is both a basic support with the supply of medicines to the population, both specialist activities And ultra specialized thanks to the presence of different skills: surgeons, orthopedists, anesthetists, gynecologists, paediatricians, nurses”.
The patients arriving on the ship are selected by the shore medical staff according to urgency criteria and, if necessary, once stabilized, they are then transferred from the Vulcano to advanced level hospital facilities.

Curing on a ship

“On board the most disparate cases arrive: from the pregnant woman, to the riddled one, to the paralyzed one who we operated on, restoring her upper limbs to function, and then lacerated and mutilated children – continues Stroppa -. At the basis of every treatmentas Hippocrates said, there is trust which even in such a complex context is the first step of treatment and means first of all linguistic and cultural mediation». Professionalism, ability to resolve critical issues and a strong motivation to help anyone in need have quickly made the group cohesive and effective. «On board we found ourselves with personnel who, for the most part, did not know each other, in a structure that had never been tested but, thanks to the tested military structures and team work, not only of the healthcare personnel but of the entire crew on board (approx. 200 people), we are able to supply any type of need and also carry out ultra-specialist surgical interventions, such as the surgical transplant of a nerve”, says Stroppa. «Between reading things
and seeing them, experiencing them, the difference is terribly different. Behind the numbers there are people, with their stories. The impact on the human level is very strong. In a world like the healthcare world full of rules and protocols, we sometimes forget what it means to be a doctor. In this context I appreciated it to the fullest. I realized the value that simple human gestures, within a treatment process, make the difference. For me it was the reconfirmation of having made the right life choice”, concludes Ferrazzi.

The interpreters

Break down the linguistic and cultural barriers between the population and the healthcare team is the first step in starting treatment. «Patients need to bring out the enormous pain they carry inside and this also has a therapeutic function. Without the support of our cultural mediators, the doctors' work would not be possible”, he says Vincenzo Attanasio, Lieutenant of the Cavour aircraft carrier. «My task is to mediate the suffering of every single individual and make them as accessible as possible to doctors, starting from that relationship of empathy and trust that I create with the patient – ​​he says Nadia Trabelsi, Arabic interpreter for the Navy —. Sometimes small gestures are enough, such as offering tea or a date which, for Palestinian women, is not a simple fruit but something linked to faith, traditions, memories, useful in triggering trust.”

Military welfare levels

They are divided into ROLE 1, ROLE 2, ROLE 3, ROLE 4, which represent four different levels of assistance according to the standards defined by NATO. “The Role 1 it is the basic level, with devices that deploy close to the line of operation and offer advanced dressing points with the presence of 1 doctor and 1 nurse, with the aim of direct stabilization of the patient – explains Stroppa -. The Role 2 it is a higher level, with field hospital structures and is made up of a medical structure that includes: 2 anesthetists, 1 orthopaedist, 2 surgeons, 1 emergency doctor and a series of nurses and professional figures who allow the use of the laboratories, the radiology set-up, the 2 operating rooms. Role 2 allows you to deliver
both ordinary hospitalization and surgical services, with the aim of stabilizing the patient and being able to transfer them to higher levels of care. The Role 3 it is, in fact, a Role 2 cwith greater, ultra-specialist skills such as neurosurgery or ophthalmology, which are not present in Role 2 which is more emergency. And then there's the Role 4which in Italy is the Celio, the military hospital in Rome, which welcomes the wounded for definitive treatment, with advanced levels of assistance. The Vulcano ship, in this case, offered the logistics to be able to work to which the Role 2 structure was applied, a structure in support of the civilian population already tested (for example in Libya and Afghanistan) and established, and therefore extremely effective. To this basic structure others can be added that can assist depending on the situations. In this mission, the Francesca Rava Foundation provided expertise in the gynecological, obstetric and pediatric fields, while Qatar provided three specialist doctors.”

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